The nurse who assessed Aboriginal woman Ms Dhu at Port Hedland hospital 18 hours before her death from pneumonia and septic shock, said she didn’t see the need to take the 22-year-old’s temperature and told the police her symptoms “could be the drugs”.
Dhu, a Yamatji woman whose name is not used at her family’s request, died at the Hedland Health Campus, about 1,600km north of Perth, Western Australia, on 4 August last year, about 44 hours after being arrested and put in police cells for unpaid fines.
A coronial inquest into her death, which began at the Central Law Courts in Perth last Monday, has heard that Ms Dhu was taken by police to hospital twice, on the evenings of 2 August, 2014, and 3 August, 2014, before her death.
On both hospital visits she was given a triage score of four out of five, the second-lowest score and indicating she needed to see a doctor within an hour. Emergency medicine expert, Dr Stephen Dunjey, and Dr Ganesan Sakarapani, district medical officer from Hedland Health Campus who reviewed the hospital’s treatment of Dhu, have criticised that score as being too low.
However, triage nurse Alyce Hetherington, who saw Ms Dhu on 3 August, 2014, told coroner Ros Fogliani on Tuesday that if presented with identical symptoms and information again, she would give the same triage score.
Hetherington said Ms Dhu arrived in handcuffs at the emergency department triage window just before 5pm, escorted by two police officers.
She said she attributed Dhu’s symptoms – which she listed as an elevated heart rate of 126, dehydration and agitation – to drug withdrawal. She said Dhu told her she was “stoned” when she went into custody, and had smoked marijuana and done “half a point [gram] of speed” two days earlier.
“I attributed her tachycardia to her dehydration, recent drug use and agitation, not a febrile illness,” Hetherington said.
She went on to say she treated the dehydration, and therefore Dhu’s most concerning symptom of a racing heart rate, by making her drink two sachets of dehydration salts and two cups of water.
“When they left, [when] both police officers and Ms Dhu went out to the waiting room, I said to the police officer that, ‘this could be withdrawal from drugs’.”
She said Ms Dhu was moaning and grunting, but considered those noises to be “voluntary” and more a signal of emotional distress than pain. A member of Ms Dhu’s family sitting in the gallery muttered in response: “She was dying.”
Hetherington said she “had no concerns” that Ms Dhu had an illness that would carry a fever, such as an infection, and maintained she was following procedure by not taking her temperature unless concerned. By that stage, the inquest has heard, the infection in Ms Dhu’s fractured rib would have spread to an abscess in the surrounding muscle and smaller abscesses in her lungs. The extent of her infection upon death, forensic pathologist Jodi White told the court, was so extensive it would have been building for at least a week.
Failure to take Ms Dhu’s temperature on this hospital visit has been identified by several expert witnesses as a significant failure of care, as an elevated temperature would have caused doctors to look for signs of infection, which, if correctly diagnosed would have led to her being given potentially life-saving antibiotics.
Hetherington said it was not her normal practice to take temperature on triage unless the person appeared to have a fever, and said it was the duty of the ward nurse to take a full set of observations, including a temperature. Gitte Hall, the ward nurse who saw Ms Dhu 90 minutes later, also didn’t take Ms Dhu’s temperature, telling the court on Tuesday it was usually done by the triage nurse.
Hall said the emergency department had just two thermometers at the time as the devices had a tendency to disappear, which meant that, unlike the tools for every other observation, she didn’t have one to hand in the cubicle where she was examining Ms Dhu. She told council assisting, Ilona O’Brien, that she assumed Dhu’s temperature had been taken at triage and she had not been prompted to take it because Ms Dhu had not felt hot.
She said she was confident, if she had taken her temperature, it would have proved Ms Dhu didn’t have a temperature.
“I wish that I had [taken her temperature] so that I could prove that the number was correct and she was afebrile,” Hall said.
Dr Vafa Naderi, the emergency department doctor who saw Ms Dhu that night, also didn’t take her temperature and didn’t realise it hadn’t yet been taken. He told the court on Friday that while it was usually done earlier, the ultimate responsibility for ensuring someone checked Ms Dhu’s temperature lay with him.
Ms Dhu also complained of trouble breathing and all-over pain at both triage and when assessed by Hall, but Hetherington said Ms Dhu had no trouble breathing – based on the fact she was able to talk quickly and extensively – and didn’t elaborate on any pain besides that in her lower ribs. Both said Ms Dhu did not have central chest pain. Hall also attributed Ms Dhu’s symptoms to drug withdrawal.
“She did not have chest pain that correlated with cardiac pain, she told me that she had rib pain and respiratory distress, [but] when someone has respiratory distress they can’t actually tell you,” Hetherington said.
“I did consider giving Ms Dhu a triage score of three, knowing what I know now, but on that day on the information I had at that time, I would still give her a four.”
The diagnosis listed in the notes of both Dr Naderi and Dr Anne Lang, who saw Dhu the previous night, was “behavioural issues”. Both doctors have since told the inquest their primary diagnosis was of musculoskeletal pain, but both admitted they had not written that diagnosis down.
Ms Dhu had a heart attack by the time she was seen by a triage nurse at 12.40pm on 4 August, 2014.
Dr Rolla Campbell, an emergency medicine consultant who led efforts to resuscitate Ms Dhu, said she was completely unresponsive in the more than 45 minutes spent to revive her, which he took to mean the heart attack happened before she got to hospital.
“To me it suggested that there had been some time between when she cardiac arrested and presentation to the emergency department,” Rolla said.
The inquest was originally expected to be finished on Friday but has been extended for another nine days next year. Under the new schedule, the police officers who saw Ms Dhu in Port Hedland will not give evidence until March.
