Doctors ordered to discharge patients from hospital before ready: union

South Australian doctors are being directed by hospital administrators to discharge patients before they are clinically ready and data is being manipulated to make wait lists look better than they are, a parliamentary committee has been told.

Mar 09, 2021, updated Mar 09, 2021
Photo: Tony Lewis/InDaily

Photo: Tony Lewis/InDaily

SA Salaried Medical Officers Association chief industrial officer Bernadette Mulholland made the startling revelations this morning while giving evidence at a parliamentary committee on health services.

“The pressure to get people out of hospitals has become so great that we are now seeing administrators actually directing medical officers to discharge patients before they are ready to go,” she told the committee.

“That’s only happened in the most recent weeks and we’ve raised that on a couple of occasions.

“The focus is clear for the health administrators and for the board – it’s about finance, it’s not about championing the hospitals, it’s not about championing the clinicians and it’s not about championing the patients.”

Mulholland said it was a “terrible indictment at the moment on our health system”.

“We need clearly more funding in our health system and that’s not happening and we see a focus on cuts and limiting of care rather than working together to bring the most efficient, world-class standard of care that we would expect in country like Australia,” she said.

Mulholland also said there was “manipulation of data” of patient wait lists.

“So we see wait lists that our medical officers will say are a lot longer,” she said.

“There’s a lot of manipulation of the data to give an appearance that the health system is in a better way than it probably is.

“We’ll hear within the media that wait lists are down and wait lists are being addressed and then we’ll get calls from our doctors to say that wait lists are not down.”

Mulholland said there was “a great deal of burnout amongst our medical officers”.

“There are people or trained medical officers who are now leaving,” she said.

“I am aware of in the last four weeks in one particular local health network where we had five doctors actually resign.

“Their decision was to leave a system that was too difficult to be party to and wasn’t helping their patients or they couldn’t help their patients, so they determined to leave.”

Mulholland said the union was contacted by up to two doctors every week “incredibly fatigued and distressed, suicidal potentially and no longer want to work in the system”.

“And that’s a terrible indictment I think on where we’re at at the moment,” she said.

Mulholland said the pressure on junior doctors was particularly severe.

“Certainly the greatest impact is on our junior medical officers,” she said.

“They work extended hours which they are not paid for. They are on individual contracts which makes it difficult for them to actually raise concerns about behaviours or to challenge the fact that they are expected to work way beyond their hours.”

She said where junior doctors have challenged their work conditions “that hasn’t ended well for them”.

“They’ve been moved, they haven’t got a job in the following year, they have been replaced,” she said.

“The issues around bullying and harassment and fatigue have been an ongoing topic for as long as I’ve worked with the Salaried Medical Officers Association which is now 13 years.”

Mulholland claimed the case of a baby last week having “life-saving” surgery cancelled at the last minute at the Women’s and Children’s Hospital was because of “budgets”.

“My understanding was that… there wasn’t the nurse component to be able to staff those beds… it would have been devastating to those clinicians not to be able to provide that care at that time,” she said.

“That’s the sort of feedback that you get and the difficulties that arise is simply about budgets.”

SA Health has rejected that, saying the baby’s surgery was postponed not because of budgetary issues but rather because of higher priority emergency cases that presented.

Mulholland also raised concerns about paediatric services being “stretched”.

“We know of services in there that have one doctor to work 24/7 – it’s ridiculous,” she said.

“Certainly our paediatric services have not been looked at for an extensive period of time, they are poorly resourced.”

Mulholland said she was aware of one unit that had had a business case in with hospital management for 13 years for an extra consultant.

She said, however, the pressure was felt “across all of the units”.

“I know at the end of last year there were 14 business cases put in to the Women’s and Children’s executive to be escalated up to the department for extra staffing,” she said.

Concerns were also raised about a lack of planning for the new Women’s and Children’s Hospital.

She understood there was one less ICU bed planned for the new hospital.

“The treatment spaces were not developed in consultation with the doctors or indeed clinicians,” she said.

“What we are doing is building (the new hospital) too small, which is quite concerning really.

“Over the next five to ten years we’re going to see increasing delays of children being cared for in our hospitals because we are just not putting the funding into the development of it.”

Mulholland also said there was a lack of planning for the new hospital to adequately deal with a pandemic such as COVID.

“We now know that the accommodation and spaces need to accommodate a pandemic,” she said.

“The current way that the proposed treatment spaces are being designed does not provide for a safe environment in a pandemic situation.”

Mulholland also talked about the ramping “crisis” that paramedics have been raising for years and in particular in the past few weeks.

“Oh, there’s an absolute crisis in our adult system on ramping and bed-block in emergency departments,” she said.

“It’s distressing and it flows right through the hospital. Ramping shouldn’t be normal.”

Mulholland said a lack of mental health services across the state was partly to blame.

“One of the comments that was made to me is ‘mental health is probably the worst I’ve seen it at this time’,” she said.

Mulholland said the problem was so severe that hospital executives – not just doctors – had even raised concerns with her about a lack of community mental health services across the state.

“My understanding is it’s because they’re not getting the budget allocation from the department who probably don’t understand what’s happening in those hospitals on a daily basis and at worst don’t care what’s happening in our hospitals on a daily basis,” she said.

A State Government spokesperson said the Marshall Government had invested more than $2 billion extra into the health system since 2018.

“Since the election, we have significantly strengthened engagement with health professionals and their unions and will continue to do so,” the spokesperson said.

“At the WCH, we have provided more than $600,000 to support medical officers to be involved in helping plan the new hospital.

“The Project User Groups (PUGs) play a vital role in the planning and design of the new Women’s and Children’s Hospital (WCH) and have now met more than 500 times.

“The new hospital continues to achieve very significant levels of consultation with almost 1,000 hours already contributed by more than 580 clinicians, 110 other staff and 35 consumers.”

The spokesperson said the final plans for the new Women’s and Children’s Hospital had not yet been determined “however they will have more treatment spaces, hundreds more carparks and will be a world-class hospital”.

The spokesperson said “increased infection controls due to COVID-19, such as distancing of patients with respiratory systems in our EDs, and a spike in demand of mental health patients during the pandemic has been a difficult challenge throughout the nation”.

“Western Australia for example has experienced significant (transfer of care) delays of about 4,000 hours a month according to recent reports,” the spokesperson said.

“Ramping is unacceptable and this government will continue to work with the doctors, paramedics and all health staff to mitigate its impact.”

Responding to concerns about ramping, Treasurer Rob Lucas this morning told FIVEaa “the claims that the government hasn’t been providing additional resources need to be put to rest”.

“The Auditor-General’s report shows in the first two years of this government we put in an extra 187 full-time staff,” he said.

“This year we’re budgeting for another 76 full-time staff; so 260 additional staff.

“So the point is, the additional staff … just doesn’t solve the problem.”

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