South Auckland health chiefs were warned 18 years ago that an earthquake-prone building should not have patients in it, but it still does.
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They were also warned five years ago that Middlemore's children's hospital was rapidly becoming unsafe, but did little about it.
The clear and early warnings about deteriorating buildings are revealed in a mass of documents released by Counties Manukau District Health Board under the Official Information Act.
They show that in July 2013 a hospital engineer investigating the Kidz First Children's Hospital, removed a dozen leaking external wall panels.
"There was severe damage to the underlying panel frames caused by the prolonged persistent moisture ingress ... affecting the structural integrity," the engineer reported.
"To allow this, will further weaken the building structure, and possibly render it unsound, unsafe and unhealthy to occupy."
Read the full report titled The Wall Claddings System on the Kidz First Building (PDF, 312KB)
Read HAC Reports 2017/2018, Facilities and Asset Management (PDF 1.2MB)
The hospital's executive leadership team did allow it to continue, up until the present, with only ad hoc repairs in the meantime.
The full reclad of Kidz First is now not due to be done until 2021.
The documents show how the delays have impacted on costs: In mid-2017, the reclad of the Manukau Superclinic, which is also decaying, was estimated at $40 million; by March this year it was $60m.
Other documents reveal earthquake risk warnings dating back to 2000, when the consulting engineering firm Holmes assessed the five-storey Galbraith building that houses birth and maternity care.
It was "not suitable for service as an essential medical facility due to seismic issues making it earthquake prone with associated life safety risk," the engineers said.
The DHB's 2007 facilities master plan called for operating theatres to be gradually pulled out of the Galbraith building, and they were.
Shortly after, however, the building's quake rating was boosted to 55 percent of New Building Standards (NBS).
This was done by altering how the ground was assessed and reducing how long the building was expected to last.
This was allowed under the rules at that time, but is not allowed now. One seismic engineer told RNZ this approach was "unusual" for a hospital even back then; but a second engineer said it was known to happen.
By 2011, a report shows the hospital's position was very different from 2007: "Note that under current codes Galbraith can continue to function for at least a 10 year period (2011-2021) for the purposes of housing theatres and other critical services required post disaster."
By early 2017, this was looking likely, with plans to recommission operating theatres in Galbraith.
In the interim, only a single beam and column had been strengthened.
But in October 2017, the acting chief executive told the Health Ministry that Galbraith was probably earthquake-prone, and two seismic assessments this year confirmed that, putting the building at 20 percent of NBS.
RNZ asked the health board for an interview about whether the way it kept changing position over Galbraith represented best practice.
"The DHB has to continue weighing up the cost and impact of remediation against risks of life safety in the unlikely event of a major earthquake," it said in a statement.
"We are more certain, however, that we will put patient outcomes at risk if services that are currently provided in Galbraith are discontinued or disrupted.
Changes to legislation and quake assessment methods had changed how it understood the risks it had to manage, it said.
As for the 2007 master plan, this assumed theatres would be decommissioned by 2021, and the other OIA reports "confirmed that these early assumptions were appropriate".
Any new buildings required regional and national prioritisation, and any quake strengthening entailed a lot of disruption, it said, emphasising there were no easy choices for it.
Counties Manukau had returned operating surpluses in 12 out of the 13 years up until last year's deficit, itself a big turnaround on a forecast surplus.
Yet the documents show the DHB's budget for new building was just 6.5 percent that of neighbouring Auckland DHB; its maintenance budget was $1 million to look after $660 million of assets, versus Auckland DHB's $12 million.
The Facilities Manager Philip Healy said in August 2017 that he was facing the deepest budget cuts of any DHB division.
"The 12 percent of total facilities budget imposed as enforced saving targets are proving undeliverable," his report said.
The budget for 2017/18 was a challenge, he said.
He called it a "run to failure approach".
The health board is about to commission a risk survey of its buildings.
This survey was even more necessary because of the "collapse" of the Manukau Superclinic electricity supply, Mr Healy wrote.
The DHB is also employing 11 new workers over the next two years to catch up with deferred maintenance that's now estimated to total $60 million over five years.
In March this year, before the DHB's building woes were exposed by RNZ, the Health Ministry had told the Health Minister that Counties Manukau appeared unlikely to undertake the capital expenditure it had budgeted for, so it "should end the year having minimal need to draw on its overdraft facility".
By that stage, however, the DHB already had to-hand forecasts that it would have to spend more than $120 million, just to fix up four of its dozen inadequate buildings.
