Orange Hospital bed shortages delay cancer, emergency surgeries

Australia Broadcast Center

28-05-2025

When a "code black" is declared at a New South Wales hospital it means staff safety is at threat.
For clinicians it also signals their hospital is at capacity.
Senior doctors at Orange in the state's central west say this declaration is being made at the city's public hospital, Orange Health Service, too often.
Director of surgery Rob Knox said recently the hospital had spent half a month in the most "critical state of bed block".
"[That's] where we've used up all surge capacity. There are no more beds available for patients. Patients can't leave [the emergency department]," Dr Knox said.
Dr Knox recently went public with concerns that he and his colleagues had been asked to reduce the clinical urgency of cancer surgeries so the hospital did not breach waiting list targets.
The Western NSW Local Health District (WNSWLHD) rejected the claims, however NSW Health has ordered a review of the re-categorisation of surgeries at Orange Hospital.
Dr Knox said he now felt compelled to speak up for colleagues in other hospital departments.
"When messages are going around from fellow surgeons asking if anyone has the option to accommodate a child who's been stuck in ED for over 24 hours with appendicitis [and she] is the same age as your daughter, that's when it starts to become a personal issue," he said.
The Orange Health Service's intensive care unit (ICU) and emergency surgery regularly experience high demand.
The ABC has seen correspondence from doctors detailing operations which had been postponed due to a shortage of ICU or high dependency beds despite some of their patients' surgeries being overdue.
The hospital's anaesthetics department wrote to management in September 2024 expressing its alarm about what its doctors were seeing.
"For a while now, the department of anaesthesia (sic) at OHS [Orange Health Service] has raised concern at a local level that patients requiring emergency surgery are given a lower priority than patients waiting for an elective procedure," the letter stated.
"We suggest that both the hospital and the district [WNSWLHD] need to prioritise the sickest surgical patients in the district rather than meet KPIs for elective surgery.
Dr Knox said the hospital's management of emergency surgeries prompted his department to make a tough decision.
"I think emergency surgery is the real hidden crisis," he said.
"We've certainly agreed that if we have an enormous volume of patients waiting, who do not look like they're going to get their emergency surgery operation in time, we are going to cancel patients off our elective lists."
Senior doctors have put forward proposals to hospital management which they say will slash waiting lists, deliver high quality patient care and future-proof the hospital and its workforce.
They have been campaigning for robotic surgical equipment to be installed.
Urological surgeon Clair Whelan said she had to refer half of her patients to Sydney because she could not see them in the recommended time frame, and many expected to receive robotic surgery which was only available at metropolitan hospitals.
Two urologists are due to start in Orange in 2026, but Dr Whelan said their appointments would be compromised if the equipment was not available.
"I can say unequivocally that the young urologists, who have trained on robotic surgery, will not be able to work in the Orange area or in the western district because they won't have that facility," she said.
Dr Whelan said Sydney hospitals would then have to care for all of the Central West's surgical patients, including those requiring prostate cancer operations which was the most common cancer in NSW since 2020.
"It basically means every one of them will be going over to Sydney to see someone," she said.
"That's a massive burden on what is already an overstretched system in Sydney as well.
"Hospitals are stretched, regardless of where they are. The burden of half the state coming to them is not going to help."
In an email to senior doctors, seen by the ABC, WNSWLHD chief executive Mark Spittal said while work was being done on the proposal for robotic surgery at a ministerial level, he did not want to apply pressure.
"I do not necessarily want to be forced to justify of (sic) why Orange would be the rural pilot site against another rural/regional hospital with a larger catchment such as Wagga, Tweed, Port Macquarie or others etc." he wrote.
Dr Whelan said a decision was needed soon.
The doctors have approached the hospital and WNSWLHD with another proposal to help ease surgery waiting list pressures.
They want them to consider using vacant operating theatres at a neighbouring private hospital for lower acuity surgeries.
Ramsay Healthcare leases level four of the Bloomfield Medical Centre for its Ramsay Surgical Centre.
It has one vacant theatre and two others available once they are fitted out.
He said using private resources would not result in problems experienced at Northern Beaches Hospital in Sydney.
"If it's a question of patient safety I think the obvious safe situation is literally across the road from the main referral hospital of the district," Dr Knox said.
"There's an on-site ICU, cardiologists, interventional radiologists, specialists, anaesthetists, and it's a 10-minute walk or 30-second ambulance trip."
In a statement, Ramsay Surgical Centre chief executive Ben Chiarella said its facility had "significant capacity and resources available for growth and further utilisation if and when required".
"We have a good working relationship with Western NSW LHD's executive team and continue to offer our support in any strategic discussions or collaboration required to improve health access, equity, and outcomes in this region," Mr Chiarella said.
WNSWLHD has been contacted for a response.
On March 27, State Health Minister Ryan Park told the NSW parliament that adverse patient outcomes at Sydney's Northern Beaches Hospital did not preclude other types of arrangements with the private sector.
"The bill does not and is not intended to prohibit or impact on other arrangements entered into with the private sector," Mr Park told parliament.
"[The private sector] can also be contracted to provide specific clinical services to public patients, such as [instances like] private health facilities providing elective surgery to public patients to reduce waiting lists after the COVID‑19 pandemic.
"Such arrangements can be beneficial to NSW Health, patients, and the private sector, and are generally relatively simple to administer."