Family say Tony Knott’s death in Middlemore Hospital’s emergency department waiting room was preventable

• Tony Knott, 82, died in a toilet cubicle in Middlemore Hospital’s overcrowded emergency department after waiting for treatment.
• His family believes his death was preventable and is calling for urgent reforms to the health system
• Coroner Amelia Steele identified multiple delays in his care as relevant factors in his death.

The family of a man who died while waiting for assessment in Middlemore Hospital’s “severely overcrowded” emergency department believe his death was preventable, saying he was “caused by cracks in a broken system”. came out”.

The Herald can exclusively reveal details of the case, in which 82-year-old Tony Knott collapsed and died in a waiting room toilet on 22 April 2021 after he waited to be assessed for a leg injury.

Nat’s wife Lynn was with her husband on the day.

“It was the worst day of my life. It was a horrible situation,” she told the Herald.

A coroner’s report into his death was only finalized in February of this year and paints a grim picture of sleeplessness and delay while he awaited an ambulance and assessment and treatment.

Coroner Amelia Steele said Nutt’s cause of death was high blood pressure. However, she determined that many of the delays he faced were “related to the circumstances” of his death.

Knott’s family is speaking publicly for the first time, not blaming any individual but calling on the government to prioritize addressing the “huge gaps” in New Zealand’s health system.

Knott’s daughter Rachel Cassidy told the Herald: “Dad is showing cracks in a broken system.

“He was not one to be ready to die or wait for death. Two days before he was playing croquet, the next day he would go fishing with his nephews.

“I believe 100 percent that his death that day was preventable,” she told the Herald.

‘Code Red’ and a 4.5 hour wait for hospital transport

According to the coroner’s report, Tony Knott arrived at North Shore Hospital’s emergency department at 11:30 a.m. on April 22, 2021, after suffering a leg injury at home.

Specialists there decided that a large hematoma in his leg required plastic surgery at Middlemore Hospital. Referral for treatment was accepted and transport by ambulance was requested at 2.30pm.

However, the coroner said it was four and a half hours before an ambulance arrived.

Cassidy said the wait time was “not remotely” acceptable.

“That’s a big part of why dad ended up in the condition he did. Because of that delay for an ambulance, he wasn’t really under hospital care.”

According to the coroner’s report, when Knott arrived at Middlemore Hospital, it was just before 8pm – the hospital’s emergency department waiting room was “overcrowded” and in an evacuation procedure known as “Code Red”. becomes

The report said that a total of 51 patients came in two hours from 7 pm to 9 pm.

Lynn, who was with her husband in the ED, said the situation looked “impossibly chaotic.”

He was in the middle of a lot of people. There was no sign that anyone acknowledged his presence, especially above anyone else, which I think we just acknowledged.”

The ambulance officer who transported Nat got a wheelchair and a pillow for him to prop up his injured leg.

Lane said the ambulance driver tried to raise concerns in the ED.

“He went to reception and said, ‘I’m really worried about my patient.’

Knott was identified as needing a bed, but a bed was not available due to overcrowding, according to a doctor who gave evidence to the coroner.

The 82-year-old and his wife continued to wait.

‘Terrible situation’: The moment Tony Knott collapsed

When Knott arrived at Middlemore’s emergency department, his vital signs had not been checked. Nor were they arrested as he sat upright in an overcrowded waiting room.

Cassidy said there were “huge gaps” in her father’s care.

“I don’t think anyone even looked at him, let alone took him [his] Blood pressure or oxygen saturation or pulse rate [reading] or something like that.

“And by then, Dad looked very sick. According to my brother, he was as white as a sheet.”

Around 9pm that evening, Nat told his wife he needed to use the bathroom.

As he stood from his wheelchair in the waiting room bathroom, Nott collapsed and told his wife, “I feel depressed”.

Lynn said she did all she could to support her husband as he fell to his knees.

“I was supporting his body, and went to the bathroom door and asked another patient. [if they would] Help me with something,” she said.

“It was very difficult and a very sad, scary place, and in a terrible state.”

Attempts by hospital staff to revive Nat were unsuccessful.

The Herald asked Health New Zealand – Te Watu Ora about the delay Nat ended up in as a result of his death, but they have yet to respond.

Commenting in general, County Manukau group operations director Dr Vanessa Thornton told the Herald that overcrowding remained a problem.

She said there had been “higher than expected demand” at Middlemore ED recently.

“People are coming [the] The ED is assessed on arrival and prioritized based on their clinical risk and urgency rather than order of presentation,” she said.

She said there are policies in place to reduce stress in the ED, including discharging patients early and increasing the number of staff if they are available to work.

Thornton said the team works closely with Hato Hoon St. John to make sure patients’ needs are met.

Health ‘must be a priority’

Lynn’s faith in New Zealand’s health system has been “completely shattered” and he believes hospital overcrowding and pressure on health workers are far better today than in 2021.

“I think it could be worse. I think this whole system needs a major overhaul,” she said.

She acknowledged that much good had been done but felt that serious shortcomings remained that “need to be addressed”.

Cassidy agreed.

“You know if you call an ambulance, it’s going to be on time. If you get to the ED, you’re in the safest place possible.

“It felt like a safety net. There are a lot of people who get exactly what they need but there are people who don’t, and that’s not fair to anybody.”

She had a message for the government.

“Put health first. Put Kiwis first, because we’re not numbers. We’re individuals and we’re family.”

She believed that health care failures like those her father faced were not isolated.

“This is happening to a whole lot more families, and the preventable deaths in the health system are just heartbreaking.”

Cassidy, who has been a nurse for 30 years, said she wished she had been in the ED with her father that day to push for better care.

“I will forever regret not being there to advocate for him that day.”

Cassidy said now the family has the coroner’s report, they will likely make a formal complaint with the Health and Disability Commission.

Coroner’s report

Tony Knott had atrial fibrillation, type 2 diabetes, high blood pressure and osteoarthritis, but his GP told the coroner he was in good health and managed his conditions with medication.

A forensic pathologist said Nutt’s leg injury would worsen his already vulnerable condition.

“The hematoma would have reduced the overall blood volume of the heart, which may have contributed to the death of those with underlying heart disease.”

Another doctor told the coroner that blood loss, dehydration and sitting upright in the waiting room at Middlemore also contributed to the reduced circulation.

She said the delay in ambulance transport was a “systemic factor” in Knott’s death, because when he arrived at Middlemore’s ED that evening, it was heavily congested.

Lynn is sure that her husband would be alive today if he had taken care in time.

“It was the stress of all those hours of neglect that led to this,” she told the Herald.

Steele said many of the delays are related to what happened.

She said: “The delay in the arrival of St John Ambulance at North Shore Hospital and the delay in Mr Knott receiving assessment and treatment at Middlemore Hospital are relevant to the circumstances of Mr Knott’s death.”

Lynn remembers her husband as a family man who was always quick to make friends with everyone he met.

“He was a warm and loving man. We all miss him dearly.”

– This story was originally published by New Zealand Herald.