WA's Coroner is examining whether ambulance ramping and staff resourcing at Royal Perth Hospital's emergency department caused delays in the treatment of a 26-year-old woman who died from a meningococcal infection.
On December 27, 2019, Geraldton woman Ashleigh Rebecca Hunter was taken by ambulance to RPH after becoming increasingly unwell over about three hours at the holiday apartment she was sharing with her partner.
The WA coroner's court was told that on a scale of one to five, Ms Hunter was assessed as having a triage score of three, which meant it was recommended she be seen by a doctor and treated within 30 minutes.
Counsel assisting the coroner Sarah Tyler said despite that recommendation, Ms Hunter was not seen by a doctor until about an hour later when she quickly became unresponsive, and her heart stopped.
That hour included the 26-year-old spending between eight and 13 minutes "ramped" in the ambulance.
ED at capacity on admission day
Ms Tyler said Ms Hunter's time spent ramped in the ambulance was because it was a very busy day, and the emergency department was at capacity.
Hospital policy meant patients who were deemed suitable were placed at the ramp under the care of St John officers rather than hospital staff.
The inquest is investigating whether the ambulance ramping and resourcing considerations had an impact on or delayed the care Ms Hunter received.
It is also examining the appropriateness of the triage assessment she was given and "...whether there was a lost opportunity for Ms Hunter to survive due to delays in the provision of her care".
The first witness called was St John officer David Kenny, who responded to the triple-0 call made by Ms Hunter's partner.
Mr Kenny said Ms Hunter was conscious and oriented but distressed and grimacing in pain.
He also said she told him she had taken ecstasy and methamphetamine the night before, but he denied Ms Hunter's drug use had coloured his judgement, saying it was "just part of the whole picture."
'A whole bunch of ambulance stretchers lined up'
Mr Kenny and his partner transported her to hospital where, after being triaged, she remained in their care while "ramped".
Mr Kenny described it as being "a whole bunch of ambulance stretchers lined up" — something he said was "common" in his five years as a paramedic.
When Ms Hunter became agitated and was moving around a lot, Mr Kenny said he became concerned for her safety, so he arranged for her to be moved from a ramping stretcher to a ramping bed.
There, because she was moving around, staff were unable to take her observations so it was decided she should be put into the care of the nursing staff, who were looking after other patients in the ambulance bay.
After Ms Hunter collapsed in the toilets and nurses couldn't get a blood pressure unit, she was finally moved into the emergency department into a critical care unit, but she could not be saved.
Mr Kenny said he was "very surprised and shocked" when he was told later she had died from a meningococcal infection, saying she had not displayed the usual signs of sepsis.
Ramping has become 'common practice'
Mr Kenny's colleague on the day, Fiona Sutton, told the inquest the 13 minutes spent "ramped" was "pretty reasonable".
She testified that over the years, ramping had become part of an ambulance officer's job.
"It's common practice these days to be ramped for one hour to eight hours," she said.
"Crews are getting ramped with low-acuity patients for that long."
Outside the inquest, Ms Hunter's parents Kim and Kellie said they were appreciative of the coroner for looking into their daughter's case "because it can happen to anybody".
Kim Hunter said the main issue for the family was the difficulty for people getting immediate access to medical care.
"Even though you've come to hospital by ambulance, you still may find you're not going to get in there," he said.
"The way she died in hospital, effectively wheeled into a corridor and just left to roll around in pain and agony until she basically had a heart attack and died."
Kellie Hunter fought back tears as she described her as a "beautiful, vibrant" member of the community.
"She did what she did to help others, she didn't deserve what happened."
Assessment 'clouded' by patient's meth use — triage nurse
Later, the nurse who triaged Ms Hunter told the inquest she did not see any clear indications of meningococcal disease when she assessed her.
Andrea Walthew said she still believed the triage score she gave of three was appropriate because she did not see any immediate threat to Ms Hunter's life.
Ms Walthew said the 26 year old was quite lucid, coherent and orientated, although in hindsight she accepted that maybe the irritation she had at being touched was setting off pain signals in the body.
She also told the inquest she believed Ms Hunter's use of illicit drugs the night before, did have had an impact.
"The whole picture was clouded by the fact that she'd used meth … if there were no drugs on board, I would have said yes that looks like sepsis," she testified.
"Would it have made any difference to the length of time she'd waited to see a doctor? I doubt it."
The inquest is set down for a week.