Four-hour ED wait for self-harming man not on, says top Waikato doctor

Wednesday, 14 July 2021

A former director of Waikato Hospital’s emergency department says it's not acceptable a man who went to hospital following a mental health incident waited alone for four hours without seeing a doctor.

And his mother says she's “really disappointed” her son could not get timely help when he needed it most.

Hamilton man Liam Jacob Phillips, 24, was found dead at his home on August 9, 2016.

He had suffered a mental health incident days before, calling the crisis team and arriving at ED in an ambulance.

He was partially assessed by a triage nurse but had not been seen by a doctor, when, several hours later, he left the hospital of his own accord.

A three-day coronial inquest looking into Phillips’ death has concluded at the Hamilton District Court.

Phillips had been suffering chronic pain from a pulmonary embolism since 2014, had anxiety, and was dealing with an opiate addiction and self-harm.

On Tuesday, Waikato Hospital nurse Julie Parker told the inquest about the night Phillips went to ED in 2016 – saying there was no mental health nurse working there at the time, nor access to mental health notes.

Phillips had been referred to Waikato Hospital's mental health crisis team weeks before, but was discharged to the community for ongoing treatment.

But Parker said she would have still given Phillips a level 3 triage score, indicating lower risk, given he seemed rational, had family support and appeared capable of making his own decisions.

On Wednesday, Waikato DHB emergency doctor John Bonning said it was “not satisfactory” patients could wait up to 12 hours to be seen by a doctor.

Bonning was clinical director of ED in 2016, and he remains a consultant in the department.

Coroner Louella Dunn asked Bonning whether it was acceptable Phillips went to ED after contacting the mental health crisis team, and waited by himself without a doctor for four hours.

“No it is not,” Bonning replied.

He said systemic issues were occurring in emergency departments in New Zealand and Australia, meaning the long wait times happened on a daily basis.

“That is not satisfactory, it is not something we are proud of.

“When every physical space is full in the department you can’t put people in there, and it's getting worse.”

Mental health patients presenting at ED had doubled or tripled in past five years, he said.

Bonning said Phillips’ death was “an unspeakable tragedy”.

Changes had been made in the emergency department since 2016 when Phillips showed up.

ED staff can now access mental health notes, and there is a mental health nurse working night shifts, as well as Safety Watch staff who sit with mental health patients.

Follow-up calls to mental health patients after they left hospital, which Phillips received, were much more frequent now.

Bonning defended Parker’s assessment of Phillips as a level 3 triage, or lower risk, as valid.

He said being a triage nurse was one of the “most complex” roles in the hospital, requiring an extremely brief assessment to categorise risk in an environment of overwhelming demand.

If Phillips had been seen by a doctor they would have eventually completed both a medical and mental health assessment, Bonning said.

Phillips’ parents, Brett and Leeanne, spoke of their grief and confusion following his death.

“I’m really disappointed Liam was not able to get timely support in his time of need,” Leeanne said.

Father Brett said there were contradictions in what his son told mental health services – saying he had suicidal thoughts, then denying he was suicidal – which required more investigation.

As a kid, he was 'a joy to be around” and a caring friend, Leeanne said.

Phillips was a talented footballer who got a scholarship to the US for the sport, and played at high level until the age of 22.

But after nearly five years of waiting for a coronial inquest, the process did not help the family, Brett said.

“I grieve and I continue to grieve.

“I talk to Liam every morning, I say goodnight to him every night.

“He was my best friend.”

Coroner Dunn apologised for the Phillips’ long wait for an inquest, saying a decision was expected by late August.