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Health bureaucrat urges surgeons to 'say no' to older, sicker patients
Exclusive by state political reporter Isabel Dayman
Posted Yesterday at 3:37pm
A group of doctors pictured during a surgical operation, with a heart rate monitor in the foreground.
A group of doctors pictured during a surgical operation.(Unsplash.Com: Natanael Melchor, CC-0)
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Public hospital surgeons are being encouraged to "say no" to "old" patients and those with multiple medical conditions, emails leaked to the ABC reveal.
Key points:
An SA Health program manager emailed surgeons about GP patient referrals
She asked them to "say no" to older or very sick patients when it's "not sensible" to accept them
The doctors' union said only qualified clinicians should be making patient referral decisions
A senior SA Health program manager, Mandy Nolan, emailed surgeons on Saturday, arguing that health services needed to "tighten up our processes with regards to incoming referrals".
The CALHN acting surgery program delivery manager suggested surgeons "say no" to general practitioners referring patients who are elderly or have comorbidities (multiple health conditions).
"We also expect that where the person is old or has many comorbidities, you might suggest to the GP that is [sic] not necessarily in their best interests," the email reads.
The email has prompted outrage from the doctors' union, SASMOA, which stresses that only qualified doctors should make decisions about whether a patient's referral should be accepted.
SASMOA President Dr David Pope told ABC News it was "unethical" for a person in an administrative management position to be making suggestions about clinical care.
Australian Medical Association Vice President Dr Chris Moy, who is a GP, said it was legitimate to consider a patient's age and general health in deciding whether they should have surgery, but said Ms Nolan's email was "clumsy".
A nurse prepares for surgery wearing blue scrubs and a surgical mask and pulling on a pair of gloves in an operating theatre.
The doctors union argued clincians working in patient care were the only ones who should get involved in referral decisions.(Rawpixel: Chanikarn Thongsupa)
Ms Nolan's email also warned that some GPs were sending patient referrals that were not filled in completely enough.
"We expect that many referrals might need to be returned to GPs as they will be insufficiently complete for safe and accurate triage," it reads.
Hospitals 'don't have enough resources' to care for current patient numbers
In a later email, sent on Sunday, Ms Nolan stressed that she did not wish to cause offence and that the surgical leadership team was "extremely patient centric".
"The 'we' is the surgical leadership team who are extremely patient centric, and by no means was offense [sic] intended," it reads.
She warned that Adelaide's central public health network did not have the resources it needs and that patients are "deteriorating" because they are not getting the care they need.
"Due to this, a great proportion of our wait lists are long and the patients are deteriorating and they potentially could have been somewhere else, sooner.
"I agree that all referrals have a patient suffering in some way at the end and we are trying to get patients that need us the most, quickly and providing other options for those while they are waiting."
She added that returning referrals to GPs was to ensure the patient goes to the right service and takes the "fastest route to care".
A clinician's reply to Ms Nolan's Saturday email prompted her Sunday email. The ABC has not seen the clinician's email.
Health services collaborating to reduce wait times
SA Health provided no response when asked whether it is appropriate for administrative staff to be making suggestions about referral management and patient care.
But in a statement to ABC News on behalf of SA Health, CALHN Medical Lead for Surgery Professor Jane Andrews said hospitals and GPs were collaborating to improve services for patients.
Exterior of a modern hospital
SA Health said hospitals and GPs were collaborating to reduce patient wait times.(ABC News: Dean Faulkner)
"We are implementing a number of solutions to improve wait times, and through collaborative working with our GP colleagues," Professor Andrews said.
"Referrals from GPs, who know their patients best, need to include sufficient information so our specialists can accurately triage consumers to ensure no-one is left without advice or care.
"Our recently appointed GP Liaison doctor is working with us and her GP colleagues to improve two-way communication to ensure our community can access the best and fastest route to care."
Posted Yesterday
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