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Girl's appendix burst in WCH emergency department after eight hour wait for surgery


An investigation is underway into the care of a little girl whose appendix burst while waiting for treatment in the overcrowded emergency department of the Women’s and Children’s Hospital.

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Her parents have lodged a formal complaint and are now speaking out in the hope of preventing a “tragedy” for another family.

The doctors’ union says the case is symptomatic of a system at breaking point and it comes after frontline medicos told a parliamentary committee that resources at the Women’s and Children’s Hospital are “so thin on the ground now that we are seeing errors”; doctors’ incident safety reports are being downgraded and staff have serious reservations about planning for the new hospital.

Annabelle and David Oates say they took their 7-year-old daughter Audrey to hospital for urgent treatment after their GP diagnosed her with acute appendicitis.

But they say she wasn’t examined by a doctor at the hospital for six hours and didn’t have surgery until 8.5 hours after their arrival – only after her appendix burst while waiting, leaving her in agony.

“She was arching her back and gritting her teeth and screaming – she was in extreme pain,” said Annabelle Oates.

“There were no staff around when it happened.

“I think it put her health at risk. I think it was dangerous.”

In a statement, a spokesperson for the Women’s and Children’s Hospital said “a senior clinician has been in contact with the family to apologise for the delay in treatment”.

“An investigation into the circumstances surrounding the care of the child was launched several weeks ago and is still underway,” the spokesperson said.

Oates said they arrived at the hospital’s “chaotic” emergency department at 3pm on March 1 after their GP diagnosed Audrey with acute appendicitis and told them to go straight to the emergency department.

“There was no place for people to sit,” Oates said.

“There were families of babies who were standing. There were people out in the corridors sitting there. All the seats were taken.

“There were families leaning up against walls.

“I counted 60 people in the waiting area of the ED and that’s not including people in the corridors. According to a sign the COVID limit was 30.

“There were lines all the way down the corridor just to get to the first window.”

Oates said Audrey wasn’t examined by a nurse until 6pm, and then a doctor at 9pm who ordered blood tests and an ultrasound.

Oates said at 9.30pm her daughter was examined by a surgeon who said she needed surgery.

Audrey was given pain relief but her condition quickly deteriorated.

“She just wasn’t given the care that she needed at the time,” Oates said.

“Going through extreme pain is one (thing), but you don’t know whether she could have died or whether she could have had permanent injuries as a result.”

Oates believes Audrey’s appendix ruptured about 10pm, leaving her writhing in agony.

She was given stronger pain relief and had surgery about 11.30pm, and stayed in hospital for nine days.

Oates said she was told by a doctor after the operation that “it was a nasty surgery”.

“He said her appendix had a hole in it, it had ruptured, and around the bladder area there was an infection there as well so they couldn’t just do an easy surgery,” she said.

“They had to do a fair bit to get all of the infection out of her body. Then she had this drain as well.”

Oates said “this could be anyone in the state that this happens to”.

“It could have been way worse than what it was – if we had gone home,” she said.

“It’s really quite serious.

“And also the implications of having all those poisons throughout her body.

“There were families who left with the big wait, kids with head injuries, and they didn’t receive medical care.”

Oates said she “felt really sorry for the doctors and nurses and staff because there weren’t enough of them to deal with the amount of people coming in”.

“Audrey was able to get the surgery even thought there was a delay in it,” she said.

“But you can imagine some family just turning away or not understanding things and you know their child could have died.

“I don’t want that for anyone. I want the staff and the hospital to have the resources to be able to provide for the state of South Australia.

“Audrey wasn’t the only one. There were other people in the same ward who had horror stories as well.”

Oates said after putting in an official complaint, “the head of the emergency department contacted me and said it wasn’t supposed to happen and apologised for it”.

“He said it wasn’t supposed to happen, (they) profoundly apologise and that they’re going to be doing an investigation into their processes,” she said.

“They said an investigation would take 35 days.

“We just don’t want it to happen again to anyone else.”

Professor Warren Jones from the WCH Alliance, a retired obstetrician and gynaecologist, said this was “one of the worst cases of neglect of duty of care by a hospital” he had seen in his 50-year career.

He said on one recent occasion the WCH was at “220 per cent capacity and ambulances were diverted to other hospitals”.

“This is unacceptable,” he said.

“It is dangerous to patients and distressing for staff. It cannot be allowed to continue’.

The doctors’ union said the case was a prime example of a system not coping.

SA Salaried Medical Officers Association chief industrial officer Bernadette Mulholland said “it’s very sad to hear these stories – it would be very distressing for the clinicians as well”.

“It’s just symptomatic about the lack of space and the amounts of presentations that are coming to the emergency department,” she said.

“And having health administrators put in processes to try and ease some of the pressure that’s on the hospital so patients can be seen.

“We’re going to see the same thing at the new Women’s and Children’s Hospital if we don’t start to listen to the patients, their families and the clinicians about the size of the hospital, the spaces in the hospital and the help they need.”

Opposition health spokesman Chris Picton said “this is an awful case and it is the latest example of the inadequate care that is being provided for women and children under the Liberal Government”.

“I feel for the parents who had to go through a traumatic experience – and especially with this little girl who suffered pain and a long recovery for something that should have been prevented,” he said.

“Everywhere across the health system is in crisis – the Women’s and Children’s, our ambulance service, our emergency departments and our mental health service.

“Our doctors, nurses and paramedics do an amazing job but when they are under such overwhelming pressure without adequate resources then unfortunately lives are going to be at risk.

“How many more shocking cases and lives at risk will it take to spur (Premier) Steven Marshall to stop cuts and address the crisis in health?”

Health Minister Stephen Wade said “this experience would be deeply stressful for any child and their family”.

“I understand that a senior clinician has apologised to the family and an investigation is underway into what occurred,” he said.

“Consultation on the new Women’s and Children’s Hospital is continuing.

“The current proposed allocation of treatment spaces at the new Women’s and Children’s Hospital has been modelled based on state-wide planning for women’s and children’s health, allowing for population growth and providing care closer to home, as well as an analysis of clinical activity at the current hospital.

“While planning provides for future growth in low acuity paediatric care requirements being delivered in the northern suburbs, the number of Emergency Department treatment spaces at the new hospital is expected to increase by around 40 per cent.”

Women’s and Children’s Health Network Executive Director of Medical Services Dr James Rice told reporters this afternoon that “we want to ensure that we learn from that event such that it does not occur again”.

“We have already been in contact with the family to acknowledge there was a delay in care and we are sorry that that happened,” he said.

“That should not have occurred.

“An investigation has been instigated to understand why this occurred and that investigation is ongoing.

“When the investigation is complete, we will be in contact with the parents so we can share with them what that found and importantly what we aim to do so this does not occur again.”

Rice said the hospital had recently had “some quite extraordinary demands upon the emergency department in terms of these surge periods where we have very large numbers of patients presenting for assessment”.

But he sought to assure the community that “we do have the systems in place, we do have the resources available to provide the very best care to the children and women of this state”.

“As a parent of two children who have themselves had issues with abdominal pain and had that concern, I can certainly understand any parent’s concern and worry at the time that they only want the very best care for their child and they want the best assessment and treatment,” he said.

“That is what we aim to provide every time at this hospital through the services that we have available and the training of our staff.

“Clearly in this case that did not occur and we want to ensure that we learn from that event such that it does not occur again.”

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