Mental patients kept for days in Emergency

Aug 19, 2014
Ambulances lined up during a busy night at the Lyell McEwin last week.

Ambulances lined up during a busy night at the Lyell McEwin last week.

Acutely ill mental health patients are routinely being confined in windowless cubicles at the Lyell McEwin Emergency Department for between four and five days, medical staff say.

The concern was raised by doctors and nurses last week during an inspection of the department by the South Australian Salaried Medical Officers Association (SASMOA), which also heard that the northern hospital’s emergency department was “categorically unsafe for everyone”.

Senior doctors, junior doctors and nurses told the SASMOA inspector that:

  • It was “the norm” for mental health patients to be confined to windowless cubicles for between four and five days, waiting for a bed.
  • A mental health patient had been waiting for nearly five days in a cubicle at the time of the inspection.
  • Public waiting rooms and corridors have been used to assess and diagnose patients when all other spaces are occupied.
  • General medical patients, requiring immediate medical attention, were being made to wait for hours because of an overwhelming number of mental health patients.
  • The capacity of the Emergency Department to provide health care to general medical patients had been decreased by 30 per cent because of the backlog.
  • The hospital environment was dangerous for patients and staff  – and a patient had recently “smashed up the Emergency Department”.
  • Staff and patients regularly suffered threats of violence from mental health patients, and their numbers were significantly over the capacity of the Emergency Department.
  • Hospital management and the Health Department had known about the dangerous conditions at the hospital “but they do nothing to address the situation”.
  • “Patients will die in this environment and the hospital will blame us and accept no responsibility for the conditions of the service”.

Senior emergency doctor at the Lyell McEwin, David Pope, told InDaily it was now common for 80 patients to be at the Emergency Department requiring treatment, when it has the capacity to treat just 42 patients.

The overcrowding, he said, meant patients’ health would deteriorate while they wait unacceptably long periods of time for treatment.

“Patients have been known to spend six days in cubicles in the Emergency Department after they’ve been assessed as needing an acute psychiatric bed, and they stay for that long waiting for that bed to become available,” he said.

“Meanwhile, they’re not getting the proper care or treatment that they need.”

“Some [patients] will die when they otherwise wouldn’t have died.”

Pope said the Emergency Department was unsafe for staff and patients.

“You’re probably talking close to one actual assault every one to two weeks,” he said.

“There have been multiple events where SWAT teams have needed to be called to control certain patients.”

“We’ve had police in the department threaten to shoot people because they can’t contain certain behaviour.”

He said the necessity to assess general medical patients in public waiting rooms and in corridors when the Emergency Department was over capacity hobbled doctors’ ability to properly diagnose patients.

“You can’t properly talk to people in the private way, so they often are not able to give you their complete story because they feel uncomfortable doing so and you’re not able to properly examine them either.

“So enormous shortcuts are taken, and when you take shortcuts in medicine, you’re likely to make diagnostic errors. And those errors can be catastrophic for patients.”

He said SA Health had a responsibility to invest more resources so that doctors could safely and satisfactorily deal with an increasing demand for emergency medical care.

“We’ve seen a dramatic decline in acute mental health beds with ongoing closures over the last few years … where they’ve left those patients with nowhere to go.”

“Those patients have to have somewhere to go. They can’t be put out on the street; they’re just too unwell.”

A spokesperson for Health Minister Jack Snelling said he had not received any advice that supported the view that the hospital was unsafe.

However, the SASMOA inspector who compiled the report, Bernadette Mulholland, said SA Health had already acknowledged that conditions were unsafe at the Emergency Department, and had suggested strategies to improve the situation.

“[SA Health representatives] have confirmed that they don’t disagree with what we’ve put forward – that there are certainly issues of safety for the staff,” Mulholland said.

“They have met with SASMOA. They have met with a more broader group of clinicians at the Lyell McEwin Hospital and established some clear strategies that we’re not unhappy with.”

The spokesperson for Snelling told InDaily that the minister had not seen the inspection report and would therefore not be commenting on it.

The spokesperson also said “the CEO of the Northern Adelaide Local Health Network (Margot Mains) is responsible for the day to day operations of the Lyell McEwin Hospital.”

SASMOA has referred conditions at the hospital to SafeWork SA, alleging that senior management at the hospital and the department had breached the Work Health and Safety Act.

“Our view is that they’ve breached the health and safety of the medical officers by placing them in these compromising positions,” Mulholland said.

“They’re breaching the health and safety and the welfare of the patients, and they’re breaching the health, safety and welfare of the families and other patients who arrive to be provided with appropriate assistance from an Emergency Department.”

Mulholland said the entire South Australian hospital system was struggling to meet ballooning demand for emergency medical assistance.

“A year ago we could have relied on the Royal Adelaide hospital to pick up that surplus of patients that were moving through the process. That capacity is no longer there.”

“This isn’t about the patient. This is about the patient’s situation.

“It becomes an environment not good for anybody.”

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