Wakari Hospital ward closed after Ombudsman 'disturbed' by findings

Health New Zealand has closed Wakari Hospital's ward 10A after an inspection by Chief Ombudsman John Allen revealed "compelling evidence" of "punitive and coercive treatment" of people in the ward.

The ward, in the northwest of Dunedin, is a 12-bed inpatient forensic unit for adults with intellectual disabilities or mental illness, who are displaying behaviour which cannot be safely managed in the community.

Allen said inspectors visited the ward in March this year, and he was left "disturbed" by what they had found – and highlighted an urgent need for agencies to show greater commitment to the safety and dignity of "the most vulnerable people in their care".

He added inspectors found "some of the worst practices we have observed anywhere" at the ward.

"In one instance, a person was being tied down on a bariatric or ‘EVAC’ mat to move them around the ward. This was causing physical and mental harm to the person who suffered carpet burns as a result."

Allen called on Health New Zealand and the Ministry of Health to act immediately.

In response to the inspection, Health New Zealand said its board decided to close the ward on Wednesday.

Work had now begun to close the ward, which would be completed when patients have been "safely relocated to facilities that are better suited to their needs".

The Ministry of Health also confirmed the district inspector and the ministry itself were considering legal options for further investigation to ensure the concerns would be fully examined.

During the inspection, it was also found one person had been “secluded for around 18 months” with “an almost complete lack of meaningful human contact and no access to the outdoors”.

Allen said other instances of ill-treatment included restrictions on dental care, and people being denied access to their own money.

“Staff were observed incentivising 'good' behaviour by rewarding people with access to basic necessities including the use of a toilet or dental treatment.

"Inspectors also noted that treatment of people may have extended to the unlawful administration of medication.

"These are allegations of serious and significant failures that amount to potential human rights abuses. This punitive and coercive approach to the care of people in Ward 10A is unacceptable.”

He added there had been “next to no improvement to the physical structure” of the ward despite the ongoing concerns.

“Infrastructure, facilities and the physical environment must be fit-for-purpose. This is critical to the health, safety and well-being of people in the ward and for staff. This applies not just to ward 10A but across the system.”

The inspection was carried out between March 17 and March 20 under the Crime of Torture Act 1989 and concerns were raised with the Ministry of Health and Health NZ in April. Following that, both agencies were given time to respond to the findings and had done so.

“We chose to raise our concerns directly with the Ministry of Health and Health NZ," the Ombudsman said. "They have both acknowledged our concerns and the importance of ensuring that all people in Ward 10A are treated properly.”

Allen said the Ministry of Health had accepted his recommendation to undertake an independent investigation into the treatment and conditions of the people at the ward, and closed it to new admissions.

“It is very important now that they make sure the same number of beds are available across the structure to avoid putting more pressure on the system.”

He added Health New Zealand had “taken the matter very seriously”.

“I will be closely monitoring the progress and actions taken by both Health New Zealand and the Ministry of Health.

"The issues at Ward 10A are a stark reminder that much more needs to be done to make sure the very vulnerable in our community, like people with intellectual disabilities, are kept safe and treated with dignity and respect.

“This requires a sustained approach and acknowledgment that a one-size-fits all approach will not work.”

Allen said New Zealand has an obligation under international and domestic law to ensure people are not subjected to ill-treatment, along with a positive duty to investigate where there are reasonable grounds to believe that ill-treatment has occurred.”

The inspection at ward 10A were an example of the critical function performed by his office, he said.

“While we don’t want to find and uncover situations like this, when we do, this is how we respond. I am very grateful for the work of our inspectors.”

In response to the Ombudsman's inspection, Health New Zealand director of mental health and addictions Phil Grady confirmed the closure of the ward.

"We take patient safety and care very seriously and want to acknowledge the patients, their families, and our staff, all of whom we are supporting during this period of change. Our focus remains on ensuring the safety, dignity, and rights of the current patients, while strengthening oversight and reviewing practices," Grady said.

"While we acknowledge many of the concerns outlined by the Ombudsman, some of these matters involve complex clinical circumstances that remain subject to further review. It is important these processes are completed so that all available evidence and clinical context can be fully considered.

"The decision to close the ward and relocate patients reflects longstanding concerns about the physical environment of Ward 10A and its suitability for supporting a therapeutic model of care and rehabilitation for people with high and complex needs."

A wider review of forensic intellectual disability services nationally would also be undertaken with the services funder, the Ministry of Social Development.

Grady said Health New Zealand had also halted new admissions to the ward on April 24.

"Actions already undertaken by Health NZ include enhanced clinical oversight, reviews of patient care and rehabilitation plans, strengthened approaches to reducing seclusion, and strengthened governance arrangements.

"We have been working closely with patients and their families throughout this process and will continue to be available to discuss concerns or seek further information about care arrangements."

Opportunities to redeploy affected staff were underway, and engagements with them and unions were ongoing.

"The future use of the Ward 10A facility, including refurbishment and repurposing options, remains under consideration, and further decisions will be made in due course."

The Ministry of Health said it had agreed to undertake an investigation into the serious concerns raised about the ward, and Ombudsman's call for an independent investigation.

"An investigation by a district inspector into two complaints relating to care provided in Ward 10A is underway. In addition, the district inspector and the Ministry are considering legal options for further investigation to ensure the concerns are fully examined," it said.

"The Ministry acknowledges the decision taken by Health New Zealand to close Ward 10A. The closure of the Ward does not impact on the investigation which will continue and report back to the Ombudsman in due course."