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ABC News
28-05-2025
- 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
Health district tells inquest of protocol lapses after sepsis death of toddler Pippa Mae White
A western NSW health executive has told an inquest that his hospitals are still not consulting a sepsis diagnostic guide enough after a toddler died of the condition almost three years ago. Two-year-old Pippa Mae White died from the disease, and pneumonia, at Orange Hospital in central west NSW in June 2022. She initially presented at Cowra Hospital before being transferred later that night to the health facility in Orange. The inquest into her death previously heard her high heart rate alone at both facilities was considered in the "red zone" for a child likely infected with sepsis and required a rapid response, according to a NSW Health policy document. A rapid response triggers senior doctors to quickly attend and assess a patient, which was not activated at either hospital. The nurse at Cowra said she was aware of the paediatric sepsis pathway document but did not use it, while the nurse at Orange said she had never seen it. Executive director of quality, clinical safety and nursing at the Western NSW Local Health District (WNSWLHD), Adrian Fahy, gave evidence at the inquest on Tuesday. He said he was "concerned" the document was not used in Pippa White's care. "It's indeed quite remarkable," he told the inquest. "Sepsis training has been quite prevalent across NSW Health for a number of years." He said the WNSWLHD made optional training on detecting the condition mandatory since the young girl's death and has so far delivered 75 virtual sessions on the topic. The inquest heard hospitals across the district audited how often the sepsis pathway document was used in the care of patients who were diagnosed with the condition. Mr Fahy said despite an increasing trend, the hospitals were not using it in all cases. "What I think needs to happen is there needs to be a much stronger emphasis. "[And] where needed, having some difficult conversations around 'why wasn't a pathway included?'" Mr Fahy also gave evidence that the district made several changes to improve care since Pippa White died. He said an alert tool was being developed which would send a prompt to clinicians if the vital signs they are logging on the electronic medical record could indicate sepsis. The concern of a parent or carer will also be included in the new paediatric observation chart due to be released next month. "A specific question will be asked around 'do you feel your child is improving or deteriorating?'" Mr Fahy told the inquest. If it was the latter it would trigger an additional "yellow zone" criteria which could result in a clinical review within 30 minutes. The inquest heard Pippa White's mother, Annah White, attempted to activate the REACH initiative (recognise, engage, act, call, help) during her daughter's care without success. The system allowed family members or parents to escalate their concerns with hospital staff about the patient's condition, and prompt a review, which should occur within half an hour. Mr Fahy said the WNSWLHD had tried to make the initiative more obvious, such as clearly including it in local emergency response procedures. Hospitals had also put up posters about the initiative with a phone number and a QR code with a video that explained the process. The inquest continues on Wednesday.
