A man who walked into Wellington Regional Hospital with chest pain spreading into his left shoulder waited five hours before anyone ran the test that showed he was having a heart attack, and the Health and Disability Commissioner has now found the care he received fell short of the standard he was entitled to.
The decision, reported on Monday, concerns a 55-year-old man who arrived at the emergency department just after midnight in August 2023. He told staff the pain had been going for about three hours and had not shifted after he took an antacid. A nurse assessed him within 15 minutes and recorded pain at 7 out of 10, raised blood pressure, and a family history of heart attacks.
That assessment produced a triage score of 3, which under the scale used in New Zealand emergency departments means a patient should be seen by a doctor within 30 minutes. He was not seen for four and a half hours. Just after 5am an electrocardiogram confirmed he was having a heart attack. He was sent urgently to the cardiac team, who fitted a stent to open one of his arteries.
Commissioner Morag McDowell found the score should have been a 2, which carries a 10 minute target, and that an electrocardiogram should have been done at the first assessment. According to the Otago Daily Times, she said the man’s symptoms, age, gender, MΔori ethnicity and family history should have raised “immediate suspicion” of a cardiac problem, and that the wrong triage score meant he was seen well outside an acceptable timeframe. Health New Zealand was found to have breached the Code of Health and Disability Services Consumers’ Rights by failing to treat him with reasonable care and skill.
What makes the decision more than a single bad night is the picture it paints of the department around him. RNZ reported that the emergency department was running at 200 percent occupancy on that shift and was 10 nurses short of the roster it needed. Twice as many patients as the department was built to hold, and a nursing team missing a large slice of itself, is the setting in which one triage decision went wrong.
McDowell recommended that Health New Zealand Capital, Coast and Hutt Valley audit the triage scores given to its last 30 cardiac patients to check whether they were graded correctly. She also asked for updates on the hospital’s critical capacity plan, on staffing levels in the emergency department, and on how well its waiting room nurses are working. Health New Zealand has apologised to the man and says it has put extra training in place for emergency nurses on recognising cardiac events, along with a hospital wide plan for responding when the department reaches critical capacity.
The nurses who work in that department say the pressure that shaped the 2023 shift has not eased. In a statement issued on Monday evening, New Zealand Nurses Organisation College for Emergency Nurses co-chair Natasha Hemopo said the numbers have gone the wrong way. “Occupancy has not improved; it has increased to 240%,” she said. “Critical care and significant care deficit hours at Wellington ED are now at 72%, meaning the vast majority of patients are not receiving the interventions or monitoring they need.”
Hemopo said the staffing gap identified for the department has closed only slowly. The shortfall was measured at 63.7 full time equivalent positions, fell to 62 in 2024, to 56 in May 2025 and stood at 41 full time equivalents in May 2026. “A 20 percent vacancy rate in ED is not sustainable and is not good for patient outcomes,” she said. “More staff must be hired for the department.” In the same statement she welcomed the Commissioner’s continued oversight and the enrolment of nurses in the national emergency nursing triage course.
Triage is the point where an emergency department decides who cannot wait. A nurse spends a few minutes with each arriving patient and assigns a category that sets how long it is safe for that person to sit in the waiting room. Chest pain is one of the hardest calls in the job, because most people who present with it are not having a heart attack, and the ones who are do not always look unwell. Every hour of delay in opening a blocked artery costs heart muscle that does not grow back, which is why the difference between a 10 minute target and a 30 minute target matters, and why a four and a half hour wait matters far more.
Nationally, emergency departments are still well short of where the government wants them. The most recent published quarterly result, covering January to March this year, had 74.4 percent of patients admitted, discharged or transferred from an emergency department within six hours, up from 74.2 percent in the same quarter a year earlier, according to the Government’s own release. The target is 95 percent by 2030. On current movement, that is a long climb.
The man at the centre of the case survived and was treated once the problem was found. The Commissioner’s decision does not suggest anyone set out to do him harm. It describes a nurse making a judgement call at midnight in a department holding twice as many people as it was designed for, without the colleagues the roster said should have been there. That is the part of the finding worth sitting with, because a training module for triage nurses answers the first half of the problem and not the second. The Health and Disability Commissioner has asked for updates on staffing as well as on training, which suggests the office knows it too.
Have you waited longer than you should have in a New Zealand emergency department, or do you work in one? Tell us what you have seen in the comments below.
This article was written by AI, briefed to report the facts, hopefully without some of the bias people bring to the job π
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