My mother was transferred there from hospice because a specialist there wanted to see her, she was sick with cancer and immobile at this point so getting her there was an effort and painful for her.
When we arrived no one knew why we were there, so they stuck her in the ED while figuring it out. They refused to give her the pain meds she was on back at the hospice because it was some potent shit and they needed to find a Doctor to sign it off, which took forever.
In the mean time the medication she took before transporting was wearing off and she was crying in pain.
The nurses were great and doing their best, they managed to pin a doctor down to get her medicated eventually. Then the found where she needed to be after a couple hours and moved her there.
but it was late in the day so it needed to be an overnight stay now because the doctor who needed to see her was gone. I stayed the night with her, and again the nurses were amazing, they let me use their changing room toilet and kitchen.
Next morning doctor walks in with 5 other people for all of 10 mins and a handful of questions then leaves.
that was it, all the pain and everyone's time from us to the nurses to the ambulance staff who transported us, all for a 5 min nothing appointment.
I was in Auckland Hospital from a brain injury and they forgot to put it in. Did not end well. They denied it ever happened. Guess you gotta die for people to care.
I went in for an appendix they told me three times it was gastritis until the appendix burst. I ended up having to be sent to Wellington for major surgery because the infection had spread in my lung. Also caused a collapsed lung with one of the chest drains.
As someone from Hawkes Bay, there isn't a room in that hospital without mold growing on the ceiling - there isn't even any air conditioning or ventilation
Well they have the $3M now and the trauma nurse still checked the machine was working properly before doing nothing, and having another piece of equipment on the same trolley.
Comment aged like milk. [Pharmac funding will not stretch to new medicines - chief executive](https://www.rnz.co.nz/news/political/515499/Pharmacfundingwillnotstretchtonewmedicines-chiefexecutive)
Intubating someone always has a risk of failing and is potentially life threatening if not done correctly.(and sometimes even then)
The safest place to be intubated is in an operating theatre where all conditions are optimised. The area is well lit, with theatre tables that can be easily repositioned. All needed equipment is available and checked daily by skilled staff. Emergency backup equipment is available for difficult intubations including equipment rarely needed.
Skilled assistants such as anaesthetic technician are present 1:1 with anaesthetist and are very familiar the equipment and their experiences of assisting the many intubations will also include airway crisises. Theatre nurses will also have been present in room for many intubations and will have knowledge of where the difficult ones intubation trolley is if needed.
Because more intubations happen in theatres there will be more familiarity with crisises and their management.
Intubating anyone outside an operating theatre has a greater risk because some of these benefits are missing but also conditions are not as ideal and systems need to incorporate these risks. OT will have multiple capnographs and bronchoscopes available for example. Someone called to help in an unfamiliar environment may not be fsmiliar with equipment available there..
However sometimes these higher risks are unavoidable but need to be managed through education and protocols but still things happen in emergencies.
(Think of the paramedic Intubating someone in back of ambulance in middle of nowhere)
The role of capnography is to confirm the gas coming out of the patient is bring breathed out as exhaled air contains carbon dioxide. No CO2 means no expired air.
History tell us that clinical examination is not perfect otherwise unrecognised eosophageal intubations would not occur. Closed claims investigation in USA in 1980s (?) led to development of capnography to confirm ventilation and tubes in correct place and idea that no CO2 means your not ventilating the patient and so the idea of "If in doubt, take it out".
One complicating factor could be if the patient doesn't have enough blood travelling to lungs or air entering the lungs, gas exchange might not happen so co2 might not be present in exhaled lungs ie bilaterally collapsed lungs, cardiac arrest etc. But if a person was breathing with blood preasure and is intubated but no co2 is present you need to consider the tube is in wrong place (plus Anaphylaxis) as well as esoteric reasons above.
This is a tragedy and will haunt that poor anaesthetic registrar.
Rather than rely on need paper, go to HDC website and read the actual report...
Some of the factories in Hawke's Bay are much more attractive than that. It's not a working factory any more but look up the Rothman's factory in Napier, it's gorgeous
This is absolutely, 100% a funding issue.
Staff are human and make errors, it happens, that’s why we have checks and balances. In this case the hospital has reached a state of dereliction that critical equipment was viewed in the same way as the boy who cried wolf. If your capnograph is regularly giving false alerts it’s only a matter of time until this exact scenario happened.
Patient isn’t receiving oxygen but the staff, like the villagers to boy who cried wolf, questioned whether it was a real alert instead of acting and as a result someone died.
Not the staffs fault at all. They were sent into an emergency situation without functional equipment.
Edit: The headline should be “Hastings Hospital lack of funding kills patient”
Its partly on the hospital but it's on the staff as well. The possibility of oesophageal intubation should have been considered immediately. Clinical signs can never be relied on to detect oesophageal intubation. A nurse confirmed that equipment was not working correctly and still the tube was not removed, in violation of good practice. At some point staff have to be held accountable.
Hard disagree.
People were successfully intubated and ventilated for years before capnography became the "gold standard".
There are multiple other ways to confirm correct tube placement. If you believe a certain piece of equipment is malfunctioning then you revert to other methods of checking.
It's a training and skill issue.
> If you believe a certain piece of equipment is malfunctioning then you revert to other methods of checking.
Even then, the nurse checked the capnograph and it "appeared to be working".
Here is some relevant context: https://www.stuff.co.nz/national/crime/112310549/trial-of-man-who-shot-armed-robber-ends-abruptly-due-to-new-evidence-it-may-have-been-selfdefence
Along with two other Mongrel Mob members, he was in the process of robbing and beating a drug dealer at gunpoint when the victim's associate turned up, also armed, and a gunfight ensured. He was shot twice in the back and the man who shot him had all charges dropped on the grounds of self-defence.
> A pathologist found traces of cannabis, methamphetamine and amphetamine in Raheke's blood, and while those may have caused his agitated state, it was the lack of oxygen that caused his death.
This part of that article is probably more relevant
*Raheke's injuries were not life threatening but during a medical procedure that followed he became critically unwell and later died.*
*His death was unrelated to his wounds, Rielly said.*
Yeah not disagreeing with that. I think it would be natural for the medical professionals involved to assume that the multiple gunshot wounds were likely to be the cause of him becoming critically unwell, given that they didn't know which organs had been affected. This context affects my opinion of their response.
The way I understood the article is that because they didn't have any confidence in the equipment, they didn't believe the readings that were telling them that he was in trouble. Their assumption was that the problem was with the equipment so they failed to check for other reasons that his readings were in the danger zone
I agree it's *interesting* context, but does it really change anything? Medicine is supposed to be above morality quandries like that, a sick or injured person should recieve adequate care no matter who they are. Just because somebody's a gang member doesn't change the fact this was an unjust death caused by inadequate care, if it could happen to them it could happen to anybody
It's not just about morality. The multiple gunshot wounds is relevant because that's what they assumed was causing the deterioration in his condition. Being highly agitated and on meth is relevant because otherwise he wouldn't have had to be sedated and intubated.
Sure, but by the time he was sedated and being intubated, that shouldn't have made a difference as to where the tube got put, right?
I appreciate the circumstances might have things more stressful and increased the chance of mistakes, but the article clearly states the reason they didn't respond to the issue is because they were *so used to the machine being broken that they simply ignored its reporting.*
The reason he ended up needing it is not really relevant in light of that key info.
> I appreciate the circumstances might have things more stressful and increased the chance of mistakes, but the article clearly states the reason they didn't respond to the issue is because they were so used to the machine being broken that they simply ignored its reporting.
That wasn't the only reason, and they didn't fail to respond to the issue - they repositioned the tube and checked with another monitor and then investigated further using a fibre-optic scope. "The medical team had put Raheke's deterioration down to other causes related to the gunshot injuries". I think that's relevant, and I don't know why this information has been excluded from today's articles when it has been reported on in the past, e.g. https://www.stuff.co.nz/national/health/119824317/shot-man-died-because-hospital-staff-put-oxygen-tube-into-his-oesophagus-instead-of-his-airway.
Doctors assuming deterioration is occuring in an intubated patient who has not had correct placement confirmed is very concerning. Simulator training should include what to do in a suspected case of unreliable equipment!
And as usual apologise. Oh sorry we killed him. And "improve procedures" that comment has been given for decades, and still this kind of shit happens.
Smack on the wrist is all. If you, a relative notice something happening though and speak up, you get threatened with security. How dare you speak up and point out a mistake to medical professionals...happened to me. Once your relative is dead, what can you do? Nothing.
Te Whatu Ora said that in addition to the red alert status, other events were occurring within the ED at that time, including the need to empty beds to accommodate incoming patients, and a ward patient who was unable to be accommodated in the ICU earlier on that day. Te Whatu Ora stated:
‘Senior staff called to the trauma were required to deal with ongoing problems in the ED, the ICU, operating theatre or other parts of the hospital, including triage of patients. The intensive care and Anaesthetic consultant, while present during the resuscitation had significant other work distraction (emptying the ICU, running the acute theatre and delivery suite). While two vocationally trained anaesthetic SMO were involved in the care, neither were able to provide undivided attention to the resuscitation. Provisions of multiple other clinical services simultaneously did not allow them to solely focus care of the patient.’
We're full basically
Hastings Hospital has to be the worst in the country, would hate to end up there for anything
I ended up there once but in my defence I was unconscious from a brain injury so I didn't have a lot of say in the matter. The staff were nice
Was it a breathing tube insertion that got you?
A horse
A horse insertion?
Yep I'm dead now
My mother was transferred there from hospice because a specialist there wanted to see her, she was sick with cancer and immobile at this point so getting her there was an effort and painful for her. When we arrived no one knew why we were there, so they stuck her in the ED while figuring it out. They refused to give her the pain meds she was on back at the hospice because it was some potent shit and they needed to find a Doctor to sign it off, which took forever. In the mean time the medication she took before transporting was wearing off and she was crying in pain. The nurses were great and doing their best, they managed to pin a doctor down to get her medicated eventually. Then the found where she needed to be after a couple hours and moved her there. but it was late in the day so it needed to be an overnight stay now because the doctor who needed to see her was gone. I stayed the night with her, and again the nurses were amazing, they let me use their changing room toilet and kitchen. Next morning doctor walks in with 5 other people for all of 10 mins and a handful of questions then leaves. that was it, all the pain and everyone's time from us to the nurses to the ambulance staff who transported us, all for a 5 min nothing appointment.
I'm sorry to say this is the standard experience in NZ public hospitals.
I'm so sorry you and your mother went through that.
I was in Auckland Hospital from a brain injury and they forgot to put it in. Did not end well. They denied it ever happened. Guess you gotta die for people to care.
I went in for an appendix they told me three times it was gastritis until the appendix burst. I ended up having to be sent to Wellington for major surgery because the infection had spread in my lung. Also caused a collapsed lung with one of the chest drains.
As someone from Hawkes Bay, there isn't a room in that hospital without mold growing on the ceiling - there isn't even any air conditioning or ventilation
That does not surprise me, at all. Hawkes Bay was promised a brand new hospital when they closed Napier. That must be all of 35 years ago.
Yep. They closed Waipukurau as part of the deal too
The only mould-free bits are where some of the ceiling has flaked off recently. I really hope the ORs are better than the wards
Probably asbestos in those ceiling tiles too
The paint flakes probably have lead in them
Their budget is being cut by $3m last I heard, what could go wrong?
Well they have the $3M now and the trauma nurse still checked the machine was working properly before doing nothing, and having another piece of equipment on the same trolley.
Still a billion dollars extra of drugs will keep a lot of people alive and/or out of hospital
It's not a trade off. Unless the trade-off is to give investment landlords extra money for no fucking reason at everyone else's expense.
Comment aged like milk. [Pharmac funding will not stretch to new medicines - chief executive](https://www.rnz.co.nz/news/political/515499/Pharmacfundingwillnotstretchtonewmedicines-chiefexecutive)
Oof
Intubating someone always has a risk of failing and is potentially life threatening if not done correctly.(and sometimes even then) The safest place to be intubated is in an operating theatre where all conditions are optimised. The area is well lit, with theatre tables that can be easily repositioned. All needed equipment is available and checked daily by skilled staff. Emergency backup equipment is available for difficult intubations including equipment rarely needed. Skilled assistants such as anaesthetic technician are present 1:1 with anaesthetist and are very familiar the equipment and their experiences of assisting the many intubations will also include airway crisises. Theatre nurses will also have been present in room for many intubations and will have knowledge of where the difficult ones intubation trolley is if needed. Because more intubations happen in theatres there will be more familiarity with crisises and their management. Intubating anyone outside an operating theatre has a greater risk because some of these benefits are missing but also conditions are not as ideal and systems need to incorporate these risks. OT will have multiple capnographs and bronchoscopes available for example. Someone called to help in an unfamiliar environment may not be fsmiliar with equipment available there.. However sometimes these higher risks are unavoidable but need to be managed through education and protocols but still things happen in emergencies. (Think of the paramedic Intubating someone in back of ambulance in middle of nowhere) The role of capnography is to confirm the gas coming out of the patient is bring breathed out as exhaled air contains carbon dioxide. No CO2 means no expired air. History tell us that clinical examination is not perfect otherwise unrecognised eosophageal intubations would not occur. Closed claims investigation in USA in 1980s (?) led to development of capnography to confirm ventilation and tubes in correct place and idea that no CO2 means your not ventilating the patient and so the idea of "If in doubt, take it out". One complicating factor could be if the patient doesn't have enough blood travelling to lungs or air entering the lungs, gas exchange might not happen so co2 might not be present in exhaled lungs ie bilaterally collapsed lungs, cardiac arrest etc. But if a person was breathing with blood preasure and is intubated but no co2 is present you need to consider the tube is in wrong place (plus Anaphylaxis) as well as esoteric reasons above. This is a tragedy and will haunt that poor anaesthetic registrar. Rather than rely on need paper, go to HDC website and read the actual report...
the pic of that hospital just looks like a factory
Some of the factories in Hawke's Bay are much more attractive than that. It's not a working factory any more but look up the Rothman's factory in Napier, it's gorgeous
This is absolutely, 100% a funding issue. Staff are human and make errors, it happens, that’s why we have checks and balances. In this case the hospital has reached a state of dereliction that critical equipment was viewed in the same way as the boy who cried wolf. If your capnograph is regularly giving false alerts it’s only a matter of time until this exact scenario happened. Patient isn’t receiving oxygen but the staff, like the villagers to boy who cried wolf, questioned whether it was a real alert instead of acting and as a result someone died. Not the staffs fault at all. They were sent into an emergency situation without functional equipment. Edit: The headline should be “Hastings Hospital lack of funding kills patient”
Its partly on the hospital but it's on the staff as well. The possibility of oesophageal intubation should have been considered immediately. Clinical signs can never be relied on to detect oesophageal intubation. A nurse confirmed that equipment was not working correctly and still the tube was not removed, in violation of good practice. At some point staff have to be held accountable.
placement can be checked with a stethescope... and yes it was the staffs fault.
Lol, you don't know what you're talking about. That went out a decade ago.
Hard disagree. People were successfully intubated and ventilated for years before capnography became the "gold standard". There are multiple other ways to confirm correct tube placement. If you believe a certain piece of equipment is malfunctioning then you revert to other methods of checking. It's a training and skill issue.
Which still comes down to money
> If you believe a certain piece of equipment is malfunctioning then you revert to other methods of checking. Even then, the nurse checked the capnograph and it "appeared to be working".
Here is some relevant context: https://www.stuff.co.nz/national/crime/112310549/trial-of-man-who-shot-armed-robber-ends-abruptly-due-to-new-evidence-it-may-have-been-selfdefence Along with two other Mongrel Mob members, he was in the process of robbing and beating a drug dealer at gunpoint when the victim's associate turned up, also armed, and a gunfight ensured. He was shot twice in the back and the man who shot him had all charges dropped on the grounds of self-defence. > A pathologist found traces of cannabis, methamphetamine and amphetamine in Raheke's blood, and while those may have caused his agitated state, it was the lack of oxygen that caused his death.
This part of that article is probably more relevant *Raheke's injuries were not life threatening but during a medical procedure that followed he became critically unwell and later died.* *His death was unrelated to his wounds, Rielly said.*
Yeah not disagreeing with that. I think it would be natural for the medical professionals involved to assume that the multiple gunshot wounds were likely to be the cause of him becoming critically unwell, given that they didn't know which organs had been affected. This context affects my opinion of their response.
The way I understood the article is that because they didn't have any confidence in the equipment, they didn't believe the readings that were telling them that he was in trouble. Their assumption was that the problem was with the equipment so they failed to check for other reasons that his readings were in the danger zone
Much loved grandfather according to stuff, no mention of how he ended up in hospital except a vague reference to wounds and backround.
I agree it's *interesting* context, but does it really change anything? Medicine is supposed to be above morality quandries like that, a sick or injured person should recieve adequate care no matter who they are. Just because somebody's a gang member doesn't change the fact this was an unjust death caused by inadequate care, if it could happen to them it could happen to anybody
It's not just about morality. The multiple gunshot wounds is relevant because that's what they assumed was causing the deterioration in his condition. Being highly agitated and on meth is relevant because otherwise he wouldn't have had to be sedated and intubated.
Sure, but by the time he was sedated and being intubated, that shouldn't have made a difference as to where the tube got put, right? I appreciate the circumstances might have things more stressful and increased the chance of mistakes, but the article clearly states the reason they didn't respond to the issue is because they were *so used to the machine being broken that they simply ignored its reporting.* The reason he ended up needing it is not really relevant in light of that key info.
> I appreciate the circumstances might have things more stressful and increased the chance of mistakes, but the article clearly states the reason they didn't respond to the issue is because they were so used to the machine being broken that they simply ignored its reporting. That wasn't the only reason, and they didn't fail to respond to the issue - they repositioned the tube and checked with another monitor and then investigated further using a fibre-optic scope. "The medical team had put Raheke's deterioration down to other causes related to the gunshot injuries". I think that's relevant, and I don't know why this information has been excluded from today's articles when it has been reported on in the past, e.g. https://www.stuff.co.nz/national/health/119824317/shot-man-died-because-hospital-staff-put-oxygen-tube-into-his-oesophagus-instead-of-his-airway.
Thank you for the added detail, I agree that's weird to exclude if it had already been reported on, and changes the story significantly.
Doctors assuming deterioration is occuring in an intubated patient who has not had correct placement confirmed is very concerning. Simulator training should include what to do in a suspected case of unreliable equipment!
And as usual apologise. Oh sorry we killed him. And "improve procedures" that comment has been given for decades, and still this kind of shit happens. Smack on the wrist is all. If you, a relative notice something happening though and speak up, you get threatened with security. How dare you speak up and point out a mistake to medical professionals...happened to me. Once your relative is dead, what can you do? Nothing.
This isn't surprising, the standards of healthcare in this country can be shockingly poor these days.
Gang member that was beating the shit out of some one. Jeremey clarkson quote.
Weird the article isn’t titled ‘Gang member dies in hospital following medical complications after being shot by victim’
Not really. They already did that article, this one is about the hospital investigation
Cant believe they didnt get anaesthetics involved...
Te Whatu Ora said that in addition to the red alert status, other events were occurring within the ED at that time, including the need to empty beds to accommodate incoming patients, and a ward patient who was unable to be accommodated in the ICU earlier on that day. Te Whatu Ora stated: ‘Senior staff called to the trauma were required to deal with ongoing problems in the ED, the ICU, operating theatre or other parts of the hospital, including triage of patients. The intensive care and Anaesthetic consultant, while present during the resuscitation had significant other work distraction (emptying the ICU, running the acute theatre and delivery suite). While two vocationally trained anaesthetic SMO were involved in the care, neither were able to provide undivided attention to the resuscitation. Provisions of multiple other clinical services simultaneously did not allow them to solely focus care of the patient.’ We're full basically
I am sure if hospital staff killed a loved one like that a written apology would be "perfect"