Senior doctors call for 24/7 security as ED crisis becomes ‘worst that we have ever seen’

Senior doctors are calling for security guards to be posted around the clock in every emergency department (ED) in New Zealand after an increase in abuse and assaults against medical staff.

The plea for better security is one of several demands the Australasian College for Emergency Medicine (ACEM) is making to political parties today to address a national crisis in EDs that is causing an exodus of medical workers and putting patients at risk of serious harm.

Days after senior doctors went on strike, the college is demanding major improvements to protections and conditions for frontline emergency staff who are carrying increasingly heavy workloads and being regularly exposed to threats, assaults, and aggressive behaviour while doing their jobs.

The college cited data from Te Whatu Ora Health New Zealand showing there were 7,125 assaults against public health employees recorded between April 2021 and April 2023. While those figures covered all hospital services, not just EDs, EDs are among the departments with the highest rates of violence and aggression.

Doctors say EDs can be stressful and chaotic at the best of times because of the nature of acute medicine, but the growing number of patients in mental distress or under the influence of drugs and alcohol, severe staff shortages, and ballooning waiting times are producing environments that are increasingly unsafe and explosive.

In one of the violent incidents cited by the college, a senior doctor was punched by a patient with mental health problems who had waited more than 12 hours to be seen.

At Gisborne Hospital last year, a nurse was hit in the face and knocked to the ground by a 28-year-old man, who was later arrested and charged with assault.

And on another occasion, a patient suffering severe mental distress threw faeces at emergency workers, the college said.

“People are becoming more and more frustrated by long waits,” says Dr Kate Allan, an emergency specialist in Auckland who is the ACEM’s New Zealand representative. “By waiting in inappropriate spaces. By frustrations within the system. By being unwell and not being heard. And they are taking it out on our staff.”

Dr Kate Allan, the New Zealand representative for the Australasian College for Emergency Medicine.

The rise in violence and abuse is an extreme indication of a system that is under enormous pressure after years of underinvestment and poor planning by successive governments.

“This is the worst that we have ever seen,” Allan said. “That makes it an incredibly difficult working environment. And something has to change. We can’t move forward unless there is significant change and recognition that this is a real problem.”

According to the ACEM, less than half of the EDs in New Zealand currently have the minimum staffing level required for an adequate service. Last month, the Herald revealed that a shortage of emergency doctors at Palmerston North Hospital had become so severe that a clinical director warned Te Whatu Ora it was “at serious risk of being unable to provide an emergency medicine service” in the region.

Medical staff are stressed, demoralised, and increasingly worried about the quality and safety of the care they’re providing. Waiting rooms are overcrowded. Ambulances back up on ramps for hours. Patients are marooned in EDs for days because there are not enough free beds in hospital wards to admit them to. In March, a person with severe mental illness waited 94 hours (about four days) in Auckland City Hospital’s ED to be transferred to a psychiatric facility.

To relieve the blockages, the ACEM is also asking for:

• More resources for mental health facilities so that people with serious psychological problems do not get stuck for long periods in distressing EDs;
• Another 150 beds in residential aged care facilities so that elderly patients can be transferred out of hospitals to free up places for people in EDs to be admitted to;
• Urgent measures to improve working conditions to retain current staff in addition to the Government’s longer-term commitments to recruit and train more clinicians;
• Better data collection and information systems to ensure equitable access and treatment for Māori, who are disproportionately more likely to experience poor health outcomes than other groups.

“This might be the best it’s going to be for a while, so we need to look forward and work out how we can make this better now, before it does get any worse,” Allan said.

Health Minister Dr Ayesha Verrall would not say whether Labour would commit to these measures because the party’s election manifesto has not yet been published. National’s health spokesman Dr Shane Reti did not respond to a request for comment.

Addressing the security issue, Te Whatu Ora’s chief people officer Andrew Slater said in a statement: “We are currently reviewing our security requirements, particularly in relation to our emergency departments. Our aim is to provide staff, patients, and visitors with specialist healthcare security resources to keep people safe from violence and aggression, including 24/7 where required.”

Te Whatu Ora's chief people officer Andrew Slater says the health authority is reviewing security arrangements.

At present, the ACEM says the security model it envisages - having security staff with the training and experience to handle acutely unwell people embedded at all times in EDs - is not typical in New Zealand hospitals.

Te Whatu Ora said some of the busier city EDs have embedded security guards providing protection at least on night shifts. At smaller hospitals, ED staff rely on security teams that also cover other departments and may be overstretched.

Last year, emergency nurses at North Shore Hospital in Auckland filed a formal complaint about working conditions that cited increasing violence as one of their major concerns. Security guards were “stretched to the limit” trying to respond to incidents across the hospital, the nurses said, and so ED staff were left to “manage as best as we can”.

“It is perceived by the public that healthcare organisations will provide a safe and secure environment for staff, patients, and visitors, but in reality this is not happening,” the complaint said.

Researchers say ED staff are regularly exposed to swearing, shouting, threats, sexually suggestive comments, intimidation, and physical violence, but incidents are under-reported because clinicians treat it as part of the job or believe no action will be taken if they alert their employers.

EDs are only the sharp end of the problem. Across the entire public hospital system, staff recorded more than 23,000 incidents of violence and harassment in the past three financial years, a figure that clinicians say almost certainly understates the true scale.

At Auckland City Hospital, two separate groups of nurses in the past year took the extraordinary step of refusing to provide routine treatment to individual patients because of allegedly harmful behaviour towards them.

Alex Spence is a senior investigative journalist based in Auckland. Before joining the Herald, he spent 17 years in London where he worked for The Times, Politico, and BuzzFeed News.

HELP US INVESTIGATE

The Herald will continue reporting on the impact of the staffing crisis in New Zealand’s hospitals and we need your help. Do you have information on this topic? Have you or someone you know missed out on treatment because of these problems? Are you a hospital employee working under difficult conditions? Do you have documents that can help us shed light on these issues?

We want to speak to as many people as possible who have experience in the system, to ensure our reporting is thorough and accurate. You can reach the Investigations Editor Alex Spence by email (alex.spence@nzme.co.nz), secure Signal messaging (0272358834), or post (The New Zealand Herald, Private Bag 92198, Victoria St West, Auckland CBD 1142). We can’t reply to all submissions because of the volume we receive. We will not publish your name or identify you as a source unless you want us to.