The Rural Doctors Association of NSW (RDA NSW) is warning that the after-hours roster for Casino Hospital’s Emergency Department (ED) has become unsustainable and at least two local doctors are now seriously considering resigning from the roster due to the North Coast Area Health Service’s (NCAHS) continuing inaction in developing a more tenable after-hours arrangement.

The doctors have also had to take the step of sending a letter to their patients thanking them for their patience in tolerating the doctors’ frequent weekday absences from their practice over the past year, when they have been called to the hospital to attend ED patients.

“Casino’s doctors have been bending over backwards to find a sustainable way of maintaining medical coverage at Casino Hospital into the future,” RDA NSW President, Dr Ian Kamerman, said.

“For over a year, they have been warning that the current system is unsustainable and have been attempting to negotiate with the NCAHS to employ a Career Medical Officer (CMO) – a full-time doctor working solely at the hospital – to cover the hospital’s ED during business hours from Monday to Friday. This would mean the local doctors would not have to treat emergencies at the hospital during these hours whilst also trying to meet their own general practice patient load.

“The local doctors have told the NCAHS that they are very willing to continue participating in an after-hours roster for the hospital ED from 7pm to 6am Mondays to Fridays and also to provide 24-hour coverage on weekends – but the NCAHS has told them that the current ED roster system of 24-hours on-call is not negotiable.

“This is absurd, particularly given doctors at other hospitals in the NSW North Coast area have been allowed to participate in much less onerous roster arrangements.

“The rigid 24-hour roster that the NCAHS is stubbornly sticking to unfortunately does nothing to entice more doctors to participate in the ED roster at Casino Hospital and is also acting as a deterrent to those doctors who are working there.

“The number of doctors working at the hospital has dropped from 10 to six in two years, with some doctors retiring and others resigning because of the inflexibility of the NCAHS in relation to the ED roster.

“With the NCAHS providing no alternatives to the local doctors, they are fast reaching burnout. Some of the doctors are coming to the conclusion that the only thing they can do in the face of continuing inaction by the NCAHS is to consider resigning from the ED roster completely. This is despite their desire to continue to provide comprehensive care to the people of Casino and participate in the ED roster in a way that is sustainable.

“It is now critical that the NCAHS works constructively with existing doctors to make the ED roster sustainable. It is, after all, the NCAHS’s responsibility to ensure there is a safe working environment for doctors as well as patients at Casino Hospital, and to ensure adequate medical cover is available around-the-clock at the hospital.

“At the end of the day, the NCAHS has taken the dubious decision to leave the hospital ED without medical cover for periods of up to 48 hours at a time rather than allow local doctors to provide cover after-hours on Mondays to Fridays and provide 24-hour cover on weekends.

“RDA NSW fears that, given the NCAHS has chosen a path of inaction over the ED roster and has failed to employ additional staff, it has therefore elected to leave Casino Hospital without medical cover for significant periods, resulting in the hospital being placed on bypass.

“We feel that this threatens the hospital’s long-term future and it begs the question: what does the NCAHS really have in mind for the hospital? We ask NCAHS Chief Executive, Chris Crawford: is there a plan to close the emergency department at Casino Hospital?”