Surgeons speak out over deep-seated problems

North Shore Hospital. Photo / Paul Estcourt

Surgeons at North Shore Hospital have spoken out against the unacceptable state of the facility and are demanding improvements.

Twelve surgeons at the Waitemata District Health Board led by clinical director of surgery Michael Booth have written to the Weekend Herald explaining the deep-seated problems with the 26-year-old hospital.

Their letter (reprinted below) is mainly a defence of the hospital - in response to a series of complaints in the Herald about the care of patients - but it also canvasses the hospital's weaknesses.

The Herald has received a flood of complaints from patients or their families since Leanna Kairua wrote last Saturday about how her 18-year-old daughter, who eventually had surgery following abdominal pain, first had to endure two weeks of unnecessary suffering in the hospital.

On Monday we reported that 37-year-old Brendon Parrish died of a heart attack after appendix surgery at the hospital last month. His brother, Darryl, claimed the hospital had been shoddy in its care of Brendon.

But the health board's chief executive, Dave Davies, yesterday rejected that claim, following preliminary investigations.

"So far in the Parrish and Kairua cases ... the senior clinicians' assessment is that clinical care was appropriate in both cases."

The flood of complaints raises questions over the standard of care and hygiene at New Zealand's largest health board, serving more than half a million people, and whether it has slipped from the commitments to improvement it made after the Health and Disability Commissioner's damning report last year on North Shore Hospital's horror winter of 2007.

But on a range of measures there is no evidence of a deterioration, and some of improvement.

Deputy commissioner Rae Lamb said yesterday her office had received 55 complaints about Waitemata-provided services in the last financial year, only a slight increase on the 49 the previous year. There had been no bulge of complaints like the one that prompted the investigation leading to last year's report.

Mr Davies said the board had received 195 complaints from June to August, compared with 163 in the same period last year - but this represented no change in the rate of complaints because the increase mirrored the rapid rise in overall patient numbers.

And the board had carried out all of its commitments after the HDC report, including hiring more nurses - an extra 15 per cent now compared with 2007.

One area of failure is the non-compliance of Waitakere and North Shore hospitals with the Government's target that 95 per cent of emergency department patients are admitted, discharged or transferred within six hours.

Waitemata, at 74 per cent, stands second-to-last in the country, although it is making rapid progress in this area, and has surpassed the elective surgery target.

Board chairman Dr Lester Levy said Waitemata's facilities and equipment had been neglected, but this was being rectified.

By next year, capital spending would have reached $150 million, but it would take at least two years from now to overcome the organisation's problems.

Surgeons respond

North Shore Hospital surgeons have written to the Herald on the state of their hospital and the care it provides. Here is their letter in full.

Dear Sir,

We have serious concerns about some of the recent articles in the Herald about surgical cases supposedly mistreated at North Shore Hospital. Whilst we sympathise deeply with those who have lost loved ones or feel that they have not been fairly treated we would like to provide some clarification of detail with respect to these cases. We would like to point out that although we are currently lacking in resources compared to other DHBs in our vicinity, the individual patients in your article did not have their care compromised by such constraints.

The young woman referred to last Saturday was extensively investigated for abdominal pain with all tests including an MRI and surgery being negative. She did not have appendicitis, the appendix was removed as a precaution.

The tragic case of the young man who died of a presumed heart attack after an appendicectomy raises major concerns in the way this has been portrayed in your article. The medical team involved in this man's care were devastated by his untimely death. The coroner's verdict is awaited and there is no indication in what we know thus far that his death was in any way preventable. He was admitted with complicated perforated appendicitis and had prompt surgical treatment after appropriate investigations. He died after what preliminary investigations suggest was a heart attack. As is normal in these circumstances the coroner was involved at the clinicians' request and is investigating.

Extensive discussions were had with the patient's next of kin (mother) and several offers were made to meet the family. These have not been taken up. The article alleges that another man nearly died of appendicitis at the same time. This is not correct.

Appendicectomy-related deaths are rare. Of the 27,188 acute admissions in the last five years at Waitemata DHB there have been 2621 appendicectomies performed. There were three deaths, giving a mortality rate of 0.1 per cent. This is well within internationally reported death rates for this condition.

Perceived delays in care are often beyond the control of dedicated hospital personnel. Access to the acute theatres is based on urgency and sometimes patients waiting for surgery will be deferred to accommodate those who are more ill. This can be very difficult sometimes for some patients who have been waiting for long periods, a situation which is regrettable but unavoidable given our current constraints.

The Waitemata District Health Board now serves more than 500,000 patients and is the largest DHB in the country. As mentioned in your article we are experiencing rapid population growth as well as an ageing population. These factors continue to place strain on our service to the extent that if we do not provide more surgical beds in the near future then elective surgery will not be possible at the North Shore site. For example our acute surgical admissions increased from 2106 in 2005 to 3942 in 2010.

Overcrowding in the emergency department, inadequate ward bed numbers as well as delays in getting acute patients to theatre have added to the difficulty of running a surgical service.

Our wards are out of date, the room sizes are small, mixed rooms are the norm with male and female and it is more difficult to maintain hygiene, particularly with occupancy rates exceeding 90 per cent. Outbreaks of antibiotic-resistant infections are related to these conditions. Such situations are unacceptable and must be addressed. The proposed elective surgical services unit will be a four-theatre complex dedicated to purely elective surgical procedures at Waitemata DHB. This will hopefully free more beds and theatre space so that acute surgery can be performed in a more timely fashion.

Much more capital funding is going to be required to provide a modern more hygienic environment for the efficient management of acute surgical cases. This will entail a new ward block as there are serious design constraints with our current tower block.

These problems will not be fixed overnight. We need a hospital that is appropriately designed and staffed for the current and projected population growth.

It is refreshing that with Lester Levy as chair of the WDHB we are seeing positive moves towards this goal.

We remain dedicated to providing the best available care given the current restraints.

Yours faithfully

Department of Surgery, Waitemata District Health Board

Michael Booth, clinical director
Mike Hulme-Moir
Hisham Hammodat
Pat Alley
Michael Rodgers
Susan Gerrard
Richard Martin
John Jarvis
Ian Stewart
Richard Harman
Brian Williams
Davis Theobald