The South Australian health department has been accused of having an “ageist” culture.

A leaked email from a SA Health program manager has told surgeons they need to “tighten up … processes with regards to incoming referrals” and encouraging them to “say no” to GP referrals for older and sicker patients.

“We also expect that where the person is old or has many comorbidities, you might suggest to the GP that is [sic] not necessarily in their best interests,” the email stated.

“Please use your wealth of consultant experience and start to say 'no' when clearly not sensible and high-value care.”

Council on the Ageing chief executive Jane Mussared said it is “pure and simple ageism”.

“We hear that, importantly, clinicians say they look at people's whole health circumstances,” she told the ABC.

“But age is not a health factor — age is a number.

“It's very important that we call this out for what it is — ageism. It has no place in our public health system.”

But Professor Jane Andrews, the medical lead for surgery at the Central Adelaide Local Health Network (CAHLN), defended the emails, saying critics are ignoring their “context”.

“The context of the email and the process is absolutely what we're doing in a lot of units already, which is we're making very conscious triage decisions,” she said.

“I think it can look threatening, when it's actually not threatening at all.

“It's about us making good medical decisions about who is more important to see at what point in time.”

Health Minister Stephen Wade agreed the email was “clumsy”, but left the matter to clinicians.

“It's always been the case that clinicians have to consider risk factors and comorbidities before they make a decision about patient care,” he said.

“But let me be very clear: in SA Health, decisions about patient care and clinical care are made by clinicians.

“I have no doubt that CAHLN will look very carefully at how to better communicate its processes.”