Palmerston North Hospital's emergency department was built to deal with about 17,000 patients a year, but sees more than three times that number. Photo: Jimmy Ellingham, RNZ
A woman discharged herself from Palmerston North Hospital after suffering a severe reaction to a sedative administered to her in the emergency department as pain relief.
Despite being in extreme pain, the woman waited one hour and 45 minutes without help until a nurse saw her in November 2019 and gave her the sedative.
The emergency department was overcrowded at the time.
A Health and Disability Commissioner decision released on Monday and said the woman was not given adequate information about the drug, droperidol, that would allow her to make an informed choice about its use.
Droperidol is not approved for use as a pain relief, but the commissioner's decision does not criticise its use in its decision.
After she was given the drug the woman was not appropriately monitored and no hospital staff noticed she was having a seizure.
When she recovered, the woman left the emergency department fearing that due to her reaction she would die. She did not want to remain in the hospital.
The woman, in her 30s, who is not named in the decision, did not report it at the time, and the former MidCentral District Health Board questioned if it happened.
This did not impress deputy health and disability commissioner Deborah James, who said the woman's account was detailed and believable.
James found the former MidCentral District Health Board failed to provide an appropriate standard of care for the woman.
She also said she would write to MidCentral and other health officials to remind them of the effect overcrowding can have on patient care.
When the woman arrived there were 36 patients in the 28-bed unit. Three hours later there were 49, and the hospital issued a "red alert" because of overcrowding.
James acknowledged it was a long-standing issue at Palmerston North Hospital's emergency department, which was built to deal with about 17,000 patients a year, but sees more than three times that number.
An independent adviser to the investigation, Dr Stuart Barrington-Onslow, said if the problem persisted, incidents such as what happened to the woman in November 2019 would continue.
"Dr Barrington-Onslow also advised that it was inappropriate for a patient with a pain score level of 10-10 to wait for the amount of time that [the woman] did without analgesia, and he would have expected there to have been a rapid assessment of the patient and for analgesia to have been prescribed," James' decision said.
Te Whatu Ora MidCentral response
A statement from Te Whatu Ora MidCentral interim district director Dr Jeff Brown said it acknowledged the report's findings and apologised to the woman and her family.
"We are working to implement the recommendations given by Deborah James as a matter of priority to ensure an incident like this doesn't occur again.
"An action plan has been developed which includes short-, medium- and long-term initiatives to improve ED waiting times."
Brown said key parts of that plan included work on a new emergency department observation area and medical assessment planning unit, which would be completed by the end of the year.
The new observation area would have 10 beds, up from six, while the unit will have 20, up from 13.
The hospital was also participating in a ministry-sponsored trial for weekend discharging, and recruitment for new roles, Brown said.
"Recruitment to a number of new roles, such as our dedicated nurse to support discharge of patients with complex needs, our patient flow nurse and implementing a 'patient at risk service' have all been implemented.
"Recruitment is ongoing for an equity nurse to be based in ED to work specifically with acute flow for Māori patients."