Dunedin Hospital Emergency Department (ED) specialists have warned the Southern District Health Board they cannot provide adequate cover for the department's new observation unit.
The letter to the board, obtained by the Otago Daily Times, is the latest development in a long-running row between senior doctors and hospital managers over whether the department needs more specialist medical staff for the 10-bed unit. The DHB maintains it does not.
In an August 23 letter to DHB chief executive Carole Heatly, the nine specialists warn they are "unable at this time to provide adequate cover of the new ED observation ward".
"We will not always be available to conduct ward rounds at times as indicated in our operational plans or provide patient review in an acceptable time frame.
"At times it will be necessary to restrict admissions."
Costing $2.7 million, the unit opened without fanfare this week.
This weekend, the unit's first, is likely to be a test for the ED's ability to staff the new facility, as well as the rest of the department. ED is usually more stretched on weekends.
The unit is for some head-injury patients, intoxicated people, and frail elderly people, among others. Its patients would be formally admitted.
The specialists said the unit would "undoubtedly" increase their workload, as some patients who would otherwise go to another hospital ward would be admitted.
ED already had "serious workload issues".
"If you need objective evidence of this, you need look no further than the many days when, despite the best efforts of all ED staff, we are quite unable to meet the six-hour [Government] performance target.
"Specialists have registered their concern formally on a number of occasions regarding safe ED [specialist] staff levels; workloads: safety and risk - usually after very busy and stressful shifts with lengthy delays in patient care."
The letter points to the DHB's own business case, in the middle of last year, for the observation unit, which included ED getting an additional 4.5 senior medical staff.
"Despite the careful and detailed business case, the DHB has consistently refused to ensure the appointment of adequate numbers of senior medical staff ..."
In response, a DHB spokesman told the ODT the business case was "out of date".
There had been many meetings with staff since to explain the situation.
Patient services executive director Lexie O'Shea, through the spokesman, said the unit was "staffed by nurses".
"[This] is appropriate and in keeping with the unit's purpose.
"We are happy with the current arrangements and are working through wider staffing issues with ED staff.
"We are disappointed that staff would seek to use the opening of this very positive new facility as a negotiating tactic in those wider discussions around the way in which ED functions."
The spokesman explained to the ODT that doctors were only required in the observation unit for patients with a sufficient clinical need, and would be called as required by nurses.
The doctors might be from ED, or from other wards.
One of the letter's signatories, Dr Tim Kerruish, stepped down as clinical leader in March in frustration over the situation.
