Problems in Hospital Emergency Departments - Dr David Mountain, AMA Spokesperson for Emergency Medicine

Australia now knows this happened to 32 year old Jana Horska at Sydney's Royal North Shore Hospital a few days ago. It has sent shock waves around this country and it begs the question, how does this happen?

Joining me on the program now is Dr Dave Mountain, spokesperson on emergency medicine with the AMA.

David, good morning.

DR DAVID MOUNTAIN: Good morning. How are you?

SIMON BEAUMONT : I'm very well. Five other women have come forward to say they have had similar incidents in Sydney hospitals. Can this happen in other Australian hospitals? Could it happen here in WA Emergency Departments?

DR DAVID MOUNTAIN: Absolutely. I mean, it's not just isolated to one place or one time. This is what happens when you have a degradation of emergency services throughout the country because of the chronic over-crowding in our Emergency Departments.

SIMON BEAUMONT : All right. I mean, the details of this story I suppose are important here. The woman presented in acute pain at 7:15pm at night. She told staff she had had a previous miscarriage. She was told repeatedly to wait. She was squatting on the floor bleeding. She eventually miscarries in a toilet.

This may be heresy, David, but is this - but have hospital staff stuffed up here?

DR DAVID MOUNTAIN: I - it's very difficult. I'm not really keen to cast blame because you always need to know the circumstances of the Department and what happened. So I think you only - you know, there's an inquiry going to go on and I think, you know, if there are problems with the staff.

I think what people don't realise...

SIMON BEAUMONT : Let me ask you this then, Dave, how would that situation have been handled in a Perth hospital?

DR DAVID MOUNTAIN: Well, let me tell you that in Perth hospitals recently there have been people with dislocated shoulders who have been unable to get an intravenous analgesia and have been in waiting rooms.

There have been people who - with epigastric pain who actually ended up having heart attacks and then had a cardiac arrest before they got into a resuscitation bay in Perth hospitals recently.

So, that's why I don't think it's wise to cast stones. The real issue is with the way our Departments are run. On a particular day when you're under these sort of pressures all the time, what happens is that the level of care that you normally want to provide gets degraded because you're so used to your Department being overwhelmed by the lack of resources and the lack of space and capacity in our system.

SIMON BEAUMONT : Okay. And that happens behind the front counter, as it were, once people come in and present to hospital and are asked to take a seat or we'll get to you as soon as we can; that happens behind the scenes.

But can I ask the question again: you work in Emergency Departments, Dave, here in Perth...

DR DAVID MOUNTAIN: Yes.

SIMON BEAUMONT : If that woman had come into RPH and how would that have been handled; that situation with that woman who was miscarrying?

DR DAVID MOUNTAIN: Look, you would hope that if it's obvious that somebody is having a miscarriage - and that's the point, you know, was it obvious that that something was imminent - that they would have been offered pain relief, you would try and get them in as soon as possible onto a bed, and get them into the Department.

The real issue is can you spot that, is it obvious to the person at the front desk. And then do you actually have a bed or a trolley available.

One of the big problems we've got is that we run out of trolleys on a routine basis now in our Department, so that we do not have trolleys left for anybody to get onto a trolley. So there's actually no space or nowhere to actually put people even when they're acutely unwell and clearly distressed and in pain.

SIMON BEAUMONT : Dave, so in trying to break it down - and, look, this is - I think this must be close to the hundredth interview I've heard on this type of issue in Western Australia in the five or six years I've been working on programs like this. Can we break it down into facilities, into staffing, into things like equipment? Can you just put in a request to ask for more trolleys?

DR DAVID MOUNTAIN: Well, there's no point in asking for more trolleys because the point is that then you are just going to load up a Department that's already overwhelmed, that can't look after the patients in it. You're just creating bigger parking lots.

What we really need to do is sort out the back-end which is the hospitals and the capacity of the system and make sure that there's actually space to move people through the system. Creating bigger logjams at the front or in the Department or in the ambulance bays is not the answer.

You don't sort out traffic jams by creating bigger parking lots. You sort those out by getting better flows through your system, creating capacity in the system and actually making sure that there are beds available for patients who are already admitted to go to.

That is the overwhelming issue for our health system...

SIMON BEAUMONT : The...

DR DAVID MOUNTAIN: ... unfortunately one our bureaucrats and Ministers don't really want to sort out.

SIMON BEAUMONT : All right. And if you asked any senior bureaucrat of health, if you asked Dr Fong, or if you asked Mr McGinty, they would say it's a balancing act between - health is not a black hole, you just can't keep pouring money into it, you can't have the place fully staffed and every bed open...

DR DAVID MOUNTAIN: That is absolutely...

SIMON BEAUMONT : ... just on contingency.

DR DAVID MOUNTAIN: That's absolutely fine as long as they're willing to make the decisions about who is not going to get care. But they don't say that. What they say is you've got a great health system and it's completely open, and anybody who needs care will get dealt with adequately.

Their job is to actually make the decision about who doesn't get care.

SIMON BEAUMONT : David, is there any light at the end of the tunnel? We know about the Reid report, we know that the Fiona Stanley Hospital is coming some - you know, a long way down the track. I mean, we still have some way to go before we see the new facilities being built.

What needs to be done in the short and medium term before Fiona Stanley is up and running?

DR DAVID MOUNTAIN: Well, I mean, all this - the problem is when you're rebuilding or reconfiguring a system is in fact you lose some capacity during that. So really they need to be working very hard now to actually gain capacity in the system to give you a buffer because you're going to lose some staff when there's hospitals being moved around, while you're rebuilding and doing things in place as you lose beds and capacity.

In fact, we haven't done any of that so far. In fact, if you look at the numbers in the Reid report there's hardly any new beds in the system even though we're growing at two per cent a year.

So I don't see a great deal of light at the end of the tunnel unless there's some urgency shown about getting things sorted out.

There has been some signs of increased urgency recently but it's - you know, you need more than a band-aid approach; you need a strategy that's going to continue for the foreseeable future to actually make sure there's adequate care for people presenting with emergency problems.

SIMON BEAUMONT : What has happened in the broader community, Dave, where more and more people do present at Emergency Departments? Why the overcrowding? Is it a range of things? Is it more drugs and alcohol, particularly on weekends, that see more people present? Is it the fact that there's not as much bulk billing with GPs and people do present at Emergency Departments with things that ordinarily they'd go to their local doctor for? Is it a range...

DR DAVID MOUNTAIN: That's only - it's not really. Certainly for the major hospitals anyway, it's certainly not the GP type patients that are causing the problem. The real issue is that we just - we have more admissions. I mean, we have a sicker, older - often not sicker. I mean, they're people who are very well cared for but eventually everybody gets sick, you know. So we have more people with - living longer with more illnesses, and they present, and they actually need admission to hospital. And that's the problem.

And we do have a problem with under-resourcing in general practice to manage chronic disease and chronic disease programs. Again, that's been under-resourced for a long time.

But generally it's been a blinkered view about that you don't really need hospital beds to manage people. But they've never really put in place proper programs that actually stop people requiring hospital beds. And in fact there's always going to be a certainly percentage of the population that are going to require a hospital bed and an admission. And that's really been the major problem.

SIMON BEAUMONT : All right, David, good to talk to you this morning. We appreciate your time.

DR DAVID MOUNTAIN: Thank you very much.

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