A doctor broke down and cried while giving evidence at a coroner’s court in Gundagai on Wednesday, describing 27-year-old mother-to-be Naomi Williams as “joyful” the last time she saw her alive.
“She looked well,” Dr Elizabeth Golez said. “She said [it was] the best she’d ever been.”
Less than 36 hours later, Golez saw Williams again – arriving at Tumut hospital emergency department by ambulance and in cardiac arrest.
Golez pronounced Williams and her unborn baby dead at 15.08 on New Year’s Day 2016.
An autopsy showed the cause of death was sepsis associated with the bacterium Neisseria meningitidis, a serious infection that is nonetheless treatable with antibiotics.
Williams, who was six months pregnant, had presented to the emergency department at just after midnight but was discharged after 34 minutes and sent home with two paracetamol.
No physical examination was conducted by nurses during the visit and no doctor was called.
Golez is a GP with an advanced diploma in obstetrics and gynaecology, which allows rural GPs to share the care of pregnant women with a hospital’s maternity clinic. She had been seeing Williams as a patient in her practice since June.
In the seven months before her death, Williams had presented to Tumut hospital 18 times with nausea and vomiting, and sometimes diarrhoea and dehydration. She was often sent home after receiving antiemetic medication and IV fluids.
In June, Williams tested positive for Helicobacter pylori, a stomach bacteria that can cause ulcers as well as nausea and vomiting.
During a visit to the hospital on 1 July, Golez questioned whether Williams’s nausea and vomiting could be “secondary to withdrawing” from marijuana use and ordered a drug and alcohol review. Williams had reported that she occasionally used marijuana to help manage her pain. The drug and alcohol review came back showing no drug or alcohol dependence issues.
Two days later, Williams saw another GP, Dr Curnow, with nausea and vomiting. Curnow advised her to see a specialist if symptoms persisted.
On 13 July, Williams visited Golez in her rooms again, complaining of vomiting and nausea, and was sent to the hospital for immediate treatment with IV fluids for dehydration.
Golez had called a specialist who advised her to order a test called a gastroscopy if symptoms persisted but Williams did not want to stay at the hospital and signed an “against medical advice” discharge form before going home.
Golez told the court she wanted to admit Williams to the hospital because it was easier to get the attention of a specialist by referring patients “while they’re sick”. When Williams refused to be admitted, Golez says they agreed she would collect a referral to the specialist from Golez’s rooms. But Williams never came to collect the referral and the next time Golez saw Williams on 1 September, she was pregnant, vomiting and bleeding from her vagina.
Williams was diagnosed with hyperemesis gravidarum, a severe form of morning sickness characterised by vomiting and nausea.
When asked why she didn’t persist with the referral to a gastroenterologist, Golez said it “changed the picture” that this time Williams was pregnant, had bleeding that had to be immediately dealt with, and that “she actually was saying that she has morning sickness this time, different from her previous complaints”.
Williams presented to Tumut hospital with vomiting on six more occasions from 12 September to 16 December.
Golez reported being “alarmed” at Williams’s weight loss during a visit on 17 December and referred her to an obstetrician in Canberra. In antenatal visits, Williams had expressed her desire to give birth in Canberra, where she had the support of her mother.
On 30 December, Williams once again visited Golez in her rooms for an antenatal visit, confirmed she had been seen at a Canberra hospital and had booked in with an Aboriginal health service in Canberra to have her baby.
“I can still remember her vividly in my mind,” Golez said, “because she was … happier. Because she finally went to Canberra and you could really trust her to do the right thing.
“She’s a lady who is very resilient at everything. I thought she was cured and she was definitely back to where she was supposed to be.
“If she didn’t have that infection, she could go through with it,” Golez said, referring to Williams’ pregnancy, before becoming emotional. “I’ve been practising obstetrics for 20 years. I know this was going to be a really good pregnancy for her.”
The autopsy report shows the cause of death was unrelated to Williams’ ongoing vomiting and nausea issues. The inquest seeks to find if previous visits to the hospital affected how Williams was treated on the day of her death or if the way she was treated affected Williams’s willingness to return when her symptoms worsened.
The inquest continues until the end of the week, when Williams’s partner and family are expected to give evidence.
