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Modbury Hospital policy risks avoidable deaths: surgeons


Patients that arrive with a severe airway blockage at Modbury Hospital could die unnecessarily because of a new SA Health policy, surgeons have warned.

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Patients that arrive at Modbury Hospital with a severe airway blockage no longer have access to a surgical theatre, or to specialist surgeons and anaesthetists occupied performing day surgery, under the newly implemented Transforming Health policy.

The “stage two” policy of Modbury’s “transformation”, implemented early this month, included the eradication of emergency surgery services in favour of elective day surgery.

Children and young people are most vulnerable to infections that can cause severe airway blockages, though adults can also suffer the condition.

Saving such a patient’s life often requires the expertise of a specialist ear, nose and throat (ENT) surgeon, a consultant anaesthetist and others for a procedure in which a tube is inserted into the patient’s throat. The condition sometimes requires an urgent tracheotomy – opening a hole at the base of the patient’s neck for breathing.

“It’s quite possible that someone might die because they can’t access the treatment,” the SA Chair of the Royal Australasian College of Surgeons, Dr Sonja Latzel, told InDaily.

Latzel, an ENT surgeon, said that while the condition was rare, the consequences of failing to treat it were extreme.

“An airway emergency is always extremely dire,” she said.

“The policy has had to change because surgeons and anaesthetists don’t have access to theatre for this [condition].

“They’re not allowed to take those patients to theatre, which is the safest place [for the procedure].

“There’s a risk that patients will die.”

She said an unusually high number of compromised airway patients had presented at Modbury recently – about five over the past year.

President of the South Australian Salaried Medical Officers’ Association, senior Lyell McEwen Hospital emergency department doctor David Pope, told InDaily  his association had contacted SA Health warning about the policy.

“We’ve told them this is a problem,” Pope said.

“If, and when, adverse events occur it will be the management, not the doctors, that will need to be held accountable to the coroner [and] to the public.”

He said that in normal hours, Modbury Hospital surgeons and anaesthetists are tied up in surgery, and cannot attend the emergency department in the case of a severe airway blockage, and those medical professionals were not present in the hospital at night time.

However, acting CEO of the Northern Adelaide Local Health Network Scott McMullen told InDaily in a statement this morning that “patients with a compromised airway are managed appropriately by our team of specialist doctors and nurses at Modbury Hospital”.

“We have engaged extensively with our clinicians regarding appropriate pathways for patients requiring emergency surgery and are continuing to work closely with staff to improve health services in the north and north east.”

InDaily understands the airway policy is on the agenda for a meeting of medical staff with hospital management this afternoon.

Modbury Hospital head of anaesthetics Dr Tim Hunt told InDaily the new SA Health policy involved a consultant anaesthetist being called out from the Lyell McEwen Hospital in the case of a severe airway blockage patient at Modbury – which could take about half an hour.

But he said the policy was “temporary” and would be addressed at this afternoon’s meeting.

Latzel said the Government had, so-far, failed to educate the community about changes to Modbury Hospital that had been implemented under Transforming Health.

“If this policy is to stand then the government must educate the community,” Latzel said.

“Modbury Hospital has been a full service hospital for many years.

“The general public don’t understand [that services have been] dramatically altered.

“Patients will continue to present with serious surgical problems.

“The community must be educated that they should … go to another hospital [for conditions requiring emergency surgery].”

Latzel said she was concerned by reports from surgeons that ambulance transfers from Modbury Hospital to the Lyell McEwen Hospital remained slow and often required patients to wait for hours.

However, Ambulance Employees Association General Secretary Phil Palmer told InDaily transfer times between the hospitals had been adequate.

The Government’s Transforming Health program aims to make Modbury a “centre for excellence” in day surgery, with patients to be transferred to the Lyell McEwen or the Royal Adelaide Hospital for emergency surgery.

Transforming Health materials distributed by the Government urge patients to call an ambulance rather than self-presenting to hospital.

“In an emergency, always call 000. Please do not self-present to a hospital or your local GP,” a Transforming Health brochure for Modbury Hospital says.

InDaily asked SA Health what proportion of patients self-present, and how many arrive in an ambulance at Modbury Hospital, but received no response.

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