Matter of Public Importance - Launceston General Hospital Emergency Department Crisis
Mrs Armitage (Launceston) (by leave) - Mr President, in accordance with the provisions of standing order 32(3) I move -
That the Council does now adjourn for the purpose of discussing a matter of public importance, namely:
the current crisis in the Launceston General Hospital emergency department and the public concerns surrounding it.
Mr President - In accordance with the Standing Orders, are there three members prepared to rise in support of the proposed motion? That being the case, I again refer all members to what was stated at the commencement of the morning, that the duration of the debate shall not exceed two-and-a-half hours. There is no right of reply and at the conclusion of the debate the member for Launceston will seek leave to withdraw the motion.
Mrs Armitage (Launceston) - Mr President, I thank the members for standing.
Mr President, I have been aware of this issue since 6 June and advised the minister of what I consider to be an impending crisis on that evening. The following day I met with the minister and the THS CEO in the hope that this matter could be resolved quickly without causing alarm in the community but unfortunately that was not to be.
While I accept that the minister believes he is doing all he can, unfortunately I do not agree with the Government's approach. I believe we need to keep many of these doctors and nurses who have since resigned or cut their hours. My understanding is that many do not want to go, but they do not know what else to do as the situation has come to a head. The Government blames management and they probably do have a part to play. But if there are no beds in the hospital it does not matter how good management is, patients cannot be moved from the emergency department.
On Sunday I called together a group of people to support our Launceston General Hospital and its hardworking and dedicated staff who so often go over and above what is required or expected of them. The crisis in the emergency department at Launceston General Hospital is a symptom of bigger problems within the hospital itself. We have to ask why we have constant bed block and ambulance ramping, with doctors and nurses leaving.
Whatever the Government does, the emergency department cannot stay the way it is. The minister has mentioned to me the acute medical unit has been in place for several months. I believe it has eight beds. It does not appear to be helping as it should. I have asked the minister and he has agreed there will be a review, to find out if it is not working well, why it is not and perhaps improve the situation.
The emergency department is just that. Patients should come in, be diagnosed, treated and discharged or admitted to a ward, not stay in the department for up to six days or longer. That is not fair on the patients or staff. Statistics show the longer you spend in an emergency department - over a certain number of days - the worse your outcome is. It is really important that patients are moved out of the emergency department.
Another concern is winter is not upon us yet and we know the workload and the pressures will increase. It comes down to a case of supply and demand. The demand is greater than supply and demand requires resourcing.
I will read a couple of letters that have now been published. One was in The Examiner today and one from the ABC. They are certainly on the public record. Monday evening 20 June, the ABC -
A doctor at the Launceston General Hospital has resigned over what she says is a lack of action to address problems in the emergency department. Nine of 11 specialist doctors from the hospital's emergency department are resigning, retiring or reducing their hours.
Dr Grace Sousa is one of the doctors who has resigned. She said a shortage of ward beds in the hospital meant patients could not be transferred out of the emergency department and new patients could not be admitted.
'I'm trying to ask patients personal questions while they are sitting in a chair, in a row of other patients who are being similarly, sort of... mistreated', she said. 'I see patients with dangerous situations in an area that's not appropriate for the issue that they're having. Someone delivered a baby in that area a few weeks ago. It really puts you in a position where you feel like your patients are suffering and that bad things have happened, bad things are bound to happen in an area where we have too much overcrowding'.
Dr Sousa said she did not want to resign but felt she had to because while there had been efforts to lessen the bed block, the problem had not been fixed. 'I think it's just not enough and at some point I think you have to ask yourself if you feel good about what you're doing, if you feel good about how you're caring for your patients, and I think for a lot of us the answer is no' she said. 'I have worked in eight hospitals in the United States but I have never worked in a hospital that closed beds when there was a significant bed block'.
The conditions have been described as "dangerous" by a nurse who continues to work at the hospital. The emergency room nurse who did not want to be named for fear of reprisal said doctors and nurses were leaving because of the stress. 'It's dangerous and it's … from … spreading resources so thin that no-one can safely be doing their job, and even if they do get fly-in, fly-out doctors to be doing that it's still in a very kind of bandaid-type environment and it's just not safe'.
Health Minister Michael Ferguson insisted the resignations were not putting patient care at risk and he blamed a range of factors, including retirements, for falling staff numbers. But the concerned emergency nurse said she did not agree with the minister's take on the situation. 'The reason the doctors are leaving is because of systemic management issues, because of bed block, because of the stress of the environment and the way that it's managed from a governmental state level, and also their pay', she said. 'But that's not the critical issue, it's the working conditions mostly'.
The Examiner today, 22 June -
A Launceston General Hospital nurse says she has never seen a situation as dire as that in the LGH emergency department during her almost 40-year career. Nine out of 11 LGH emergency department consultants have resigned, retired or reduced their hours in the past month.
Doctors, unions, the Greens and the Opposition have linked the staff exodus with a lack of resources and a pay dispute. Health minister, Mr Michael Ferguson, has repeatedly said the situation is under control.
LGH registered nurse Deb Elmer, who works in emergency, said staff could see no end to the issue.
'There's usually 26 admitted patients in the ED which leaves us with no beds for anyone to care for the new patients arriving,' she said.
'Winter's always been bad and this winter will be the worst ever. What we need immediately is more beds.'
Ms Elmer said some patient were taking their frustrations out on staff.
'Some people are understanding, some people get angry - and they get angry with us,' she said.
Mr Ferguson said he and Tasmanian Health Service chief executive David Alcorn had made addressing issues at the LGH their number one priority.
'While it would not be appropriate for me to comment on ongoing industrial matters and discussions with staff, I would like to make it clear that allegations that nine ED doctors have resigned are completely false and discissions are ongoing to support and retain our valued staff wherever possible,' he said.
'It is important that we continue to support those who provide the care and don't overlook the progress that is being made as we implement our longer term reforms. This includes significant service upgrades at the LGH, across a wide range of specialties.'
But Australian Medical Association state president Tim Greenaway said Mr Ferguson had upset some staff with his assessment of the issue.
'For him to say this is an operational matter and there is no systemic problem at the LGH is just wrong,' he said.
'What has happened is it's a chronically underfunded system (and the situation) is compounded by the department cutting the salaries of the consultants.
'He is happy to take the credit where he thinks something's going well but as soon as there's a problem he blames the department and the THS. He can't have it both ways.'
I will make a comment regarding the statement from Tim Greenaway about consultants and their pay. It was mentioned by Dr Richardson in Sunday in the media that many consultants, when they had come to the Launceston General Hospital, relocated to Tasmania. They bought a home, sent their children to school and then to be offered a contract on less pay was, for them, something that was untenable. If you work in an area that is under constant stress, such as the ED, it must become more of an issue if you feel you are undercompensated. I believe on the mainland that Fellows of the Australasian College for Emergency Medicine are given a special loading. We need to remember that the doctors in our emergency department are just that - specialist emergency medicine doctors.
I also acknowledge the Government plans to employ locums, at a considerable cost I might add, to fill the spaces while they advertise for permanent staff. Locums, as good as they may be and I am sure they are very good, are not familiar with the referral doctors, with the current staff or the procedures in the ED. Coming in new, it is only natural because it takes time to develop relationships with other staff. It all helps the working environment and the efficiencies within the department.
Another concern I have, and that has been held by many of the staff there, is to do with the training and the registrars. One of the doctors who has resigned was in charge of training and at the moment there is no-one there to take her place. To take that place, you must have three years of Australian fellowship. If we do not have someone take that place, there will be no accreditation, which makes it very difficult for registrars to undertake training.
I have had many calls over the last week or so. One very sad call the other day was from a husband of a staff member. I do not believe she worked in the emergency department. He said his wife did not know he was calling. He said -
I just need to talk to someone about the fact that my wife is working 12 to 15 hours every day and she is working weekends, and I am really concerned what is going to happen to her. She is so committed to actually making sure she gets her job done, but what happens if she gets sick or if she has a stroke or a heart attack? Will the Government take responsibility and can I sue them for unsafe working hours?
I could not answer that man. I do not know the answer. I said to him, 'Maybe you just need to encourage her to take some time off because if she has an accident or an illness or something happens, she will not be there anyway.' He said, 'She won't, she is so committed.' That is the one thing with the hospital and I can say in all honesty, I believe it is a safe place to go because of the dedication of the staff there. They are working above and beyond and they are doing absolutely everything they need to do to ensure that place is safe. The question is, how long can they continue with the stress they are under?
I also received a copy of a time sheet from another staff member. It showed that people are working well in excess of 60 hours a week because they have to pick up the time that other people are not there. It is terrible stress for people that cannot be continuing.
I believe the current situation in the emergency department is a symptom of a hospital under stress. Hopefully, the new acute medical unit of the extra eight beds can ease the pressure. It has been in place for some time and it does not seem to be working at the moment. We have a great hospital in the Launceston General Hospital, kept that way by the goodwill of the staff. I believe we need to show these staff that we appreciate and value what they do.
I would say to the minister - and I realise he believes they are doing everything they can - at the very least they could try to keep some of the staff who I know do not want to leave. Whatever issues they need to do - bringing locums in is all very well to fill a void for the time being while you try to find other staff. We have great staff there and a lot of them do not want to leave. I would ask the minister and the Government to look at renegotiating to see if they can convince those staff to stay. With winter upon us the situation is only going to get worse. Last week the minister said, 'What is important is we ensure our staff are happy to work in the emergency department.'. I am sure he means that for the whole hospital and the whole hospital system throughout the state, but I ask the minister to please make that happen and keep our hospital a safe place.