Hospitals hit pause on some surgeries as doctor says delays are ‘torture’

Several major hospitals have again started postponing elective surgery amid a surge in COVID-19 hospitalisations, with one top surgeon warning the mental toll of repeated delays is akin to psychological torture for the more than 80,000 Victorians on the surgical waitlist.

Alfred Health chief executive Professor Andrew Way sent an internal memo to hospital staff on Thursday, outlining plans to pause non-urgent category two and three elective surgeries. Western Health, Bendigo Health and the Royal Melbourne Hospital also confirmed on Thursday that some surgeries would be delayed.

The moves come as COVID-19 hospitalisations hover at 771 across the state and almost 2000 healthcare workers are furloughed due to coronavirus.

In a memo to staff, seen by The Age, Way said the hospital would “start reinstating the principles and plan that guided our COVID response across the health service during the last wave”, as pressure increased under the spread of the vaccine-evasive Omicron BA.4 and BA.5 subvariants.

“As expected, COVID transmissions continue to rise,” he said. “We are now looking directly in the face of a third Omicron wave.”

Urgent category one, emergency and high-level category-two surgery, where patients are at risk of quickly deteriorating to life-threatening situations, will still go ahead.

The Alfred hospital, in Prahran, will defer elective surgery as COVID-19 cases surge again.Credit: Getty Images

Neurosurgeon Patrick Lo, the new Victorian chair of the Royal Australasian College of Surgeons, said he was increasingly concerned, not just about the worsened physical health outcomes of the thousands of Victorians on the surgical waitlist suffering painful conditions, but the mental toll of having their procedures delayed for years.

He described the ongoing delays as a form of psychological torture and likened it to being held in a hostage situation.

“This stop and start phenomenon really affects someone’s brain,” he said. “I’m really worried that 10 years from now we will see the development of post-traumatic stress disorders.”

Lo said it was inevitable other Victorian hospitals would soon be forced to trigger pauses on category two and three surgeries to deal with high volumes of coronavirus patients.

Category two surgeries are procedures that need to happen within 90 days and that can cause significant pain or disability, but are unlikely to escalate to an emergency. This could be something like a standard heart valve replacement.

Category three surgeries, which have already been paused at other major hospitals such as the Royal Melbourne Hospital, include procedures such as hip and knee replacements.

Melbourne IT worker Paresh Patel has waited a year to have endoscopic sinus surgery, a routine procedure, used to remove blockages in the sinuses. He was told by Alfred Health this week that his surgery, booked in for this month, was cancelled. No new date has been set.

“This winter has just been terrible,” he said. “Almost every week I have an infection and need to take antibiotics.”

Paresh Patel has just had his elective surgery for his sinus condition cancelled. He has been waiting more than a year for the procedure.Credit: Jason South

He said his condition leaves him in chronic pain and impairs his ability to work and sleep. The limbo of not knowing when it will be treated causes him distress. “It has got to the point now, where I often struggle to breathe,” he said.

John Ferraro, acting executive director of operations at Western Health which runs Sunshine and Footscray hospitals, confirmed on Thursday some non-urgent surgery was already being deferred.

Monash Health said changes to planned surgery is sometimes required, but emergency surgery was being prioritised.

Bendigo Health also said it was being forced to cancel non-urgent surgery on some days in response to bed shortages and rising numbers of staff being on leave.

The Alfred hospital’s chief executive, Professor Andrew Way, has told staff to limit outpatient appointments as a third Omicron wave takes hold.

At the Northern and the Austin hospitals, category one, two and three surgery continues to be performed, while the Royal Melbourne Hospital is undertaking only category one and urgent category two operations.

In a further acceleration of the pressure building on the health system, hospitals are tightening visiting hours and reducing numbers of people allowed in. The Alfred hospital has even mandated highly protective N95 respirator masks for all visitors.

Fresh delays on elective surgery comes after internal health department documents, obtained by The Age, described plans to cancel leave for hospital staff and cancel elective surgeries if hospitalisations continued to rise.

The documents, shared with hospital bosses, outline a four-stage “Health System Winter Response” to cope with rising hospital admissions and workforce shortages.

Victoria is close to crossing the 800-hospitalisation threshold, which could trigger stage three of the winter response plan.

Phase three includes deferral of some non-urgent surgery and the potential to cancel leave for hospital staff if workforce constraints become too severe.

Stage four will be enacted if Victoria surpasses 1400 coronavirus admissions. It recommends an emergency code-brown be considered.

Asked if Victoria needs to enact a system-wide code brown now, Australian Medical Association Victorian president Roderick McRae said most hospitals were already running services like they did during the emergency declaration earlier this year.

“Perhaps, rather than declaring a code brown, what we desperately need is greater community awareness about how dire things are and how much worse it will get,” he said.

Victoria’s Acting Premier, Jacinta Allan, said about 1900 of the state’s hospital workers were off work due to COVID-19 on Thursday. But she said decisions on any surgery delays were the responsibility of hospitals.

“The hospitals are best placed to make those really difficult decisions about the delivery of local services,” she said.

Lo has warned against enforcing a blanket ban, something the Health Department has relied upon heavily in previous coronavirus waves, before it handed back control of elective surgery to individual hospitals.

“We know the previous solution of a blanket ban was really devastating, and I am really hoping the government keep their word and do not go back to that,” he said.

Alfred Health said it continues to carry out clinically urgent surgeries within the recommended 30 days and trauma, transplant and cancer surgery is being prioritised.

Some other non-urgent procedures, including cataract surgery and endoscopies, are still going ahead at Alfred Health’s smaller Sandringham hospital.

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