NEW ZEALAND: Substandard care of patients slammed

. AUCKLAND, New Zealand / stuff.co.nz / May 1, 2009 Four elderly patients who died at an Auckland hospital suffered "substandard care" on overcrowded and understaffed wards, a damning report has revealed. Health and Disability Commissioner Ron Paterson examined the cases of five elderly patients treated at North Shore Hospital. Four died; the fifth made a good recovery. He said yesterday: "This is a report about our mums and dads going to hospital and the treatment we want for them''. Mr Paterson described the report as a "window into a system under pressure''. But the former chief executive of the health board than runs the hospital, Dwayne Crombie, said the Paterson report should have gone harder on the government - underfunding of the DHB was chronic and the real issue at fault. Though careful to note that the deaths were not due to a lack of medical care, he said overcrowding and understaffing led to poor care. He refers to staff being "overwhelmed'' by their workload and states: "The nurses did not have time to care.'' The cases included: An 82-year-old admitted from her rest home. She spent 36 hours in the hospital's emergency centre. The complaint from her partner was about her care, the lack of communication and support when she was discharged. Two days after her discharge, it was discovered she had a fractured right hip. She was readmitted for surgery and died eight days later. An 81-year-old suffering a severe stroke and heart attack who died eight days after being admitted. Her son, a doctor, complained his mother's deteriorating condition was not given necessary priority. An 85-year-old admitted for assessment and treatment of heart problems. Two days later her condition deteriorated. Her family raised concerns. She died three days later. A 73-year-old with a history of lymphoma admitted with breathing difficulties and a heart condition. His family thought he was dying and were frustrated by a lack of communication about his condition. He was discharged at their request, but readmitted later the same day and died the next day. In the 131-page report on the state of the hospital between April and October 2007, published today, he says: "These cases vividly demonstrate how overcrowding and staff shortages can translate to substandard care for patients. "What emerges is a picture of an overcrowded hospital, staff who were stretched and stressed and patients and families who were left in the dark.'' It goes on: "Although the standard of medical care was largely reasonable, the nursing care was not. The nurses did not have time to care.'' Patients were often kept in corridors when there were no beds and during the 2007 winter, when demand for hospital services peaked, ambulances were used as makeshift wards. Ward care was also criticised, with claims hygiene standards, care and supervision were inadequate. The report said the long waits and lack of attention to the patients amounted to disrespect. Another incident saw a pneumonia-stricken 79-year-old forced to sponge herself with paper towels in a hospital toilet because no proper towels or nurses were on hand. "Care was not provided in a manner that respected their dignity as acutely unwell senior citizens,'' the report said. Blame for the conditions was placed on Waitemata District Health Board. Health board chief executive Dave Davies admitted the care provided to the five elderly patients was not adequate. "We have apologised unreservedly to the patients and families who were identified in the report and who received care that was not as good as they could have expected." Acting health board chairman Max Abbott said the board had taken steps to address the issues highlighted in the report. Nursing staffing had greatly increased since 2007 and 62 extra beds were added. Former board chief executive Dwayne Crombie, who resigned in late 2006, said government underfunding of the DHB was chronic. "The real issue that is not talked about in this report is that we move money between DHBs depending on whether they are wealthy or deprived,'' he told Radio New Zealand today. He said health services in Waitakere and North Shore got about $135 million a year less than other regions because they were considered more well off. You tell me how you provide a universal access system to people with needs when you've got that kind of deficit.'' Dr Crombie said it was almost impossible to fund staff and if $100m was borrowed from the government, it had to be paid back with an annual $8m finance charge on top. "What I'm saying is, the commissioner really didn't have the courage to look at some of the deeper issues in the system. "And I can tell you that Waitemata is going to face the same issue for the next five to 10 years, because fundamentally those people have a lot less money to provide...'' Dr Crombie said he agreed a lack of good nursing care was inexcusable under any circumstances. However, reports such as yesterday's often "beat up'' on management or clinicians, but seldom looked at the context in which decisions were made. Politicians, Treasury and the Health Ministry had known for 10 years about the issues of bed shortages in the greater Auckland region, but didn't want to know about it unless people could deal with it using their set annual operating grants. Dr Crombie said there was hypocrisy and a lack of honesty within the system, DHBs were often "whipping boys'' for politicians who didn't want to take any responsibility, and that prompted his decision to move to the private sector. Nevertheless, he agreed the care of those outlined in the report was lacking, and the DHB should apologise. By David Hargreaves, Hayden Donnell and NZPA © 2009 Fairfax New Zealand Limited