By MARTIN JOHNSTON and STAFF REPORTERS
The experience of doctors in emergency departments in at least two North Island hospitals falls short of the international minimum.
At Whangarei and Tauranga Hospitals, the doctors left in charge of emergency departments on the night shift are second-year house officers.
The international standard is that doctors in charge should be third-year registrars training to become emergency medicine specialists.
The Ministry of Health said yesterday that it was a laudable aim but difficult to achieve, partly because of limited money.
An Australasian College of Emergency Medicine spokesman, Dr Michael Ardagh, said the practice at the two hospitals was "okay but not ideal."
The Weekend Herald has surveyed hospitals in the top half of the North Island about emergency department staff and experience.
This follows Health and Disability Commissioner Ron Paterson's finding that 19-year-old Tommy Whittaker died because bleeding in his brain was detected too late. He was taken to Taranaki Hospital emergency department in 1997 after a fall.
Mr Paterson said New Zealand emergency departments fell below international standards for a safe and effective service.
Rural hospitals struggled to have experienced medical or nursing staff available, although he believed experienced doctors were now always available in emergency departments.
Mr Whittaker was treated by a first-year house officer with just six weeks' experience in the emergency department and she had difficulty contacting the on-call registrar.
Since the tragedy, Taranaki always has experienced medical officers on duty.
All the larger hospitals have registrars and a range of specialists on call in the hospital or from home. In many cases they are required to get to the emergency department within five or 10 minutes.
Gisborne Hospital says its specialists and other doctors "can make it to the emergency department well within 30 minutes and usually much quicker."
Rotorua Hospital said that because of underfunding it was four short of the 20 nurses and doctors recommended for its emergency department by an internal review.
Tauranga was short of nurses, and Auckland Hospital said that because of underfunding it sometimes had insufficient emergency specialists at weekends and nights.
Dr Ardagh, a Christchurch Hospital specialist, said junior doctors might not recognise when they were out of their depth, so might not call for help when they needed it.
Emergency departments had made great progress since 1992, when emergency medicine became a separate specialty, he said.
There were 40 specialists, and 120 registrars in the five-year training programme. This put the country well on track to having the 150 specialists it needed.
The Ministry of Health is reviewing emergency department staff and competence levels at the suggestion of Mr Paterson.
Spokesman Sandy Dawson said the ministry stipulated the competence level of emergency departments' senior staff, but not the minimum experience level of the doctors in charge of each shift.
Having only third-year doctors and above in charge was "a great standard to head for," but there were constraints, especially in rural areas, despite increases in training places.
Who's working at night
Staff on night-shift duty - between midnight and 8 am - at upper North Island hospitals:
* Whangarei. A second-year house officer.
* Tauranga. A senior house officer or a second-year junior house officer.
* Rotorua. A registrar, and a house officer (at least second-year).
* Gisborne. A doctor with at least two years' experience and a diploma in emergency medicine.
* Taupo. A senior medical officer (non-specialist doctor).
* Starship (children). A registrar and a house officer.
* Auckland. Two registrars and a house officer.
* North Shore. A senior medical officer and a house officer (at least second-year).
* Waikato. At least one registrar.
* Taumarunui, Tokoroa, Te Kuiti and Thames - which all send the more serious cases to Waikato - are staffed by nurses. Senior medical officers are on call, except at Te Kuiti, which is covered by local GPs.
Middlemore. Two registrars and, on most nights, an emergency medicine specialist.
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