Doctor Shortage in Far North Critical, Posing Significant RisksDoctor Shortage in Far North Critical, Posing Significant Risks The chronic shortage of doctors in the Far North has reached an “acute” level, jeopardizing patient safety and raising concerns about avoidable deaths. A leaked email from a senior clinical manager reveals several high-risk areas, including Dargaville Hospital, where on-site doctors have been replaced by a telehealth service. With one doctor retiring, the hospital can no longer provide 24/7 care and has resorted to night nurses and inter-hospital transfers for critically ill patients. Telehealth clinicians face difficulties due to heavy reliance on paper medication records and lack of electronic medical protocols, leading to medical errors. Inter-hospital transport is also a major concern due to limited availability of ambulances and alternative services. Emergency physician Gary Payinda warns that long waits in overcrowded emergency departments could result in additional deaths. Research shows that for every 82 patients waiting over six hours for admission, one additional death occurs. The lack of after-hours primary care has a direct impact on emergency services, while limited access to laboratory and radiology services adds to the challenges. Private telehealth company Emergency Consult has been providing services to rural hospitals in the region since 2019. While it supports local physicians, it cannot fully replace the need for on-site doctors. Ambulance Association chief executive Mark Quin highlights the collapse of primary care in Northland as a major factor in stretching ambulance services beyond capacity. Staff morale is low, and they are reluctant to work overtime due to burnout and a pay dispute. Dr. Payinda emphasizes the dedication of frontline health workers, despite the insulting and inaccurate portrayal of the health system as “bloated.” He urges politicians to acknowledge the underfunding and prioritize the well-being of patients in the Far North.
Doctors in the Far North are very concerned and fear that people are dying as a direct result of the acute staff shortage in hospitals.
In an email to staff leaked to RNZ, a senior clinical manager warns of several high-risk areas, including Dargaville Hospital, where on-site doctors have been replaced overnight by a telehealth service.
The chronic shortage of doctors in the region had now become ‘acute’, which was not helped by the lack of financial resources to recruit new staff and the recent decision to cut the salaries of locums who were supposed to fill the gaps.
With one doctor retiring, Dargaville Hospital can no longer provide safe 24/7 care. The hospital has moved to telehealth and night nurses. Critically ill patients are transferred to Whangārei by St John’s Ambulance.
“This isn’t perfect, it causes anxiety among nursing staff, but it is the only option,” the manager wrote.
Problems include:
- Hospitals in Dargaville, Kaitaia and Kawakawa are facing a shortage of 10 experienced doctors (more than one in three vacancies are vacant), while replacement of junior doctors is described as ‘ad hoc’ due to a lack of coordinated recruitment and funding.
- Telehealth clinicians are hampered by ‘heavy reliance on paper medication records’ and lack of electronic medical protocols in Northland ‘has led to medical errors’: HIGH RISK
- Lack of after-hours primary care has direct impact on ED services
- Inter-hospital transport: HIGH RISK. Lack of availability of St John’s Ambulance and alternative services.
- Limited access to laboratory and radiology services during normal working hours and on-call: MODERATE RISK – “The staff providing these services are under pressure and often have to return calls 24 to 72 hours a day.”
Northland emergency physician Gary Payinda said staff were regularly receiving messages asking them to cover shifts in rural hospitals.
But even at the region’s largest hospital, in Whangārei, they struggled to fill patient lists.
Replacing sick colleagues now requires approval from multiple managers.
“On my last shift the emergency department occupancy was 133 per cent, on the shift before that the emergency department occupancy was 200 per cent. That means we have twice as many patients seeking emergency care as we have doctors and nurses to see them,” he told RNZ on Friday morning.
According to Payinda, there is no doubt that people will die because of long waits in overcrowded, understaffed emergency departments.
This was based on international research which showed that for every 82 ED patients who had to wait longer than six to eight hours for admission, there was one additional death.
“That’s for a 6 to 8 hour delay, which we have all the time. I don’t mean all the time, like a few times a month or once a week, I mean daily.
“And in fact, we’re not just having delays of 6 to 8 hours before a bed becomes available on the upper floor. We’re having delays of 12 hours, 18 hours, 24 hours.”
The manager admits it was “very risky” not having a doctor present in Dargaville at night.
The letter obtained by RNZ admits that the lack of a doctor on site at Dargaville at night posed a “high risk” – there could be a chance of an obstetric emergency or a seriously ill child or adult turning up after hours.
“We have scenarios where people in rural hospitals have heart attacks and they are managed through a video monitor because there is no doctor in the hospital.”
Since 2019, private telehealth company Emergency Consult has been commissioned to provide services to hospitals in Kaitaia, Kawakawa in the Bay of Islands, Dargaville and Rawene.
In the three months to the end of June, Emergency Consult, led by John Bonning, treated 1,270 patients in those four rural hospitals.
An emergency physician himself said that the service ‘does not replace doctors, but supports them’.
“Of course we cannot perform remote resuscitation, nor intubation or other major surgeries, but it is safe and it strengthens the local population, supports them and also helps to retain some of the workforce in rural areas.”
It was “not sustainable” for 3.25 doctors at Dargaville Hospital to work day shifts of 10 hours or more and then also work night shifts, he said.
Dr Bonning was not aware of any patients who had suffered harm due to errors in remote prescribing of medication, as highlighted in the letter.
However, he admitted that the lack of electronic systems in rural hospitals sometimes caused “confusion”.
The letter said the lack of ambulance services to transport patients is a major risk and “a major source of stress for staff.”
Ambulance Association chief executive Mark Quin said the collapse of primary care in Northland was stretching the capacity of ambulance services.
“The staff are burned out, morale is low and they are currently in a pay dispute with St. John. All of these factors mean that staff are sometimes reluctant to work overtime because they have simply had enough.”
Gary Payinda, who came to Northland for six months 17 years ago with his wife, a doctor, says he stays because the people of Northland are “absolutely wonderful” and the need is huge.
It was “insulting” to frontline health workers when new Health Commissioner Lester Levy described the health system as “bloated” and politicians denied it was underfunded, Dr Payinda said.
“Either they are hopelessly misinformed and living in a fantasy land – or they are deliberately twisting the truth for political purposes. And I don’t know which it is, but both are equally unacceptable.
“These are real patients whose lives are at stake, so it’s time to be honest.”
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