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Doctors unite against 'dangerous' Modbury plan

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Doctors at two Adelaide hospitals have united in opposition to State Government health proposals they say will put patients at risk, InDaily can reveal.

Doctors from the Lyell McEwin Hospital (LMH) and Modbury Hospital met last month, warning in minutes seen by InDaily that there would be “dangerous consequences” if the plans to downgrade Modbury’s emergency department go ahead.

Modbury Hospital’s emergency department was upgraded by the State Government at a cost of $17.4 million in the lead-up to the 2014 state election.

Health Minister Jack Snelling argued at the time that because Modbury was seeing around 40,000 patients per year – and that number was growing – it was the State Government’s intention “to significantly expand public hospital facilities in the north and north-east to enable more people to receive health care locally”.

“This includes the redeveloped Modbury Hospital Emergency Department, which has almost doubled its treatment and assessment bays from 23 to 40,” he said in a January 2014 media release.

Under the Transforming Health proposals unveiled last month, Modbury Hospital would continue to provide “24-hour emergency care for the local population”, but “life-threatening emergencies” would be handled at the state’s three largest hospitals, the closest being the LMH.

However, new figures reveal the larger hospitals, especially the LMH, regularly transfer patients to Modbury when overcrowding occurs.

Figures provided by doctors to InDaily show that in January this year, 112 patients from the LMH, 19 patients from the Royal Adelaide Hospital, six patients from the Flinders Medical Centre and seven patients from the Queen Elizabeth Hospital were transfered to Modbury for care during periods of “load levelling”.

On 10 occasions, a period of load levelling lasted for more than four hours.

On three occasions, the load levelling period lasted more than six hours.

“We are taking the heat off the LMH and the Royal Adelaide Hospital emergency departments now,” one doctor told last month’s meeting.

“Decreasing our capacity will not allow that flexibility for surges of activity that will always happen in our profession.”

Australian Medical Association SA President Dr Patricia Montanaro said it was “very curious behaviour” for the government to upgrade Modbury Hospital emergency department and then propose a downgrading of its functions.

She said there should be no change to the Modbury Hospital until “bed block” issues at the Lyell McEwin Hospital are solved.

Patients with serious trauma, including the most serious strokes and heart attacks, are already often diverted from Modbury Hospital to the Lyell McEwin Hospital.

However, a Modbury Hospital doctor told InDaily, “two separate audits at Modbury showed that just over 45 per cent of patients with the ultimate diagnosis of a stroke arrive by private transport”.

“(Modbury Hospital) has significantly increased its (emergency doctor) numbers in the last three years,” another doctor told the meeting.

“It has undergone a major renovation and is now functioning well as an ED.

“This Transforming Health proposal has the potential to do major harm by reversing the changes made in Modbury over the last few years.

“It is not unreasonable to extrapolate this to potential harm to patients.”

The minutes of the meeting reveal that “the LMH emergency department consultants are opposed to the downgrading of Modbury Hospital ED from how it currently functions”.

“Any downgrade of its current function will lead to dangerous consequences.”

One Modbury doctor, who did not wish to be named, told InDaily that his colleagues were “100 per cent opposed to the changes”.

“The reason we were upgraded was that (the State Government) identified that the Lyell McEwin Hospital was having increasing difficulty coping,” the doctor said.

“We just think the whole thing’s poorly thought out and it does not take into account what’s happening on the ground at this time.

“It beggars belief that now they will downgrade us now.”

Snelling told InDaily this morning he would not be able to comment further on the Transforming Health process until thousands of submissions on the proposals had been reviewed.

“We released our Transforming Health Proposals Paper four weeks ago, we have spent the last four weeks explaining the reasons behind these proposals,” said Snelling.

“During that time more than 2,300 individuals and organisations put in submissions to our proposals and we are now going through those submissions.

“Once we have looked through them we will be able to comment further on the Transforming Health process.”

One of the doctors at the meeting claimed that the hospital saw around 6,000 priority one and two patients (those suffering the most serious illnesses requiring emergency care) last year.

“Given the (larger) emergency departments routinely operate at 150 to 200 per cent capacity, goodness knows where the extra patients will go,” said another.

A Lyell McEwin doctor told the meeting: “We don’t have the physical space to see extra patients”.

“We already have patients in our corridors and, or, ramping of ambulances to cope with the current workload.”

Doctors also expressed concern about the speed of transfer to the LMH in “life-threatening emergency” cases.

“Where will the (ambulance) services for those transfers come from, given we often wait four to six hours now for a patient transfer?”

“Large numbers of transfers are expensive, unsafe and do not work.”

The Transforming Health proposals include increases to staffing levels in unspecified numbers at the Lyell McEwin Hospital.

“We want to better support our emergency departments by having more senior clinical staff available in the hospital after hours and on weekends, so treatment for an admitted patient starts sooner,” a fact sheet on proposed changes at the LMH reads.

“It will also create capacity in the Emergency Department, improving waiting times and patient outcomes.”

The corresponding Modbury Hospital fact sheet also commits to having more senior clinical staff available in the hospital after hours and on weekends.

SA Health told InDaily: “Following the release of the Transforming Health Discussion Paper and the Proposals paper, we have received a total of approximately 4,500 submissions from staff, unions and the community, and also hosted a summit involving over 600 clinicians”.

“All of this feedback has helped to shape discussions and will help to inform the final decisions, which will be released in due course.”

It remains unclear if or when the host of submissions will be made public.

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