Patients sedated ‘because of bed shortage’

Sep 08, 2014
File photo.

File photo.

Mental health patients have been sedated because of bed shortages at the Queen Elizabeth Hospital (QEH), doctors say.

Medical staff told a union inspector last month that between four and five acute psychiatric patients are “chemically restrained” each day at the Emergency Department.

An inspection report by the South Australian Salaried Medical Officers’ Association (SASMOA), obtained by InDaily, reveals mental health patients have been confined to the QEH Emergency Department for up to five days when acute psychiatric beds are unavailable, exacerbating patients’ conditions and forcing medical staff to use chemical restraints.

Over the weekend, Health Minister Jack Snelling announced that 12 mental health beds – four at the Lyell McEwin Hospital and eight at Glenside Health Service – would be reopened to help reduce overcrowding.

Last month, InDaily revealed that mental health patients at the Lyell McEwin Hospital Emergency Department were being regularly confined to windowless cubicles for between four and five days, waiting for acute psychiatric beds to become available.

This morning, new claims of extreme overcrowding and its effects on patients and staff have emerged in the western suburbs, including patients being examined in public waiting rooms and sensitive patient interviews being conducted in public places.

Doctors claim that:

  • Physical and chemical restraints have to be used each day on mental health patients whose conditions are exacerbated by extended waits in the Emergency Department.
  • Between four and five mental health patients are chemically restrained each day at the QEH Emergency Department.
  • Physical examinations of patients have had to be conducted in public waiting rooms when no other space is available.
  • Patients’ symptoms are being misinterpreted because they cannot explain their conditions while being assessed in public.
  • Mental health patients are having to answer questions such as “do you feel suicidal?” in public waiting rooms.
  • Hospital management has repeatedly failed to increase staff numbers adequately during periods of extreme overcrowding.
  • The Emergency Department has been operating above capacity for at least six weeks and is “unsafe and dangerous, waiting for something to go wrong”.
  • On August 17, the QEH was functioning at over 200 per cent capacity for most of the day, peaking at 245 per cent.
  • On the day of the inspection (August 24), a mental health patient had been in the waiting room for five days.
  • Hospital management has no formal procedure relating to ramping at the hospital, although a draft for the process has been circulated amongst medical officers.

Doctors quoted in the inspection report pinned the blame on hospital management for many of the problems:

“A patient will die because of what management are requiring this Emergency Department to do.”

“Overcrowding is now happening every day. It’s unsafe, it’s dangerous and patients will die due to the overcrowding.”

“It’s not changing, it’s not slowing, overcrowding is growing and it’s clearly unsafe for patients and staff.”

“It’s a domino effect: delay for one patient means delay for the next and the next and so on. Next thing you know, five or six patients who should have been cared for have all been delayed, all have had their care compromised.”

“My experience is that if you express concern regarding the unsafe conditions with management, management puts a spin on your concerns and suddenly it’s your problem if you put in an SLS (Safety Learning System report).”

“The nursing numbers aren’t right, management don’t increase the number of nurses when there is overcrowding, making it more unsafe.”

InDaily has also obtained a letter from the advocate for mental health patients in hospitals, Principal Community Visitor Maurice Corcoran, to Minister Snelling dated August 12.

“I am writing to you because of my sincere concerns about the numbers of mental health patients presenting to all out Emergency Departments (EDs),” the letter reads.

“Just last week at the QEH, we were informed that they are now regularly having patients staying for 4-5 days where previously, this would have been only during the peak times.

“The longest recent stay for a (mental health) patient in QEH ED was 7.45 days …

“I believe there is a direct correlation between the length of stay, the likelihood of physical and chemical restraints being applied and Code Blacks (an emergency response to threats of physical violence) being called.”

SA Health told InDaily in a statement that South Australia’s hospitals have been experiencing unprecedented demand, due in large part to a large increase in flu and other respiratory conditions.

“Additional staff have been rostered to the QEH Emergency Department throughout this period to help manage the increase and ensure patient care is not compromised.

“All mental health consumers who attend the ED are treated as quickly as possible and the use of chemical restraint is only ever used if a clinician determines that is an appropriate response to the patient’s condition.

“Out ED staff are doing an outstanding job in exceptionally challenging circumstances.”

Chief psychiatrist Peter Tyllis’ told InDaily last month that the reason mental health patients were being held in emergency departments for “unacceptable” periods was a lack of integration in the mental health system, not a lack of beds.

“There’s this discussion about a reduction of beds, but in fact there’s been an increase in the overall beds and places available for mental health consumers since the reforms started,” Tyllis said.

“By the time the reforms are completed in 2015, in total there will be an additional 102 beds and places for mental health consumers.”

Executive Officer of the Mental Health Coalition – the peak body for the non-government mental health sector – Geoff Harris said more investment was needed to prevent people requiring emergency department services in the first place.

“In South Australia we already have the highest number of beds per capita in the country,” Harris said.

“We need to increase our investment in services that will support people to live and stay well in the community and reduce the flow into ED.”

“This is a complex problem but we do know that supporting people effectively before and after a crisis will reduce the likelihood of future crises. This approach leads to better long term mental health and quality of life for the individuals and their families.”

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