The next time someone assures you that Australian hospitals don't need to improve their services, ask them to read this story.

A women we will call ‘Maree’ was in her mid thirties. Maree had lived with Multiple Sclerosis for over eight years.

She knew that her condition was slowly deteriorating. However, Maree was determined to lived as normal life as possible. Finding medication unhelpful,  she stayed as fit as possible and took herbs and supplements.

Maree knew that when her disease suddenly flared up, she would need a short course of intravenous Methylprednisolone and some assistance to get around.

So when she suddenly developed severe leg pains, stiffness and lack of coordination, she knew what to do. Maree called a taxi and went straight to the Emergency Department.

She arrived there before ten in the morning. It wasn’t busy. There there she waited.

And waited.

The Emergency Doctor rang Maree's regular neurologist. He could not recall this patient. As Maree was not on medication for her Multiple Sclerosis, she did not see a specialist on a regular basis.

For her general needs, Maree went to a public clinic and just saw who ever was available. The clinic kept very little information, apart from her diagnosis and hospital notes from her previous admissions.

Maree's case was put to one side. She quickly approached the regulation 'four hour waiting period' limit.

Concerned about the possibility of facing a heavy fine from the health bureaucrates, the nurse manager had Maree moved from a cubical in the front to a small ward, hidden away at the back of the long, winding Emergency Department.

This move would prevent her from showing up on the hospital ‘over the four hour waiting time’ computer list.

Avoiding fines for keeping patients in Emergency for over the set time limit is a full time job. Hospitals keep beds all over their facility that are classified as 'medical' or 'fast track' but in fact take in Emergency Department overflow.

The result is that while hospitals bend over backwards to avoid ill conceived fines, patients get shunted around from bed to bed, fragmenting their care even more.

The Emergency team didn’t consider assessing and treating Maree themselves. This is despite the fact that the medical staff included an Emergency consultant, a registrar and several residents on site.

The standard treatment for an exacerbation of Multiple Sclerosis is straightforward. A large daily dose of intravenous steroids, some pain relief and nursing assistance with mobilising.

During the day, nursing staff did not even offer Maree assistance with toileting.

The food trolly came and went, and in the rush of transferring her to different beds around the Emergency Department, Maree was not offered any food or drink.

By ten o’clock that night a ward bed was finally found.

The nurse in charge of ED was delighted to ‘move her out’.

Maree was bundled into a wheelchair and taken up to a neurology ward. She was hungry, thirsty, needed to go to the toilet and was in severe pain.

Her twelve hours of waiting patiently in ED resulted in no plan, no treatment and no care.

No one apologised. No error report was filed. No hospital procedures were subsequently changed.

Wikihospitals 2014