Doctors and patients criticise state government decision to suspend procedures during Covid wave
When the La Trobe University lecturer Dr Yves Rees was told their gender affirmation surgery would be cancelled, they were devastated. “It was impossible to contemplate,” they said.
Rees’ procedure was scheduled for November, during the Delta wave, and was later reinstated when elective surgery was reintroduced in Victoria. But at the time, Rees was told there would be an eight-month wait for the procedure.
“There can be a perception gender affirmation surgeries are a choice, something people would prefer to do rather than not,” they said.
“That’s not correct; the reality is these are very much medically necessary surgeries …this can be the difference between a life of constant gender dysphoria and acute stress and anxiety, and a life of feeling good.”
Health experts warn delaying elective surgeries in Victoria, including gender affirmation procedures, will see blown out waiting lists spiral into a “massive healthcare crisis”.
On 5 January, the Victorian government announced elective surgery – except for “emergency and urgent” procedures – would be temporarily suspended to ease pressure on public and private hospitals amid the Omicron wave.
The changes came into effect from 6 January across Melbourne and major regional cities for a three-month period – to help hospitals manage record Covid-19 patients.
But on Thursday, IVF procedures were exempted from the restrictions following a social media backlash, with hospitals scaling up to resume procedures from 25 January.
Royal Australasian College of Surgeons president Dr Sally Langley said the recurring ban on elective surgery in Victoria had a “profound effect”. She wants a return of short-stay surgery in adequately-equipped hospitals and facilities.
“Across the board, all specialties have been affected. Urgent surgery too has seen waiting times longer than ideal because of staff shortages, staff illness and staff furlough,” she said.
“Victoria has already been through this with the bans on elective surgery in the last couple of years. There’ll be an even longer waiting list for important surgery and [patients] may well deteriorate.”
Langley said the term “elective surgery” encompassed “serious pressing” surgeries including painful mobility and arthritic problems that would be “significantly worse” within 30 days.
“We do know surgery can go ahead in a hospital that’s adequately staffed, where people are free of Covid,” she said.
“Surgeons and their teams should be working to keep up their skills. The longer periods of time they’re away from work, there’ll be some anxiety about maintenance of skills.”
A Victorian anaesthetist employed in the public and private sector said he welcomed the return of IVF but the current shutdown in clinical work had left him with a “very nasty taste” in his mouth.
“I don’t see a reason for the overwhelming shutdown of every sector of healthcare,” he said.
“Hospital and ICU beds are in short supply … so I can understand restricting surgery if those resources are required, but there’s a whole sector of day surgery procedures, where most of the patients never even see the inside of a ward or a hospital bed. Why can’t those operations carry on?”
The current national definition for elective surgery is care that can be delayed for at least 24 hours – used to distinguish between emergency care which requires action within that timeframe.
The banner includes a wide range of procedures from cataract extractions and endometrial procedures to coronary artery bypass grafts, full hip and knee replacements and some cancer procedures.
The department of health said further advice was being sought about other services that could resume without a “critical impact” on workforce capacity.
It said the state’s chief health officer, Prof Brett Sutton, provided advice to the acting health minister, James Merlino, that the “specialist nature” of the workforce, facilities and equipment used in IVF weren’t “imperative” to support the pandemic response.
Merlino said he was “deeply sorry” for the distress caused by affected services in recent weeks and was “working to have other services restored as soon as we can”.
There are three “clinical urgency” categories for elective hospital care – the highest with the potential to become an emergency within 30 days.
Category two recommends admission within 90 days for a condition causing “pain, dysfunction or disability”, while category three recommends admission is “unlikely to deteriorate quickly” or become an emergency.
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In New South Wales – a state with comparatively higher hospitalisations and ICU bed occupations – less urgent day procedures like cataracts, routine endoscopies and minor surgeries are able to continue.
“The nursing staff for such procedures are generally highly skilled in their relevant fields and, as such, probably wouldn’t be able to easily be redeployed to a Covid streaming hospital or ICU without some very intensive training,” the anaesthetist said.
“As a result, we have thousands of staff sitting idly by, while the rest are absolutely struggling to cope with their workloads. Is it any wonder that nurses are resigning, not renewing their registrations and moving on to other fields of work?”
The anaesthetist said no new or extra requests had been made to private hospitals since Victoria’s coordinated code brown was announced, leaving the “vast majority” of staff forced to take leave due to restrictions.
“It’s been two years. We cannot keep shutting down other parts of the hospital to cope with increased hospitalisations. This was fine as a short-term gap measure but is not sustainable long term.”
In Victoria, according to September figures, there were 67,596 people on the waiting list for category two and three elective surgeries.
In NSW, the figure was even higher, at 90,123 people. In Queensland, 53,933 people were waiting for elective care.
“There needs to be a better plan moving forward, as we are going to have a massive healthcare crisis in Victoria in the years to come,” the anaesthetist said. “We have one of the lowest rates of hospital and ICU beds per capita in any developed country. How have we let this happen?”
On Friday, the NSW premier, Dominic Perrottet, said plans to resume non-urgent surgery in his state would be reviewed in the middle of February, aligning with the Victorian approach
“Obviously, it is highly dependent on … hospitalisations so the next week or two will be critical in terms of making a decision,” Perrottet said.
“For urgent surgery, and during the Delta wave, 100% of surgery was completed on time and we continue to operate on people each and every day and the thing we’ve kept going is day surgery procedures. We will absolutely be turning surgery back on as soon as we possibly can.”
For Rees, the trans community had already been disproportionately impacted by the ripples of the pandemic.
They said while all elective surgery was important, unlike having a broken leg, they had to undergo years of internalised transphobia and an extensive process to prove their procedure was medically necessary.
“It’s enormously stressful,” they said. “I’ve been contacted by many online who are at their wits’ end at the thought of having waited so long for these surgeries and having to wait again.”