The public tab for last year's deadly eruption at Whakaari/White Island continues to grow, with Counties Health revealing its response has cost more than $2 million and counting.
Four patients are still receiving treatment at Middlemore Hospital following the 9 December eruption - three are in the National Burns Centre, while one person remains in intensive care.
Four Middlemore patients were repatriated to the United States and United Kingdom in the first week of February. The official death toll stands at 21.
Counties Manukau District Health Board (CMDHB) papers show a $2.6m budget outlay for December 2019, caused almost entirely by a $2.1m spend on Middlemore's response to the disaster.
"In addition to the Whakaari/White Island costs referred to above, nursing costs are particularly high this month reflecting a combined response regarding occupancy, complexity and phasing," the report reads.
In addition, CMDHB is indicating there could be further costs associated with the eruption response, with the report stating operational and financial impacts will become clearer this year.
"There may be further costs associated with the downstream effect of the eruption. Bed occupancy has remained high throughout December."
Chief financial officer Margaret White said CMDHB officials met with ACC during the second week of February to discuss covering the multimillion-dollar cost of responding to the eruption.
"I was really encouraged with ACC's willingness to come to the party and understand what the direct costs related to these patients are," White said.
"The Ministry [of Health] are very keen to ensure that DHBs that have incurred additional costs are sorted for those.
"There's the cost of standing up the incident team and we spoke to them about that - certainly our expectation's that ACC will meet that."
Meanwhile, CMDHB was still establishing whether any elective surgeries, some of which were put off following the eruption, would need to be outsourced to other hospitals.
The potential additional costs to CMDHB of elective surgeries being displaced had been raised, White said.
"We have flagged that. While we are meeting our planned care targets, we still have a number of patients that have been displaced and our board might decide that actually we want to incur additional outsource costs to remedy that," White said.
The board would continue engaging ACC over the coming weeks to confirm the actual costs incurred during Middlemore's response. It remained unclear whether CMDHB would be reimbursed in the form of a straight-up cash payment, White said.
ACC hoped to have a proposal confirming the first tranche of repayments to DHBs ready in late March, she said.
The Whakaari/White Island eruption stretched Middlemore Hospital's human and material resources.
Late last year, Middlemore Foundation chief executive Sandra Geange said the hospital's National Burns Centre was "short on a couple of pieces of equipment" needed to treat badly burnt patients undergoing medium-to-long term rehabilitation.
One of the machines, a Sonosite ultrasound, would cost CMDHB between $60,000 and $70,000.
A $25,000 specialised skin graft machine, called a MEEK mesher, was also needed.
In January, Geange said more than $100,000 had been donated to the National Burns Centre the week following the foundation's public appeal on 19 December.
"We have continued to receive donations this year at quite significant levels," she said.
An ultrasound machine had been purchased for the burns centre's intensive care unit, as well as skin grafting equipment and entertainment devices for patients.
Whakatāne District Council last week revealed its costs associated with the disaster were up around $500,000.
Ngāti Awa holds the exclusive licence to land vessels on the island.
It paid $9m for White Island Tours in 2017, in a bid to expand its asset base and develop employment for iwi members.
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