“The current situation is unsustainable and only working because of the significant commitment of [junior doctors] to continue providing a service under adverse conditions,” according to HETI - the organisation responsible for accrediting hospitals with junior doctors in their first two years after graduating medical school. Loading The inspectors warned medical teams were not directly notified when a patient’s diagnostic test results were abnormal, raising the risk that they could be “missed”. “Unreliable” electronic medical records and paging system could also lead to “missed calls [or] notifications”. HETI The hospital inadequate planning and preparations by the time the facility opened last October, the December report read.

It confirmed significant staff shortages particularly after-hours on medical and surgery wards, and a scarcity of senior supervisors. The report's author Dr Martin Mackertich detailed mistrust between hospital management and trainees, and a lack of cohesive policies, procedures and protocols to support safe work practises. “Morale among [junior doctors] is low, and quick clear progress on issues will need to be demonstrated and maintained to regain their trust in the organisation," according to the report. Two reports - the December inspection and a second detailing a follow up inspection in January - were released on Tuesday after the Australian Salaried Medical Officer's Federation spent months attempting to obtain them under GIPA laws. ASMOF NSW president Dr Tony Sara said the December report “completely vindicated” its threat of industrial action, and warnings to HETI of significant concerns for patient care and staff safety.

“In a sense, it was possibly worse than we had described,” Dr Sara said. Loading The Sydney Morning Herald understands senior and junior staff have been reporting a series of issues that compromise their ability to deliver optimal care to patients as recently as last week. They include ongoing staffing gaps, unresolved policies, unclear processes and the need for more support for inexperienced junior staff. Dr Sara would not comment on specific reports from ASMOF members but said the federation was in constant communication with staff working at the hospital, and was collating their feedback for its submission to the parliamentary inquiry.

“The January report notes improvements, but it is likely not running optimally yet,” Dr Sara said. The hospital’s opening was marred by shortages in basic drugs and medical supplies, understaffing, high-profile resignations and anaesthetists threatening to cancel elective surgeries over serious concerns for patient welfare. In May, a cancer patient had the wrong side of his colon removed due to an error in his pathology report. A parliamentary inquiry tasked with examining the hospital’s operations is expected to hear evidence from senior executives, NSW Health bureaucrats and whistleblowers next month. At the time of HETI's December inspection almost half of the hospital's 488 beds were closed, and elective surgeries were limited in response to staffing and operational issues.

The hospital’s executive told HETI it was committed to addressing the serious issues, but “progress has been slow”, according to the December report. HETI granted the hospital provisional accreditation (noting JMOs did not want its accreditation withdrawn), and tasked managers with a 15-point action plan to address the problems, 11 demanding immediate action. The follow up inspection in January noted the hospital had made significant progress in addressing the issues identified at the December 2018 visit, including improvements in staffing levels, electronic medical records, diagnostic result alerts and the paging system. “Junior [doctors] are generally happier and acknowledge the progress that has been made,” according to their January report. “Overall the review team were satisfied with the progress made by the hospital and the commitment of management to continue doing what was required to ensure a safe and efficient working environment for junior medical staff within the hospital."

But the hospital still had a “less than ideal reliance on locum staffing particularly after-hours” and were concerned that the new cohort of inexperienced doctors posed “a significant risk” in once all the trainees with “corporate memory” would have left the hospital. The hospital agreed to have an additional senior career medical officer familiar to the hospital to offer support and local knowledge for the new trainee. In a statement, a spokesperson for Healthscope said the hospital had improved training and support for junior doctors over the past six months, further increased staffing levels, and implemented better team structures, and streamlined its systems and procedures. Since the January inspection, the hospital has created a deputy director of medical services position responsible for junior doctors and restructured the medical units to meet the workloads. Group newsletters and a group SMS system were improving communications with trainees, and comprehensive policies, protocols and procedures were now accessible on the hospital’s computers.