Text messages describe ‘Third World’ conditions in Sydney hospital emergency room

The 88-year-old woman had been in the western Sydney hospital emergency room for six hours. She was in kidney failure.

Accompanied by her daughter, she was lying across three chairs in the waiting room when emergency medicine doctor James Tadros first attended her. But there was little he could do.

At the inquiry (from left) emergency medicine physicians Dr Pramod Chandru and Dr James Tadros with Dr Setthy Ung of the South Western Sydney Local Health District.Credit:Renee Nowytarger

“This is basically Third World,” Dr Tadros wrote in a text message to a colleague after treating the woman earlier this year. “They just keep prioritising the ambulance offloads who aren’t the sickest.”

Nurses could not do anything for the woman while she was in the waiting room, including delivering her slow intravenous fluids, Dr Tadros wrote. At her age, a more rapid infusion could be deadly.

“Maybe that will get her a bed,” he added.

A “disillusioned” Dr Tadros painted an unflattering picture of a NSW emergency department on Wednesday, reading the text messages to the parliamentary inquiry into ambulance ramping at hospitals.

A tale of desperation from the frontline of a western Sydney hospital

Dr James Tadros: “I’ve spent hours trying to sort out an 88-year-old lady in kidney failure who has been waiting six hours. I had to go out to the waiting room to pick her up in a wheelchair, found her laying down across three chairs and some bystanders were helping her daughter to slowly move her around because she was so weak. This is basically Third World. They just keep prioritising the ambulance offloads who aren’t the sickest. It took me 20 minutes just to get her into a wheelchair then wheel her around to find a space to see her.”

Dr Pramod Chandru: “What a use of time.”

Dr Tadros: “The nurses just can’t start anything for this woman while she’s out there. They cannot give any slow intravenous fluids, but she’s 88, so a fluid bolus will just put her into pulmonary edema and might kill her. Maybe that will get her a bed. I just wrote up 500ml to try and do something for her.”

[Twelve hours after she first presented, six hours after she was first seen]

Dr Tadros: “Remember the 88-year-old? Her abdomen is riddled with metastatic cancer of unknown primary. Twelve hours later, she finally got to a bed in time for me to tell her that she’s probably going to imminently die from this. The worst part is, her and her daughter have been so nice the whole time despite our rubbish care. She still hasn’t had the fluids.”

Dr Chandru: “God that makes me feel worse.”

The inquiry heard NSW ambulance patients routinely wait up to 36 hours to be admitted due to increasing bed block and overcrowding, resulting in inadequate and unsafe care.

Dr Tadros was among health professionals, union officials and experts to give candid testimony about the reality of a hospital system they say is failing patients daily.

The Labor-led inquiry heard evidence about the pressures on emergency departments, ballooning treatment times and staff burnout, with one nurse describing it as “a war zone”.

“Every day one of those junior nurses goes on the floor and treats her patients, she’s risking her registration,” said senior nurse of 25 years, Kelly Falconer.

Ambulance ramping in NSW hospitals is “at its worst”, an inquiry has heard.Credit:Janie Barrett

“Making decisions, which ultimately may end her in a coroner’s court explaining why the patient died. And it’s no fault of the nurses. It’s a system that’s failing.”

Upper house Labor MP Rose Jackson said the evidence had given a “shocking insight” into the frontline crisis in NSW hospitals.

Data from the Bureau of Health Information last month showed more than a quarter of patients arriving at NSW hospitals by ambulance spent at least 30 minutes parked outside or waiting in corridors before entering.

The inquiry on Wednesday heard patients had a 10 per cent greater chance of dying within seven days of admission after experiencing delays in admission.

Chief executive of the Council of Ambulance Authorities David Waters said it was not uncommon to see patients on stretchers for four to six hours, and in some instances “up to 12 to 14 hours”.

A NSW Health spokeswoman said almost 84 per cent of ambulance patients were transferred to an emergency department within 30 minutes, which is the best performance among all Australian jurisdictions.

Setthy Ung, chair of South Western Sydney Local Health District, said it was common that patients who had been driven to hospital were given lower priority, simply to free up ambulances to get them back on the road.

Earlier, Australasian College for Emergency Medicine president Dr Clare Skinner said it was now normal that hospitals were forced to treat patients in corridors.

“It’s like working with a conveyor belt full of things you can’t get to fast enough, but what’s on the conveyor belt is human distress and suffering,” she said.

While she acknowledged “tremendous” recent health infrastructure spending by the government, Dr Skinner said there had not been concurrent investment in staff.

In the June state budget, the government announced more than 10,000 workers to be recruited to hospitals and health services under a $4.5 billion investment.

Health Minister Brad Hazzard said the state had just endured a one-in-100-year pandemic, but acknowledged individuals at the frontline, “who would feel particularly stressed, and I’m sympathetic to that”.

Health Services Union secretary Gerard Hayes said Hazzard had guided the health sector through the challenges of the pandemic, but a royal commission was needed into health spending.

“We have to get to the root cause of why one-third of the state budget isn’t sufficient to deliver quality health service,” Hayes said.

Greens MP and health spokesperson Cate Faehrmann said Wednesday’s witnesses had “resoundingly rejected” the minister’s assertion that ambulance ramping and bed block was rare in NSW.

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