A District Health Board found by a coroner to have contributed significantly to two deaths through its own error has apologised unreservedly and says changes are being made.
An inquest into the deaths of Ian McLeod and Marlene Strongman found that staff at a Tauranga hospice and hospital failed to provide adequate care.
Mr McLeod died in 2012 at Waipuna Hospice from pneumonia and liver disease following years of treatment for cancer.
Coroner Wallace Bain found that a tube put into Mr McLeod for his chemotherapy drugs had moved to a dangerous position and this was not taken seriously enough by hospital staff. That affected his treatment and ultimately contributed to his death.
Mr Bain also found failings at Tauranga Hospital contributed to the death of Marlene Strongman, who died from a brain injury and pneumonia in June 2010.
She was misdiagnosed by a junior registrar at the hospital and concerns about her condition were not passed on to her consultant.
Read the coronial report on Ian McLeod
Read the coronial report on Marlene Strongman
Families not listened to
In both cases, Coroner Wallace Bain found that the Bay of Plenty District Health Board did not listen to the families' concerns.
The Bay of Plenty DHB says it acknowledged where it failed and was taking steps to ensure that such incidents did not happen again.
Dr Hugh Lees, a medical director at the DHB, said on Friday that he regrets that communication with the families involved was inadequate.
"All staff in the hospital need to be reminded all the time of being open and honest and transparent in their communications with families. We apologise unreservedly and we accept the findings of the coroner."
Dr Lees told Radio New Zealand's Checkpoint programme that he other senior staff are doing their best now to emphasise the importance of openness and transparency. He said he is happy to meet with the families of the deceased.
But Ian McLeod's son, Scott McLeod, said the DHB ignored his father's concerns and questioned if its apology is genuine.
"With days to live, he's worried about the next guy to go through what he was going through and trying to come up with ideas on how it could stop in the future. He tasked me personally and the family to go and follow up on those concerns, and we were treated more like that was a hindrance."
Mr McLeod told Checkpoint he wants to meet with the district health board make sure the same mistakes are not made again.
Listen to Checkpoint interview with Dr Hugh Lees
Listen to Checkpoint interview with Scott McLeod