Tauranga Hospital faced ‘worst-case scenario’ of one surgical theatre for weekend: ‘No safety net’

Internal emails show a Tauranga Hospital staff member warned having only one surgical ward open for a weekend was "a disaster waiting to happen". Photo / George Novak

A hospital staff member alarmed by the prospect of having a single surgical theatre over an entire weekend called the situation “a disaster waiting to happen” that could “come back to bite the DHB”.

The comments were made in an email to a senior Tauranga Hospital staff member among those released by Te Whatu Ora - Health New Zealand under the Official Information Act on September 20. It was in response to Bay of Plenty Times questions sent on July 7.

The response showed a manager’s June 28 memo asked staff — for the second weekend in a row — to “only take life, limb or organ-preserving operations to theatre” because there was “no option” to open a second theatre on July 1 and 2 — a result of having no second acute theatre anaesthetist and no second on-call anaesthetist.

The day after the memo was sent, a staff member told the Bay of Plenty Times they feared a patient “would most likely die” if there was only one theatre for the weekend.

In the staff member’s opinion: “As an example, if I’m critically unwell … and I need immediate surgical intervention and there is no theatre available, I am likely to die in the ED [emergency department] waiting in the hallway.”

The Bay of Plenty Times first asked Te Whatu Ora about the situation on the morning of June 30 and was told late that afternoon that “normal service levels” would be in place at Tauranga Hospital, with two acute theatres operating on Saturday and one on Sunday.

“As with any other weekend, the BoP population can be reassured that if they require urgent care, they will receive it,” a Te Whatu Ora spokesman said in a media response. He said there were “well-established” protocols to open additional theatre space if needed.

But in the staff member’s view, if the media inquiry had not been sent, “we would’ve continued to proceed to running one theatre and putting the entire community at further risk”.

In the Official Information Act response, Te Whatu Ora said an anaesthetist picked up a Saturday shift on Friday at 2.57pm.

It said anaesthetists had been working on weekends and public holidays “on a voluntary basis” and a second acute theatre was rostered on such days “if able to be resourced”.

However, Te Whatu Ora said a Memorandum of Understanding was now in place until March 2024 that agreed for after-hours anaesthetists to be rostered “on a firm basis instead of voluntary”.

The memo

A memo — dated June 23 — warning of the single theatre “situation” was first sent to staff on June 23 about the weekend of June 24 and 25. It was also sent on June 28 for the weekend of July 1 and 2.

It said there would be “one theatre available for use for all specialties for the entire weekend (48-hour period)”.

“As a result, only priority one and two bookings will be able to receive surgical treatment during this time.”

The memo said the service could only supply “a safe service for one priority one or two patients at any time during the weekend”.

“There will be no option to open a second acute theatre over this weekend.

“We need you to only take life, limb or organ-preserving operations to theatre. An assessment of the maternity unit will need to be considered prior to commencing other surgeries.”

Anesthetists at Tauranga Hospital have been working on weekends and public holidays 'on a voluntary basis'. Photo / Mead Norton

‘A disaster waiting to happen’

A hospital staff member sent an email to a colleague in a senior role on June 30, concerned there was “no safety net due to lack of anaesthetic cover”.

“There is no plan.

“This will come back to bite the DHB if we have an adverse outcome.”

The staff member said it was “totally unprofessional and unacceptable”.

“We cannot provide adequate obstetric cover without adequate access to theatre and anaesthetic support.

“This is a disaster waiting to happen.”

The email’s recipient responded, saying she understood cover had been found for July 1 but had not been finalised for July 2.

“I know this has and continues to be very stressful — trust me, I share the feeling — and I am sorry for that. I truly hope we are out of that worst-case scenario.”

Te Whatu Ora told the Bay of Plenty Times cover was found for the Saturday 8am to 6pm “list”, but no second acute theatre was available on Sunday.

A staff member told the Bay of Plenty Times in June that nursing staff were "genuinely concerned" about one theatre operating at Tauranga Hospital. Photo / George Novak

Concerned staff member speaks out

A hospital staff member spoke out to the Bay of Plenty Times about the situation on the condition of anonymity.

“It is clear the decision was made at [2.57pm on June 30], and from my view, I believe that had that not happened, we would’ve continued to proceed to running one theatre and putting the entire community at further risk like the previous week.”

The staff member said on June 29 that nursing staff were “genuinely concerned” about one theatre operating, as this had happened the previous weekend.

They said there could be two or three emergency caesareans a night.

The staff member said they believed that “if a theatre has been booked up with an emergency cesarean … If a theatre is needed and it’s being used, that patient would most likely die.”

A Hauora a Toi Bay of Plenty spokesperson said in response last month that work to review the remuneration model for anaesthetic senior medical officers after hours was already “well-advanced” during the period in question, resulting in the rostering memorandum.

Anaesthetists working on a ‘voluntary basis’

Te Whatu Ora’s Official Information Act response said anaesthetists at Tauranga Hospital had been working on weekends and public holidays “on a voluntary basis” since 2016.

Initially, it was on an “ad hoc basis”, but had been “more regular” since 2019.

One acute theatre is available 24/7 Monday to Friday. Two “all-day orthopaedic trauma lists” are open from 8am to 6pm and an obstetric theatre from 8am to 6pm on weekdays.

A second acute theatre was rostered on weekends and public holidays “if able to be resourced”.

Between January 1 and August 25, there were five weekend days without a second acute theatre running from 8am to 5.30pm: March 26, April 2, June 24, June 25 and July 2.

The response said one theatre operating was “business as usual” between 6pm and 8am.

Te Whatu Ora said Tauranga Hospital employed 34 anaesthetists.

According to a 2021-22 annual report, the hospital served a core population of 213,300 residents in the Western Bay of Plenty.

Megan Wilson is a health and general news reporter for the Bay of Plenty Times and Rotorua Daily Post. She has been a journalist since 2021.