Covid-19 has locked down parts of Northland, but if the virus rips through how will Whangārei Hospital cope when the battered building can't even stand up to heavy rain?
During heavy rain, the lights can pop out of the ceiling in Whangārei Hospital's ICU and buckets are needed in radiology (composite image). Photo: RNZ/Sam Olley/Vinay Ranchhod
On paper, the lifts in Whangārei Hospital's surgical wing have "expired". In reality, they are still in use. On the way between floors, they break down, sometimes with deteriorating, bed-ridden patients inside.
Intensive care anaesthetist Dr Erna Meyer remembers the time, in the mid-2010s, when an elevator jammed shut with a patient running low on tanked oxygen inside.
"At the last moment, somebody managed to get the door open and push a cylinder in."
When the faulty lift to the helipad on the roof gives out, choppers have to land at Kensington Park instead and then ambulances race the critically unwell down State Highway 1.
Meyer says nowadays staff consider these "nightmare" situations "normal". That's because their workplace, Whangārei Hospital, doesn't meet building standards or requirements for clinical best practice.
For years, the Northland District Health Board has been reporting the "decay and dilapidation" to the government. But redevelopment talks - that began in 2015 - have not been resolved and now Covid-19 is here.
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Anxious staff fear it's not a matter of if Covid-19 exhausts Whangārei Hospital's capacity, but when.
Fourteen cases have spread across Kaiwaka, Kaikohe, Taipā and Kaitāia in the past fortnight, prompting Covid-19 Response Minister Chris Hipkins to lockdown the northern part of Northland from 11.59pm last night.
DHB modelling predicts cases will fill about half the hospital - including all eight ICU beds, and another 121 beds in the medical wing - three to five months into an uncontrolled outbreak. With one in five people still unvaccinated in Northland, the region can expect dozens of deaths in this scenario.
For infection control, builders have used wooden framing and zipped plastic sheets to separate eight of the 32 emergency department (ED) bed bays into rooms, so contaminated air can be filtered out and replaced. But the ED remains just 38 percent of the size it should be, under Australasian Health Facility Guidelines.
As for the hospital's ICU - it can't even stand up to bad weather, Meyer says. In heavy rain, the lights have dropped out of the ceiling.
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Dr Erna Meyer calls plans for the hospital a 'band-aid on a bullet wound'. Photo: RNZ / Sam Olley
Since the Northland District Health Board began discussing a hospital redevelopment with the government, Te Tai Tokerau's population has boomed, growing 18 percent in the five years to the 2018 Census. The median age is 42, making it the oldest region in the North Island, and more than one in three people fall into the most deprived quintile in the country.
The DHB wanted a $1 billion rebuild but the government ruled that out early. It's since lowered its hopes to a $572 million redevelopment, but, with the growing population, that will only meet bed demands until 2030.
Meyer calls it a "band-aid on a bullet wound".
She and other Northland members of the Association of Salaried Medical Specialists met with DHB leaders about the project delays a month ago.
"Staff were feeding back to management that they should say no to government, that we don't have confidence that this will be suitable for the needs of Northland. But on the other side we feel that if they do that, we will be in a position where the building will fall down around us."
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Jill Mortimer has been "punched and flung around" four times by people frustrated by Whangārei emergency department lines. The clinical nurse coordinator jokes that her petite frame makes her an easy target, but admits: "It can be really scary, 'cause you know it's going to hurt."
Verbal abuse, she says, happens most days. But she doesn't blame Northlanders - the backlogs upset her too.
Over the last two years, one in every 10 emergency department (ED) arrivals has spent at least six hours in the waiting room. Some months it's one in five.
Even if ED were bigger, patients wouldn't necessarily be admitted faster, because as it is - without Covid-19 patients - often there is no space on the wards.
Since 2017, the DHB has told the government that overall demand for ED, intensive care, inpatient beds, and theatre services has surpassed capacity - and Northland's medical and surgical needs have been "unprecedented".
Often, Mortimer says, anything that isn't 'code black' (when the hospital has run out of beds) is a "relief".
Sometimes ambulances are 'ramped' - forced to park outside ED with a patient inside, because the hospital is too full for them to get the immediate treatment they need, and they are too unwell to be in the lobby.
Whangārei emergency medicine consultant Dr Gary Payinda believes ramping is "compromising the lives of an entire community".
"It is the most dysfunctional, repugnant, repulsive thing," he says.
To quickly make space in ED, patients may be queued for care in a ward corridor - a "last-ditch" process known as a 'one up'.
"How much of a treatment or exam can you do on a patient covered by a sheet in a hallway that may need an intimate exam, a rectal exam, a complete physical examination, a complete history about mental health, social health, family history? ... That's failed care."
As for the condition of the hospital overall - don't get Payinda started.
When he was elected onto the DHB for the 2016 to 2019 term, builders were securing corroded windows that had fallen off the surgical wing (which is on a lean) onto the ground below.
"Not just the glass pane, but literally the frame ... You can imagine a helicopter's landing on the roof. There's vibration and huge winds and if a window falls out, that can kill somebody."
When it rains heavily, Payinda's colleagues in the radiology department use buckets to stop leaking water from damaging their delicate multi-million-dollar equipment.
"The building is so old, and it has been cobbled together with so many different piecemeal, itsy-bitsy parts, that it can no longer just be fixed," he says.
"When we heard that Middlemore Hospital found black mould, we were wishing it was us. Because it's almost like we need an overt, health-threatening emergency to try to get things rebuilt."
He is pessimistic about Whangārei Hospital's Covid-19 fate.
"If on a regular day, we can't cope with patient demand, how the heck could we possibly be expected to cope with a surge?"
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Whangārei GP Geoff Cunningham says he has patients in 'extreme pain' waiting for surgery at Whangārei Hospital. Photo: Supplied
Crystal White (Ngāti Whātua, Ngāpuhi) has no doubts her daughter Phaerie was "traumatised" when she was sent to Whangārei Hospital in an ambulance after skull surgery in Auckland's Starship in 2019.
When the 16-year-old reached Whangārei, there was no room, so she was taken further north to Bay of Islands Hospital, and later the same day back to Whangārei when a bed became available.
There, doctors noted her rising high temperatures and pain - she was fighting post-neurosurgical chemical meningitis - and had been through transfer after transfer after transfer.
White says the ordeal was "terrifying" for Phaerie: "She was in hysterics."
Hospital disruptions have also caused upset for Oromāhoe mother Ruiha Kara (Ngāti Kawa, Ngāti Apa) and her 12-year-old son. He spent months waiting for surgery last year, only to be "gutted" when dates were pushed back multiple times.
Kara's brother didn't want to face a similar wait for an operation he needed, so her mum paid for him to go private.
She thinks upgrading and expanding Whangārei Hospital is "a need not a want".
"When you're having appointments pushed, it makes us feel like we're not worth it."
Another woman, who RNZ agreed not to name, had surgery this winter after waiting two years in "severe pain" that left her depressed and suicidal. Sometimes she sought help from ED and was "on the verge of an absolute wobbly in the car park" when the hospital hit 'code red,' meaning it couldn't keep up with demand and was down to its last available beds.
She says staff gave her "brilliant" help but "they run themselves ragged".
Whangārei GP Geoff Cunningham sees stories like these play out in daily consults, leaving him "incredibly despondent and disillusioned".
"There seems to be a huge disconnect with Wellington and the massive need, and the exponential growth, that we've had here in Northland."
The growth that has been recorded, he believes, is significantly underestimated because of low Census response rates among deprived, rural populations, and therefore the hospital redevelopment will be "dangerously small".
The current facilities' widespread shortfalls have a "phenomenal" impact on his patients, many of whom are in "extreme pain" and needing joint replacements.
"Three patients who saw me yesterday are well overdue ... Patients have to be now significantly disabled to be able to even get on the list for an assessment by the specialists."
In the meantime, those on the lists are at higher risk of falls and need to see their GPs regularly for pain relief - GPs that are also struggling to keep up with Te Tai Tokerau's booming population.
Bush Rd Medical Centre, where Cunningham practises, has had closed books for two years.
When hospital surgery dates are locked in, he has to warn people there are "almost always" cancellations, not necessarily because of theatre space, but because wards are so full there are sometimes no beds for post-op recovery.
Cunningham has resigned himself to the fact: "It's not right on so many fronts."
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Amid the Covid-19 response, Northland DHB chief executive Dr Nick Chamberlain was unavailable for an interview about the hospital redevelopment. But University of Auckland Emeritus Professor Des Gorman (Ngāpuhi, Ngāti Kurī) - an advisor on the Minister of Health's Capital Investment Committee - was. He thinks Whangārei Hospital "needs bulldozing".
"I have nothing but admiration for the women and men who work there and the care they provide in what are quite appalling conditions."
Due to vaccine hesitancy among some in Te Tai Tokerau, Gorman believes there will be an "epidemic of the unvaccinated, which will be quite nasty in the north" that Whangārei Hospital is "going to really struggle to deal with".
He says successive governments have underinvested in hospitals for "a very long time" and big-budget hospital builds like those in Christchurch have "sucked a lot of the oxygen out of the atmosphere" for others in need.
"There's no question that in an ideal world, Whangārei Base Hospital would have been replaced a decade ago."
But he fears the forthcoming Health NZ centralisation of DHBs won't do the redevelopment any favours.
"It's hard to see how that will help local solutions for local need."
If budgets allow, Gorman would like to see the DHB's initial total rebuild pitch to government implemented, but, of course, the government long ago rejected that option, that the DHB says will cost $1 billion.
After that initial rejection, in 2018 the business case process was put on hold because money wasn't expected to be freed up until at least 2021.
Even with a cheaper $572 million redevelopment, rather than a wider 'rebuild', affordability is a "particular concern" for the Ministry of Health, according to a heavily-redacted report written in February, obtained by RNZ.
The funding uncertainty is forcing the Northland DHB to put tens of millions of dollars into patching up facilities that may soon lose accreditation, be decommissioned, and need to be bowled anyway.
It predicts the main block of Whangārei Hospital, alone, will cost $5.2 million per year to maintain - that's more than the DHB's current budget for minor works at all properties.
Suspected asbestos in the hospital, construction market constraints, and new Carbon Neutral Government Programme requirements also threaten to extend the project timeline and building costs.
Chief executive Dr Nick Chamberlain had anticipated funding would be announced in Budget 2021, and, in a written statement, he said the latest amended version of the business case would now be handed to government at the end of this year or early next year, as "the Ministry of Health is concerned with the cost".
He said the DHB's best option was to go ahead with a minimised redevelopment, "even if the new spaces built are only large enough for a short time".
"Our current accommodation carries too many risks."
Andrew Little Photo: RNZ / Samuel Rillstone
Earlier this year, in a press release, Chamberlain assured Northlanders Whangārei was "the highest priority major hospital redevelopment in New Zealand".
But when asked if that was the case, Health Minister Andrew Little would not confirm this, saying it's one of "a number" of priority redevelopments needed.
"There's also Nelson, there's one in Palmerston North, there's one in Hawke's Bay, all needing reasonably urgent attention."
He reiterated the Labour government has a $6 billion health infrastructure programme, after what he has previously described as "nine long years of underfunding" leading to a "rundown" estate.
But, when challenged over why a new Whangārei Hospital wouldn't be built from scratch, he said: "I'm not sure that a $1 billion hospital in Whangārei is what is needed to serve the population that the Northland DHB serves."
Little said most people with Covid-19 in Te Tai Tokerau would be cared for at home and by community health services, not Whangārei Hospital.
"But if it exceeds their capacity, then it's expected that any other patients will be transported to Auckland for care. And there will be capacity there."
In his view, the Health NZ amalgamations next year will make decision-making over the hospital's future "easier".
But for now that is little relief to patients currently facing long waits for treatment in a crumbling hospital.
Last winter one wrote this poem and put it in a hospital feedback box:
Waiting with patience it's all I can do, just sit and wait and my pain waits too.
Doctors and nurses are busy doing what they do.
This can't be helped by me or by you.
So hold on to your patience, it's the best you can do and if you have a pen and paper maybe you can write too.
Just sit and smile as hard as it is to do.
Let the time roll on next thing you know they will call you.