Hundreds of Wairoa residents at risk of flooding were only evacuated because an official was woken by her baby, then checked her emails in the middle of the night.
About 4am on 26 June, Wairoa District Council Civil Defence and Emergency Management controller Juanita Savage woke up to her baby crying, as the child had lost her doll.
Savage found it and soothed her daughter back to sleep, then - by "pure luck" - opened her emails.
She saw a message, sent at 3.59am by the Hawke's Bay Regional Council flood forecaster, warning that the Wairoa River had "risen higher than expected in the last few hours".
Hawke's Bay Emergency Management criticised
"It has reached the Orange - 5 year level at the Town Bridge. This could result in flooding along Kopu Road, depending on the condition of the mouth."
Knowing that a channel had not been dug in the river bar to open up the river mouth, Savage sprang into action - phoning homeowners in low-lying areas to tell them to evacuate, calling emergency responders, sounding the fire station siren and requesting an Emergency Mobile Alert.
After the 3.59am email was sent, there were no phone calls made from Hawke's Bay Civil Defence to Savage to warn about the flood risk.
Four hundred properties were flooded, causing about $40 million in damage.
"Sending me an email at that time of the morning and thinking I might see it - I don't know what the intention was of sending that email at that time, but it wasn't to wake me up," she said.
"I'm quite angry when I look back. Right now thinking about it I'm getting quite emotional because our people were at risk - why wasn't a phone call made to me to ensure I got the message?"
It had left her with a deep mistrust for the Hawke's Bay Civil Defence Emergency Management Group, she said.
"I can't rely on them, because I don't trust them."
Savage worried people could have died if she had woken at her usual time of 6am, two hours after the email about flooding risk had been sent.
"We were very lucky we had no lives lost in this flood event. I would hate to think what a delay of two hours would have meant for our whānau who are impacted.
"I feel our Wairoa community hasn't really been considered or looked after, I feel there is a disrespect there."
The Civil Defence system was set up so there was a duty response manager on call 24/7, which meant local controllers like Savage could always be reached even if phones were switched to 'do not disturb'.
But she told RNZ that there had been no debrief over the communication failure in June. Likewise, there had been no conversations at a local level since Cyclone Gabrielle about how the system could be improved.
That was despite a report in March calling for a complete overhaul of the national emergency management system because it was not prepared for large-scale disasters and "sets good people up to fail".
"I don't know what we've been learning, but we haven't put anything in place to reduce the risk," Savage said.
Because of that, she now sought advice and support from other emergency management groups outside the Hawke's Bay area.
"I don't rely on HB CDEM information because I've got no confidence now due to what happened in the June flood."
She said she wanted reassurances from Hawke's Bay Civil Defence Emergency Management Group that next time there was a flood risk, they would pick up the phone and make sure people were evacuated quickly.
"They need to show us a plan, a structure that is going to look after Wairoa District.
"They haven't demonstrated that they care about our people because they haven't given us the right support or resources to be able to do so."
'A phone call could have been made'
The Hawke's Bay Civil Defence Emergency Management Group declined RNZ's request for an interview.
In a statement, acting group manager Shane Briggs said the group understand the frustrations and concerns that had been raised, particularly around communications between Hawke's Bay Civil Defence Emergency Management, Hawke's Bay Regional Council and Wairoa District Council.
"WDC were provided all MetService weather warnings, further information on Monday 24th of June, and key WDC staff attended a multi-agency meeting on Tuesday, 25th June.
"While HBCDEM acknowledge that a phone call could have been made at 3.59am on Wednesday the 26th, it is important to note that the response was locally led by Wairoa District Council," he said.
He added that the 'Hawke's Bay Civil Defence and Emergency Management Group Response to Gabrielle' review, led by former police commissioner Mike Bush, had provided valuable insights into how the group could better serve the local communities in Hawke's Bay.
"HBCDEM are actively implementing the recommendations of the March 25th report. As part of this process HBCDEM are reviewing all internal protocols to ensure they align with local expectations and the needs of those affected."
A key area of focus was ensuring a greater localised approach to emergency management, Briggs said.
"We are working to strengthen our connections with local leadership and communities, including those in Wairoa, to improve our responsiveness on the ground."