The death of a woman in her 70s who was ramped and waiting to be admitted to a Tasmanian hospital's emergency department for more than nine hours is "totally unacceptable" and shows the state's health system is crumbling, a union says.
The union that represents paramedics in Tasmania said the woman was taken to the Launceston General Hospital about midnight on Friday night, and died at about 9am on Saturday.
"The patient had been ramped for nine hours at the time when they passed away, and they were still in an inappropriate setting and had not been allocated a bed at that time," said Robbie Moore from the Health and Community Services Union (HACSU).
"This is a very sad situation that just demonstrates how bad our health system is, that we couldn't have a bed available for a patient who clearly needed medical assistance, and shows that ambulance ramping is out of control and patients' lives are being put at risk."
Ambulance ramping happens when hospital emergency departments are full and cannot admit new patients.
Paramedics care for the patients they have transported in an area of the hospital outside of the emergency department.
Mr Moore said the patient received care from emergency department staff while they were waiting for an ED bed to become available, and was also cared for by ambulance paramedics.
"A patient being ramped for nine hours is totally unacceptable, and demonstrates that we are letting down the Tasmanian community," he said.
"Unfortunately this is not an isolated incident … we're unfortunately aware of several other incidents where patients have been unable to get a bed and passed away on the ramp."
Nursing staff 'distraught' at conditions in LGH emergency department
The Australian Nursing and Midwifery Federation's Tasmanian secretary Emily Shepherd said on the night the woman was brought to the hospital, the LGH's emergency department was full, with 20 patients waiting to be admitted to beds in other parts of the hospital, about 50 people in the ED waiting room, and seven ambulances ramped.
"It's incredibly concerning [to have a patient die after being ramped]," she said.
"Our members have been absolutely distraught for many years about the situation in the LGH emergency department, and indeed across the state."
Ms Shepherd said nurses, doctors and paramedics did their best to care for patients who were waiting to be admitted to the ED.
"We've got patients receiving care not only on the ramp but also in waiting rooms surrounded by dozens of other people.
"Clearly the environment and circumstances upon which that care is being delivered is sub-optimal, of course our members would like to see every patient presenting to the emergency department moved into a cubicle and cared for appropriately in the appropriate environment and the appropriate space.
"But we know for many years now that unfortunately that just isn't the case."
Patients spend twice as long at LGH ED as at comparable hospitals
Access-block, also known as bed-block, is the root cause of ambulance ramping.
It occurs when acute beds in hospitals are full, so patients in the emergency department cannot be admitted to the hospital, meaning new patients cannot be admitted to the emergency department.
In 2019, the Australasian College of Emergency Medicine determined the Launceston General Hospital's ED suffered the worst access block in Australia.
According to the Australian Institute of Health and Welfare, up to 10 per cent of patients spent more than 16 hours at the LGH ED, compared with more than eight hours at comparable hospitals nationwide in 2020-21.
While the number of patients presenting at the LGH ED has barely changed over a decade, the number of emergency presentations has nearly doubled from 3,228 in 2011-12 to 6117 in 2020-21.
In June this year, 52 per cent of patients were seen on time at the LGH ED, according to Tasmania's Health Department.
Federal government urged to do more
Premier Jeremy Rockliff said he could "look Tasmanians in the eye and say that we can and need to do better when it comes to our healthcare" that was "why I've retained the health portfolio".
But he added he believed the federal government needed to do more.
"A lot of our challenges in the acute care system is about people's lack of access to GPs and primary healthcare services. This is a federal government responsibility.
"We're happy to play our part as a state government, and we have been. We've been stepping into that primary healthcare space, providing access to GPs, we're stepping into that role.
"I was critical of the previous [federal] government when it came to access to GPs, and I'll be working with our new government to ensure they lift their game with improving access to GPs and primary healthcare."
Mr Rockliff said he had called on the federal government to "address sub-acute challenges that we have when it comes to our aged care and NDIS participants, who are spending far too long in our hospitals".
"They need to be provided their care in the appropriate setting, and that's a federal government responsibility. Again, we'll work with them in a collaborative way, but all governments, state and federal, need to step up."
Formal review into ramping death underway
Tasmanian Health Department secretary Kathrine Morgan-Wicks said the patient was receiving care in a transition area while waiting for hospital bed.
"While waiting for an Emergency Department (ED) bed to become available, the patient was receiving care from ED staff and paramedics in a transition area inside the ED," she said in a statement.
The health boss said a formal review of the case was underway.
"As is the case whenever a patient dies in our care, we take this matter very seriously and we give our sincere condolences to the family and friends of this patient," Ms Morgan-Wicks said.
"The Launceston General Hospital and Ambulance Tasmania will be conducting a root cause analysis to fully review and understand the circumstances around this patient's death."
Ms Morgan-Wicks said she could not comment further due to patient confidentiality.
Asked on Tuesday about what the state government was doing to reduce ambulance ramping, Premier and Health Minister Jeremy Rockliff said his government had employed an extra 870 frontline health staff over the past 12 months and was working on system improvements.
"It's about ensuring that we get the access and flow from triple zero right through to patient discharge through our hospital system and through our emergency department," he said.
"And it's those system improvements that are so crucially important, as well as, of course, the investment into staff and infrastructure resources."
