An elderly woman died after allegedly being dropped from her stretcher at Whangārei Hospital, the Herald understands.
Four separate investigations are now taking place into the incident, which occurred at the hospital on 12 May.
The patient, 83, had been treated at the hospital and was being discharged to return home to her retirement village.
Te Whatu Ora - Health New Zealand and Hato Hone St John Ambulance would not provide details about the circumstances of the incident.
But it is understood the patient was being wheeled on a stretcher in the ambulance loading dock when she was dropped.
As well as the fall from the stretcher, she fell another metre from a ledge in the loading dock and landed face-first, with the stretcher landing on her back.
She was re-admitted to hospital and later died.
Te Whatu Ora, St John, WorkSafe and the coroner have confirmed they are investigating the incident.
The woman's family declined to comment until the coroner had completed their inquiry.
In a tribute on Facebook - published with permission - her son said she had "a good innings" but was "tragically taken whilst on her way back to the home".
She was remembered as a keen fisher and a good cook.
Her son said he would always remember fishing with her at Muriwai, Whangārei Heads and Tūtūkākā, and holidaying at Whangaroa, Long Bay in Russell and at Ngunguru.
"We will miss her fish and chips, fruit cake and vege soup," he wrote. "At peace now, in Dad's company playing 500."
He added: "My biggest critic, and go-to smoked fish taster, gone but never forgotten. I will miss my fourth umpire, video ref and commentator when there is live sports."
Te Whatu Ora Te Tai Tokerau said in a statement the incident was being treated seriously and Te Whatu Ora was investigating the circumstances to establish what happened and how.
"We extend our deepest condolences to this patient's family for the tragic loss of their relative," interim district director Tracey Schiebli said.
"As this investigation is under way, as well as to respect and maintain patient confidentiality, we are not able to comment further."
After the incident, bollards were installed on the hospital's loading dock. A guard rail was also being installed.
WorkSafe said it had been notified about the incident and its inquiries were ongoing.
Hato Hone St John general manager of ambulance operations Debra Larsen confirmed an inquiry was under way and that it was co-operating with all parties involved.
It is understood that ambulance officers were transporting the woman when she was dropped.
The coroner is also investigating the woman's death, as is routine for an unnatural or accidental death.
One of the investigators' areas of focus will be on the use of the stretcher which the patient was being transported on.
Guidelines for the Stryker stretcher say it should only be used on flat surfaces or with a gradient of less than six degrees, or the stretcher could tip over.
* This story was first published by the New Zealand Herald.