Stethoscope: $200, Gloves: $200, Surgical equipment: $100,000. A patient not noticing you left a rag in their newly sewn up stomach… priceless. Wellington Hospital is becoming renowned for what Dr Liz Hesketh described as “unsafe clinical practice.” Several news media publications have followed what seems to be an increasing number of errors and staff resignations. Salient Feature Writer Jenna Powell looks at Wellington Hospital, the moral panic surrounding its practices, and what is being done to ensure the safety of all patients.
CHILD CANCER WARD CLOSURE AND STAFF DISCONTENT
Respected child cancer specialist Dr Liz Hesketh told The Dominion Post she left the Wellington Hospital Unit because of “continual dwindling resources and a unit moving towards unsafe practice.” Hesketh was soon followed by her colleague Anne Mitchell, which caused the temporary closure of the child cancer ward in Wellington. Patients of the unit were then transferred to Christchurch and Auckland units until replacements arrived. Wellington Hospital currently works in a joint cancer unit service with Canterbury which many commentators, Hesketh included, saw as a questionable and highly controversial move. Wellington Hospital has a huge turnover when it comes to staff. Nurses are constantly leaving due to what one nurse described as an “unsustainable workload.” Salient visited Wellington Hospital on four separate occasions and used stealth (see: strolled into the hospital) to talk to members of staff while they took a load off in the cafeteria. When questioned about how they felt at Wellington Hospital and how they were managed and rostered, the standard answer was a blank drone-like statement indicating that they were to refer all media enquiries to Capital and Coast District Health Board. However some staff, when pressed, did reveal their feelings provided their names were not mentioned in print. A junior doctor told Salient that “depending on the shift” she feels “utterly bereft of guidance” and that her preliminary training at another main urban centre hospital seemed “far more organised.”
PATIENT WAIT and EMERGENCY MEDICINE
A Capital and Coast spokesperson promised The Dominion Post at the start of the year that the hospital was working towards a “maximum 6 hour wait” for all patients. This was after patients had to be left in corridors awaiting attention in the emergency ward. Salient, ever so discreetly (see: got asked to leave by a terribly on-to-it orderly), buzzed around the emergency services waiting room and emergency overflow area asking patients how long they had been waiting. On the four separate occasions Salient visited, the wait varied extremely. On one occasion the most anyone waited was four hours, whereas on the next visit a patient could be waiting anywhere between two and eleven hours for proper attention.
MATERNITY WAR
Maternity wards throughout New Zealand have come under increasing pressure through the past few years because of the lack of midwives in the medical workforce. There is also a steady decline in the number of GPs who are willing to perform the midwifery function – a common practice of years gone by. Giving birth is no picnic, with an array of complications that can arise for both mother and baby. Before professional maternity wards and modern birthing procedures, dying in childbirth was a very real possibility. But possible modern complications still persist, including but not limited to preterm labour, placenta issues, bleeding issues and foetal distress.
Wellington Hospital has recently come under scrutiny for sending a mother and a newborn baby home within hours of delivery. The birth itself was difficult and the woman was a first time mother, so sending her home so early is against policy and is unethical. The death of a baby boy at Capital and Coast’s Kenepuru Maternity Ward during delivery prompted huge online complaints against Wellington Hospital, the maternity ward and the mother and baby’s independent midwife. When questioned by Salient, Capital and Coast spokesperson Micheal Tull tried to distance Capital and Coast from the death by emphasising the independent midwife. The midwife was a recent graduate and failed to diagnose the breech birth. Her midwife supervisor looked on during the birth and “assured the duty midwife that she was doing well”. Tull also stressed that a review of the death, sponsored by the Ministry of Health, would be made public shortly.
Complaints surrounding the ‘DIY’ style of Wellington Hospital’s post-natal care and the limited space available arose after one woman was put in the gynaecology ward, so she was alongside women who had just lost their babies. Campbell Live recently reported on how hectic the Wellington maternity ward is and how it is far from a peaceful environment for mother and baby. Mother Angela Mansford told Campbell Live that “overflowing wards and a shortage of staff would lead to mistakes being made.”
Capital and Cost District Health Board tried to give women having their subsequent child a hundred-dollar grocery voucher for leaving the hospital early. They later withdrew the offer after being accused of bribery and pandering to vulnerable mothers. A stay of longer than six hours at the hospital is needed for mother and baby to check for problems as well as to establish a bond and breastfeeding.
It seems New Zealand, a country plagued with domestic violence and dysfunctional homes, is yet again neglecting children’s needs. There is currently no private user-pays alternative to public maternity and post-natal care units. There was a professional maternity hospital in Wellington during the 1980s but it was later closed for the supposed superior services at Wellington and Kenepuru Hospitals.
JUNIOR DOCTORS AND INTERNS
An anonymous source from Otago University’s School of Medicine told Salient that it is “general knowledge” that junior doctors and interns at Wellington Hospital are not “given much direction or guidance by senior staff” as a result of bad management and illogical rostering. Interns need a system of checks and balances, which should be provided by Wellington’s senior staff. According to the source, interns “need senior knowledge to avoid errors and misdiagnosis” and “too much self-direction for inexperienced people in the medical profession is never a good thing.” Capital and Coast spokesperson Michael Tull acknowledges that Wellington Hospital does have a senior staff shortage but told Salient that “it is not impacting on our ability to provide 24/7 senior medical staff cover.” Tull even went as far to say that the “level of cover is no different to when we are fully staffed.” Tull also assured us that the senior medical staff are all working additional hours to ensure that the unit is well supported by senior staff 24/7. These long hours worked by staff, although necessary, are questionable when snap (potentially ‘life or death’) decisions have to be made by the tired and fatigued. Rumours of widespread staff discontent and a documented rise in errors is hardly surprising under these conditions.
MANAGING A HOSPITAL UNDER A BUSINESS ETHO
Last year Capital and Coast District Health Board underwent a massive managerial shakeup. In December CEO Margot Mains quit her post (to be replaced by Ken Whelan) amid claims the DHB was almost $10 million in debt. Health Minister David Cunliffe then sacked chairperson Judith Collins in December to bring in Sir John Anderson, a former TVNZ chairperson, due to preceived managerial inflexibility under the old regime. These changeovers highlighted low staff morale within the organisation, although it is hoped that the change should set Capital and Coast on the road to good health. Underneath the controversies, issues of inadequate funding remain. District Health Boards are funded on a per-capita basis, and Capital and Coast, with a population of 276,000, is considerably smaller than Auckland or Canterbury – but its hospitals service a total of almost 900,000 people from the entire lower North Island, which is not factored into funding. This leaves Capital and Coast in a uniquely difficult position.
Despite media attention on “dwindling resources” Capital and Coast spokesperson Michael Tull denied any funding problems. “We have the budget to employ staff – there aren’t staff available to employ,” Tull said. Although there is short staffing in maternity services (here and in many other parts of New Zealand) “this is not related to any lack of funding.” Tull left the alleged “dwindling resources” unaddressed. The business ethos of Wellington Hospital was accidentally implied to Salient through Tull’s description of mothers in labour as “consumers.” If we follow this ethos, maternity service could start to mirror Turkey’s, where the majority of births are done through caesarean sections, so hospitals can book mothers in to give birth at a specific time to avoid over-crowding.
The new $300 million Wellington Hospital is currently being built and sure does look pretty, but does it address the hospital’s real problems?