Medical staff in the Queensland Gulf community of Doomadgee have labelled the remote health situation as a "national disgrace" and the local hospital as "dysfunctional" at an inquest into the deaths of three young Indigenous women.
Warning: Aboriginal and Torres Strait Islander readers are advised that this article contains images and names of people who have died.
Issues around staff communication, and a lack of staff, funding and resources in Doomadgee were mentioned in Wednesday's evidence at the Cairns inquest into the deaths of the women from preventable heart disease in 2019 and 2020.
Kaya, 17, Ms Sandy, 37, and Betty, 18, died from complications associated with rheumatic heart disease (RHD), which was eradicated from non-Indigenous Australian communities in the 1950s and 60s.
Two paediatric cardiologists Robert Justo and Ben Reeves told the court RHD screening in the region was widely underfunded.
They said they used personal and professional development leave to run RHD screening programs across northern and western Queensland, and that staff and expenses were largely self-funded or assisted by donations.
Dr Reeves described the RHD situation in northern and western Queensland as a "national disgrace".
"We see unnecessary deaths [and] unnecessary cardiac surgeries. We see the patients and their families really suffering from this disease," he said.
"We've been crying out for some time for additional resources, people on the ground, in the front line."
Deficiencies in healthcare not addressed
Craig Hamilton, the town's longest-serving medical officer, said that in his opinion systemic communication failure played a role in the women's deaths.
He referenced animosity between the town's Queensland Health-run hospital and the Indigenous-run clinic Gidgee Healing.
He also described the workplace as dysfunctional.
Dr Hamilton, who was no longer working in Doomadge at the time of the deaths, said the two health services were in neighbouring buildings and many locals assumed the two were affiliated, but records were not easily shared between them.
Dr Hamilton told the coroner he had made numerous complaints about the systems, but felt he was not heard at the time.
"If I could say something, it's maybe investigate the people that allowed the deficiencies to continue to be perpetuated," he said.
Locum Mary Anderson, who treated Betty on the night of her death at Doomadgee Hospital in September 2019, said when she arrived at work Betty's heath had already rapidly deteriorated.
Dr Anderson said a scheduled handover with the outgoing doctor didn't go ahead.
She told the court she didn't initially know Betty had presented at the hospital the day before or been diagnosed with a heart valve disease, because as a recent arrival at the hospital she was locked out of the electronic health records.
"I didn't understand my patients as well as I should have," she said.
Nurses Nazihah Asgar and Brytt Grogan also described communication issues between the clinic and hospital at the inquest.
Ms Asgar said staff at the hospital now have access to Gidgee Healing records, but in addition to a paper chart, a patient could have records in up to five different systems.
She told the court that historically the hospital had a dedicated staff member whose role was to manage patients with RHD.
She said this had worked well, but the position ended after a year and she was told Gidgee Healing would manage cases, something she later found had not happened.
Gidgee Healing nurse Lesley Salem told the court the clinic had always worked collaboratively with the hospital, but admitted there had been a communication breakdown.
"There was nothing relayed to me that I needed to act or do anything more. I would have done it … but nobody handed over," she said.
Ms Salem said she would love to see the return of the dedicated RHD role, but there wasn't the personnel for it.
Cultural training needed
Earlier in the week, family members of Kaya and Ms Sandy told the inquest they believed systemic racism had played a part in the deaths.
Kaya's cultural father, Alec Doomadgee, said there was a power imbalance inherent in health systems, especially in Indigenous communities.
Several family members said they would like to see a "Guardian Angel" system where Indigenous-patient advocates work in the hospital but are separate from Queensland Health staff.
Medical staff were also asked about the amount of cultural awareness training available.
A lawyer representing several of the women's families questioned Ms Grogan over her choice to request police presence along with paramedics on the night Ms Sandy's heart was failing.
Ms Grogan denied there was a racial element to the decision and said it was to have more people present to help with CPR.
When asked about allegations of patients being turned away without being triaged and instead given paracetamol, Ms Asgar said that should not have happened.
"Patients can only be asked to wait after they've been triaged," Ms Asgar said.
"That's something that nurses should not be allowed to do … if that's happening, that's not correct."
Dr Hamilton said that during his time working in the town he was on-call for 24 hours during the 10-day shifts, with many people needing or requesting treatment after midnight.
Dr Anderson described a similar experience which she said was "very taxing to my physical body and mental stress as well".
Despite the hospital's known staffing issues, Ms Asgar said that since the deaths there have been periods of time as long as eight days where the hospital had been without a doctor.
She said the hospital struggled to fill its positions, which has worsened since the ABC Investigation.
The inquest continues.