OIA30092021 VAUGHAN Covid Treatment Protocols.pdf

21st October 2021

Michael Vaughan
Private/Individual
Email: [FYI request #16802 email]

Dear Michael

Official Information Act Request for – Covid Treatment Protocols

I write in response to your Official Information Act request received by us 30th September 2021 by way
of transfer from the Ministry of Health (ref: H202113000) , you requested the following information:

1.  What is the Covid-19 treatment protocol for hospitalised cases?
2.  Are some DHB's following different treatment protocols from others?
3.  Are DHB's free to make decisions about treatments for individuals with Covid-19?
4.  To what extent are patients able to participate in decision-making about their treatment
programmes?
5.  If a patient requests a blood test for Vitamin D and/or the administration of high dosage
Vitamin C, are hospital staff able to provide these?
6.  Do hospital staff have the right to refuse a patient's request and, if so, is there a process for
a patient to appeal the decision?

Counties Manukau Health Response:
For context Counties Manukau Health (CM Health) employs over 8,500 staff and provides health and
support services to people living in the Counties Manukau region (approx. 601,490 people). We see over
118,000  people  in  our  Emergency  Department  each  year,  and  over  2,000  visitors  come  through
Middlemore Hospital daily.

Our services are delivered via hospital, outpatient, ambulatory and community-based models of care.
We provide regional and supra-regional specialist services i.e. for orthopaedics, plastics, burns and spinal
services.  There are also several specialist services provided including tertiary surgical services, medical
services, mental health and addiction services.

1.  What is the Covid-19 treatment protocol for hospitalised cases?
In  relation  to  the  clinical  treatment  of  a  patient  admitted  with  Covid-19,  we  treat  every
Emergency  Department  patient  according  to  the  symptoms  they  present  with  and  have  an
individual care plan for each patient.

CM Health follows guidance from the Ministry of Health as per the publicly available information
at  the  below  links.  This  guideline  covers  patient  severity,  investigations, respiratory  support,
medication  management  and  discharge  planning  for  the  clinical  management  of  COVID-19
hospitalised adults.
Counties Manukau Health

Private Bag 93311, Otahuhu, Auckland
T: 09 276 0000 | cmdhb.org.nz

•  https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-
coronavirus/covid-19-information-health-professionals/covid-19-advice-all-health-
professionals#adult-management
•  https://www.health.govt.nz/system/files/documents/pages/interim_guidance_-
_clinical_management_of_covid-19_in_hospitalised_adults.pdf

2.  Are some DHB's following different treatment protocols from others?
We cannot comment on what protocols other DHBs are using.

3.  Are DHB's free to make decisions about treatments for individuals with Covid-19?
The clinician treating the patient is responsible for their treatment pathway.  The Ministry of
Health guidance and factsheets linked above in question one are to support health professionals
managing COVID-19.

4.  To what extent are patients able to participate in decision-making about their treatment
programmes?
Patients are always encouraged to participate in decision making around their treatment.   We
follow  the Health and Disability Commission (HDC) code of rights,  including Right  6 italicised
below obtained from the HDC website.
  https://www.hdc.org.nz/your-rights/about-the-code/code-of-health-and-
disability-services-consumers-rights/

“Right 6 - Right to be fully informed
(1) Every consumer has the right to the information that a reasonable consumer, in
that consumer's circumstances, would expect to receive, including—
(a) an explanation of his or her condition; and
(b) an explanation of the options available, including an assessment of the
expected risks, side effects, benefits, and costs of each option; and
(c) advice of the estimated time within which the services will be provided; and
(d) notification of any proposed participation in teaching or research, including
whether the research requires and has received ethical approval; and
(e) any other information required by legal, professional, ethical, and other
relevant standards; and
(f) the results of tests; and
(g) the results of procedures.
(2) Before making a choice or giving consent, every consumer has the right to the
information that a reasonable consumer, in that consumer's circumstances, needs to
make an informed choice or give informed consent.
(3) Every consumer has the right to honest and accurate answers to questions relating
to services, including questions about—
(a) the identity and qualifications of the provider; and
(b) the recommendation of the provider; and
(c) how to obtain an opinion from another provider; and
(d) the results of research.
(4) Every consumer has the right to receive, on request, a written summary of
information provided.”

5.  If a patient requests a blood test for Vitamin D and/or the administration of high dosage
Vitamin C, are hospital staff able to provide these?
Each patient’s treatment plan is tailored to fit their clinical requirements and clinicians provide
treatment as clinically indicated.  If the clinical view is that Vitamin D and/or the administration
of high dosage Vitamin C will not benefit the patient and is not clinically required for the patient,
they are not required to provide it.

6.  Do hospital staff have the right to refuse a patient's request and, if so, is there a process for
a patient to appeal the decision?
Patients are able to request a second opinion and this is facilitated where possible.  Clinical staff
discuss treatment options and pathways with all patients.  If the patient does not agree with
treatment plans, they have the right to obtain an opinion from another provider.

I trust this information answers your request. You are entitled to seek a review of the response by the
Ombudsman  under  section  28(3)  of the  Official  Information  Act.    Information about  how  to make  a
complaint is available at www.ombudsman.parliament.nz or Freephone 0800 802 602.

Please note that this response or an edited version of this may be published on the Counties Manukau
Health website. If you consider there are good reasons why this response should not be made publicly
available, we will be happy to consider this.

Yours sincerely

Fepulea’i Margie Apa
Chief Executive Officer
Counties Manukau Health