Delays in the hand-over of patients from ambulance staff to casualty departments has cost one Westcountry hospital over £100,000 in penalties this year.
The Royal Cornwall Hospital (RCH) has reported more than 1,000 delays of longer than 30 minutes, which incurs a fine from South Western Ambulance Service Trust (SWAST).
However, the hospital is not alone in experiencing delays as Plymouth's Derriford Hospital, the busiest accident and emergency unit in the peninsula, in August reported more than 2% of hand-overs were longer than the 30-minute target.
Joe McKenna, chairman of the campaign group Health Initiative Cornwall, said serious questions must be asked.
"I was appalled," he said.
"There are either insufficient staff to cope with the hand-over more speedily or the process is not right.
"Either way, something is going wrong."
According to their contracts, ambulance staff should formally hand over the care of patients to hospital casualty staff within 30 minutes and generally this is accomplished much more quickly.
Hospitals say there is no question of patients being left in ambulances though delays are sometimes caused by the formalities and paperwork.
However, every time the 30-minute limit is exceeded, SWAST is able to levy a penalty of £100.
Primary care trusts are billed for the amount and then negotiate with the hospitals in their area over how much each organisation pays.
At RCH, this year so far there have been 1,018 delays of more than 30 minutes, meaning just over £100,000 worth of penalties.
Jo Gibbs, the Truro-based trust's chief operating officer, said they were working hard to improve matters.
"Improving ambulance turnaround times continues to be a priority for us and we are working closely with colleagues at the SWAST and our other NHS and social care partners to ensure patients are able to receive to the right level of care in the most appropriate setting.
"At no time are patients left waiting in ambulances outside of our emergency department."
She said a £4.5 million building project was shortly due to begin which would expand the hospital's emergency department and this would "increase our capacity and offer better facilities for patients and staff."
The trust said that with the exception of August, ambulance turnaround times at the RCH had remained stable over recent months.
The change could be partly attributed to the holiday season and influx of visitors, the hospital said.
According to board papers at Plymouth Hospitals Trust, during August, two per cent of patients experienced a hand-over time of more than 30 minutes, exceeding the target of 0.5%.
The actual number of patients was not available yesterday, but Richard Best, acting chief operating officer at Derriford, said the trust was considered to be one of the best in the region for managing the clinical transfer of patients from ambulance services.
"As the largest trust in the peninsula and a major trauma centre, we do receive a higher number of ambulances at our emergency department," he said.
On an average day, around 300 patients are admitted to casualty and assessment units, with about one third arriving by ambulance.
"Due to the high numbers of patients being seen and treated in these areas on a daily basis, there are occasions where patients will be delayed and this is predominantly because capacity within these areas is not immediately available, however this wait is rarely more than 15-20 minutes."
At North Devon Hospital, a spokesman said they worked closely with SWAST and were meeting targets.
"We are currently achieving our target, as set by commissioners, for no more than 10% of ambulance hand-overs to be delayed by over 30 minutes."
A spokesman for SWAST said: "The priority for all services is the provision of the highest standards of patient care and measures are in place to address the issues associated with these delays.
"For confirmed delays over 30 minutes a charge is made to cover the cost of replacement resources to compensate for those tied up in delays.
"It is then for commissioners to decide if they wish to pass this charge onto the hospital."