Far North doctor shortage now 'acute', clinical manager warns

Desperately worried doctors in the Far North fear people are dying as a direct result of critical workforce shortages in hospitals.

In an email to staff leaked to RNZ, a senior clinical manager warns of several high risk areas, including Dargaville Hospital where on-site doctors have been replaced by a telehealth service overnight.

The chronic doctor shortage in the region had now become "acute", which was not helped by lack of funding to recruit new staff and the recent decision to cut pay for locums to fill the gaps.

Have you been affected by staff shortages in the health sector? Share your stories with us at ruth.hill@rnz.co.nz

With one doctor retiring, Dargaville Hospital was no longer able to provide safe 24/7 care and was "defaulting" to cover by telehealth and nurses overnight, with critically ill patients transferred to Whangārei by St John's Amublance.

"This is not perfect, is causing anxiety to nursing staff, but is the only option," the manager wrote.

Problems include:

• Dargaville, Kaitaia and Kawakawa hospitals are short 10 senior doctors (more than one in three positions vacant) while resident doctor cover is described as "ad hoc" due to lack of coordinated recruitment and funding.
• Telehealth doctors are hampered by the "heavy reliance on paper-based medication charting" and the lack of electronic medical protocols in Northland "has resulted in medical error": HIGH RISK
• Lack of primary care after hours service having direct impact on ED services
• Inter-hospital transport: HIGH RISK. Lack of availability of St John's Ambulance and alternative services.
• Limited access to laboratory and radiology services within normal working hours and on-call: MODERATE RISK - "The staff providing these services are stretched, often providing 24 to 72 hours continuous call back service."

Northland emergency doctor Gary Payinda said staff frequently received messages asking them to cover shifts at rural hospitals.

But even at the region's main hospital in Whangārei they were struggling to fill rosters.

Replacing colleagues off sick now required now sign-off from multiple managers.

"On my last shift there was 133 percent occupancy, on the shift before that 200 percent emergency department occupancy. That means we have twice as many patients seeking emergency care as we have doctors and nurses to see them," he told RNZ on Friday morning.

Payinda said there was no doubt that people will be dying due to long waits in overcrowded, understaffed emergency departments.

That was based on international research that showed for every 82 ED patients who waited longer than six to eight hours to be admitted, there was one extra death.

"That's for a 6- to 8-hour-delay, which we have all the time. I don't mean 'all the time' like a couple of times a month or once a week, I mean on a daily basis.

"And in fact we don't just have 6 to 8 hour delays in getting a bed to open up upstairs - we have 12 hour delays, we have 18 hour delays, we have 24 hour delays."

The manager admits not having a doctor on-site overnight in Dargaville was "high-risk".

The letter obtained by RNZ admitted the lack of an onsite doctor overnight in Dargaville was "high-risk", with the potential for an obstetric emergency, or critically ill child or adult to turn up after hours.

"We have scenarios where people in rural hospitals are coding, which means having cardiac arrests that are being managed via a video monitor because there is no doctor in the hospital."

The private telehealth company Emergency Consult has had the contract for hospitals in Kaitaia, Kawakawa in Bay of Islands, Dargaville and Rawene since 2019.

Its director of engagement, John Bonning, in the three months to the end of June, Emergency Consult treated 1270 patients at those four rural hospitals.

An emergency physician himself said the service was "not replacing doctors, it's supporting them".

"Obviously we can't provide CPR from a distance, nor can we intubate or do major procedures, but it's safe and it augments local people, supports them, and helps to retain some of that rural workforce as well."

It was "not sustainable" for 3.25 doctors at Dargaville Hospital to work day-shifts of 10-plus hours, then cover night shifts too, he said.

Dr Bonning was not aware of any patients who had been harmed by mistakes in prescribing medicines remotely, as highlighted in the letter.

However, he admitted the lack of electronic systems at rural hospitals did create "confusion" at times.

According to the letter, the lack of ambulance services to transfer patients is a high risk and "a major source of distress to staff".

The Ambulance Association's head, Mark Quin, said the collapse of primary care in Northland was stretching crews beyond capacity.

"The staff are burned out, the morale is low, they're currently in a pay dispute with St John, so those factors are lending themselves to the fact that sometimes staff are reluctant to come in and do overtime because they've simply had enough."

Gary Payinda - who came to Northland with his doctor wife for 6 months 17 years ago - said he stays because the people of Northland were "absolutely wonderful", and the need was huge.

It was "insulting" to frontline health workers to hear the new Health Commissioner Lester Levy describe the health system as "bloated" and for politicians to deny there was any underfunding, Dr Payinda said.

"Either they are woefully misinformed and living in a fantasy land - or they are intentionally mangling the truth for political purposes. And I don't know which it is, but either are equally unacceptable.

"It's real patients whose lives are on the line here, so it's time to start being honest."

'Patients aren't dying because of waiting times'

Te Whatu Ora Northern region hospital & specialist services director Mark Shepherd told Morning Report all adverse events were investigated.

"I can assure you patients aren't dying because of waiting times..."

Shepherd said a loss of "a small number of doctors" compromised the roster.

He said Te Whatu Ora was doing a "range of significant things" to ensure patients remained safe.

It was continuing to recruit, Shepherd said, however this was difficult in a rural environment. He could not comment on the number of jobs ads currently.

"It's an open recruitment for rural doctors," he said.

"We are continuing to recruit all clinic roles as they are reviewed as priority."

Shepherd said to cover some gaps, Te Whatu Ora was looking to other skilled staff, like senior nurses and paramedics.

Minister of Health Dr Shane Reti said it was not a desirable position to be in.

"It's never a good option to not have a doctor there," he told Morning Report.

There was funding for 10 positions across Northland, he said.

"I can reassure the people of Northland that the level of care that they need, if they need to turn up to a hospital, that they'll be looked after by competent and professional staff and their level of care will be met."

It may not be a doctor though.

Reti said Dargaville's hospital remains viable but may have to rely on what he called alternative service mechanisms until doctor positions can be filled.

Labour's Health spokesperson Ayesha Verrall told RNZ the situation was another example - after a controversial plan to have Rotorua doctors cover shifts at Taupō, and no plans to increase staffing at Rotorua - of where the government's claims of financial mismanagement did not stand up to scrutiny.

"Health facilities should be able to be staffed by doctors and nurses and their rosters should be full. I think that's the best way of assessing whether we've got enough staff," she said.

She said having staff but not in the right places could be part of the problem - but "I very much doubt that is the only problem, because I'm aware particularly for specialists that we're just so behind in terms of the gaps".

"It doesn't appear that [Reti's] story hangs together .... he said that there were cost overruns due to back-office bloat, but it now appears to be due to nurses. The prime minister said there were 14 layers of management, but that doesn't hang together either.

"Big cuts are being proposed for our health system, I think we need a clear explanation from the government as to why."