Home' Greymouth Star : April 21st 2015 Contents Greymouth Star
Tuesday, April 21, 2015 - 5
I have lost count of the number of pages I
have written trying to come up with the right
words to express our feelings and concerns
over Matt ’s untimely death.
First of all, I want my colleagues to know
what I am about to say does not reflect on
the amazing people who I have worked with
and the incredible support they have shown
On April 20, the Health and Disability
Commissioner published the report into
Matt ’s death. I won’t go into a lot of detail
because it is for you to read if you wish.
The bottom line is this — Matt ’s death
should not have happened.
The health care providers trusted to look
after Matt failed to give him the care he
needed, in fact it was total neglect of care.
Matt had a simple appendectomy with no
problems (approximately 9pm Friday night),
but the after care or in Matt ’s case, lack of
care, was the main contributing factor in his
They failed to notice that he had developed
pulmonary oedema, despite many obvious
symptoms so no further investigations or
treatment were given until he was found not
breathing at 6.30 the following morning.
Our thanks go to all those involved in
Matt ’s resuscitation in Grey Hospital and to
the Christchurch hospital retrieval team and
Although they tried their best to save
Matthew, but in vain, at least they gave us
three more days to be with him. Matt was
unconscious the whole time but we could
barely accept how unwell he was let alone
that he would soon die, so those three days
meant a lot to us.
He died surrounded by family and friends.
I have read every report that I was allowed
to read regarding Matt ’s death 21⁄2 years ago
and the conclusion has always remained the
same. This was a totally avoidable death and
a waste of a young man’s life.
Through this whole event I have come to
realise some very important facts. Firstly
that a health system I have trusted and spent
most of my life working for has some major
Although there were several people involved
with Matt ’s care those most accountable for
his death in my opinion are various nurses
and the anaesthetist. The HDC has stopped
me from giving out any names but in my
opinion the person most responsible for
Matt ’s death was the anaesthetist.
She was not from Greymouth, was in fact
a locum who is still practising somewhere
else in New Zealand. She was the senior in
charge and missed all the symptoms Matt
was displaying even after he had stopped
breathing once already, after surgery.
My second interesting fact was the way
in which her colleagues protected her
transgression by writing subjective reports
on Matt ’s death.
The last two reports were written by
specialist anaesthetists and weren’t worth the
paper they were written on.
A boy has lost his life, our son, as proved
in black and white through utter neglect of
care and all they cared about was protecting
each other. When I complained about this
I was told that the HDC commissioner is
not a medical person and can only make his
decisions based on the information that he
Surely it would be better if he was medically
trained when all of his cases are medically
based but regardless, when the answers don’t
stack up wouldn’t it put into question the
credibility of such people.
Apparently not. You can only work with
the information that you have and no
further questions will be asked. This is the
department we are encouraged to contact
when things go wrong. Who we wrongly
assumed would act fairly and seek justice for
The end result of the investigation. One
nurse is referred to the nursing council,
one nurse is referred to the director of
proceedings who then decide if they will take
it any further and the anaesthetist is referred
to the medical council.
These people are clearly accountable for
the death of our son and the result is just ‘lip
The truth of it is this — if you shoot
someone in New Zealand you will go to jail,
but if you die in our health system, those
responsible just get told off !
Where is the justice in this? I am
disheartened and disappointed. I believed
in this system but it has let us down in the
worst possible way. The coroner once asked
me ‘how can we fix the health care system’
and I wish I knew.
I have worked in the USA under a horrible
health care system that is dictated to by the
insurance companies. I wouldn’t like to see
that extreme here but we could definitely
do something about the ACC system that
covers medical professionals so well that they
have no accountability.
Thank goodness there are still those that
genuinely care about their practice.
My message to nurses is to remember when
you trained you agreed to be an advocate for
your patient. Not everyone can speak up for
themselves and you may not always agree
with your colleagues, but remember you are
there to do the best you can for your patients.
There is no dumb question, only the one
that was never asked! Nobody questioned
what was happening with Matt and as a
consequence he died. I strongly believe that
if just one person had questioned Matt ’s
condition he would still be alive today.
My message to doctors is to please try to
remember we work better together as a team
than individually. If we feel intimidated and
unable to talk to you this benefits no one,
least of all our patients who are the reason
we are all there in the first place.
We each have our own level of knowledge
and expertise and together we can make
a difference. To the public, remember your
rights. It is your right to receive quality care
and to understand what is happening.
If something doesn’t feel right then
it probably isn’t so I encourage you ask
questions and seek clarification.
In Matt ’s case there was no one person who
was solely responsible for his death (though
some more than others) as there were many
people involved in his care.
Through a multitude of failures with
obser vation, procedures and lack of protocol
and guidelines not to mention a distinct lack
of critical thinking our son paid the ultimate
price with his life.
Since this time the hospital has made
some major changes to their procedures
and protocols and continue to strive to
make things better. They have also been very
supportive of myself and my family and I
would like to take this opportunity to thank
my colleagues, especially Karen Bousfield
and the late Wendy Hawkins who have
worked hard to make changes to prevent
anything like this from ever happening again.
To our family and friends we offer our
sincerest thanks for all the love and support
you have given us over the past 21⁄2 years,
for which we know we couldn’t have gotten
through without you.
As I hugged my son, I will never forget
the sound of his heart beat slowing down
before stopping forever. My heart broke that
day too. I hope that no one ever has to go
through what we have and I encourage all
of you to feel empowered to ask questions
as patients, family, nurses and doctors.
Our lives and those of our loved ones are
A traumatised family have hit out at the health system over the “totally
avoidable” death of their 15-year-old son after a nurse disconnected
his oxygen-monitoring machine while attending to another patient at
Grey Base Hospital. Matthew ‘Matt’ Gunter died in November 2012
from a brain injury caused by a lack of blood flow and oxygen while he
was recovering from emergency surgery. Here is a statement prepared
by his parents David and Heather. Heather is a nurse.
family hits out
after son’s death
The West Coast District
Health Board has unreser vedly
apologised to the Gunter family
for the tragic death of Matthew,
chief executive David Meates
“ We deeply regret that in this
instance our systems did not
support staff responsible for
caring for Matthew to provide
care of an acceptable quality. The
West Coast DHB accepts all the
HDC’s findings,” Mr Meates
said. “ We have made significant
changes which will reduce
the possibility of something
happening in the
“ When there is a serious adverse
event such as this, the DHB
carries out an internal review
called a ‘Root Cause Analysis’ to
understand what — if anything —
could be done differently in future
to improve care and minimise the
risk of harm to patients.”
Some of the changes the DHB
has implemented include:
Standardisation of paediatric
training across the system (which
will be provided on an ongoing
Ongoing training for nurses
on monitoring, documentation
and critical thinking
A number of policies
and procedures have been
developed or updated to reflect
recommendations and to guide
and support staff in their delivery
Reduced numbers of locums
working on the Coast and
improved orientation for locums
“Throughout this review process
we have been working with the
Gunter family to ensure they are
kept updated about the work we
are doing and to incorporate their
feedback. I am confident that this
process will result in improved
care and better outcomes for
patients,” Mr Meates says.
The West Coast District Health Board responded to the
HDC report yesterday. Here is its statement.
Jim Brooker became the first
New Zealand representative in
world ploughing after winning
the country’s first national
ploughing competition in 1956.
Mr Brooker was a guest
of honour at the 60th
New Zealand Ploughing
Championships held at
Palmerston at the weekend.
Winning the inaugural
New Zealand Ploughing
Championships at Papakaio,
earned Mr Brooker a ticket
to the world championships
in Oxfordshire, England, in
Up against representatives
from 26 countries, some
countries with more than one
representative, he placed 11th.
He went to the world
championships with all
borrowed gear and it was not
what he was used to.
But that was no excuse for his
performance, he said.
“ I was well up on the stubble
the first day, I was probably first
a wrong decision to change my
mulboards on my plough and
it was no good the next day,”
As part of his prize, he was
able to travel around the world.
“ I had such a wonderful
trip and made so many
friends within the ploughing
fraternity,” he said.
“ It was a chance of a lifetime
Mr Brooker never competed
at a national level again after
winning the inaugural event.
“ I thought I’d been more
than spoiled with one win; I’d
let someone else have a go,” he
He has continued to be
involved in the sport ever since,
though, competing at Young
Farmers matches and judging
competitions around the
Mr Brooker had been using
his father’s tractor and plough
before he had a licence to drive,
but his interest in competitive
ploughing was sparked at the
Young Farmers Club started
a ploughing competition
to improve the standard of
ploughing in the district.
“Its a skill and you like to do
it well and if you don’t plough
well, there’s no other implement
on your property that will put it
right,” he said.
“The other thing is the
camaraderie — the touring and
the people you meet around
New Zealand and the world. ”
He remains good friends with
ploughmen around the world.
Mr Brooker said, now 83, he
felt “very lucky” to be at this
Thousands flocked to
Palmerston to watch the
country’s top ploughmen
compete in four events held on
the Sheat family property.
New Zealand Ploughing
Association executive officer
Noel Sheat said he was thrilled
with the good weather and the
support for events.
The Silver Plough overall
winner was Ian Woolley, who
will represent New Zealand at
the World Ploughing Contest
in England next year.
Malcolm Taylor won the
Fred Pilling won the horse
plough and Paul Houghton
took out the vintage plough.
— Otago Daily Times
Murray Baird, of Balfour, competes in the reversible plough
PICTURES: Otago Daily Times
Colin Drummond, of Erowhon, competes in the Horse Plough with his horse team of Steppa,
Tom, Solly, Mac, Hawky and Bess, at the 60th New Zealand Ploughing Championships at
NZ’s first ploughing rep guest at national champs
Many owners of big apartment blocks are
going through their second leaky building
repair project, after the first fix-up failed.
Lyn Gillingham, chairwoman of the new
Auckland branch of the Body Corporate
Chair’s Group, said a large number of those
attending the inaugural meeting last Thursday
evening were facing a second major repair.
“The topic of leaky buildings clearly
resonated with those who came and we had
people travelling from Tauranga, Orewa and
Hamilton. The majority of chairs attending
were either currently involved in, or had been
through, a leaky building remedial process.
“An alarming number were going through it
for a second time. Many questioned the role
of councils and the fact that so many of the
contracting parties they were dealing with
could effectively hide behind limited liability
provisions in their contracts,” she said.
About 60 people attended.
Brian D uffy from Contrado Consulting said
the building industry was in a boom phase
and those going into remedial projects now
were likely to have difficulty getting architects,
contractors and sub-contractors. Prices were
also likely to be higher than expected.
Gillingham said one common theme was
how concerned building owners were to
protect their investments, often at the expense
of future owners, as they do not take action
or seek appropriate advice when problems are
“Being labelled a leaker can be viewed as
the kiss of death. The reality, however, is that
failing to deal with issues earlier can result in
far more expensive repairs further down the
track,” she said.
“The fact that leaky buildings are still being
constructed, or remediation work is failing
is also cause for alarm as many of these
buildings and their owners do not qualify
for the Government ’s Financial Assistance
Package scheme.” Three of the major banks —
Westpac, BNZ and ASB — have put in place
an escrow (third party) arrangement which
Michelle Hill of Kensington Swan discussed
at last Thursday ’s meeting.
The escrow arrangement meant money
was held by an approved agent such as a law
firm, payments were strictly for remediation
purposes and only made after tight certification
Owners paid interest on their loans but the
money was held in an interest-bearing deposit
Gillingham said many people who attended
were interested to hear more about that.
“This can alleviate the necessity for some
owners to sell at heavily discounted prices as
they cannot fund remedial contributions.”
— N ZM E-New Zealand Herald
Leaky apartments facing second lot of repairs
AA SMARTFUEL SAVINGS!**
**Terms and conditions apply ask in store for details.
*TERMS & CONDITIONS APPLY. SEE below FOR DETAILS.
12 MONTHS INTEREST FREE!
ON PRODUCTS $499 & OVER* plus
• 5kg capacity • Child
lock • Crease free
option • Stainless drum
• Clean the filter reminder
• Wall mountable
• 298 litre capacity • Frost free NeoFrost cooling • Bottle rack
• Fast freezing function • Antibacterial door seal • White finish
Pure Air Vacuum Cleaner
• 2200 Watts • Hepa 13 filter with TimeStrip • 2 piece
telescopic wand • Dual Park System with auto standby
• 11 metre maximum reach • Replace bag indicator
Galaxy Tab3 LITE
• 1.3 GHz Quad Core processor
• 1GB RAM • 7.0” (1024 x 600)
display • 2MP camera
• 8GB storage • Expandable memory
up to 32GB (MicroSD) • Wi-Fi
• Bluetooth • Up to 8 hours video
playback • Multitasking, Multiuser
mode • Samsung Kids Mode
(available on Galaxy App store)
• Android KitKat 4.4
$249 NEW MODEL!
(OFFER VALID 1ST APRIL TO 10TH MAY 2015 OR WHILE STOCKS LAST)
• Scrapes the bowl so you
don’t have to • 700 Watts
• Planetary mixing action
• 4.7 litre mixing bowl with
handle • 6 speed electronic
control • Includes scraper
beater, dough hook & whisk
• Also available in Cherry
$499 BUILT-IN DVD!
TEAC 70cmv (28”) LED HD TV/DVD Combo
• High Definition (768x1366) resolution • DVD/DVD+R/DVD-R/DVD+RW/DVD-RW/CD/
MP3/JPEG Playback • HDMI Input • USB recording to external
Fisher & Paykel WashSmartTM Top Load Washer
• 7kg capacity • Smart Drive system • 5 wash cycles • 1000 RPM spin speed
• Auto water level • Load sensing • 3 spin speeds • 3 Star water rating
FINANCE TERMS & CONDITIONS:
12 Months Interest Free on purchases $499 and over.* Excludes Gift Card purchases, Apple products, and Gaming products. Offer ends Monday
27 April 2015. *Finance not available online. Q Card: 12 months interest free is available on Q Card Flexi Payment Plans. Offer excludes Gift
Card Purchases, Apple products, and Gaming Products. Minimum purchase $499. Account Fees may apply. A $55 Establishment Fee for new
Q Cardholders and a $35 Advance Fee for existing Q Cardholders will apply. Minimum payments of 3% of the monthly closing balance or $10
(whichever is greater) are required throughout interest free period. Paying only the minimum monthly payments will not fully repay the loan
before the end of the interest free period. Q Card Standard Interest Rate applies to any outstanding balance at end of interest free period.
Offer expires Monday 27 April 2015. Q Card lending criteria, fees, terms and conditions apply. GE CreditLine & Gem
Visa: Minimum purchase $499. Offer excludes Gift Card purchases, Apple products and Gaming products. Credit
and lending criteria, $55 establishment fee and $55 annual fee apply. The prevailing interest rate will apply to any
outstanding balance on the expiry of the interest free period. Finance offer expires Monday 27 April 2015. GE Creditline
and Gem Visa are provided by GE Finance and Insurance. The choice of finance company will be at the sole discretion
of each 1OO% Appliances Store. This finance offer cannot be combined with any other finance offer.
Terms & Conditions:
Product and Finance offers valid until Monday 27 April 2015. Delivery and installation fees
may apply. Savings - actual savings may vary between stores. ‘Raincheck’ - some products
advertised may not be displayed in all stores but subject to availability a ‘Raincheck’ can
be issued holding the advertised price upon delivery. All efforts have been made to comply
with the Fair Trading Act, relating to product and pricing.
Links Archive April 20th 2015 April 22nd 2015 Navigation Previous Page Next Page