A senior doctor working in the north of Western Australia had this simple assessment of the planned repeal of Western Australia’s hard border: “It will be an absolute fucking disaster.”

The doctor, along with multiple others who spoke to The Saturday Paper, warned of an impending catastrophe that may explain the decision by Premier Mark McGowan on Thursday night to indefinitely postpone WA’s reopening. Doctors have warned of critical staff shortages in some regions and a lack of bed capacity. “We’re severely short on staff and that is before we’ve had a single Covid infection. We have next to no critical care facilities outside of Perth.”

Another senior doctor said: “Our hospital will be a great place to get Covid. I’d say it could all fall over extremely quickly. If you had the first case wander through the ED, that takes out a huge proportion of staff in one fell swoop.”

A leaked email from the chief executive of the WA Country Health Service referred to “critical staff shortages” at Geraldton Regional Hospital, echoing concerns seen by The Saturday Paper about another regional hospital.

One doctor expressed fear of the impact both for patients and front-line staff. “I feel really scared for the young nurses and young doctors because I think they’re going to be really traumatised,” the doctor said. “There are a lot of people who are not going to be ready for this.”

This week, a “code brown” was declared across Victorian hospitals following a record number of admissions with Covid and the widespread furloughing of staff. The designation would usually last a few days during a major disaster but is expected to be in place for weeks. The acting Health minister, James Merlino, said the system is “under extreme pressure”. In New South Wales, leaked memos suggested flying in nurses from overseas and cancelling scheduled leave to deal with the crisis.

In WA, however, Premier Mark McGowan has celebrated being “an island within an island” after almost two years without community transmission of Covid-19. Hardline border closures have ensured fewer than 1400 Covid-19 cases in the state since March 2020. But McGowan’s Covid-zero approach was set to end on February 5, when WA’s “double dose” vaccination rate will reach about 90 per cent. With just a fortnight left until the proposed reopening date, however, McGowan retreated late this week amid widespread doubt about the capacity of the health system to withstand Covid despite almost two years to prepare. At a late-night press conference in Perth on Thursday, the premier announced that border restrictions would remain for the foreseeable future. It may yet prove that keeping the border closed is the easy part – what happens afterwards is the real test.

Earlier this month it was revealed that ambulance ramping – the amount of time ambulances wait to discharge a patient outside a hospital – reached 52,000 hours in WA in 2021. This was more than double the number of hours in 2020. When the McGowan government came to power five years ago, the ramping figures were five times lower and even then were labelled a “crisis”.

Mark Duncan-Smith, the president of the WA branch of the Australian Medical Association, explains that ambulance ramping is a visible indication of critical shortages inside hospitals. “We started this pandemic with the lowest number of beds per head of population of any state or territory in Australia,” he says. “And the lowest number of ICU beds of any state or territory in Australia.”

The most recent figures from the Australian Institute of Health and Welfare show that WA had just 2.24 public hospital beds per 1000 people, the lowest in the country. WA also had fewer intensive care beds per capita in 2021 than the previous year, 30 per cent below the national average.

WA Liberal MP Libby Mettam, the shadow Health minister, says Premier McGowan has squandered “the gift of time” to prepare the WA health system for Covid-19. “ICU bed capacity, and more importantly the available staff to support them, is now a major barrier to responding to Covid and ensuring pre-pandemic models of care,” she says.

Although WA’s ramping remains slightly lower per capita than in Queensland, the only other state where figures are published, escalating numbers throughout 2021 became a focal point for the McGowan government’s handling of the health system. As Duncan-Smith remarks, “For the only state in Australia with a $6 billion surplus, it’s not a good place to be.”

The pressure culminated in April last year following the death of Aishwarya Aswath in the emergency department at Perth Children’s Hospital. Seven-year-old Aishwarya died of sepsis in her father’s arms after waiting more than two hours for treatment. Aswath Chavittupara and Prasitha Sasidharan had repeatedly sought to alert hospital staff to the severity of their daughter’s condition. Just two nights later, an interview with the distraught parents on 9News initiated a tsunami of local media coverage.

Family spokesperson Suresh Rajan explains that Aishwarya’s parents wanted the hospital or the Health minister to accept blame for their child’s death. “For them to have closure, they need to be made aware that it was not their failing,” he says. “They did all the right things, but the system failed them.”

He says the family perceived a sympathetic media as a crucial tool in “chipping away at this bureaucracy”. Their relentless public campaign involved a hunger strike outside the hospital and multiple inquiries into the circumstances surrounding Aishwarya’s death. “The parents have seen this as an opportunity for them to ensure that this doesn’t happen to anyone else,” Rajan says.

He says it was especially galling to see the speed with which the premier flew to visit Cleo Smith after she was rescued following an abduction, given McGowan has not once met with Aishwarya’s parents. “It is now nine months and he has not made a phone call to them,” Rajan says.

For Andrew Miller, a former president of AMA (WA), public pressure has been an essential element of advocating action from the McGowan government. “If you’re not playing in the political space, then you’re not going to have an effect,” he says. “You’ve got to be prepared to make enemies in politics.”

The AMA and other medical unions have followed what Miller describes as a “message that came through loud and clear from Aishwarya’s family” to reinforce their calls for systemic change. The state budget in September, McGowan’s first since making himself treasurer following his landslide re-election last year, was headlined by a $1.9 billion health investment. McGowan promised a further $400 million in November, to establish more than 500 additional beds in the coming year.

In response to questions directed to WA Health and the new Health minister, Amber-Jade Sanderson, a state government spokesperson said 1259 new nurses and midwives were employed in WA hospitals during 2021. They say that a further 485 doctors were recruited in 2021, including 220 from Britain and Ireland.

“We have invested a record $3.2 billion in our health and mental health system,” the spokesperson said. “Like most hospitals and health services around the world, healthcare workforce shortages have been exacerbated by the ongoing demands of the pandemic.”

The AMA suggests these demands have taken a significant toll on existing medicos. “ ‘Burnt out’, ‘demoralised’, ‘tired’ is the kind of feedback I get,” says Duncan-Smith.

“You get a disconnection between the people at the front line who provide the services and know full well what the problems are,” adds Miller. “And then this sort of fantasy world of bureaucracy and politics which exists above it.”

Both say WA’s five-year contracts for doctors, unique in Australia, have a chilling effect. All other states offer permanent contracts to doctors in their public systems. “If a doctor complains about workplace safety [in WA], then they just don’t get renewed,” Miller says. “There only has to be a summary execution of one of the prisoners to keep the rest of them in line.”

Front-line doctors who spoke to The Saturday Paper under strict anonymity, concerned about repercussions for talking to the press, confirmed an absence of confidence in the WA health hierarchy. “We get told all this stuff that we know is complete fantasy, and we’re supposed to believe it, and nobody does,” one said.

This doctor described regional emergency departments where a red line painted on the floor is all that separates the Covid-19 “red zone” from the rest of the patients.

“Do you know what they will say? ‘We could never have predicted this. Who would have thought?’ ” the doctor said. 

McGowan’s last-minute reversal came as a reprieve. “Thank god [McGowan] decided to do this,” the doctor said. “Thank god. This is a reprieve which will save lives – but it is not an answer, because I think very few really understand the endgame.”

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