NORTHLAND DISTRICT HEALTH BOARD A Te Poai?i' Haiwra 1i Rahe 0 Te Ta! Tokemu 25 September 2019 Nicholas Jones New Zealand Herald Nicholas.Jones@nzme.co.nz Dear Nicholas Official Information Act Request You have asked for information about an individual's bad debt write-off. Can I please request copies of the correspondence to Immigration NZ and the relevant Embassy, and any documents, briefings, reports and correspondence summarising this debt write-off. Anyone in New Zealand requiring acute health services can receive the services they require from a district health board. if they are not eligible to receive publicly funded health services, they can expect to be invoiced for the services they received. If a person is too unwell to make an informed decision about whether they want further treatment, and a clinician determines that treatment is necessary to prevent loss of life or significant disability, treatment should be provided. If the person is not eligible for that treatment to be publicly funded, they would be asked to pay afterwards. information on eligibility criteria is available on the Ministry of Health?s website. The individual concerned is a vulnerable elderly patient who continues to reside in Northland. The individual has complex medical needs and there is a high probability they may need to receive care in one of our hospitals in the future. In order to protect the privacy of that individual and ensure they remain engaged with our clinicians and services I have decided to provide the information you have requested by way of document summary and/or extracts as set out below. Where information is publicly available this is noted. If you have any questions regarding Northland response to your information request please contact Liz Inch, Communications Manager, in the first instance. Liz can be contacted by e-mail at or by telephone on (09) 430 4100 ext 60518 or 021 730 543. Yours sincerely Dr Nick Chamberlain Chief Executive 34287 Phone {091430 4101 Fax: (091411] [1001 - DHB Office, Tundra House. Hospital Road. Private Bag 9?42. Wnangarei 0143. New Zealand Date From To Summary/Extract 22/5/18 Email NDHB Service Manager NDHB Manager Customer Services Enquiries with Consulate have determined that the patient is in New Zealand illegally. Patient is aware of this and is very fearful of being deported. Consulate suggested that NDHB contacts Immigration NZ. Patient is still receiving social services payments from home country and has no visas, residency or citizenship that would allow them to stay in New Zealand 23/5/18 Email NDHB Manager Customer Services NDHB Service Manager; CFO General Manager Senior Clinicians Confirmed that patient is not eligible to receive publicly funded healthcare. Confirmed that outstanding invoices are sent to Immigration NZ. Patient?s visa expired in 2012 and has been in New Zealand illegally since that date. Patient is very ill and may be in hospital for some time. 1/6/18 Email NDHB Service Manager NDHB Customer Team Member Services Immigration NZ needs to be informed of patient's status as soon as possible. If Immigration NZ wants to contact the patient contact is to be with Clinical Nurse Manager in the first instance, 5/6/18 Email NDHB Customer Services Team Member NDHB Service Manager Confirmed that Immigration NZ has been contacted and advised that the patient is in hospital and the amount owed for care provided by NDHB to date. 13/6/18 Email NDHB Customer Services Team Member Immigration NZ Follow-up to Immigration NZ including patient details, steps taken with Consulate, request for urgent advice to inform development of clear plan for future. Noted that steps taken have not been discussed with the patient as the patient has not been well enough. 10/7/18 Email NDHB Service Manager Immigration NZ Patient discharged to previous address on 9/7/18. Home support to be provided for a short period, unclear whether previous social services payments from patient?s home country will continue. NDHB district nurses will check on the patient. Patient?s inability to care for themselves may result in further hospital admission. NDHB Service Manager has explained to patient that it would be in patient?s best interest to contact Immigration NZ and return to home country but patient is adamant that they do not want to return. Patients clinicians believe the patient is capable of making own decisions but are concerned at the patient?s ability to care for themselves. If the patient were a New Zealand citizen NDHB would seek funding for alternative care. Concern that the patient requires a level of support that they are not eligible for. 26/7/18 Email NDHB Service Manager Consulate NDHB has communicated with immigration and they are unable to help The patient has unfortunately deteriorated overnight and is requiring active medical input. 13/9/18 Email NDHB Service Manager Consulatev Patient has been with NDHB for a number of months and is recovering after a prolonged illness. Discharge to the patient?s home environment would likely result in rapid deterioration in health and function. NDHB was hoping to convince the patient that their home country is the best place to receive ongoing care. The patient?s circumstances have been explained to Immigration on a number of occasions who say they are unable to act due to a new policy with the DHBs that prohibits Immigration NZ acting on information supplied by DHBs. The patient does not wish to return to their home country, has a significant hospital bill that they are unable to pay. NDHB would appreciate any help to resolve the issue. 14/9/18 Email NDHB Service Manager Consulate Whether patient can access funded care in patient's home country. 14/9/18 Email NDHB Service Manager Consulate Patient unlikely to be willing to apply for funding as he does not wish to be repatriated. NDHB appreciates Immigration stance on the patient but it puts NDHB in a difficult position. NDHB believes that the patient returning to their home country is the best course of action. 1/10/18 Email NDHB Accounts Receivable Team Member NDHB CFO NDHB Patient costs incurred to 1/10/18 updated 7/5/19 Email Debt Collection Agency Accounts Receivable Team Member Seeking authorisation to undertake a field visit to the patient 7/5/19 Email NDHB Accounts Receivable Team Member NDHB General Manager Seeking authorisation for debt collection agency to undertake a field visit to the patient 14/5/19 Email NDHB Financial Manager Service NDHB CFO Seeking approval for debt collection agency to undertake a field visit to the patient 14/5/19 Email NDHB CFO NDHB Manager Financial Service Approval for debt collection agency to undertake a field visit to the patient 28/5/19 Email Debt Collection Agency Northland DHB Meeting with patient to discuss debt owed to NDHB. Patient receiving a single source of income which goes to living expenses. No other income or savings. No money to start paying debt. Patient does not wish to return to their home country to live. 24/6/19 Executive Management Report to Finance, Risk and Assurance Meeting Bad Debt for write off SUBJECT: BAD DEBTS FOR WRITE OFF That the Finance, Risk and Assurance Committee recommends to the Board to write off up to $335,531 as bad debts noting that these fall well within the provision for doubtful debts. BACKGROUND INFORMATION: There are total debts of $335,531 made up of 48 debtors from whom Northland DHB has been unable to recover; all the debts are at least six months old. Areas into which the majority of debts tall are non?eligible patients (overseas visitors) and loan equipment not returned. All debts over $50 have been placed with our debt collection agency and non-eligible patients have had their debts lodged with Immigration NZ ISSUES: With regard to non-eligible patient debt, all avenues have been exhausted trying to recover these debts. There is a doubtful debt provision of 75% of the 60+ days debt of $192,947 and doubtful debt provision of 100% for two other large debts totaling $288,098. Total non-eligible debt is $508,134 as at 30 April 2019. Attachment Summary relating to individuai Debt from May18 October 18 Resident illegally in NZ as no visa - lmmigration NZ won't deport for humanitarian reasons. With Immigration and Debt Collectors 24/6/19 Minutes Finance Risk and Assurance Meeting large portion of the bad debt for write off can be attributed to one patient. The patient is a non?resident who Immigration NZ will not deport for humanitarian reasons. The debt for this patient has been forwarded to a collection agency who have gone to visit the patient and have advised there are no assets to be collected against to try to reclaim any of the debt? 26/7/19 Executive Management Bad Debt for write off Report to Board Publicly available in Board agenda papers on