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SA hospitals face major reform -

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STEVE CANNANE: For years, South Australia's stretched emergency departments have been beset by overcrowding, long waits, and near misses.

Now, the state is on the verge of its biggest health reforms in years, with emergency departments in the firing line.

The government says it's about centralising acute services and improving quality. But emergency doctors fear the reforms to be released early next week, will have a devastating impact on the state's already stretched services.

Alex Mann reports.

LIBBY HEATHERSAY: We're lucky that we didn't have to make quick decisions about mum's home, so it still today looks like it did the day she died.

ALEX MANN: Time stands still at Libby Heathersay's mum's house in Adelaide.

LIBBY HEATHERSAY: Obviously haven't been for a few weeks now with the papers out the front.

ALEX MANN: It's been six months since Libby's mother Christobel died.

LIBBY HEATHERSAY: Lots of memories, lots of sentimental things.

ALEX MANN: But her death almost came early, during an extreme summer heatwave last year.

LIBBY HEATHERSAY: She had a cracking headache and it all just happened in a day basically, I just dropped in and found her with this terrible headache and vomiting.

ALEX MANN: As temperatures soared above 40 degrees, Christobel's condition spiralled and she was rushed to hospital.

When she and Libby arrived, her ambulance was forced to wait behind five others, in a practice known as ramping.

LIBBY HEATHERSAY: There was no room, they just couldn't be admitted, nobody else could go in because they just didn't have the beds or the little bays that they could go to.

It was very stressful, knowing that we were at the hospital and we couldn't go in, that was really stressful and I could see that she was just fading, and that's when they kept saying what number would you give the pain in your head, and she was just going "ten, ten, ten".

After an hour and a half in line, Christobel was finally admitted to the crowded Emergency Department.

The dehydration they suspected was in fact a haemorrhaging brain tumour the size of a fist.

ALEX MANN: Do you think you were lucky and she was lucky not to have died then and there in the ambulance?

LIBBY HEATHERSAY: Yeah I do, It could have easily happened.

ALEX MANN: Christobel survived the operation and lived for another six months before the tumour eventually took her life.

DR DAVID POPE, SA SALARIED MEDICAL OFFICERS: The problem is real, it affects real people, it could affect you or I at any stage if you are unlucky enough to need the services of an emergency department.

ALEX MANN: At his home in Adelaide, emergency doctor David Pope is poring over many of the same stories.

His organisation has audited the city's over-stretched emergency departments.

DR DAVID POPE: It showed enormous cracks in the entire system of emergency care going on, because of overcrowding, because of access block, and not being able to move sick people out of emergency departments.

ALEX MANN: The report described a litany of near misses, miss diagnosis and a system at breaking point.

DR DAVID POPE: Rest assured that we are seeing people come to real harm because of these overcrowded emergency departments.

ALEX MANN: For 32-year-old bipolar sufferer, Simon, exercise is one way to keep his fluctuating moods in check.

SIMON: I don't wanna go back to the emergency department, I don't wanna go back to hospital. So I've gotta keep my body healthy, and I've gotta keep it right. Just to try and keep me out of hospital in the first place.

Cause it really, isn't a nice feeling, going into the emergency department, and being locked away like I'm some kind of prisoner, because my head ain't screwed on right sometimes.

ALEX MANN: His story is just one more piece of the puzzle explaining the city's crowded hospitals.

From his home in Port Augusta, Simon was sent to the Royal Adelaide Hospital's Emergency Department during a psychotic episode two years ago.

SIMON: Obviously they don't have the facilities in Port Augusta to deal with acute mental health patients, so it was shortly after that I was detained under the mental health act and transferred to Adelaide.

ALEX MANN: There were no acute mental health beds when he arrived, and Simon was forced to wait in emergency.

SIMON: It's very hard for someone to relax in that kind of environment. So they give you medication and they'll drug you up as much as they can to try and keep you quiet.

ALEX MANN: Heavily sedated, Simon was shackled to the bed. He spent five days alone waiting for a transfer.

SIMON: Someone with a mental illness shouldn't made to be feel alone even more. Jeez even in prison you get to share a cell with someone.

DR DAVID POPE: It's so common it's routine. It's what we expect to happen, just last week we had a large number of patients waiting three four, up to seven days, it's quite unacceptable and it needs to be fixed.

ALEX MANN: With a crisis looming the South Australian State Government is on the verge of reform, but there is deep trepidation in the sector over plans to merge six emergency departments into three and the impact that Federal budget cuts and a proposed GP co-payment will have on an already stretched service.

It's got emergency doctors running scared, and the State Government looking for a scapegoat.

JACK SNELLING, SA HEALTH MINISTER: Our focus to deal with that is by focusing on quality. If we have high quality and more consistent outcomes across our health system, that's going to drive improvements in quality which in turn is going to help us deal with these massive cuts made by the Federal Government.

ALEX MANN: But if hospitals are forced to close, the Federal Government's going to be a convenient scapegoat for you, isn't it?

JACK SNELLING: Well, my interest is Health Minister and my responsibility as Health Minister is to ensure we are delivering the highest quality health system that we possibly can.

Now, that's made very, very difficult given the scale of the cuts which the Federal Government have made.

ALEX MANN: The Federal Health Minister was unavailable for interview but in a statement said: "It's disappointing they [SA Labor] are using this genuine opportunity to address clear shortfalls in the state's health system as a cynical excuse to score political points."

She's right, though, isn't she, that there are problems you are seeking to address through the reforms existed a long time before there were any Federal budget cuts?

JACK SNELLING: There are issues where we are seeking to a address, seeking to address them with a strong focus on quality so we can get more consistent outcomes.

DR STEPHEN DUCKETT, GRATTAN INSTITUTE: We're all losers when the Commonwealth and State fight over issues. It's called the blame game.

ALEX MANN: Stephen Duckett is the Director of Health at the Grattan Institute.

DR STEPHEN DUCKETT: The Commonwealth blames the states and the states blame the Commonwealth, and in reality we're all Australians, we're all voters. South Australians vote for a State Government and the same people vote for the Commonwealth Government, so we shouldn't be having these fights. We have cost shifting, we have blame shifting and we are all losers as a result.

ALEX MANN: Back in Port Augusta, Simon is trying to keep his cool.

SIMON: We are supposed to be leading the world as far as Medicare and hospitals and treatment of Australians in general and we're supposed to be the best in the world. It's about time we started showing it.

STEVE CANNANE: Alex Mann reporting.