Special report: Royal Darwin Hospital hits crisis point as whistleblower staff speak out

Royal Darwin Hospital is in crisis with a lack of beds placing extraordinary pressure on the emergency department and forcing doctors to use distressing ­practices.

Royal Darwin Hospital, pictured yesterday, is in crisis and angry clinicians have spoken out to reveal what is happening behind closed doors. Picture: Che Chorley

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ROYAL Darwin Hospital is in crisis with a lack of beds placing extraordinary pressure on the emergency department and forcing doctors to use distressing ­practices.

A sharp increase in mental health presentations and a lack of appropriate facilities and workers are creating a dangerous environment where the safety of staff, patients and visitors is being put at risk, whistleblowers say.

An NT News investigation can reveal:

DOCTORS in the emergency department are being forced to administer massive doses of sedatives to psychiatric patients as there are no mental health beds available for them;

SOME patients are being intubated, given a general anaesthetic and sent to the intensive care unit on a ventilator because they are too violent to be kept in the emergency ­department;

MENTAL health patients are sometimes forced to spend several days in seclusion in the emergency department with no access to daylight or fresh air – a situation staff say is leading to an escalation in their violent behaviour; and

STAFF in some cases have been forced to let “sectioned” or involuntary patients leave the emergency department to avoid violent confrontations or unethical “take-downs”, where patients are physically ­restrained and administered big doses of otherwise unnecessary and potentially dangerous drugs to sedate them.

Royal Darwin Hospital, pictured yesterday, is in crisis and angry clinicians have spoken out to reveal what is happening behind closed doors. Picture: Che Chorley

Hospital staff, who spoke on the condition of anonymity, said doctors had been left with no option but to let some ­sectioned patients walk out of the emergency department.

“This places the patient and community at risk – but has been deemed safer than getting into violent confrontations with unwell patients in the ED and administering otherwise unnecessary and dangerous medication to the patient,” one whistleblower said.

“None of this would be happening if the patients were out of ED and in a mental health bed. Patients are suffering serious psychological harm and zero or negative therapeutic effect by being held prisoner in ED for prolonged periods.”

In response to the claims, an NT Health spokesperson said: “Medication provided to any patient is based on clinical need and is proportionate to the medical condition they are presenting, not due to bed availability.”

Documents seen by the NT News show the mental health beds in the dedicated Cowdy Ward, Joan Ridley Unit and Youth Inpatient facility are regularly full with the main hospital forced to accommodate “outliers” – mental health patients who should be in a specialised facility but instead are being forced to be kept on another ward or in the emergency department.

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One document shows on May 24 there were 18 patients in the Cowdy Ward, eight in the Joan Ridley Unit and four in the Youth Impatient facility.

Another 14 “outliers” were being held in the main hospital, including four in the emergency department.

Last month, the Top End Mental Health Service hired a dedicated locum consultant to manage a team of mental health clinicians working ­within the emergency ­department.

However, she resigned after just four days on the job.

Sources say she was concerned about the high level of risk associated with the role and the potential for her to be held accountable if someone was killed or seriously injured.

Other measures to deal with the bed shortage have also proved unsuccessful.

The capacity at the Joan Ridley Unit – the secure unit for patients with acute psychiatric problems – had been increased from eight beds to 11 by repurposing a common area.

But the changes had to be undone recently due to safety concerns for patients and staff.

The Youth Inpatient facility also had to be temporarily closed recently because of a shortage of nursing staff.

In response to questions sent to the NT Health Department and Health Minister Natasha Fyles yesterday morning, an NT Health spokesperson said: “Service demand and patient flow at Royal Darwin Hospital has been an area of significant focus for some time in order to provide safe, high quality clinical care.

“There has also been an increase in mental health client presentations, along with revised processes and systems to cater for COVID measures.”

The NT government has released a tender for a new 18-bed mental health unit and dedicated stabilisation and referral area.

Tender documents say the facilities are intended to provide a “stepped-care approach” to mental health care, “which means people receive support that matches their level of need”. “To enable this transition, new and upgraded facilities need to be developed at the Royal Darwin Hospital Campus to augment the existing facilities,” the documents say.

Ms Fyles said the facilities would boost mental health care at RDH.

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