Doctor speaks out
Saturday, 28th May, 2011
Dr Brian Senewiratne, who has been visiting the local hospital for five years, said he had decided to lift the lid on conditions at the hospital in an effort to force a review of aged care in Australia.
The 79-year-old, who runs six medical clinics in Brisbane, said the use of hospital beds for elderly patients who were awaiting aged care places was putting lives at risk.
Dr Senewiratne said overcrowding reached a critical level on April 26 when there were no vacant beds in any ward.
To alleviate the problem he said he was asked to send a heart patient home to free up a bed, leaving him in a possibly life-threatening situation.
“There was not a single patient that I could, with a clear conscience, discharge,” he said.
“Since a bed had to be found I decided to send (home) a patient who had a major cardiac problem who I had just reverted to normal rhythm with an intravenous infusion of isoprenaline.
“I asked that the IV be stopped, the central line be taken out and the patient sent home. Was that safe? No, it was not. That is not how things should have been done.
“If he had dropped dead, how could I face the coroner? How could I face my junior staff? If I had a junior doctor who had done that I’d have torn him to shreds... and here I was doing the same thing.”
On that same day, Dr Senewiratne said 75 per cent of the hospital’s Medical Ward beds were occupied by patients awaiting aged care places.
“Let me be clear. Three quarters of the patients in the Medical Ward had no acute medical problem and should not have been in an acute ward,” Dr Senewiratne said.
“At the same time ED (Emergency Department) had some very sick patients who needed in-patient care, but could not be found a bed.
“I was told that this was a recurring problem - bed block. It’s a chronic, acute and growing problem of beds in hospitals being used to care for patients who aren’t acutely ill at all - they are old.
“We’re turning hospitals into nursing homes, and caring for the elderly is very different to caring for a person who is very sick.”
Mr Senewiratne painted a bleak picture of isolation, depression and even suicide when describing the lives led by those awaiting placement in aged care facilities.
“When you’re an elderly patient waiting for placement, you’re not treated like a patient in a nursing home,” he said.
Elderly residents in a nursing home were encouraged to socialise and exercise, and received specialised treatment which helped promote a happy and healthy lifestyle, said Dr Senewiratne.
In the hospital things were vastly different, he said.
“They sleep all day because there’s nothing to do - you can’t talk to the walls. You might go from your bed to a seat, and that’s about it,” the doctor said.
“They get breakfast, then they sleep. They get lunch, then they sleep, then they have dinner in the afternoon and sleep again. Then they can’t sleep at night and you have to give them sleeping tablets.
“You can’t sleep all day like that unless you’re depressed, and many of them do have major depression.
“I have spoken previously on suicide in the elderly ... and one of the ways it happens is by just refusing to eat.
“We’ve got a couple like that right now, who have just lost interest. You have to use anti-depressants just to get them to eat and drink.”
Although Dr Senewiratne admitted he was “blowing the whistle” on the many problems faced by the hospital, he said local staff and administration were not to blame.
“I’m not throwing mud at the local hospital administration; they’re working within the confines of what they’re given and within their budget,” he said.
“And the nursing staff is of the highest level ... if I could I would bribe them all to come work for me.
“It’s the friendliest hospital I’ve ever worked in in my 52 years of medicine.”
Dr Senewiratne stressed he not was acting as a spokesman for the hospital, but speaking as a visiting physician who is concerned for the wellbeing of patients in the country’s health system.
The Broken Hill Health Service spoke with Mr Senewiratne about his concerns on Thursday, and issued a statement acknowledging that they cannot provide the level of care that aged patients would receive in a nursing home.
“The main function of the hospital is to provide acute inpatient care and outpatient specialist services,” a spokesperson said.
“Aged care patients are provided with quality physical care but the hospital is not able to provide nursing home type activities that make their living environment more like a home. These include things such as activities and communal rooms to socialise with other residents.”
As for patients being discharged unsafely, the Health Service said its records show no evidence of this happening.
“The Broken Hill Health Service has a high occupancy rate and monitors and manages the bed allocation very closely on a daily basis.
“This includes consultation with the senior medical staff, ward managers and community services to coordinate admissions and discharges and patient care and quality of the care provided is paramount.
“In a routine audit of patient re-admittance within 28 days of discharge, no evidence was found to suggest that patients were being discharged unsafely.”