Emergency doctors fear more unnecessary deaths as overwhelmed hospitals struggle with surging patient demand in what one desperate clinician describes as a "s**tstorm".

Frontline health staff are pleading for the Government to take urgent action to address the growing health crisis which they say is forcing ambulances to queue outside stretched EDs due to a lack of beds, putting patients at further risk.

The warnings follow the release of a damning report into the death of a "healthy" 50-year-old woman at Middlemore Hospital who had suffered a brain bleed in June.

She was allegedly told by ED staff there would be an eight-hour wait before she could be examined and as a result went home before dying the following day.

The independent report, sought by the South Auckland hospital and released yesterday, found Middlemore Hospital's emergency department was "unsafe, dysfunctional and overcrowded".

Australasian College for Emergency Medicine (ACEM) chair Kate Allan told the Herald she feared there would be further avoidable deaths.

"Every emergency department doctor is worried that there will be more cases like the one in June because it is a reality of most emergency departments every day."

Allan - who worked clinically as an emergency physician in Auckland - said the report needed to be looked at with urgency.

"If we don't fix the problem of moving people through the system so patients can move on to their next stage of care then emergency departments will continue to be overcrowded."

She said she couldn't talk specifically about the June tragedy but could speak generally about the issues underpinning the case.

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Australasian College for Emergency Medicine (ACEM) chair Kate Allan. Photo / Supplied

Patients were walking into overcrowded waiting rooms with no room to sit, only stand. They thought, "Oh well I'm not going to be seen", or "everyone's under pressure", so they sought care elsewhere or returned home, Allan said.

"The system should be there to process patients and be able to triage patient's in a timely manner. But when you have a waiting room that was completely overcrowded or ambulances that are unable to offload patients because patients cannot get into the emergency department, that means those patients are not receiving a timely assessment."

In her 15 years of working as an emergency specialist doctor, Allan said she had never seen it this bad. The situation was alarming.

Asked how confident she was New Zealand would start to see improvements in the next year, Allan said she was "hopeful".

"We all know we need to make that better so things like this don't happen."

Allan sent ACEM's deepest condolences to the whanau and loved ones of the woman who died in June.

A doctor who consults at Middlemore Hospital described the hospital's current state as a "sh** storm" and described Te Whatu Ora as dysfunctional with almost complete decision paralysis.

"Now that winter and Covid are gone, we are supposedly at baseline, [but] things are just as bad as ever and people are losing their goodwill to keep this ongoing and unrewarded slog continuing."

The doctor, who asked to remain unnamed, said there were huge disputes on pay equity, even with doctors getting paid more at Auckland City Hospital for the same work at Middlemore Hospital.

"There are now massive shortages of senior medical officers all over New Zealand and a number of resignations occurring and still senior management just keep saying everything is fine."

Health Minister Andrew Little. Photo / File

Written by an unidentified fellow from the Australasian College for Emergency Medicine, the report warned that only the exceptional hard work and dedication of Middlemore's staff was keeping it from more serious incidents.

It also expressed "serious concerns" about the degree of overcrowding in the ED, which it said was an indicator of significant systemic failures and "it is clear that this institution is struggling".

"The evidence provided to me strongly reflects an overcrowded ED, a hospital well over acceptable capacity and subsequent system dysfunction," the report said.

"This is an unsafe environment for both patients and staff and is not sustainable."

The report's recommendations called for Te Whatu Ora – Counties Manukau to review and improve the processing of acute patients.

Health Minister Andrew Little offered his condolences to the woman's family but noted that the report found her death could not be attributed to delays at Middlemore Hospital's ED.

He said the hospital had been coping with larger than usual ED presentations at the time due to Covid-19, the worst flu season in living memory and significant staff illness.

"I expect Te Whatu Ora – Health New Zealand to take on board lessons from this report, such as making sure people waiting in emergency departments have good information about what's happening and assessing anyone leaving without treatment. But these problems did not happen overnight. They've developed over a long period."

Little said this Government had increased funding for hospitals by nearly 45 per cent, adding about 5000 nurses and spending about $7 billion on facilities.

He was confident health professionals were making the best decisions to keep patients safe.

"The system has been under immense pressure this winter and continues to see high numbers in many EDs and high occupancy rates in some hospitals. I am satisfied Te Whatu Ora Health New Zealand is doing everything it can to step up recruiting to fill vacancies and keep our public health system working well."

Prime Minister Jacinda Ardern yesterday said investigations into the June death were important to both understand what had occurred and prevent any similar tragedies.

She noted the woman's death came during an unprecedented period of demand on the health system during the Omicron outbreak.

In a statement, Te Whatu Ora chief executive and former Counties Manukau District Health Board boss Margie Apa recognised the issues raised in the report.

"The experience of patients in emergency departments at times of high demand is challenging for both patients and staff. Middlemore is one of many emergency departments which have raised concerns about the impact of constrained resources at peak times," she said.

"Although the reports released today indicate that a likely outcome would not have been different with earlier triage in this very sad case, we also recognise the broader issues raised in the emergency department review."

Apa said Te Whatu Ora is carrying out a national review to look at what it can do to better support staff and prepare services for winter next year.