Patients are dying and are being injured because of deteriorating conditions at the Royal Hobart Hospital, emergency department doctors say.

Key points: Emergency department registrars have written a scathing five-page letter to management

Emergency department registrars have written a scathing five-page letter to management They said they can provide "as many examples as desired" of patients dying or being injured because of bed block and ambulance ramping

They said they can provide "as many examples as desired" of patients dying or being injured because of bed block and ambulance ramping The Government says it recognises demand has increased and has provided funding for more staff

The department's registrars have written a scathing letter to management, saying they have "grave concerns" and can provide examples of "direct patient injury and death" because of worsening conditions and bed block.

The no-holds-barred five-page letter said "extreme access block" and ambulance ramping were having a "devastating effect" on patients, and the registrars "will no longer be silently complicit in sub-standard patient care and an unsafe work environment."

It said there had been "abundant cases of direct patient injury and death resulting from access block".

The letter outlines the waiting and ramping times, which in some cases, resulted in patients waiting for more than 170 hours for an in-patient bed.

The doctors said they could not wait for the $690 million redevelopment, and the new K-Block, to be completed.

The letter reads in part:

Extreme access block and ramping are having a devastating effect on our patients. We have done everything possible as individuals and a department to buffer patient impact. System failures are also causing severe moral injury, physical exhaustion, emotional depletion and psychological trauma among our registrar group. As employees, we are entitled to safe work conditions under Australian law. We are currently working beyond our scope of practice, experience and skill-set. We will no longer be silently complicit in sub-standard patient care and an unsafe work environment. Mental health patients are remaining in the Emergency Department for up to 7 days due to access block. These patients are denied dignity, efficacious therapy and a safe environment.

Do you know more about this story? Contact tasindepth@abc.net.au

The registrars said the entire southern ambulance fleet was often ramped at the hospital leaving up to 13 triple-0 cases to go "un-responded", including heart attack calls.

Dr John Saul says GPs are treating patients who can't get an ambulance. ( ABC News: Lucy MacDonald )

They said the constant overcrowding would likely lead to more registrar stress and sick leave in coming months, and there were not enough staff members to cover absences.

Hobart GP John Saul said every facet of the medical community was feeling the flow-on effects.

"We are looking after people and emergencies we've never looked after because the ambulances can't attend in a timely fashion," he said.

"It's the same message we've been saying for decades and it's escalating.

"Things seem to be getting worse. We just need urgent support."

Call for emergency access summit

The group has listed recommended measures, including more staff and improving bed access across the entire hospital.

Dr Marielle Ruigrok, who is the Tasmanian Faculty Chair for Australian College for Emergency Medicine (ACEM), said everything in the letter was concerning.

Doctors say they will no longer be silently complicit.

"[Firstly], it leads to increased death and morbidity for patients, so patients who otherwise wouldn't have died do die and the second, even just as concerning, is the staff will leave," she said.

"So the good, dedicated staff that we have there will go elsewhere and as the reputation deteriorates, we won't be able to get any others."

She has called for a summit to discuss access block.

In a statement, the Government said it recognised demand had increased and it had invested "a record $757 million into health" including $5 million to enable the recruitment of more emergency department staff.

"Admissions to Tasmania's Emergency Departments have increased by 21 per cent in the past three years," the statement said.

"This situation is not unique or isolated to Tasmania and there are similar demands and challenges in Emergency Departments across the country."

Doctors say the entire southern ambulance fleet can be ramped at the Royal, meaning they can not respond to other emergency calls. ( ABC News: Scott Ross )

The letter comes as the coroner's office confirmed it was investigating the death of a 71-year-old man in the hospital's emergency department 11 days ago.

After the death, it was revealed the Government was considering opening up beds at a Taroona nursing home for elderly patients.

Last month, the Hodgman Government released its revised masterplan for the next stages of the hospital's redevelopment, allocating $91 million over the next three years to commence stage two.

The plan prompted concern from doctors that vital components of the troubled redevelopment might not be in place for up to three decades.