Latest news with #healthcarecrisis
RNZ News
5 days ago
- Health
- RNZ News
Taupō clinicians plan for emergency hospital shutdown amid critical staff shortages
Photo: RNZ / Dan Cook Contingency measures drawn up by concerned Taupō Hospital clinicians include plans to move patients to Rotorua Hospital if staff shortages forced Taupō's clinic to close. The hospital, which serves a population of 40,000 people in the tourist region, has struggled to attract enough senior doctors to fill its roster, which forced workers to plan for the worst. The hospital relies on locums to fill gaps, and permanent staff take on a high portion of night and weekend work. There are 3.3 full-time-equivalent senior doctors working there permanently, out of nine funded positions to staff the emergency department and general ward. Overnight, one senior doctor is on duty to take care of the department and ward. RNZ has obtained a copy of the Escalation and Closure Plan for Taupō Hospital, which outlines what could happen if the hospital were forced to shut down due to not finding enough staff. No closures have happened, and Health NZ's top manager for the area, regional deputy chief executive Cath Cronin, has told RNZ she wouldn't allow this and was instead focused on keeping the hospital open. But closures aren't unprecedented. Last year, Westport's hospital shut its doors several times due to short staffing. The plan's introduction outlines the gravity of a closure: "Temporary closure of Taupō Hospital poses a potential risk to the population and, as such, Health NZ Lakes has a responsibility for managing the risk with a contingency plan, to safeguard the public to the best of its ability." The document said its purpose was to set out an agreed process when there weren't enough senior doctors to staff the hospital's emergency department. It said authority to consent to a closure sat with the regional deputy chief executive - Cronin - and "every possible option for covering vacant roster shifts must be exhausted" before the plan was put into action. If closure were required, contingency measures would swing into action three days before the unstaffed shift, allowing time to tell the public and other affected parties. If the emergency department were to close, but some services continue, security would be stationed at the hospital entrance with a list of patients allowed inside. A February memo from senior clinical staff to management outlined further details. The senior staff cited upcoming vacancies and difficulties in getting locums. "Consequently, we are unable to guarantee that the Taupō Hospital will be able to cover every shift in the ED or the inpatient ward. Therefore, we thought it prudent to have contingency options documented and agreed in advance, which could be employed if and when this situation arose." The memo described possible situations in which the plan would be enacted. "Although none of these scenarios are considered acceptable under normal circumstances, we may be forced to implement one or more of them to ensure continuation of service provision," it said. Two scenarios involved using doctors from Rotorua to keep open Taupō's general ward, or its ward and emergency department. A third scenario suggested closing the Taupō general ward, which usually has about 15 patients. "All inpatients requiring admission will be transferred to Rotorua, increasing the workload for Rotorua physicians and registrars/nurses." Option four was to use telehealth for emergency department patients. Option five tabled closing the department, which sees an average of 50 patients a day. This would also potentially involve telehealth, but otherwise, emergency cases would have to travel to Rotorua. The memo said risks for this were: "No access to emergency care for Taupō-Turangi communities. No onsite clinician for ward. No onsite support for birthing unit." The sixth option was the status quo, with a reliance on locums (temporary staff). This was time-consuming to sort and expensive. Emails released to RNZ show the hospital's battle to find staff. On 15 May last year, then-clinical lead Jared Bayless said there were five emergency department shifts, including four overnight ones, unstaffed in the coming week. Another email from Bayless, a month later, discussed juggling staff to cover vacancies during the week, which stretched the weekend roster thinly. There was concern that the hospital would have to operate at decreased capacity. Bayless subsequently informed emergency services about the possible staff shortfall. In other messages, Bayless stated what would happen if staffing wasn't found to cover all shifts, options that the Escalation and Closure Plan covered. A draft memo to Cronin in October from Health NZ's Lakes district group director of operations, Alan Wilson, again talked about the possibility of closure when staff couldn't be found, and outlined the risks of this, including having to rely on an already under-pressure Rotorua Hospital. The memo said $1.29 million was spent on locums for Taupō Hospital in 2023-24. It recommended changing the staffing structure away from senior doctors working 24/7, and employing more doctors to allow for round-the-clock coverage. Cronin found out about the memo from doctor unions and emailed them to say she had concerns about the issues at Taupō Hospital's emergency department and how they'd been addressed. "All discussions, planning or other communications regarding Taupō ED are now on hold." Cronin also emailed Wilson expressing her disappointment about the memo's contents and that he let it happen. "The proposed plan is not a direction I will endorse without further discussion, so don't progress any further planning or discussions with the team." However, the Escalation and Closure Plan was circulated early this year in further emails. Cronin told RNZ this week the Escalation and Closure Plan wasn't an "active plan". "My approach is always to work on plans to keep hospitals open and EDs open," she said. "This wasn't an approach that I endorsed. It got a life of its own, with the team wanting to do the right thing but not in quite the right way. "When I found out about it, I did stop that approach to making a plan to close the ED, and instead we reconvened to work together on how we keep our ED open." Cronin said she'd never been asked to consider closure, as outlined in the plan, although it was challenging to fill shifts. "But we always get there, one way or another," she said. "We always manage to cover that. We haven't had to close. "We've got a particularly tough time in the next couple of months, not only in Taupō but across the whole country. "We're getting right into the middle of winter, with lots of sick leave, but everyone's endeavouring to do what they can to maintain that access for patients." There were plenty of other mitigations before closure would even be considered. "We take that week by week when we plan, then day by day, or shift by shift if we need to." Cronin said this year she met with Taupō's medical staff weekly and would regularly check in with the lead clinician. Asked about shifting patients to Rotorua if required, Cronin said moving patients to ensure they received the proper standard of care was something that happened nationwide. This week, there were 4.7 full-time-equivalent senior doctor vacancies in Taupō, which would drop to 2.7 in October when two staff members joined. Two extra junior doctors had recently joined, and one would soon start. By January, another two were due, which left two vacancies. She said recruitment would focus on how Taupō was a great place to live and the quality of the clinical team at the hospital. Rural hospital medicine specialist Ralston D'Souza has just taken over as Taupō Hospital's clinical lead. He said the lack of permanent staffing at Taupō wasn't new, and he and the other clinicians developed plans in response. "It's probably been known about for a couple of years," he said. "With that short staffing, there's going to be gaps in the normal, everyday roster. So, as a group, we were trying to [say] to management: Look, this is a risk to the organisation. "If permanent staff are unable to fill these gaps, if locums are unable to fill these shifts, we have to have a contingency plan on what we need to do. "There's a huge amount of people affected in the hospital and in the community if there's no doctor in the hospital, so we wanted to get something on paper or get protocols in place if that were to occur because of the vulnerability of our workforce." He said additional junior doctors were welcome, although it would take some time until they were trained to fill overnight shifts, with their varied responsibilities. But he was more hopeful than previously, and he said Cronin was working closely with the hospital on staffing issues. Clinicians, management and the community were working together to find solutions, D'Souza said. Sarah Dalton, the executive director of the senior doctors' union, the Association of Salaried Medical Specialists, said clinicians drawing up the Escalation and Closure Plan showed there weren't enough doctors to staff the hospital. "Between 40 to 50 percent of their roster at any given time is filled either by locums or their employed staff being prevailed upon to do extra shifts, so do extra work for extra pay to keep the place open." She said the arrangements to fill the roster were "hand to mouth, subsistence stuff". Dalton criticised Health NZ for paying little attention to the well-being of permanent staff, while spending plenty on locums. Patient Voice Aotearoa's Malcolm Mulholland said the Escalation and Closure Plan showed how concerned clinicians were. "It's pretty confronting seeing that plans have been drafted to actually shut down one of our hospitals in New Zealand, and to know that it serves a community of 40,000 people or more. "It's extremely concerning." Mulholland said the advocacy group held a public meeting in Taupō earlier this year, where he heard from clinicians' concerns about staff shortages and the prospect of patients transferring to Rotorua. It was planning to hold a further public meeting in the town on 30 July at 6pm, at Taupō's Hilltop School. Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
CNA
14-07-2025
- Health
- CNA
South Korea medical students end 17-month class boycott
SEOUL: Thousands of South Korean medical students are set to return to classrooms after a 17-month boycott, an industry body told AFP on Monday (Jul 14), ending part of a standoff which also saw junior doctors strike. South Korean healthcare was plunged into chaos early last year when then-president Yoon Suk Yeol moved to sharply increase medical school admissions, citing an urgent need to boost doctor numbers to meet growing demand in a rapidly aging society. The initiative met fierce protest, prompting junior doctors to walk away from hospitals and medical students to boycott their classrooms, with operations cancelled and service provision disrupted nationwide. The measure was later watered down, and the government eventually offered to scrap it in March 2025, after Yoon was impeached over his disastrous declaration of martial law. "Students have agreed to return to school," a spokesperson for the Korean Medical Association told AFP Monday, adding that it was up to each medical school to decide the schedule for student returns. The Korean Medical Students' Association said in an earlier statement that the students had reached this decision because a continued boycott "could cause the collapse of the fundamentals of medical systems". Some 8,300 students are expected to return to school, but no specific timeline has been provided. Prime Minister Kim Min-seok welcomed the decision, calling it a "big step forward" in a Facebook post Sunday, adding President Lee Jae Myung was deliberating ways to solve the issue. In addition to the student boycott, some 12,000 junior doctors went on strike last year - with the vast majority of them still declining to return to work. Lee - who took office in June after winning snap elections following Yoon's removal from office - had said on the campaign trail he would seek to resolve the medical strike. The increase in medical school admissions led to a record number of students re-taking the college entrance exam in November in a bid to capitalise on reforms that made it easier to get into coveted majors.
Fox News
02-07-2025
- Health
- Fox News
‘Crisis brewing' in Trump Country as hospitals shutter at alarming rate, top ER doc warns
There is a healthcare crisis brewing in the nation's heartland, as evidenced by a landmark study conducted by the RAND Corporation in conjunction with top national emergency physicians. The study from the Arlington nonprofit research institute found that emergency rooms (ERs) are no longer the safety net but the proverbial "front door" to the U.S. healthcare system, particularly after a 1986 law passed requiring ERs to stabilize patients or deliver babies from women in labor regardless of their ability to pay. That has led to instability and hospital closures across the heartland, including in states where a dozen or more have closed, like Texas, Oklahoma, and Tennessee. States like West Virginia, Pennsylvania, the Carolinas and Alabama have also been affected. "This RAND study is the first ever that points to this crisis, which is that the emergency departments and the care that patients receive in them usually is so critical that, especially for time-sensitive conditions that patients can have, just the fact that you have to travel as far as you might have to, or that even in some cases if a hospital is close to you, but it still doesn't have the resources to operate efficiently," said Dr. Randy Pilgrim, an ER doctor and chief medical officer for emergency room services company SCP Health in Atlanta. "[I]n emergency medicine, we do time-sensitive, high-quality care as long as we have the resources to do it. And this study shows that we really have a crisis brewing here." Nearly $5.9 billion in emergency services go unpaid every year, the study found. Overcrowding and spates of violence towards staff have exacerbated the problem. EMTALA, the aforementioned law, is essentially an unfunded mandate in many cases, and lack of funding for hospitals that treat a large proportion of that uncompensated care — which tends to fall in rural areas or poor neighborhoods in cities — leads to the dual issue of higher patient volumes and more uninsured patients being seen. Many hospitals outside of cities cannot fully account for the funding gap, Pilgrim said. "The economics of reimbursement for physician care play a huge role. … We need more physicians generally in America, and we need physicians to feel like they can and will go to where they're needed," he said. "Physicians won't go where they are needed if there's not enough resources or reimbursement to attract them." Rural hospitals characteristically pay less than higher-end urban hospitals and have fewer local resources. With hospital demand "higher than ever," all of the above factors mean help is needed now. Pilgrim said he has met with HHS Secretary Robert F. Kennedy, Jr., and other top officials at the agency, to discuss the issue — and hopes Washington can help. "Secretary Kennedy… did a beautiful job of listening to what we were saying about the impending crisis that would probably happen during this administration," Pilgrim said. "And he was concerned about it because he could tell that you can't make patients healthy unless you have a healthy healthcare system for them to engage. So I'm very encouraged about what Secretary Kennedy and his staff are doing to try to make a difference on the pieces that they control." He also said Congress must act, particularly as 10,000 Americans turn 65 every day and are therefore eligible for Medicare, which presents a different environment than separate Medicaid. "That's where we see more volume of patients, more complexity, and much more clinical demand. But if the reimbursement in Medicare doesn't keep pace with that demand, once again, you're in this vicious cycle where emergency departments will be at greater risk, starting with the rural and underserved areas and moving forward from there." Some in Congress have banded together to advocate for healthcare-related issues, including members of the bicameral "Doctors Caucus." One member, Rep. Greg Murphy, R-N.C., is a urologist from Greenville who previously served as chief of staff at a Level-I trauma center. "Congress cannot leave rural America behind," he said. "The most important thing Congress can do is to fix dwindling Medicare reimbursements for rural providers and ensure health insurance companies don't play games with denied care and denied payments," he said, pinning the decrease at 33% since 2001 if adjusted for inflation," Murphy told Fox News Digital. The lawmaker added that many hospitals in his area do not have commercial payers as part of their funding sources to help offset losses from Medicare and Medicaid disbursement amounts — and that all hospitals must root out waste as well. Pilgrim was also asked why Americans outside the heartland with more reliable emergency care should be supportive of added funding or resources miles away from them. "In a large city like Atlanta, if rural healthcare is not healthy and patients have to go somewhere else, they will eventually end up in your hospital… So spending a dollar somewhere else besides in your own hospital if you're in a better place makes a lot of sense for you…" he said.
Irish Times
02-07-2025
- Health
- Irish Times
You might as well expect Conor McGregor and Paul Murphy to work together as Stormont to function
When I speak with people in Dublin I'm shocked by the lack of knowledge of the scale of crisis in Northern Ireland 's health service. 'But you have a free service in the North, so much better than the HSE.' A free service with inadequate capacity can be no service at all. Long waits – often for several years – are standard for health treatment in Northern Ireland. Recently published analysis by the Economic and Social Research Institute concluded that while 12 per 1,000 people on waiting lists in Ireland were there for 18 months or longer, in the North the comparable figure was 86 per 1,000. Sadly, the crisis in healthcare in Northern Ireland is not a unique failure in political delivery . Indeed, health waiting lists cause other problems. Health incapacity is the most common cause of economic inactivity – thousands who want to work are unable to do so because of long waits for surgery and other treatment. Water infrastructure is another crunch point. Lack of sewage and water supply capacity is constraining housing construction and industrial development. Around £300m (€350m) a year is being invested in water infrastructure, compared to the minimum of £500m that NI Water says it needs and the £640m a year that the construction industry argues for. READ MORE [ Stormont is slow, afraid of new thinking and costly, says report Opens in new window ] The North's infrastructure crisis – and yes, it is a crisis – is further illustrated by last week's court judgment blocking the upgrade of the A5 , the most dangerous road on the island which connects Donegal as well as Derry to Dublin. The court found that NI's Department for Infrastructure did not explain how the scheme meets the obligations of Stormont's own climate change legislation. Another serious failing in Northern Ireland is the education and skills system . The North has too few graduates, with around a third of undergraduates studying away because of lack of capacity within the local universities. Nor are there enough adults with high-level vocational skills. This, in turn, reflects a schools system based around academic selection – with many children from lower-income families not making the grade into the best-performing grammar schools. A consequence is that Northern Ireland has lots of teenagers who switch off in school and leave the education system at an early age. Rates of early school leaving are three times higher in the North than in Ireland. One in ten school pupils in the North becomes disengaged as a teenager. These children are more likely to become economically inactive as adults, less likely to gain well-paid employment, more likely to suffer ill health and more likely to gain criminal records, becoming prisoners at high cost to the state. All these problems (and many more) can be argued to be results of a political system that is unable to make difficult choices and allocate resources objectively. The Belfast Agreement achieved peace, but failed to provide an effective system of government. Indeed, Stormont has not even been sitting or operational for 40 per cent of the time since the agreement was signed. The Belfast Agreement never evolved beyond 'conflict by peaceful means'. [ 'People don't care that much': Frustrated sighs audible as students asked the 'British or Irish' question Opens in new window ] This context raises the question: can Stormont be reformed? After working within the Stormont system as a political adviser, I left convinced that it cannot be made to work effectively. I was astonished at the continued sectarianism I perceived from some politicians, 27 years after the Belfast Agreement and the declaration of peace. For many politicians in the North, governing is a zero-sum game – our community loses if your community gains anything. The result is that both communities are held back by the failure to govern for the good of all. And, equally important, Northern Ireland is no longer a society of just two communities. While Catholics today outnumber Protestants, these religious groupings contain a wide range of differences and neither forms a majority. The third section – from other and no religions and arriving from elsewhere – is large and in a sense, underrepresented politically. It is difficult to see how the existing structures of mutual veto by the senior representatives of unionism and republicanism can be remoulded to create a functional system. One wag suggested it is like giving joint government to Jeremy Corbyn and Nigel Farage and expecting it to work. (Or, it might be said, to Conor McGregor and Paul Murphy.) The permanent impasse at Stormont and its inbuilt dysfunctionality causes many to find Irish unity the attractive alternative. But unity is not an easy option. For one thing, there is the cost. Unaffordable says Professor John FitzGerald, given the scale of the subvention (subsidy) from the UK government. Affordable argues Professor John Doyle, not least given the potentially transformative impact of unification. Then there is the timeline, process, destination and lack of preparation. It is perhaps wrong to consider Irish reunification as a potential 'big bang' event. As Professors Seamus McGuinness and Adele Bergin have pointed out, the handover of Hong Kong to China took 13 years. The transition of East Germany is an ongoing process that has so far taken 35 years. What concerns me most is the suggestion that Irish unity should lead to a federalised arrangement in which Stormont continues. When I argued to an Oireachtas committee a couple of years ago that the Northern Ireland Assembly is so dysfunctional that it cannot be retained within a new Irish State, the reaction from some senators seemed like suppressed horror. Why an institution that does not work and apparently cannot work should be retained within a new island-wide constitution is completely beyond me. For many close observers, abolition of Stormont is the single most attractive element of Irish unity. For all their faults, the Irish Government and the Irish State work and are effective. Difficult decisions are taken, with mostly good outcomes. If the Irish Government comprises adults, their equivalents in the North often seem like rowdy teenagers – more focused on arguing and scoring points than on reaching compromise, consensus and the best solutions. It would be understandable if people in Ireland read this and think, 'why do we want them?' Despite the challenges, the emotional desire for Irish unity remains stable across the South's population. The work of the Shared Island Unit has illustrated the challenges involved – it is the practical path to be navigated that remains to be agreed. Paul Gosling is author of A New Ireland – A Five Year Review of Progress, published by Colmcille Press
CBC
27-06-2025
- Health
- CBC
St. Clare's internal medicine doctors give mass resignation notice, warn of 'impending crisis'
Five doctors at a St. John's hospital have tendered a joint notice of resignation, saying their work environment has become "unsafe for both patient care and provider well-being," CBC Investigates has learned. The doctors make up the internal medicine department at St. Clare's Mercy Hospital — responsible for a wide range of critical services provided for both emergency patients and those admitted to the hospital. The letter says the doctors will not be performing any duties outside their contractual obligations — no evenings or weekends — starting on July 1, until their resignation takes effect on Oct. 1. "It has become increasingly clear to them that continuing under the current model would further compromise patient safety and the already fragile well-being of the team," reads the letter, written by lawyer Kyle Rees of O'Dea Earle and sent to the provincial health authority's executive on Monday. Rees declined comment when reached by CBC News on Thursday. In a statement, Newfoundland and Labrador Health Services said it cannot comment on the resignation letter, but said it values relationships with all health-care providers, and seeks to ensure patient care remains unchanged by human resources challenges. In the letter, Rees writes that multiple concerns have led to this point, citing a recent decision to remove the hospital's resident support. The doctors feel NLHS has not done enough to find solutions to the reduction of patient coverage resulting from the move. "NLHS has consistently deferred responsibility and failed to provide any substantive plan to address this impending crisis," the letter reads. The five doctors are Michael Jakovac, Olatunji Odumosu, Stephanie Genge, Sanampreet Gurm and Evan Wee. Sources say two others — Leonard Phair and Alex Dias — had previously resigned. Concerns backed by doctors at 2nd St. John's hospital Meanwhile, internists at the Health Sciences Centre in St. John's are warning the health authority not to shift the workload to their hospital if the team at St. Clare's resigns en masse. Another letter was sent on Thursday, co-signed by the internal medicine teams at St. Clare's and the Health Sciences Centre. "Transferring the workload to the Health Sciences Centre is also not an option," it reads. "HSC is operating at full capacity, and there is no infrastructure, space or staffing to absorb the additional burden." According to that letter, St. Clare's routinely manages 100 admitted internal medicine patients, along with responsibility for 15 to 20 emergency room consults on a daily basis. The letter also warns that once the resident physician coverage ends on July 1, St. Clare's will not have an effective team in place to handle Code Blue emergencies — cardiac or pulmonary arrest. "Lack of a proper Code Blue team is unsafe and will have disastrous patient outcomes for medical and surgical patients." The teams are calling for "immediate engagement" and want a written response "outlining how N.L. Health Services will ensure safe and sustainable internal medicine coverage at St. Clare's beyond July 1, 2025."
