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Falls, sports, and vehicle accidents are the leading causes of traumatic injuries among the 161 people covered by the New Zealand Spinal Cord Injury Registry’s first report, released yesterday by ACC Minister Iain Lees-Galloway.

You may remember the launch of the Registry in 2016, when it was jointly established by ACC, Canterbury District Health Board and Counties Manukau Health, in partnership with the Rick Hansen Institute (Canada).

This report is a significant step toward improving information sharing and the understanding of spinal cord injuries, and the common complications that occur following injury. 

Snapshots from the report:

  • New Zealand Europeans make up 47 per cent of all participants in the report, followed by Māori (21 per cent), and Samoans (six per cent);
  • Māori have a much higher incidence of traumatic injuries (28 per cent of all traumatic injuries) than non-traumatic (eight per cent);
  • Males account for 73 per cent of all spinal cord injuries, and are more likely to suffer a traumatic (78 per cent) than non-traumatic injury (64 per cent);
  • Women are more likely to have non-traumatic (36 per cent) than traumatic injuries (22 per cent);
  • The youngest participant in the report was 15 and the oldest was 88. The average age is 51.

Please take the time view the report and the infographic summary provided at https://nzspinaltrust.org.nz/current-nzscir-statistics-and-information/ 

Further information

Auckland Spinal Rehabilitation Unit (ASRU)

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The new chair of Counties Manukau Health, Vui Mark Gosche, yesterday toured Middlemore site buildings, including the Galbraith and Scott buildings and KidzFirst.

Next week (16 May) the Board will receive a report about the Galbraith building, including an expert, peer reviewed report about its earthquake status.

The Board will consider the options and costs of seismic strengthening. That advice includes considerations on the detailed engineering works that would be required and the impact on services.

It is likely that the DHB will be required to notify the public of the seismic status of Galbraith before options for strengthening are considered.

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How many buildings at Middlemore Hospital are affected by weather tightness and potentially, mould as a result?

CM Health has significant weather tightness issues in four buildings – Scott, Macindoe, Kidz First, Manukau Elective Surgical Centre.  Random testing of different parts of the buildings has revealed that cladding is likely to require repair and/or replacement.  The deterioration of cladding has led to leaking in some parts and as a consequence mould growing inside the building. 

There are other buildings that have cladding issues but they are not as serious as the four buildings above.

 

What buildings are affected?

The buildings that require immediate remedial work are Scott Building, Kidz First, Manukau Super Clinic, McIndoe Building (which includes the ambulance bay).

Scott is prioritised for works because it is the most high risk building of cladding falling off and risks to public safety.  It is also the ‘prototype’ for testing the works method and the largest building that requires remediation.

In short, we cannot confirm the cost of cladding the remaining buildings until we start work on the Scott building and get a better estimate of time, costs and risks – this is why there are no detailed proposals yet for Kidz First, Macindoe and Manukau Elective Surgical Centre.  We have, however, estimated the total cost of recladding to be more than $40m.

 

What about reports of sewage leaks at Middlemore Hospital?

Media have recently reported that Middlemore Hospital has ongoing issues with sewage leaking down walls. This is not correct.

The occasional plumbing leak is not uncommon in any building, particularly a hospital where we have a high density requirement for ensuite facilities. Some of these leaks are the result of materials being put down our waste system that shouldn’t be, leading to blockage.

We continue to monitor and repair all infrastructure, including sewage pipes.

In 2017 we had two serious incidents of sewage pipes needing repair work in the following two places:

  • Ward 1 on Ground Floor of Scott building in November 2017– a pipe junction cracked and required replacement;
  • Retail area October 2017 – this was due to pipe joinery requiring replacement.

These were immediately repaired and did not have a negative impact on staff or patients. We respond to these incidents as part of our normal maintenance response.  

It should be noted that both these leaks are related to the sewer stacks in the Scott building. Unlike our sewer stacks elsewhere in the hospital, the Scott building stacks are PVC and are more prone to breakage.

With the re-cladding of the Scott building, the replacement of the façade will enable these stacks to be inspected and replaced should that be necessary to ensure their future integrity. In the event that existing sewer leaks become evident, the hospital has risk mitigation plans to isolate and prevent any related health risk to patients, staff, contractors and the public.

It is important that any leakage is reported as quickly as possible to the Facilities team.

 

Is the mould a public health risk?

Currently, while interior walls and exterior cladding is intact, there is no risk of mould affecting patients, staff or the public. The safety of patients, staff and visitors is paramount and we have been assured by our infection specialists that the presence of fungal growth presents no safety risk while the walls remain intact. This is because the cavity between the internal and external walls provides sufficient protection.

When works start, however, we will have in place the necessary protections.  This will include regular monitoring and checking by Infection Control team.  They will sign off our progress for patient and staff safety every step of the way.

 

What about the cladding? Is it safe?

We have in place a programme to regularly monitor cladding on the high risk parts of buildings.  If additional fixtures are required to secure cladding, this work will be actioned as part of our normal maintenance programme.  Facades are regularly monitored and barriers installed if/as required.

A contract to re-clad the Scott building has recently been signed between Counties Manukau Health and Hawkins 2017 Ltd, a subsidiary of Downer.

The contract represents an important first step in fixing a number of Counties Manukau DHB facilities

The remediation work will be carried out whilst Middlemore Hospital remains operational. There will be an immediate start to a 25 week design and material importation period, followed by an 11 stage construction period of 644 working days. 

Construction work has been tailored to mitigate disruption and allow patient care to continue throughout with careful selection of tools for the work at hand alongside physical barriers to address noise transfer and keep out any debris.

 

Why did it take so long for CM Health to comment on the weather tightness issue?

On release of the OIA to the media, the questions around public safety were immediately addressed by CM Health.

We advised that the safety of our patients, staff and visitors is paramount and the presence of mould in our buildings is not a safety risk.

Due to on-going contractual obligations, we have not been able to discuss some of the issues regarding weather tightness.

We are hopeful that these issues will soon be resolved and remediation work will be able to be started.

 

What is CM Health doing to ensure the safety of patients, visitors and staff?

There is no risk until remediation work commences. Infection experts are checking off all construction plans and work processes at each step. There will always be an airtight seal between construction work and patient areas and no air intake in proximity to the work. We will also be erecting appropriate barriers to ensure that passers-by are not in the area.

We have rechecked panels on sections of buildings that were highest risk (Scott, McIndoe) to apply repairs.  Those repairs mean additional fixtures (screws) to secure the panels.  We will do this regularly while the works are being planned to those areas that are not yet scheduled for works.

With the recent signing of the contract between CM Health and Hawkins 2017, a subsidiary of Downer, remediation work will be carried out whilst Middlemore Hospital remains operational. There will be an immediate start to a 25 week design and material importation period, followed by an 11 stage construction period of 644 working days. 

Construction work has been tailored to mitigate disruption and allow patient care to continue throughout with careful selection of tools for the work at hand alongside physical barriers to address noise transfer and keep out any debris.

Hawkins is using innovative design solutions such as a 'breathable building wrap' to ensure that the increased water tightness of the building does not lead to internal condensation issues later. A High Pressure Laminate product from Austria has been selected for both durability and fire safety integrity.

When works start, we will have in place all the necessary protections. The designed methodology will be carefully adhered to throughout. This will include regular monitoring and checking by Infection Control teams. They will sign off our progress for patient and staff safety every step of the way.

CM health will also be erecting appropriate barriers to ensure that passers-by are not in the area, and will continue to recheck panels on sections of other buildings that may be high risk (for example the KidzFirst and McIndoe buildings) to apply repairs.

 

What about asbestos. What air monitoring is CM Health undertaking?

There are 2 types of air monitoring for asbestos currently undertaken at CM Health:

  • Air monitoring as part of remediation work (in accordance with the current code of practice and regulation)
  • Background/reassurance monitoring where a potential risk has been identified and/or monitoring has been recommended

The air monitoring for remediation work has been carried out in the Galbraith building, including basement plant rooms, the sub-basement and PABX room, and the plant room in Esme Green.

As further remediation projects are approved we will continue to carry out appropriate monitoring.

Background monitoring has, and continues to be, undertaken in the Galbraith building only.

Areas that have undergone initial assessment are in the basement (corridor, Phlebotomy, PABX, plant rooms 4 and 6, and Clinical Records), the operating rooms, and laboratory.

Repeat monitoring is being carried out

  • Corridor Basement - twice weekly since Sept 2017
  • Operating Rooms – x1 per 2 months since August 2017
  • Plant Room 6, post remediation scheduled 1x per 3

None of the locations being monitored to date have exceeded the minimum level 0.01 fibres/ml (trace level).

 

What precautions will be implemented when remediation works are undertaken?

When works commence and walls are demolished, testing will commence.  Testing to date has been primarily to inform how we may undertake the construction works.  The building of barriers will happen when the works are about to commence and before barriers are breached.  This may include blocking off spaces to staff, patients and the public.

 

How long have you known about the issues with these buildings?  Why have you kept this quiet?

The systematic failure of the compressed sheet cladding system utilised on these buildings progressively became well known throughout New Zealand over many years, however it wasn’t until the failure of the cladding on the Scott building in 2012 that the extent of the problem at Middlemore Hospital was realised.

 In 2012, in fine conditions, a cladding panel fell from the Scott Building near the entry to the Day Dialysis unit. CM Health took immediate action to protect the public and to secure the panels at greatest risk. This lead to subsequent investigations that identified the panel system had failed by systemic failure compounded by poor workmanship issues.  Following investigations on Scott, CM Health further investigated the effects on buildings that were built around the same time and using the same materials as the Scott building.

The problem buildings are those that were built around the year 2000.  Building codes of the day allowed non-treated timber and the use of direct fixed painted compressed sheet cladding reliant on back seals.  Over time, the consequence of non-treated timber and the cladding itself deteriorating has resulted in water damage.

Recladding issues with four buildings have been on CMDHB’s work programme.  This means we have been gathering technical expert advice (including the Alexander and Co report) to assess the extent of damage by testing random sites.  This work has also involved piloting how a remediation works might happen in a live operating hospital.  We have also been consulting with senior clinicians and managers through our normal decision making bodies (e.g. Hospital Management Team) to scope the approach to replace cladding.

We have also been preparing business cases and proposals for the Board endorsement for the full remediation.  The cost of all the buildings are not yet formal proposals because we are still working out cost estimates.  We believe we need to start with Scott building first to test how the works method may work, how complex (or simple) the works might be and build up a more accurate estimate of costs to remediate the following buildings.

We have not kept these issues quiet although we have been limited in what we can say publicly because we are still in negotiation with a contractor to undertake the works.  We are pleased to confirm that the Minister of Health and Minister of Finance both agreed additional funding so that we can start work on the Scott building last week.

 

What recourse have you had with the builders?

CM Health took legal action against the design build contractors and eventually accepted a cash settlement in 2017.  A contract to remedy those defects and install a compliant cladding system is currently being negotiated and close to signing.

The confidential settlement with Hawkins was arbitrated by the building disputes tribunal and only covered the Scott building as we had no legal recourse on the other buildings. This is because by the time the issues with the other three buildings (which are older than the Scott building) came to light, it was outside the 10 year limitation period in which claims could be made against the builder.  Please note that with any kind of construction dispute a building owner only has 10 years to bring a claim from the date of the building work.

Comment has been made that the settlement was low compared to cost of remediation.  The settlement took into account that the new cladding would improve the building, extending its life and adding value.

 

How long is this going to take?

The current estimates suggest that it will take about 5 years to complete recladding works assuming we start this year.  This is because we will be undertaking the work while the hospital remains operational.  We have preferred this approach because we cannot close beds given our acute demand pressures – particularly over winter.  We will also start with the Scott building, learn from the first few months of experience and then be able to plan the remaining buildings based on those learnings

 

There has been comment in the media about power supply. Is the electrical power supply to CMDHB Facilities reliable?

CM Health considers the electrical power supply to CMDHB facilities, including Middlemore Hospital and the Manukau Superclinic to be reliable.

There have been three power supply incidents mistakenly represented as one in media reports.

Power outage 9 October 2017

The Middlemore high voltage supply cables tripped on high current at 1.18 pm on Monday 9 October 2017. All generators in the affected area, apart from two, operated as expected. The two generators covering KidzFirst and the McIndoe building started but due to various control issues, did not connect for nine minutes.  

Critical functions are not affected by these types of issues and saw no loss of power supply because they continually run on batteries via Uninterruptible Power Supplies (UPS). The batteries are constantly being recharged via the Essential Power supply/generators.  During those nine minutes patients and staff saw a loss of power and the activation of emergency lighting.

The Middlemore high voltage circuit breakers have since been reviewed and adjusted and consultants will undertake an asset remediation review.

Power outage 11 March 2018

Transpower had a transformer issue that affected a significant part of Mangere including Middlemore Hospital from approximately 4.15pm to 5.30pm.

During this time the six generators supplied power to the Essential Power, after the standard 20 seconds it takes for them to connect to the power supply. Critical functions are not affected by these sorts of outages because they run on batteries via Uninterruptable Power Supplies (UPS).

Patients and staff experienced a 20 second loss of essential power before the generators took over. Non essential power was affected from 4.15pm to 5.30pm.

Non Essential power issue at Counties Manukau SuperClinic 3 April -28 May 2017

Vector owns and operates the 2 high voltage power cables which supply the Manukau Health Park (of which the Superclinic is a part).  One HV cable supplies the Essential Power system (which is backed up by a CMDHB generator), the other HV cable supplies power to the Non Essential power system.

We have experienced one significant fault.

At approx. 5.45 pm 3 April 2017 the Vector Non Essential high voltage power supply cable faulted. This resulted in the Manukau Health Park having HV mains power for the Essential Power system and no power for the Non Essential Power system. This is a normal system design. 

The CMDHB emergency generator, which is reserved for the use on the Essential Power system, was not subject to a power failure and as a result was not required to start, as per normal system design.

CMDHB engineering staff attended the outage in conjunction with Vector staff.  Initial investigations were undertaken to determine the fault was on the high voltage supply side.

At approximately 7.30pm CMDHB engineering staff manually started the CMDHB emergency generator and manually operated switches to allow the emergency generator to supply the Non Essential power. 

This design feature allowed CMDHB the flexibility to use the emergency generator for the Non Essential supply, and provided resilience to the overall system.

Vector undertook emergency investigations to locate the fault, which was underneath the building.  Vector determined the fault to be unrepairable.  Vector supplied and connected a large temporary generator over the night of 3 April. This meant the HV mains were supplying Essential Power and the Vector generator was supplying Non Essential power.

When the Vector generator was on-line, the CMDHB generator was stopped and again switched to provide back-up to the Essential Power supply.

The period that Vector provided a generator to cover the Non Essential power system was from 3 April to 28 May. No surgeries were cancelled or postponed as a result. There was a half hour delay to the beginning of the day on 4 April.

Vector has subsequently replaced the 2 original HV cables with 2 larger capacity cables which will also cater for future electrical load at Manukau Health Park.

CMDHB has ongoing projects to further increase resilience of the power system. This is referred to in the Indicative Facilities Capital Requirements table under the Remediation Programme heading. There is a line which refers to Manukau Power Resilience Upgrade. The figures are 17/18 $1 million; 18/19 – 21/22 $2 million; Total $3 million.

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The Auckland region is experiencing an outbreak in mumps. Mumps is a serious and highly infectious viral disease. It can spread from an infected person by saliva or mucous droplets when coughing, sneezing, or talking. Early symptoms of mumps include fever, headache, muscle aches, tiredness, and loss of appetite.

Please be extra vigilant whaanau. The best way to protect against mumps is to be vaccinated with two doses of the measles mumps-rubella (MMR) vaccine. Please contact your doctor if you're unsure if you've been vaccinated or your experiencing any of the symptom.

Visit the ARPHS website for more information

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Media statement

26 June 2017

Middlemore Hospital experiencing long wait times for minor illness and injuries due to winter spike
Middlemore Hospital is experiencing a significant spike in the number of people coming to its Emergency Department as it sees the impact of winter hitting early.

“This week we are seeing record numbers of patients coming in to our Emergency Department, many with underlying medical conditions including respiratory related illnesses which we often see in winter” said Dr Vanessa Thornton, acting Chief Medical Officer for Counties Manukau Health.

In the last week, the Emergency Department at Middlemore Hospital is frequently seeing well over 350 patients per day and on Sunday we experienced record levels of patients with 366 patients in a 24 hour period. Total hospital occupancy is 105% with particular pressure on medical wards. Middlemore Hospital has one of the busiest emergency departments in Australasia.

“We are mainly seeing growth in the number of patients with medical issues; however the number of children coming into our emergency department is also very high. Alcohol related injuries are also a growing trend, particularly as Auckland has been host to a number of high profile events,” added Dr Thornton.

The DHB has taken steps to anticipate this increase in demand including providing extra staff and additional beds in wards; however these steps could not anticipate the sudden spike in demand. Contingency arrangements are in place to manage the demand for care across the hospital’s services.

“This is the highest and fastest rate of increase in demand for our services we have ever experienced,” added Dr Thornton.

“Our target is to see people within 6 hours of arrival, and we prioritise which patients are seen first based on the seriousness of their conditions. However, at the moment people are experiencing long wait times if their illness or injury is not serious.”

People are being encouraged to see their family doctor in the first instance when they’re sick. Accident and Medical Clinics are open across Auckland for non-life threatening urgent care needs.
If people are unsure on where to go, they are encouraged to ring Healthline for free on 0800 611 116 to talk to a registered nurse for advice. Healthline also have translators available if they are needed.

“We are asking every to help keep our emergency department free for people with life threatening illnesses. Anyone who is experiencing chest pain, head injuries, severe blood lose, a major accident should still come into the hospital Emergency Department.

For further information please contact the Counties Manukau Health media line on 09 250 9857

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For full information and to read the report, please click here

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Stuff.co.nz | It's been 70 years since a young Esme Green decided she wanted to be a nurse.

The year was 1947 and the 20-year-old dressmaker was living in Otahuhu when a new south Auckland hospital opened its doors on May 3.

She told her parents her plan and within a few months she had become Middlemore Hospital's first trainee nurse, doing "all the work no-one else wanted to do".

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A tragic death occurred overnight on the grounds of Middlemore Hospital. Police are involved in an investigation.

Dr Gloria Johnson, acting Chief Executive, confirmed that the death occurred late in the evening on Wednesday 3 May 2017 and appears to have involved a fall.

“Our thoughts are with the employee’s family and work colleagues. We have offered support to the family and are providing support to our staff. We will not be naming the staff member in order to offer his family some privacy in their grief”, says Dr Johnson.

Dr Johnson did confirm that the individual was a highly valued and long serving staff member.

Counties Manukau Health has begun the process of involving Worksafe.

No further comment will be offered at this stage.

Ends

For further information, please the media line on (09) 250 9857

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As we celebrate Middlemore’s 70th Birthday, who better to take us down memory lane than Esme Green (nee Montgomery) the first trainee nurse to work at Middlemore Hospital.

I lived and grew up in Mangere Road, Otahuhu, just along from the hospital. At the time of the opening, I had been working for five years as a young dressmaker. On 3 May 1947, I went along to the opening ceremonies, listened to the speeches and accompanied the tour of the hospital.

This experience confirmed my wish to become a nurse in the new hospital and a few days later I had an interview with Miss Hollan, the Matron. Within a fortnight I was on the staff as a ‘pinkie’.  In July I went to the Preliminary School in Market Road to return as the hospital's first trainee. I loved the lectures and the work and knew I had made the right choice.

There were four wards open at that time. Our duties were from 7am to 4pm, six days a week, and we were paid 33 shillings a fortnight ($3.30), no penal rates. Besides nursing the patients, we cleaned the ward, even the sluice room. After we had made the morning tea for the ward sister and the doctors we had our own refreshment in the ward.

After a bare three months training and just out of Preliminary School, I was placed on night duty in charge of Ward 1 – medical. The registered nurse took me around the patients saying. “This one could go tonight. He’s still bleeding so watch his pulse, but there’s nothing much you can do” and so on. I took fright and said to myself, “I’m not staying here” and rushed along to the adjacent ward to inform the registered nurse on duty there. Somewhat heartened by a mixture of reassurance, sympathy and an offer of help, I returned to my charges. To get through our work by 7am we had to start sponging the patients at 2am. To shave the patients we had to use cut throat razors and I don’t know who – patient or nurse was the most fearful. We both held our breaths until I was finished.

Nursing the young returned servicemen in Wards 2 and 3 was harrowing at times. We met some fine men. Their wheelchairs were dilapidated with one or both wheels off. I remember many of the nurses offering to push them along to the films in Otahuhu, along 1.5 miles but well worth the effort from their obvious enjoyment of the outing.

Transport was difficult and infrequent and many of us had bicycles to get to Otahuhu, Hall’s Corner and Papatoetoe for shopping and to dances in Mangere and as far away as Howick. At these many nurses met their husbands. We had to be back in the nurses home by 11pm and this was strictly re-enforced.

In all, I worked for 14 years at Middlemore. As with many of us, I took 23 years off to rear our children. Though I became a ward sister, those first years remain the most vivid memories. Some people have said they would find the life of a nurse monotonous, doing the same things, day after day – never for me! I have seen and shared with people under many circumstances – tragic, sad, joyful, romantic and there have been many humorous occasions. A nurse’s life is one of continued astonishment and never monotonous.

Celebrating 70 years of Middlemore: Esme Green - YouTube
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Brace yourself folks – the flu season has arrived, which can bring the dreaded running nose, scratchy throat, cough, body aches, a high fever and thumping headache of the seasonal flu.  The good news is you can easily help protect yourself and your loved ones by getting the flu vaccine.

Talking from personal experience you don’t want to get the flu? You feel absolutely dreadful, everything hurts and you find it hard to get out of bed.

So why would you put yourself or your family through this, when a vaccine is available? Getting a flu vaccine only takes a couple of minutes out of your day. Getting the flu however, can mean time off work, not to mention missed events and opportunities.

As you know I’m passionate about patient safety. As health professionals, we have a responsibility to provide a safe environment for the people who come under our care. When you get a flu vaccine, you are not only protecting yourself from the flu, but you are also protecting the people around you who are more vulnerable to serious flu illness. This includes older people, young children, pregnant women, and people with certain medical conditions who are at a higher risk of developing serious complications from the flu, such as pneumonia.

While staff vaccination numbers have increased over the past year, there are still some people who are more resistant to having the vaccine than others. To those people, I ask you to think about your responsibility to your patients.   If you were a patient would you want to be treated by someone who has the potential to pass on the flu or would you want to be treated by someone who is doing all they can to keep you and themselves safe? In other words, having the flu vaccine is part of the ‘granny test’.

I’ve had two types of flu. I’ve had man flu and the proper flu and boy do I know the difference. That’s why every year I get a flu shot to protect myself and those around me.   As for the myths out there, there are plenty. Be assured the flu vaccine won’t give you the flu, it doesn’t hurt (only a tiny sting) and it won’t make your arm drop off.  For more flu myth-busting facts click here

If you have time, check out community clinic nurse Sam Phohe’s personal flu survival story. It was her job to promote the flu vaccine to her patient’s but as she lay in a coma it became clear she forgot to get one herself.

[youtube https://www.youtube.com/watch?v=Vct-M9fz9ME&w=560&h=315]

I’ve had my flu shot, have you?

Geraint

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