KEY POINTS:
A union leader representing striking radiographers claimed that a woman with life-threatening bleeding received special treatment because her son was a senior hospital employee.
The 85-year-old woman was suffering from terminal cancer and had been bleeding for four days, but the union leader argued that treating her would breach the strike agreement.
The dispute prompted the Employment Relations Authority (ERA) to recommend that, in future, an independent specialist should decide when patients were sick enough to call in striking medical workers.
Deborah Powell, head of the Association of Professionals & Executive Employees (APEX), took the grievance to the ERA and gave evidence that "people die all the time in hospitals" and said the elderly woman did not meet the criteria to require 'life- preserving treatment'.
According to the ERA decision, Dr Powell called the board of Capital & Coast District Health a "pack of liars", and warned she would start personally checking patients' files when doctors said urgent treatment was required.
"If our concerns are found to have substance, the trust with which we can approach future [life-preserving services] requests... will have to be re-evaluated," she wrote to the board.
The decision noted that Dr Powell had not worked in a hospital for more than a decade - since her first year as a registrar.
But she was an experienced industrial relations practitioner.
The board investigated her complaints and found there had been no favouritism, although the woman's son was a senior employee at the DHB.
It had two specialists review the medical notes.
Both concluded the patient had been at "high risk of a life threatening haemorrhage" and therefore met the criteria to call in a radiographer.
Dr Carol Johnston was the radiation oncologist at the Capital & Coast DHB in Wellington who made the original decision after examining the woman on October 18 last year.
On October 14, the woman was admitted to hospital because she was bleeding as a result of her cancer.
She had been declined surgery because of her age and health status - she had a heart condition - but had been admitted twice in the previous six months for blood transfusions and radiotherapy, to stop the bleeding.
A registrar gave her a transfusion and, after checking her pulse and blood pressure, decided she was stable enough not to need treatment for four to six weeks.
But four days later, Dr Johnston met with the woman and she found no evidence the bleeding had stopped.
"Dr Johnston was unprepared to take the risk of even a 24-hour delay as that would mean that Patient A's bleeding could progress to a life threatening haemorrhage," the board told the authority.
"It would be too late to provide radiation treatment to control the bleeding once a major haemorrhage had occurred."
Radiographers had been striking for two days - between 4.40pm and 8am each day - and right through each weekend.
Dr Johnston was confident that the woman could be treated during the day but took the case to DHB management anyway, in case of delays.
She mentioned at that stage that the woman's son was a senior DHB employee.
The union agreed to provide care if needed but the woman was treated outside of strike hours, and discharged three days later.
A week later, Dr Powell wrote to the DHB. She was concerned the case breached the agreement and that the patient could have been treated the following day.
She lodged claims with the ERA in early December and a two-day investigation was held in June.
After the first day, the union withdrew its claim about Dr Johnston's decision but maintained the DHB had failed to act in good faith during the investigation.
Authority member Greg Wood dismissed that claim and noted that Dr Johnston "made not only the right medical decision, but also the right decision in terms of the agreement between the parties".
Further, he recommended: "Such matters would probably be better determined by an independent medical specialist acting in an advisory and/or decision-making role."
Dr Powell did not return Herald on Sunday calls last week.
The DHB board declined to comment further than this statement: "We welcome the ERA's decision, which finds that our actions were entirely appropriate. Beyond that, the judgement speaks for itself."
The events
October 14, 2006 : 85-year-old woman with terminal cancer is admitted to Wellington Hospital with bleeding as a result of her illness. She has been denied surgery because of her age and condition.
Oct 18: The bleeding has not stopped, and radiation oncologist Dr Carol Johnston orders urgent treatment because it could develop into a life-threatening haemorrhage. The woman is treated outside of strike hours.
Oct 25: Deborah Powell writes to the DHB's CEO, claiming the woman does not meet the criteria to require life-preserving treatment. July 17, 2007: Employment Relations Authority says the Capital & Coast DHB did not breach its duty of good faith to the union and dismisses the union's claims.
