What’s Going On At Buller Hospital?

Chair of Patient Voice Aotearoa, Malcolm Mulholland, has
launched a petition calling on the Government to urgently
fix the staffing shortages at Te Rau Kawakawa/Buller
Hospital. The petition reads: “That the House of
Representatives urgently address the issues surrounding the
unsatisfactory delivery of health services to the community
of Buller by Health New Zealand West Coast due to an
insufficient workforce.”

Of particular concern is
the case involving a Filipino man aged in his 40’s who
died on Wednesday July 17, after the hospital had been
closed the previous two nights. Earlier that day the man had
presented to Buller Hospital and was discharged. At 6pm
firefighters and Hato Hone St John were called to a
“medical event” at the hospital where it is understood
the man died.

To date, Health New Zealand West Coast
have refused to answer multiple questions from the community
including “Was the hospital open or closed, and if closed,
why was the community not notified?”, “Whether or not a
doctor was available at the time?”, and “Why were the
firefighters and Hato Hone St John called to the
hospital?” The unsatisfactory response to date from Health
New Zealand West Coast was that “Te Rau Kawakawa ASU
(Acute Stabilisation Unit) was staffed and operating as per
normal.” Health New Zealand have now decided to launch an
investigation into the man’s death by the Serious Incident
Review Committee.

Mulholland, whose family comes from
Seddonville in Buller, said something urgently needed to be
done by Health New Zealand before patients die because rural
hospitals are understaffed. States Mulholland “I hope that
the Health Select Committee undertakes an urgent
investigation into the staffing operations of Te Rau
Kawakawa, otherwise known by locals as Buller Hospital. The
community of Buller deserve straight answers about what is
happening at their hospital, including what happened on the
night of July 17. The circumstances that led to this man’s
death need to be fully understood. The community is deeply
troubled by this situation.

“The community of
Buller, just like other New Zealanders, should have faith
and confidence that their local emergency health service
will help them at their time of need. The people of Buller
pay taxes, and they shouldn’t miss out simply because they
live miles away from one of New Zealand’s major cities.
Health services in New Zealand is a right, not something you
might receive depending on where you live.

“It is
obvious that emergency health services are unable to be
offered 24/7 in Buller due to staffing shortages. Having a
hospital shut an estimated total of 11 times since its
opening in May 2023 for a total period of 25.5 days and 29
nights is not acceptable. The community need to be fully
informed as to the state of Buller Hospital, what the plan
is to get enough nurses and doctors to staff the facility,
and how long it will take for those staff to arrive in
Westport. Only then, with all the information, can the
people of Buller make an informed decision about local
health services and what they should expect if they knock on
the door of their hospital. To be clear, this is not a
criticism of staff who work at the hospital and who do their
best with limited resources. This is about recognising a
system failure and how to overcome those failures in the
future.

“I hope that the Health Select Committee
might be able to provide some insight and clarity moving
forward, rather than the folk of Buller continuing to have
no confidence in their local hospital. It could be that by
focusing specifically on Buller Hospital, understandings and
solutions can be found for other rural hospitals in New
Zealand.”

BACKGROUND
INFORMATION

Westport has had a hospital since
1868, and as recently as 2013, the hospital had 31 beds
including eight for acute patients. In May 2023, the new
Buller health facility titled Te Rau Kawakawa (TRK) opened
its doors at a cost of $21 million. The facility offers a
number of services including general practitioners and an
Acute Stabilisation Unit (ASU), the latter being advertised
as being available 24/7. TRK offers 12 beds, including seven
overnight beds and a birthing room, to service the needs of
a population of 10,000 people that has the largest
percentage of people aged 80 plus for any district in New
Zealand. West Coast chief medical officer Dr Brendan
Marshall said recently the hunt was on for two or three more
permanent doctors. He said about six doctors from Greymouth
were providing support to Buller Health, mostly in the
ASU.

The building, still called Buller Hospital by
locals as it offers an ASU and signposts to the facility
still read “Hospital”, has been shut an estimated total
of 11 times since its opening for a total period of 25.5
days and 29 nights. For 11 days in June 2024, the ASU was
closed for admissions but remained open for presentations.
In this instance, Hato Hone St John extended care paramedics
from Christchurch were contracted by Health New Zealand to
help staff the unit. Extended care paramedics are trained to
treat patients with non-urgent illnesses and injuries in
their home and can help primary health services to provide
after-hours care where there is a shortage of GPs and/or
nurses.

If TRK is closed, the community must rely on
the services of Hato Hone St John and PRIME (Primary
Response in Medical Emergency) personnel. In June 2024,
Health New Zealand West Coast revealed there had been no
PRIME service in Westport for a fortnight, as their
personnel had been called to staff the ASU. There is still
no PRIME service in Westport, except when the ASU is closed.
To travel to the closest emergency department at Te Nīkau
(Grey Hospital), requires a one-and-a-half-hour drive from
Westport or a three-hour commute from Buller’s most
northern community of Karamea. Being transported by
helicopter to either Christchurch or Nelson hospitals can
take up to approximately one hour but is weather dependent.
If Te Nīkau is short-staffed, staff from TRK are
transferred to Greymouth.

When TRK is short-staffed,
staff are sometimes transferred from the Ngakawau Health
Centre. This has contributed to the centre being shut for
19.5 days since TRK opened. Often closures at Ngakawau are
made on the day with no notice provided to patients who
travel to the clinic for their appointments. After the
centre had had intermittent closures totalling 13 days,
Health New Zealand West Coast general manager, Philip
Wheble, fronted a public meeting at Ngakawau in July 2023
and stated that the clinic was there to stay and should not
face anymore temporary closures.

Dr Marshall has
confirmed that staffing issues at Buller Hospital affect
patient safety. He said: “The two major things we talk
about are the two things that keep me restless first thing
in the morning – it’s the continuity of care at an
individual level and opening and shutting (the ASU). I know
they (local people) need consistency for both of
those.”

The staffing shortages have clearly caused
multiple problems and fall short of best hospital practice.
40% of consultations are conducted via telehealth. Two
registered nurses should be available for each shift, yet
between May and mid-July 2023, 43 shifts were staffed by a
nurse and a health care assistant. Upon its opening in May
2023 until August 2023, nurses worked 238 12-hour shifts to
cover staff shortages. For the first year of operation, 102
patients were transferred from TRK to Greymouth’s Te
Nīkau Hospital, more than the 72 patients who were
transferred from Buller Hospital for the previous
year.

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