Delays at Middlemore investigated after woman dies with brain bleed

Middlemore Hospital's emergency department is under increasing strain. Photo: NZME
Middlemore Hospital's emergency department is under increasing strain. Photo: NZME
A "healthy" 50-year-old woman has died with brain bleed after allegedly being told by staff at Middlemore Hospital's emergency department there would be an eight-hour wait before she was examined.

The woman presented to ED with a severe headache yesterday at 1am and was told there would be an eight hour wait, a doctor - who asked not to be named out of fear of putting his job at risk for speaking to the media - told The New Zealand Herald.

"She was frustrated so left. She returned at 0400 (4am) that same day and was intubated. CT showed a massive subarachnoid haemorrhage, she died," the doctor said.

Subarachnoid haemorrhage is a type of stroke and is most commonly caused by a brain aneurysm. A brain aneurysm is a ballooning of an artery in the brain that can rupture and bleed into the space between the brain and the skull.

Counties Manukau District Health Board has confirmed the death, saying they are now urgently investigating the circumstances of the patient leaving the hospital.

"Our deepest sympathy to the family," acting CEO Dr Pete Watson said.

In a statement released by the DHB this afternoon, Watson said: "In the early hours of Wednesday morning a patient presented to our Emergency Department who then left only to return a few hours later following a life-threatening emergency." 

At 2.30pm he told the Herald she was in ICU, at the same time the unnamed doctor said she had died.

The Herald sought clarification from the DHB and at 5pm were told: "It is with regret that we update this earlier statement and advise this patient has died in ICU. Our deepest sympathy to the family."

Watson said: "The circumstances of the patient leaving the hospital are being urgently investigated. We acknowledge this is an extremely stressful time for the family and we have instigated an immediate investigation into the case and circumstances."

The CEO said Middlemore continued to be under extreme pressure and patient presentations had been abnormally high for this time of year.

"We are focusing on managing the extreme demands on our services and continue to work with WDHB and ADHB to support patient demand. We have no further comment to make on this matter at this point in time," Watson said.

Frustrated doctors said the woman's death was a stark contrast to Health Minister Andrew Little's comments last week that everyone who needed medical treatment would get it.

Little responded by saying: "Hospital management advise me the facts of the case are not fully known and an investigation is under way to establish them. We're making long-term plans for training, recruitment, retention, and fair pay for the people who care for our families."

Little said it would improper for a minister to comment on an individual patient's circumstances, particularly while an investigation was under way.

"The health system has been under serious pressure from years of neglect and underinvestment. It hasn't been working for patients or the health workforce as best as anyone wants it to.

Health Minister Andrew Little. Photo: NZ Herald
Health Minister Andrew Little. Photo: NZ Herald
"We have taken a number of steps to turn around these years of neglect. This includes properly funding the health system and reforming the structures that prevent it from working as well as it could. There is more to do and turning the health system around will take time," Little said.

The doctor said if a patient presents with a severe headache the first thing they want to do is rule out "a bunch of conditions that can rapidly kill people, such as meningitis, heart attacks and a subarachnoid haemorrhage."

"It's one of the things that we get scared about missing," they said.

The doctor said a patient with a severe headache should be seen within the hour after arriving to ED.

The Australasian College for Emergency Medicine (ACEM) said they anticipated reviewing the respective reports of the death from the hospital in question, and the Coroner.

"The College would like to extend its deepest condolences to any whanau and loved ones affected by this loss and offer its support to the healthcare workers and other staff at the hospital," a statement from the college said.

The death comes after the Herald reported last week that hospitals had hit "a level of panic" with 71 patients waiting for beds at Middlemore's ED in one night.

Top emergency doctor John Bonning told the Herald, last week, hospitals across the country were seeing "record-level delays and record numbers of patients".

Emails leaked to the Herald from a different doctor showed the South Auckland ED saw more than 420 patients for the second night in a row this week - normally they see 300 - shifting the hospital to code red, which the doctor said basically meant "a level of panic".

The doctor said pressure on hospitals was "extremely concerning".

"I think red is like the level of panic basically [...] every time you deviate from optimal timely care, you increase risk of complications occurring from delays, and that includes patient death," he said.

"A patient that arrives in an emergency department with a 10 percent access block, which means if you have 100 patients and 10 have been there for longer than eight hours, then they have a 10 percent greater chance of dying over the next seven days," Bonning said last week.

"There is a very real impact for people waiting."

The unnamed doctor said last week that the minister needed to acknowledge the country was in a hospital crisis and staff needed to be paid better so they aren't forced to leave the profession they love.

Little told the Herald last week that while hospitals were under pressure, "as they were every winter", they were coping.

"A few months ago hospitals were preparing for a flu season that was expected to be bigger than the last two years and for that reason they expected to get planned care right down, most hospitals have been able to do that," he said.

The minister said he had not seen any data showing hospitals were reaching record levels of delays and patient presentations.

"It would be interesting if he (Bonning) did provide it, because he is known to say things like that without backing it up with data."

ACEM hit back, saying they stood by immediate past president, Bonning, and his assertion that emergency departments in New Zealand are under extreme and unprecedented pressure.

"The College maintains that data supports Dr Bonning's comments and will be reaching out privately to Mr Little to provide relevant supporting information, and to discuss the pressures on EDs," they said in a statement.

Aotearoa New Zealand faculty chair Dr Kate Allan said: "Emergency doctors know an emergency when we see one and right now, what is being experienced in emergency departments across Aotearoa isn't safe, it isn't fair, and it isn't sustainable, but we can fix it – together.

"We must ensure that clinicians and people who require emergency care are involved in decision-making as we navigate a very challenging winter."

Today, Allan said: "Extended delays in acute care can lead to poorer clinical outcomes which can, at times, include death."

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