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ABC News
7 days ago
- Business
- ABC News
Orange Hospital bed shortages delay cancer, emergency surgeries
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."
ABC News
27-05-2025
- Health
- ABC News
Cancer surgeries are getting delayed at Orange Hospital to hit waitlist targets, doctor claims
Inside one of NSW's largest regional hospitals doctors allege there are patient care breaches that contravene NSW health policy. Those alleged breaches include downgrading the urgency of cancer patients and delaying their surgery without clinical justification. Doctors say hospital management is to blame and also accuse them of not bringing on an extra breast cancer surgeon because it would create more demand. Doctor Rob Knox is a general surgeon and the current director of the surgical department at Orange Hospital. He first suspected something was not right in early 2024 as he prepared to operate on some of his cancer patients. While checking patient notes he saw that the urgency of their operations had been changed from the highest to the lowest priority. "When I've rocked up on the day I've seen a different category against these patients' names," Dr Knox told 7.30. "So I've questioned [hospital] management and said, 'Well hang on, what's happened here'?" He had allocated his cancer patients a Category One surgery, which meant their operations must be done within 30 days. He says those surgeries had been changed to Category Four, which means the patients were "not ready for care". "When directly challenging senior management they've dug in their heels and they've said, 'Actually no, we're allowed to do this,'" Dr Knox said. The encounter prompted Dr Knox to start keeping records of discrepancies and he asked his fellow surgeons to do the same. "We started documenting these issues and challenging management and, unfortunately, rather than advocate for patient care, decisions were taken and responses given that seem to be more protective of the system than of the patients we're supposed to be serving," he said. Since then the surgeons say they have fielded numerous requests from hospital management to change the patients' clinical urgency status, so they don't "breach" their recommended waiting time. In some instances operations have been reclassified without the doctors' approval. 7.30 has seen emails sent to doctors at Orange Hospital, which include requests to suspend an operation and to make a patient "not ready for care". Another surgeon was contacted to seek approval to extend a patient's 30-day wait to 90 days due to a lack of theatre space. Dr Knox says the re-categorisations contravene NSW Health policy. "The policy is quite clear that it should not be influenced by the availability of hospital resources or even the surgeon's availability." The NSW Health policy lists five options that must be considered by hospitals to avoid breaching waiting times. These include providing additional theatre time or referring a patient to another doctor. "Postponements or delays to surgery must be avoided and only occur when all alternative options are exhausted," the policy states. In an email to a senior manager in February 2024, Dr Knox challenged the hospital's actions. "Whilst we don't really make a noise if non-cancer cases breach their clinical urgency by a few days, we should and do for cancers," he wrote. He says health data shows a four-week delay in surgery can result in a five per cent increased mortality rate. "It's very hard to say that a delay of one to two to five days makes a difference, but undoubtedly on a broader level it does, and to one individual, it is going to make a difference." The Orange Health Service declined 7.30's request for an interview but in a statement a spokesperson for the Western NSW Local Health District (LHD) said it "rejects claims that surgeons have been asked to reclassify surgical procedures and prioritise waiting list targets over patient care". "The five options described in NSW Health policy to assist in managing patients within the required time-frames are activated where possible but may be affected by … the availability of surgical and other staff, appropriate theatre facilities," the spokesperson said. The LHD said the number of patients waiting longer for a planned surgery than clinically recommended did not "constitute a wait time blow out". NSW Health Minister Ryan Park said he had been assured by the hospital that it was complying with the guidelines. "I want to be clear that shouldn't be happening, that's against clinical guidelines. We have a framework in place," Mr Park told 7.30. "My advice is that that hospital and the staff have been following that. "If there are issues where that has not been the case, then I'd want them investigated. "What we expect is patients' clinical care to be first, second and third KPI. That's what I expect as the health minister." One patient who faced an anxious wait is Katrina Reiss. The young mother was diagnosed with breast cancer in June 2024 and underwent chemotherapy and immunotherapy before being booked in for surgery last December. She had worked in the hospital's surgery admissions office for 19 years, before leaving in 2021. She knew she could expect her surgery date within days of handing in her form. Her fears escalated when she did not have a date more than a week later. "I knew that it wasn't exactly the way that it was supposed to go," Ms Reiss told 7.30. "I was starting to get concerned, because we were coming up to the Christmas closure time as well. "I was really worried that I wasn't going to be getting my surgery within the 30-day period. "I knew the policy so well, and I knew how the system should have worked. I was able to advocate for myself, and I was confident enough to be able to go to my surgeon and say, 'this isn't right, can you help me?' Ms Reiss had her surgery within the 30-day time-frame last December and is now cancer free. But it is this lead up to Christmas which is when surgeons are under the greatest pressure. "There's a lot more cancer diagnosis that happens at that time," urological surgeon Dr Clair Whelan said. "People put off their diagnosis, something they've been ignoring a lump, bleeding, and then by the time they get to December they finally decide to go to their GP and get that thing sorted. "Those are the times when we're most stretched to be able to get cases done in theatre and to be asked to re-classify patients according to urgency." Dr Whelan was director of surgery before Dr Knox and shares his concerns about how waiting lists are being managed. She says while she has never had patients re-categorised without her approval, any requests she does receive put her in an impossible position. "Sometimes it becomes really difficult, particularly when we are talking about those cancer patients, to say, 'well, I can't pick that one of these cancers is going to be more urgent,' because sometimes we don't know that until after the [surgery]," she said. Dr Whelan said some patients have taken the matter into their own hands. "We certainly had examples of patients towards the end of last year who removed themselves from the public hospital waiting list, and what the hospital sees is, 'great, those patients no longer need their operation,'" she said. The latest data from the Bureau of Health Information in late 2024 shows 37 patients waited longer for their surgery at Orange Hospital than the recommended time-frame, which is an increase since the previous reporting period. But Dr Knox said the doctors' own records showed the hospital's figures did not reflect what they were seeing. Dr Knox says the wait begins from the time people are referred to a specialist surgeon. "That waiting time has increased significantly," he said. "We've looked at the data here and the average in Australia is that about 39 per cent or 35 per cent of patients wait more than one month to see a specialist," he said. Dr Knox's waiting list records, seen by 7.30, also show that for diagnostic procedures, such as colonoscopies, many patients could not be treated within the recommended time-frame. "It's what we often would term the 'hidden wait list,"' he said. The surgeons believe the waiting list pressures are being caused by access to operating theatres and doctor vacancies. Orange recently lost its only vascular surgeon and one of Dr Whelan's colleagues moved interstate, leaving her and one other urological surgeon servicing a large swathe of western NSW. When Dr Knox asked at a hospital clinical council meeting in August 2024 about the appointment of an additional breast cancer surgeon to cope with demand, he was shocked by a senior manager's reply. "Obviously we're not generating pathology out there in the community. We're not walking around with ray guns, zapping people to try and generate pathology. "The meaning of that is that we will generate a waitlist of patients and move this hidden waitlist into a very visible waitlist that then becomes the hospital's liability to deal with. "The obvious question is, who benefits from this? It's not patients, it's not clinicians, it's the health system." The spokesperson for the Western NSW Local Health District said "a business case was being prepared to examine the current and future vascular surgical demand". Watch 7.30, Mondays to Thursdays 7:30pm on ABC iview and ABC TV Do you know more about this story? Get in touch with 7.30 here.
