Des Houghton: Sick children at risk as Lady Cilento Children’s Hospital hits capacity
QUEENSLAND’S biggest children’s hospital put on a warm welcome for Prince Charles and his wife Camilla this week. But would the royal couple have visited if they’d been aware of a controversy behind the scenes, asks Des Houghton.
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A CRISIS response was triggered when Queensland’s Lady Cilento Children’s Hospital told its staff it was unable to admit any more children to its paediatric intensive care unit.
Dozens of senior staff received emergency texts telling them the hospital was at capacity and urging them to discharge patients.
I’m told the hospital warned doctors and senior nurses that it urgently required beds for incoming emergency cases.
I’m also told there was bed block in the general wards, and that surgery was delayed.
Lady Cilento chief executive Fionnagh Dougan has declined requests for an interview. However a spin doctor played down the emergency, saying it lasted less than three hours on Wednesday afternoon two weeks ago.
Clinicians who raised the alarm tell me the hospital is at capacity almost every day and is unlikely to cope with the influx of young patients who inevitably flood the hospital when the winter flu season strikes.
So the State Labor Government continues to gamble with the lives of its most vulnerable citizens.
I wonder if Charles, Prince of Wales, and Camilla, the Duchess of Cornwall, would have visited the hospital had they been aware of the controversy behind the scenes.
Many of the problems stem from a jump in emergency department “activity”, which has risen 10.8 per cent in 12 months. Many were children with broken bones from falls.
These kids compete for attention with burns victims, road trauma and child abuse victims, babies awaiting heart surgery, and hospital “regulars”, such as cystic fibrosis sufferers.
Compounding the controversy is a warning from senior managers that there will be no extra funding for Lady Cilento in the June state Budget, despite a surge in patient numbers, especially in the emergency department.
Meanwhile, patient care has been further disrupted while 3500 staff are trained to use a complicated new digital patient-record system, ieMR, the integrated electronic medical record.
The controversy over bed block and inadequate funding is shaping as an embarrassment for Treasurer Jackie Trad, the Member for South Brisbane whose home is a short drive from the hospital. She will have the final say on funding.
A source familiar with hospital protocol says the so-called “capacity alerts” that warn of overcrowding and bed block are part of compulsory “escalation response” directives issued by the Health Department.
Level three is defined as the “inability of emergency department clinicians and the Queensland Ambulance Service to provide services within the accepted standard of care”.
A level-two alert is triggered by a “temporary surge of patients into the emergency department”.
“Capacity alerts are used by hospitals to implement agreed strategies, such as prioritising particular clinical activity or calling in additional staff,” a spokesman says.
“In the past two years, Lady Cilento Children’s Hospital has issued five level-three capacity alerts, with many of these, including the most recent, only lasting a couple of hours. Additionally, 79 level- two capacity alerts have been issued.”
The hospital stresses that it has never been required to go on ambulance bypass.
A doctor says it appears that not all of the paediatric intensive care unit (PICU) beds are being used, possibly because of staff shortages.
The hospital spokesman says an average of 22 beds are occupied in the PICU.
He adds: “Given that demand fluctuates, the PICU is routinely staffed to manage 26 beds, and in times of high demand, there is the physical capacity to scale up to a maximum of 36 beds.”
A senior public servant says woes at Lady Cilento can be traced to a failure to expand paediatric intensive care units in Townsville, the Gold Coast and the Sunshine Coast.
He says the new $2 billion Sunshine Coast University Hospital has only two PICU beds. The Health Department bed report says Townsville has five PICU beds, and the Gold Coast University Hospital four.
The emergency department treated 14,900 children – or 166 presentations a day – over the summer holidays.
Director of paediatric emergency medicine Jason Acworth says most injuries are caused by falls.
He said playground equipment such as monkey bars, slides, swings and trampolines remained the most common cause, followed by bikes, scooters and skateboards.
“Children aged five to 11 are most likely to be injured falling from play equipment, and more than 65 per cent of trampoline injuries occur in children under nine,” he says.
“Teenagers were most likely to be injured playing sports, with 70 per cent of all presentations aged between 10 and 16.
“Young people in this age group are also more likely to sustain a fracture to their arms as they use their hands and arms to brace against a fall.”
Last summer, falls from furniture, particularly beds and bunk beds, accounted for almost 16 per cent of all fall-related presentations, Acworth says.
Health Minister Steven Miles has defended the hospital, while admitting it faces “challenges”.
“Lady Cilento is now the major specialist children’s hospital for Queensland and NSW families,” he says.
“The hardworking doctors and nurses do a terrific job of taking care of sick children.”
Miles says Lady Cilento is not the only hospital emergency department experiencing unprecedented increases in demand.
And he says some children should not have been taken to the hospital in the first place.
“A total of 360,000 presentations were categorised as GP-type, meaning they could have been treated by GPs or pharmacists and not in the emergency department,” he says.
Lady Cilento has had a troubled past. There were protests when the Royal Children’s Hospital at Herston was given the death sentence in favour of a new hospital in South Brisbane.
A leaked Cabinet document from 2007 cast serious doubt on the South Brisbane site, warning of bed shortages and cost blowouts.
The hospital ended up costing twice as much as the original estimates.
I covered this scandal, chapter and verse, for seven years – the poor planning, secret land deals, the parking scandals, and the fears of the specialists who would work there.
And a secret “memorandum of understanding” with Mater Health Services was not made public.
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