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Inquiry into RAH 'overcrowding' deaths

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SA Health has launched an investigation into the deaths of patients treated at the Royal Adelaide Hospital which doctors say were due to extreme overcrowding.

One of the deaths has been referred to the Coroner, SA Health told InDaily in a statement today.

The report from a September 1 inspection of the hospital by the South Australian Salaried Medical Officers’ Association (SASMOA), seen by InDaily, contains claims by doctors that “dangerous” conditions in the hospital’s emergency department have caused deaths.

“This is an appalling and unsafe environment (and) patients have died due to overcrowding at the RAH, and more will die,” one of the doctors told SASMOA inspector Bernadette Mulholland.

Another said that a “mental health patient had died and the RAH had let that patient down”.

Details of the alleged deaths remain unclear, but Mulholland said she believes the claims are credible.

“Given these medical officers are highly professional I do not see this as an exaggeration and take the matter very seriously, and would ask the department and Safework SA to do the same,” she told InDaily this morning.

“We’ve referred the matter to Safework SA, we’ve scheduled a meeting with the employer and I would hope that the department itself would now conduct an investigation into the matter.”

When asked about the claims of patient deaths at the RAH due to overcrowding, SA Health said: “After being notified of the death of a patient in the community, SA Health referred the case to the Coroner to be investigated. SA Health is also conducting a thorough investigation into these claims.”

Mulholland said conditions at the Royal Adelaide Hospital emergency department were “critical and concerning – very much concerned for the patients, and very much concerned for the medical officers’ welfare”.

SASMOA has written to Safework SA alleging that Royal Adelaide Hospital management has committed several breaches of the Work and Safety Act by not providing a safe workplace environment for staff.

Doctors quoted in the inspection report said no meaningful action had been taken by hospital management or SA Health in response to dozens of official incident reports submitted regarding lengthy patient waiting times in the emergency department.

One doctor said: “73 Safety Learning System (SLS) reports have been submitted in relation to mental health patients waiting excessive periods of time in the RAH ED between July 2013 and June 2014”.

“Eighteen patients (had waited) for five days or more; 32 patients for four days; 33 patients for three days and 11 patients for two days and nothing happened.”

Another medical officer said: “The use of the SLS reports are designed to protect corporate and are not designed for the protection of patient care.

“It is such a poor tool and if you send in an SLS they just send it back to you.”

“The SLS system is not based on patient care and safety it is designed to protect the employer from liability”, said another.

“I have been sending emails to Executive regarding the appalling conditions that mental health patients in the RAH ED are experiencing, patients are going to die,” said another.

“… there is no dignity, this is institutionalised discrimination and torture and we are being asked to do this by management, I did not sign up for this.

“I am angry, livid, I am professionally exposed and compromised.”

Another medical officer said: “I have sent two emails per week to management and have done so for 12 months regarding how unsafe the environment is for patients.”

“One patient’s mother complained to the media and their local member and then Executive moved the patient.”

In a statement to InDaily, SA Health said: “The Safety Learning System (SLS) enables staff and managers to identify any potential risk or concern so they can be investigated and appropriate measures can be taken to prevent them occurring again.”

Over the past two months, InDaily has reported claims by doctors that overcrowding in South Australia’s public hospitals has caused mental health patients to be confined for several days in emergency departments and to be “chemically restrained” while waiting for acute psychiatric beds to become available.

Overcrowding has also been blamed for the need to carry out physical examinations on some patients in public waiting rooms and for hundreds of violent threats against medical staff.

This latest report reveals claims similar problems exist at the Royal Adelaide Hospital.

“Due to the RAH ED environment for mental health patients and the length of stay, it’s noisy, they (mental health patients) can’t be quiet, we tie them up, sedate them, next to granny in the other bed who is terrified,” a doctor said.

Mulholland said now was not the time for various parts of the health system to blame each other for the crisis in hospital emergency departments.

“Let’s look at the solutions rather than the finger-pointing,” she said.

“What we’d like to see is some interim solutions, firstly, which would include the opening of more mental health beds.

“Let’s start making some beds available to put these people in and stop them residing in the emergency department.”

Despite this, Mulholland commended hospital management for its response to the inspection report.

“The employer are taking the matter very seriously and (is) looking to implement solutions to address the issue,” she said.

“We think that if we sit down with the department and with the minister, who has shown very good leadership skills in this matter, solutions can be found and I’m optimistic they can be.”

SASMOA will meet with hospital management next Friday.

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