Farmer Rodney Thomas Smith was stoic. He hadn’t seen a doctor for a decade and preferred to pull his own teeth rather than see a dentist.

Mid-morning on Friday, November 26, 2021, the 74-year-old had been separating a scrub fire on his Foxton farm and later told a doctor he’d been overwhelmed by the heat and had lain down for a moment.

But he denied catching fire, telling the doctor who would later treat his burns that he’d gotten on his bike and headed back to his house.

An inquest this week into Smith’s subsequent death as a result of injuries from that fire heard his wife later said it was out of character for her husband to be managing a scrub fire alone.

Describing events that day, she’d told a doctor her husband had come home, changed his clothes and returned to the fire, insisting there was no need for her to call emergency services.

She told the doctor she’d feared her husband had suffered a stroke about the time of the fire, because he’d seemed confused, telling her he thought she was out, when he knew she wasn’t.

And she’d explained his dislike of doctors was one of the reasons she’d delayed calling emergency services for four hours.

Once alerted, an ambulance and a rescue helicopter arrived at the farm, with the decision made to transport Smith to Palmerston North Hospital, rather than fly him to the burns unit at Hutt Hospital.

Arriving at the hospital in the late afternoon, his family was told his injuries weren’t life-threatening.

The inquest heard that despite being unwell, he didn’t look that way. It was only when blood results showed how critically ill Smith was that he was transferred to Hutt Hospital several hours later and then moved to Wellington Hospital the following day, where he died two days after the fire.

The inquest heard Smith’s injuries were so severe that efforts were made to send him to the national burns unit at Middlemore Hospital in Auckland, but a combination of bad weather and his deteriorating condition prevented that from happening.

Coroner Mary-Anne Borrowdale is presiding over the inquest into Rodney Thomas Smith's death in 2021. Photo/ Ministry of Justice

At the inquest in the Wellington District Court this week, Coroner Mary-Anne Borrowdale is considering a number of issues, including the decision to transport him by ambulance and the medical services he received, including whether the delay in identifying his significant chest injuries compromised Smith’s chance of survival.

She is considering whether Smith’s chances of survival were compromised by being driven to Palmerston North Hospital rather than being flown directly to Hutt Hospital.

The coroner will also look at whether burns patient care in the Lower North Island is suboptimal because of the lack of a co-located burns unit and ICU.

The early stages of organ failure

Dr David Prisk, the medical director at Palmerston North Hospital’s Emergency Department (ED), told the inquest that, having reviewed the clinical notes, Smith’s treatment in the ED that day for his burns was generally appropriate.

Smith was seen by a doctor shortly after his arrival, and Prisk told the inquest that while the farmer’s burns were initially underestimated, they were revised.

A chest X-ray wasn’t ordered because it wasn’t deemed necessary, as his chest injuries and rib fractures weren’t initially detected.

Prisk told the coroner a chest X-ray should have been done because Smith had burns to his face and low oxygen saturation. But he explained that, at the time, staff had focused on the burns because the chest injuries were deemed relatively minor.

During his evidence, the doctor said Smith may have benefited from an air ambulance transfer to Hutt Hospital.

“Mr Smith appeared to be fit and healthy; he was an elderly man and had suffered extensive and significant burns, which occurred some hours before he received cooling measures by his wife and initial treatment at the scene by paramedics.

“By the time Mr Smith arrived, he was already in the early stages of organ failure. This means, unfortunately, Mr Smith’s chances of survival would have remained very low regardless of which hospital he was initially taken to,” Prisk said.

Foxton farmer Rod Smith died at Wellington Hospital two days after suffering burns while tackling a scrub fire. Photo / Supplied

‘I don’t know that would have changed the outcome’

Counsel for the coroner, Grace Holden, asked Prisk if flying Smith to Hutt Hospital may have improved the patient’s chances of survival. Prisk said it may have.

“It would have given him the best chance if he’d been directly transferred.”

But regardless of this, he said Smith’s age and the extent of his injuries made his chances of survival low.

The inquest heard that since the incident, a training exercise was run with staff to raise awareness of how to deal with a burns patient and the transfer policy.

The hospital has introduced different trauma levels for patients, which dictate how a patient is assessed and treated, and involve specialists from outside ED.

Asked what difference this would have made to Smith’s treatment, were he admitted today, Prisk said Smith would now receive a chest X-ray and a CT scan. Despite this, he said Smith’s survivability would have remained the same.

“I don’t know that would have changed the outcome.”

When asked by the coroner what Smith’s chances of death was, Prisk said 20-25%.

She also asked if any consideration was given to sending Smith to the national burns unit at Middlemore Hospital.

Prisk said he didn’t know, but told the inquest Palmerston North Hospital’s burns patients went to Hutt Hospital.

Burns to 28% of his body

Hutt Hospital plastic surgeon Dr Annie Fullarton took the details from Smith and his wife about what had happened 12 hours earlier during the fire, but told the inquest it was difficult to draw details out of him.

She said he denied there were any problems or that he was in pain.

She told the inquest the burns to Smith’s body were initially estimated at 9%, which later increased to 28%. The national burns unit takes patients who have burns to 30% of their bodies.

Commenting on whether Smith’s chances of survival were compromised by the lack of a combined burns unit and ICU, she said Hutt Hospital’s level 1 ICU was capable of treating Smith’s injuries. But, since his death, the hospital’s ICU had increased from a level 1 to level 2.

Asked by the counsel assisting the coroner Joshua Shaw what that change meant, she said: “It’s so much better ... my confidence in treating patients like Mr Smith is so much higher.”

Shaw also asked Fullarton whether burn patients received suboptimal care because of the lack of a co-located burns unit and ICU.

“I would say if you had to redesign the unit now, you would have the burns unit next to a major trauma centre.

“Ideally, we would have a presence at Wellington Hospital, without a doubt.”

Asked by the coroner what impact the decision to take Smith to Palmerston North before transferring him to Hutt Hospital had made, Fullarton said it wasn’t ideal.

She said they would have liked it if he had been sent to Hutt Hospital straight away, but she couldn’t say what difference it would have made.

“It was a very significant injury,” she said.

The inquest is scheduled to continue for the rest of the week.

Catherine Hutton is an Open Justice reporter, based in Wellington. She has worked as a journalist at the Waikato Times and RNZ. Most recently she was working as a media adviser at the Ministry of Justice.