In a case straight from some comedy movie, a mentally-ill man posed as a doctor and checked on patients at a hospital in New South Wales before being chased out.
He was able to roam a busy emergency department, masquerading as a doctor and "consulting" patients, in a serious security breach that exposes the worsening staffing crisis in the nation's hospitals.
In the recent incident at Wyong Hospital on the NSW central coast, the intruder was able to examine five patients before being challenged while trying to escort one of them outside for a cigarette. He then ran off.
While none of the five patients was harmed, hospital sources describe the incident as a near miss. They say emergency department rosters are now dominated by "transients" such as locums -- making it all but impossible for regular staff to spot someone who should not be there.
A Locum is a person who temporarily fulfills the duties of another. For example, a Locum doctor is a doctor who works in the place of the regular doctor when that doctor is on holiday or ill.
More importantly, many of these temporary fill-in doctors are poorly qualified and undersupervised -- creating a perfect environment for "critical incidents" that threaten patient safety.
The situation is so bad that no one knows who anyone is, it is pointed out.
Tony Joseph, chairman of the NSW faculty of the Australasian College for Emergency Medicine, said it was possible for someone to slip through the cracks because of high staff turnover.
"I don't have too many details about the incident but I think it would be reasonably rare, probably a failure of proper identification," he said.
"It just sort of reflects you have a high turnover of staff and no one really knows who people are."
Dr Joseph said the Australian Medical Workforce Advisory Committee recommended 130 new emergency specialists were needed each year across Australia, but there were just 86 in 2006.
"I think one of the major problems facing emergency departments, not only in NSW but Australia-wide, is the shortage of emergency specialists to actually lead from the top down and supervise the care of patients and supervise the smooth running of departments," he said.
The gap is being filled by hospitals ringing around locum agencies and individual doctors up to an hour before a shift is due to start, sometimes bidding against each other to secure desperately needed staff.
This practice is inflating the normal rate for a junior emergency doctor from about $70 per hour, or $120 per hour in rural areas, to about $200 per hour. In NSW alone in 2004, the use of locums added an estimated $30million to salary costs, Dr Joseph said.
He said state governments needed firstly to ensure adequate senior trained staff to oversee more junior doctors, and secondly to ensure adequate numbers of beds in the hospital, to prevent the problem of "access block" where emergency beds were occupied by patients waiting for inpatient beds.
The problems in emergency department staffing were so profound they called into serious question the viability of the federal Government's proposed takeover of the Mersey Hospital in Tasmania.
Either the relaunched facility would fail to find staff, or would poach those staff from nearby hospitals, worsening services in those areas, Dr Joseph said.
He said emergency doctors often had no meal breaks. Burn-out, turnover and drop-out rates were also high, ensuring a constantly high level of new staff unfamiliar with the hospital and its patients -- threatening standards still further.
"If you don't have enough senior people making decisions about patient management, that's one thing," Dr Joseph said.
"But if the (emergency) department's full of patients who should be in the ward, that impedes your ability to see new patients.
"It's really a recipe for critical (safety) incidents."
Although the pseudo doctor fled, the man was known to the Wyong Hospital, an official said. While examination by a non-doctor could be deemed an assault, under the circumstances it was not considered necessary to inform the police. The situation was explained to the patients involved.
The official further said concerns that staff were no longer able to spot impostors were "certainly valid". But a bigger concern was the damaging effect on quality and patient safety from staffing emergency departments from locum agencies.
"There's a whole movement to improve quality, but the fact is that people who don't have a commitment to a particular hospital or particular training are just not part of that quality loop," the source said.