KUALA LUMPUR, August 12 — The ongoing transfer of all housemen from Sultan Haji Ahmad Shah Hospital (HOSHAS) in Temerloh to the Pahang state hospital in Kuantan has triggered a severe staffing crisis that doctors say is compromising patient safety.
Doctors said the general medicine or medical department, the largest in the government hospital, will have “zero” house officers left by the end of this month, following their relocation to Tengku Ampuan Afzan Hospital (HTAA) and the suspension of new housemen placements for HOSHAS this year.
Additionally, 49 remaining housemen in other departments – including obstetrics and gynaecology (8), general surgery (8), paediatrics (8), orthopaedics (10), anaesthesiology and critical care (7), and emergency and trauma (8) – are expected to leave by early 2025.
HOSHAS – the second biggest hospital in Pahang – is the lead hospital in the Ministry of Health’s (MOH) Central Pahang cluster hospitals. As a referral centre for Central and West Pahang, HOSHAS provides medical and subspecialist services for other cluster hospitals in Bentong, Bera, Jengka, Jerantut, Kuala Lipis, and Raub, as well as Sultanah Hajjah Kalsom Hospital in Cameron Highlands.
“It has reached a level where they are now trying to ask non-clinical administrative doctors to take blood as a last resort, which they are not keen on. Patient care is already compromised and has become unsafe. The health minister needs to intervene,” Dr Rey (pseudonym), a specialist at HOSHAS, told CodeBlue last week on condition of anonymity.
“JKNP (Pahang state health department) has been repeatedly contacted with various appeals for the past six months and they have failed us. We are at our final limits; I don’t think we can sustain this any longer.”
In a letter dated February 16, 2024, sighted by CodeBlue, HOSHAS general medicine department head Dr See Chee Keong urged JKNP to retain house officers at the hospital, saying that the halt in new placements of trainee doctors has “directly affected” the department’s services.
“For service continuity, the general medicine department needs at least 46 medical officers and 34 house officers. As of February 2024, it has 16 specialists (including subspecialists), 24 medical officers, and 20 house officers,” Dr See wrote to the Pahang state health director.
“As such, the current medical and house officers are facing workloads that affect quality of service, as well as their motivation, and mental and emotional health.
“Medical officers are forced to take over duties that were previously undertaken by house officers, which further adds to their workload until some officers are forced to work overtime. A few medical officers are facing burnout, while others are contemplating resigning from the medical service due to high workloads and an unconducive working environment.”
Dr See requested the retention of housemen at HOSHAS or, if that was not possible, an addition of 22 contract medical officers to meet service needs.
Patients’ Blood Tests Delayed, Antibiotics Not Administered on Time
Dr Rey said the shortage of doctors in HOSHAS’ medical department has caused delays in taking patients’ blood and ordering medications.
“Medication, including antibiotics, is not administered on time due to a lack of staff to insert IV cannulas. Patient resuscitation is inadequate when someone collapses because there are not enough staff to assist,” Dr Rey said. “This is a serious crisis. We can only provide the bare minimum of patient care due to the significant staff shortage.”
Dr Benny (pseudonym), a medical officer at HOSHAS, said the shortage of housemen across the MOH hospital has led to each medical officer handling “nearly three times” their usual workload.
“Each department has implemented contingency plans to address the crisis, such as increasing on-call medical officers for blood draws and procedures, and using staff nurses for blood taking and IV cannulation. However, administrators have not provided long-term solutions,” Dr Benny told CodeBlue last week.
High burnout rates and low morale have led to at least three medical officers resigning this year, Dr Benny said, with others considering leaving and some specialists departing due to poor working conditions.
“Medical officers are working around the clock, often well beyond regular hours, to complete daytime tasks. Despite sending an official letter to JKNP about the staffing crisis, no solutions have been provided.
“This has compromised patient safety and care quality, with regular blood tests reduced and increasing patient complaints about service quality on SISPAA (MOH’s complaints channel),” Dr Benny added.
Dr Rey warned MOH that HOSHAS is heading toward a potential “medico-legal minefield”.
Some medical officers, Dr Rey said, were so burned out on one particular morning that they couldn’t even take morning bloods from patients, while other doctors, who are also Master’s students, were too exhausted to study for their postgraduate programme.
“We are reaching our breaking point,” Dr Rey said. “All of us have very low morale, holding onto the last strand of hope. This (speaking to CodeBlue) represents our final plea for help, if help will arrive at all.”
Jerantut and Jengka Hospitals to Deploy Medical Officers to HOSHAS, Risking Local Staffing Shortages
In a more recent development, the district hospitals of Jerantut and Jengka are set to send medical officers to HOSHAS, but this potentially creates staff shortages in their own facilities instead.
In a letter on July 10 sighted by CodeBlue, Dr See, head of the general medicine department for Central Pahang cluster hospitals, requested to mobilise the “medical pool” of medical officers from non-lead Central Pahang cluster hospitals to support general medicine services at HOSHAS, amid the department’s “dire” situation in maintaining continuity of inpatient treatment.
“The general medicine department (at HOSHAS) only has 20 medical officers to maintain its services. This situation has caused serious problems within the department; all the medical officers are under significant stress due to a multiplied workload without housemen,” Dr See wrote to directors of the Central Pahang cluster hospitals and JKNP last month.
Dr See’s July letter indicates that four medical officers (MO) either quit or left the general medicine department at HOSHAS between February and July. In his February letter, the head of department said at least 46 medical officers were needed; the medical department only had 24 medical officers then (now 20).
This means the department currently has less than half (43 per cent) of its required MO manpower and needs another 26 medical officers at least, barring any further resignations.
The mobilisation plan involves sending one medical officer from each Jerantut and Jengka Hospitals to HOSHAS for 15 to 30 days, where they will assist with patient care and on-call duties. Hospitals under the Central Pahang cluster include HOSHAS, Bentong Hospital, Jerantut Hospital, and Jengka Hospital.
This mobilisation will continue until the number of medical officers at HOSHAS’ general medicine department is increased or new house officers are assigned to HOSHAS.
CodeBlue understands that the plan is scheduled to take effect on August 19.
“This was part of the contingency plan to have a medical officer rotate from Jengka or Jerantut for two to four weeks to ease the burden, but it has not been implemented. In fact, a medical officer from Jengka resigned last week, making the implementation harder,” HOSHAS specialist Dr Rey said.
Dr Max (pseudonym), a medical officer at Jengka Hospital, confirmed that a medical officer from the general medicine unit at Jengka Hospital will leave in early September, reducing the medical unit team to just five. Sending one MO to assist HOSHAS would further decrease the number of medical officers in the unit to four, whereas the unit should ideally have six.
“With two wards housing at least 30 to 40 patients each and additional duties like clinic work and patient referrals, losing a medical officer will compromise patient care. This will lead to longer wait times, less time per patient, increased risk of errors, higher complication rates, and more readmissions, which is already happening,” Dr Max told CodeBlue last week.
“It will be just ‘touch and go’. There will also be difficulty and exhaustion among the MOs, leading to more quitting MOH.”
Dr Max said it is unlikely that medical officers from other units, such as the multi-unit that covers paediatrics and obstetrics and has three available medical officers, or the emergency department with 10 medical officers, will be available to support the medical unit at Jengka Hospital.
“The emergency department sees 60 to 80 patients on regular days, and up to 100 during festive seasons. The multi-unit requires six officers to function effectively and the emergency department ideally needs 15 to maintain adequate coverage. Without enough staff, misdiagnosis and errors are more likely.
“You will see patients ‘laju laju’ and sometimes you don’t even get your primary diagnosis right.”
