Perth Hospital Surgeons Stood Down Amid Staffing Crisis

Internal documents obtained under Freedom of Information laws have unveiled a significant number of challenges within the cardiothoracic surgery department at Sir Charles Gairdner Hospital in Perth. The period under review, largely spanning 2024 and 2025, highlights critical staffing shortages, questionable recruitment practices, and operational difficulties, including the standing down of two surgeons.

These documents paint a stark picture of the department’s struggles. At the close of 2023, one cardiothoracic surgeon received a formal letter directing them to the integrity directorate of the North Metropolitan Health Service. This directorate is responsible for addressing issues of misconduct and corruption. Subsequently, in December 2024, a second surgeon was formally requested to “remain absent from the workplace on full pay until further notice.” While this absence was attributed to an ongoing, undisclosed investigation and explicitly stated as a protective measure rather than disciplinary action, it underscored the escalating concerns. Reports indicate that the first surgeon was officially stood down in 2025 due to subpar patient outcomes and unprofessional conduct, while the second surgeon remained on paid leave as of late last year.

The internal communications also reveal a troubled work environment. Emails exchanged between staff members express significant apprehension regarding the unit’s atmosphere. One message candidly states, “I need to ask you for your candid opinion about the atmosphere currently generated by your ward staff. I am hearing that the atmosphere is combative and disrespectful.” The response acknowledged a lack of direct information but committed to discussions with junior doctors.

Despite these revelations, North Metropolitan Health Service chief executive Robert Toms maintained that the department fosters a “positive and healthy workplace culture” and is a sought-after training ground for aspiring cardiothoracic surgeons. He declined to comment on the specifics of the two surgeons’ situations but addressed the broader staffing challenges.

Addressing Specialist Shortages

Mr. Toms acknowledged the national scarcity of cardiothoracic surgeons, noting their inclusion on the Australian government’s occupational shortage list. He outlined efforts to address this, including extensive national and international recruitment drives aimed at maintaining a high standard of patient care. “In the past there have been some staffing challenges, however, strategies were immediately implemented to ensure there was no impact to the service, such as undertaking short-term locum appointments and fixed term contracts,” he stated. He further confirmed that the department had achieved a full complement of cardiothoracic surgeons by August of the current year.

Operational Pressures and Patient Care

The documents further detail the severe impact of understaffing on the unit’s operations. In one alarming instance, Fiona Stanley Hospital was forced to redirect a complex patient requiring immediate surgery, stating they were too busy to accommodate the case. A junior surgeon at Sir Charles Gairdner Hospital sought assistance from a senior colleague, who reportedly declined due to it being his birthday. This incident prompted an email highlighting the critical need for a senior surgeon with a higher full-time equivalent (FTE) allocation, lamenting that this had not materialised due to “poor attitude.”

The recruitment of locum staff also revealed a complex situation. In July of last year, a locum surgeon was appointed at 0.8 FTE, and another at 0.7 FTE. An email following these appointments expressed optimism, suggesting it would be the first time in two decades that the workload would be matched by appropriate FTE with dedicated time for administrative, teaching, and research duties. However, between July 15th and 19th, further emails highlighted significant concerns about Friday staffing levels, with planned leave extending to December creating a “highly undesirable situation.”

The emails indicated that securing sufficient consultant cover required extensive planning and negotiation, with a reliance on fellows and advanced trainees to manage theatre lists independently. A significant concern was raised about the inability to secure adequate anaesthetist cover, deeming the situation unsafe for the existing team.

Registrar and Resident Shortages

Compounding these issues, the unit was reportedly operating at 50% of its required capacity for both registrars and resident medical officers (RMOs). These doctors, holding general registration, work under supervision in hospital settings. Concerns were voiced that this shortfall would inevitably “affect patient management and there will be safety issues.” The emails praised the dedication of the current RMOs and registrars, who were described as “overstretched and barely meeting the departmental needs.” A suggestion was made to actively recruit from the RMO/registrar pool, offering rolling locum contracts. In a critical communication, the lack of a registrar was identified as a “serious risk of compromising clinical services provided by CTS,” emphasising the need for “uninterrupted service provision and safe care to patients.”

Recruitment Practices and Oversight

Evidence suggests that the hospital resorted to employing staff based on personal connections, potentially bypassing formal advertising processes. While state government guidelines mandate advertising of permanent public sector vacancies or fixed-term contracts exceeding six months on the jobs board, exceptions exist for current employees of the same organisation. Mr. Toms asserted that all appointments and recruitment within the unit adhered to WA public sector guidelines. However, an email discussing the potential recruitment of a cardiothoracic surgeon from the UK posed the question, “How do you feel about the idea of headhunting a mid-late career CTS from the UK?” The email suggested a process of identifying candidates through personal contacts, “not by advertising,” acknowledging the inherent risks but viewing it as a potential “circuit-breaker.”

Public and Political Reaction

Mr. Toms reiterated that patient safety remains the department’s “absolute priority” and assured the public that “robust processes are in place to ensure we maintain appropriate staffing levels.”

In response to these revelations, Opposition Health Minister Libby Mettam described the findings as “explosive,” stating they demonstrate public hospitals are “at breaking point and the health of West Australians is being compromised.” She added, “These documents show clinicians warning that staffing shortages in a critical surgical unit were creating serious risks to clinical services and patient care.” Ms. Mettam called for the government to explain how a specialist unit responsible for life-saving heart and lung surgery was allowed to reach a point where staff themselves were raising concerns about safety and governance.