BY PATRICK BROWN AND AGNES SULLIVAN
AUCKLAND, New Zealand - "He was drowned by three top judges and two clinicians. He drowned internally, that's how he died." Said Jim Shortland as he described the death of his uncle, Rau Williams, of kidney failure in the early hours of Saturday, October 11. Shortland had helped lead a fight to have his uncle's "death sentence" -the refusal by health authorities to give him lifesaving treatment - lifted. The struggle, covered day-by-day in the media, proceeded alongside a series of protests around the country against health cutbacks.

Williams died after he was taken off dialysis treatment - which cleans the blood of impurities - on September 17, by decision of doctors working for Northland Health, the government-appointed body responsible for the provision of health services in the north of the country. Northland Health's decision was backed by the High Court, the Court of Appeal, and the Human Rights Commission, each of which turned down Williams's appeals.

Northland Health insisted that "clinical reasons" lay behind its decision, citing his "mild dementia," and claiming that Williams did not fit the medical criteria for either home or hospital dialysis. Martin Searle, the head of Middlemore Hospital's renal service, said the guidelines were set because of limits on government funding.

Williams, aged 64, was Maori and a former freezing worker (meatpacker). His kidney failure was associated with diabetes, from which Maori suffer at five times the rate of non-Maori. So far this year "Whangarei Hospital has assessed 10 patients as unsuitable for its end-stage kidney failure treatment, with most of them Maori," according to the Christchurch Press. With continued dialysis treatment Williams was expected to live several more years.

After the Life Care Trust offered a dialysis machine to treat Williams, an Australian renal specialist flew to New Zealand to examine him to assess his suitability. Whangarei hospital refused the doctor access. Around 200 people marched in Whangarei on October 3 supporting Williams's right to treatment. Williams himself took part in his wheelchair. The somber mood of the protest was punctuated by chants in the Maori language.

In the wake of the widely expressed outrage at Northland Health's, two members of parliament in the National Party/New Zealand First coalition government, Maori Affairs Minister Tau Henare of New Zealand First and John Banks of the National Party, felt compelled to protest the decision. The National Party Minister of Health, William English, backed Northern Health, as did Labour Party leader Helen Clark.

Impact of cuts in health service
Hospital care in New Zealand has traditionally been provided through a public health system, and has been free. Since the 1970s, however, government pressure to reduce health spending has led to a deterioration in the service. Major steps to cut hospital budgets were taken in 1983. Eight years later the National Party government took further steps towards a competitive, market-oriented health system. A Ministry of Health report written last December stated that real health spending had fallen 10 percent since 1988 - 89.

On October 11 the New Zealand Herald published a summary of a confidential report by doctors at Waikato Hospital on the impact of the level of funding available to hospitals in the Waikato region from 1997 to 1999.

"Hospital funding cuts will result in early death, blindness, deafness, undiagnosed cancer.." stated the summary. "[F]uture patients will be denied semi-urgent and routine surgery." Heart patients "can expect heart damage and shortened life... There will be no coronary artery bypass grafts, valve replacements, or congenital heart surgery... People who would have benefited from surgery for limb complications face amputations... There will be a reduction in dialysis treatment."

As reported in the Herald, the report warns Health Minister English "that it is pointless relying on private services to fill the gap in services, because a high proportion of children and elderly on waiting lists are from lower-income families."

The private health sector, however, is still in its relative infancy in this country. After Williams was refused dialysis, information emerged that this treatment is available only in public facilities. Around the country, waiting lists have lengthened in the face of inadequate funds for surgery. Heath Minister English plans to implement a booking system in July next year to reduce the queues, calling this the "most honest" rationing the country has seen. Points will be awarded to patients on the basis of "clinical and social criteria," according to an article in the October 12 Sunday Star Times.

The government has also recently announced a "get-tough plan" to cut drug spending. The government advisory body, the National Health Committee, suggests in a recent report that "patient charges could be increased to pay for more health care." The committee also asks, "When should we desist with publicly-funded interventions that add to pain and suffering, and prepare instead for a peaceful or `good' death?

More for-profit medicine
Amid the controversy, government ministers have been urging a greater role for private, profit-making medical ventures. Prime Minister James Bolger used a speech at the opening of a new $25 million clinic in South Auckland on October 8 to declare that "we must stop the nonsense that seeks to portray public health care as good and private health care as wrong."

The chairman of the major private health provider in New Zealand, the Southern Cross health insurance company, Hylton Le Grice, told the company's annual general meeting on October 9 that the public health system would in the future be limited to emergency services and major, expensive, or vital surgery. Southern Cross raised premiums an average 12 percent a year over the past three years.

More than 5,000 people protested in Whakatane on October 2 against a proposal to stop non-urgent surgery at the Whakatane hospital. Some 2,000 people also rallied in nearby Tauranga, and a protest meeting was organized in the South Island city of Nelson. In September, Southern Health announced plans to stop providing services to the district of Gore. A march to protest the decision is planned in Invercargill in October.

Indignation over proposed cuts to public health services in Otago drew 7,000 people to a September 19 protest march in the southern city of Dunedin, in one of the largest protests seen in the city in years. The demonstration was organized by the Public Service Association, the chief union among public employees, and the Nurses' Organisation, the main nurses' union. In Auckland, the Nurses' Organisation scheduled a strike ballot later in October. Contract talks broke down after Auckland Healthcare refused base-rate pay rises. Management's stance falls in line with a government letter ordering hospitals to freeze pay unless they can shed staff or slash wages elsewhere.

Meanwhile, Shortland said that Williams's medical file should be open to the public, and vowed to help others caught in the same predicament as his uncle. "If you're denied dialysis contact me," he said. "I'm pretty much sure we'll come to your aid - no one has the right to deny life."  
 
 
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