New documents show tension between ambos and EDs as surgery queues rise

As elective surgery lists blow out new documents on ramping reveal tensions rising as ambulance officers and ED clinicians try to do their best for patients amid clashes over priorities.

• Elderly couple’s ramping ordeal

Elective surgery queues have blown out to more than 20,000 cases as hospitals struggle to deal with record ramping.

The 20,814 cases include 4051 listed as overdue and follows cancellations of non-urgent overnight stay surgeries last month to free beds to deal with ramping – while The Advertiser has obtained bombshell internal documents exposing the depth of the crisis.

The elective surgery queue last topped 20,000 cases in January 2021 as the pandemic caused cancellations, but was well under this figure during 2023.

Ramping hit a record 4285 hours in November but dipped to 3595 in December, the same month that a disabled man known as Eddie, 54, died after a 10-hour wait for an ambulance at Hectorville.

It comes as an elderly SA couple told The Advertiser of the horrifying sequence of events that ensued after they called for an ambulance and were left waiting for hours.

Hectorville man Eddie died waiting for an ambulance 10 hours after a triple-0 call was first made. Picture: 9News

Ambulance officers and ED clinicians are now clashing over which patients should get priority – ambulance arrivals so paramedics can get back on the road, or more urgent cases in waiting rooms.

The Ambulance Employees Association says on the night of Eddie’s death “waiting room patients were prioritised into the ED over patients in ramped ambulances, leading to some crews being ramped and unable to respond for over seven hours and leaving our community at risk”.

A separate memo from SA Ambulance Service chief executive Rob Elliott to health officials dated November 30 complains clinicians at Noarlunga Hospital are prioritising patients in waiting rooms ahead of those in ramped ambulances.

“Issues with NHS indicating that they would be triaging waiting room patients ahead of delayed SAAS crews,” it states.

A review is underway into claims by SA Salaried Medical Officers Association (SASMOA) president, Dr David Pope, in The Advertiser that clinicians are being “intimidated” by bureaucrats into giving less urgent ambulance arrivals higher priority – which he says has resulted in deaths of more urgent waiting room cases.

An explosive SASMOA survey of ED clinicians backs Dr Pope’s claims.

SASMOA president Dr David Pope. Picture: Sarah Reed

The survey results, sent to SA Health chief executive Dr Robyn Lawrence last week, says just under 90 per cent of respondents had witnessed pressure to prioritise ambulance arrivals over waiting room patients, with comments such as “this is a daily occurrence” and “patients self-presenting get the short end of the stick and have to wait despite having a higher need”.

Respondents noted a ramped patient is cared for by two paramedics, but a waiting room with 30 patients might only have two clinicians dealing with them.

Respondents said there had been “repeated adverse outcomes” for waiting room patients as ambulance arrivals leapfrog the queue.

Other comments include “multiple episodes of severe adverse outcomes at the RAH”; “people have collapsed and had a cardiac arrest in the waiting room while waiting for a cubicle to be seen by a doctor”; and “SAAS crews can at times be incredibly pushy in attempting to offload their patient, so they can go and do something else”.

SASMOA chief industrial officer Bernadette Mulholland. Picture: Matt Loxton.

SASMOA chief industrial officer Bernadette Mulholland’s cover letter says it confirms “concerns regarding what our members consider to be the inappropriate prioritisation of patients arriving at EDs by ambulance over those already waiting”.

Opposition leader David Speirs said the revelations “paint a grim picture of what our health system is like under Peter Malinauskas and Chris Picton”.

“These latest claims are incredibly alarming – and add significant weight to Dr David Pope’s allegations that there is political pressure on clinicians to prioritise ambulance arrivals over sicker patients in ED waiting rooms,” Mr Speirs said.

“It’s disturbing to hear of the kind of pressure being placed on our health professionals to clear ambulances from emergency departments and that tensions are flaring in our EDs as a result.”

A government spokesman accused Mr Speirs of hypocrisy, noting the last Liberal government had issued an order to offload ambulances irrespective of clinical priority and waiting room patients.

They also noted the overdue elective surgery wait list has improved under Labor, “with more than 200 fewer people waiting longer than they should compared to when the Liberals and David Speirs were in power”.

“An independent review is currently underway into recent claims by Dr Pope,” the spokesperson said.

“Dr Pope and SASMOA have been offered the opportunity to put forward any evidence to the reviewers.

“That review is now also examining counter claims made a few days ago by the Ambulance Employees Association that patients in the waiting room are being prioritised over those on the ramp, leaving paramedics delayed on the ramp and the community at risk.

“The government is making progress to turn around the health system, while we acknowledge there is much more to do.”