As hospitals experience "extreme pressure" with "abnormally high" patient presentations, NZ Nurses Organisation co-president Kerri Nuku calls on the Government to act. Video / NZ Herald
A stroke victim who was driven hundreds of kilometres to get medical help after facing a nine-hour wait to see a doctor at Waikato Hospital's emergency department has received an apology from a hospital manager.
Whangārei pensioner Ingo Frerk is still experiencing ill-effects from a stroke on the left lobe at the back of his neck which saw him seek medical help at Waikato Hospital on May 4, while he was holidaying in the region. He walked out of the hospital before receiving treatment.
A Waikato Hospital emergency department manager sent a personally signed letter on May 31 to Frerk acknowledging shortcomings in his treatment but yesterday the district health board said he remained "within clinically appropriate wait times" when he chose to leave the hospital.
It comes after a 50-year-old woman died with a brain bleed after allegedly being told by staff at Middlemore Hospital's emergency department there would be an eight-hour wait before she was examined.
The woman turned up to ED with a severe headache early on Wednesday morning. After leaving in frustration at waiting time she returned at 4am and was intubated. A scan showed a massive subarachnoid haemorrhage - a type of stroke - and she died.
Counties Manukau District Health Board is now urgently investigating the circumstances of the woman leaving the hospital.
After suffering a stroke, Ingo Frerk faced a nine-hour wait before walking out of Waikato Hospital emergency department. Photo / Michael Cunningham
Suffering kaleidoscopic vision and a headache Frerk, 75, said he arrived at the Hamilton public hospital around 5.45pm but the lengthy wait to be seen by a senior doctor saw him quit the waiting room at the six-hour mark, despite experiencing frightening hallucinations of his dead dog and worsening symptoms.
At that stage he had seen a triage nurse and trainee doctor, who had taken blood samples and checked his limbs.
He claimed that before he walked out, an ED nurse told him at midnight he faced a further wait of up to three hours and there was nothing she could do to help.
The next day he travelled nearly 300km to his home in Whangārei, where scans confirmed he had suffered a stroke. He was admitted for three days of treatment at Whangārei Hospital, with doctors telling him he was lucky his situation wasn't worse.
After his wife Katrina Frerk left a blistering Google review criticising the lack of treatment and expressing fears he might have suffered permanent damage, Waikato Hospital's ED operations manager Andrew Coxhead sent a letter of apology saying his case should have been seen sooner.
The letter said staff members involved in his care had been spoken to and while his vital signs were normal at 7.18pm, his symptoms indicated a possible stroke or brain bleed and he should have been seen by a senior doctor.
"Unfortunately, due to the high patient volume there were significant delays to patients getting seen that evening. It is our departmental policy to inform patients of the expected wait times. According to the medical records, Ingo left without being seen around 10.50pm. We sincerely apologise for the long wait that Ingo had to endure that evening."
Coxhead said his case should have been discussed with the senior doctor.
"Ingo's presenting symptoms were concerning for a possible neurological event.
"Therefore, his case should have been discussed with the senior ED doctor so that he was seen sooner.
"We are very sorry that this did not occur."
As a result, the department's charge nurse manager had been made aware of the situation and nurses were now being educated to prevent it happening again.
A Waikato District Health Board spokesperson said hospitals were very busy at this time of year and in Waikato, winter planning had been enacted to support services as demand for acute cases increased.
"At our ED, all patients are triaged on arrival and are prioritised based on clinical need, with urgent and acute patients seen first.
"We can confirm this patient was triaged immediately on arrival and further investigation undertaken within 80 minutes of arrival. The patient then departed our ED around two hours later, before a specialist was able to see them.
"Although this patient remained within clinically appropriate wait times when they opted to leave the hospital, we acknowledge that any delay can cause additional stress for patients and whānau and there are a number of work streams underway to help reduce waits across services."
Frerk said his stroke was an horrendous experience, with his symptoms worsening the longer he waited.
"I saw my dead dog sitting next to me. It frightened me. I felt quite sick as well."
With midnight approaching, some six hours since he arrived seeking treatment, only a triage nurse and trainee doctor had attended to him, taking blood samples and checking his limbs.
"I had to stand in the queue to speak to the person at the counter again with five or six people in front of me as I was getting sicker and sicker.
"She told me there was another six people in front of me and it might be another two to three hours. By that time I knew I couldn't last waiting there. I said again, 'I think I've had a stroke, shouldn't I be seen to?' The attending nurse said there was nothing she could do."
He said he was not able to cope with a further three hours in the waiting room.
Ingo Frerk has received an apology from Waikato Hospital after he was not seen by a doctor within six hours despite suffering a suspected stroke. Photo / Michael Cunningham
On the return trip north he sought treatment at their local medical centre, with his doctor referring him for hospital-level care.
He was admitted into Whangārei Hospital on May 6 where scans revealed he had suffered a stroke. He spent the next three days on a ward.
Those treating him had told him he was "very lucky".
"They even do advertising on TV saying if you've got a stroke problem you've got x amount of time and the quicker you get action, the better.
"They call it the golden hour. Well mine was the golden six hours."
In a statement, the Australasian College for Emergency Medicine said "diagnosis and triage" of emergency patients was "fundamentally complex".
"When there is dangerous emergency department (ED) and hospital overcrowding – simply put, when there are more people that require diagnosis and acute medical care than there is staff and space to care for them – it is even more complex.
"Too often, clinicians are having to make potentially life-and-death decisions with limited space and time."
It added "adverse patient outcomes, which can include avoidable deaths, will continue to be a regular occurrence, and may increase, until the systemic issues that lead to ED and hospital overcrowding and extended waits in EDs for patient care, are addressed".
The college said it welcomed the $11.1 billion investment allocated to the health system in the 2022 Budget, "but noted absences of investment in areas that contribute to overcrowding and crippling wait times in EDs".
"Extended delays in acute care can lead to poorer clinical outcomes which can, at times, include death."
