The Sydney doctors forced to choose who lives and dies (2024)

Senior clinicians at Sydney’s busiest hospitals have warned they are rationing “life-sustaining” treatment for patients with kidney failure amid an escalating crisis in renal and dialysis services in the state’s public health system.

The kidney specialists, who work across three Sydney health districts, have pleaded with NSW Health Minister Ryan Park to “urgently address the crisis” or risk clinicians being forced to choose who receives dialysis and who misses out, a decision which would see patients die.

In damning letter co-signed by 45 specialists from western Sydney, south-western Sydney and Nepean/Blue Mountains local health districts (LHDs), the doctors warn there is “not enough capacity and resources to provide basic haemodialysis treatments to patients who need them to stay alive”.

“Due to lack of capacity, we now have patients in the community as well as in our hospitals waiting for excessive periods of time to commence dialysis treatments,” the letter, dated July 30, says. “Soon we may be forced to deny these life-sustaining treatments to patients who need them to stay alive, or to choose patients who can stay on haemodialysis while others die. We are not prepared to do this.”

The letter says the clinicians are providing haemodialysis treatments at levels seen in the developing world, where “patient outcomes are universally poor” as a result of “years of underinvestment in dialysis infrastructure and services” in the three health districts.

One in six Australian dialysis patients is treated in western and south-western Sydney, the letter says, and more than 300 patients need to start treatment across the three local health districts each year “to stay alive”.

“As detailed by our National Dialysis and Transplant Registry, we have the highest numbers and most relentless growth of dialysis patients, compared to any other state LHDs,” the letter says.

As of May 30, there were 127 patients who had their treatment reduced to twice-weekly instead of the standard three times a week, 52 patients had the duration of their treatment time reduced beyond recommended levels and 92 patients were forced to travel more than an hour each way three times a week to “sustain their lives”.

“We continue to see patients develop life-threatening complications of under-dialysis or delayed dialysis,” the letter says.

In a statement, Park, who responded to the doctors’ letter on Friday, said he had been briefed on their concerns and insisted that the government was committed to ensuring “everyone who requires renal dialysis can access this important service when they need it”.

“It’s important that this issue has been brought to my attention – it’s serious and we must do better, and while the challenge is structural, we are working to rectify it as quickly as possible,” Park said.
“In the interim, I’ve asked NSW Health to optimise shift patterns to allow more patients to receive dialysis, as well as engage with private providers, to expand capacity.”

Park said the government would add an extra 10 dialysis treatment chairs as part of the Nepean Hospital Stage 2 redevelopment, due to open in 2026, which would increase capacity for an additional 36 patients, or 5600 more renal dialysis therapies at the hospital each year.

“The Nepean Hospital renal dialysis unit has also been trialling an additional shift per day for 10 dialysis chairs to treat up to an additional 18 patients every day, or an additional 2800 dialysis therapies each year,” Park said.

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“Western Sydney Local Health District has also increased funding to Blacktown Hospital to support an extra 36 treatments a week. It’s important to note that our hospitals and facilities operate as a highly integrated network, working together daily to ensure optimal delivery of dialysis services to the community.”

He said the government would continue to monitor the growth in demand of services in western Sydney, as well as “plan to future-proof this critical service”.

The opposition’s health spokesperson, Kellie Sloane, said it was “an unprecedented call to action by dozens of clinicians who have said to the minister that lives are at risk if he doesn’t intervene”.

“This is a stark situation that is hitting people in west and south-western Sydney hardest,” she said.

“We have a situation where clinicians are rationing life-saving care and comparing the resourcing to third-world conditions. The minister needs to urgently outline his plan to address this.”

Sloane said the health system was under extreme pressure, with “rolling industrial action by nurses for unfunded wage increases and emergency departments under strain”.

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