It is unfortunately well-accepted that the health outcomes for people living in rural and regional areas of Australia are worse than for those who live in metropolitan areas. Sadly, poor outcomes in rural and regional areas often involve preventable deaths resulting from negligence.

The NSW Legislative Council is currently accepting submissions into its inquiry on health outcomes and access to health and hospital services in rural, regional and remote New South Wales. We encourage people who have had adverse outcomes in rural and regional health care to share their experience with the NSW Parliamentary Inquiry. You can find more information, including how to make submissions, at the NSW Parliament website here.

In light of the Parliamentary Inquiry, we take this opportunity to visit the findings and recommendations made in the Coronial Inquiry into the death of Ivy Dwyer.

Inquest Background

In November 2015, the NSW Coroner’s Court handed down its findings in the inquest into the death of Ivy Dwyer. Ivy was an 18 year old woman who lived in Narromine, near Dubbo in Central NSW. It became apparent from evidence heard at the inquest that she had been suffering from a viral infection which caused inflammation in her heart, or myocarditis, for a number of months prior to her death. The condition was not diagnosed or investigated and Ivy sadly died on 2 June 2012.

From around April 2012, Ivy became sick with what seemed like a head cold. She gradually became more fatigued and lost her appetite. Between 22 May and 29 May 2012, Ivy visited the same general practitioner, Dr Rose, four times. Dr Rose was a locum general practitioner who was visiting from the Blue Mountains for three weeks. Ivy reported a history of vomiting, diarrhoea and respiratory symptoms including cough. On the third visit, she was suffering coarse crepitations, which is a rattling or crackling sound made by one or both of the lungs during breathing. She was diagnosed initially with gastroenteritis, but then thought to be suffering from an infection and prescribed antibiotics. Following a blood test, the diagnosis was changed to Epstein Barr Hepatitis.  According to Ivy’s aunt, who took her to the last appointment on 29 May 2012, Ivy was unable to walk by herself and needed her aunt’s assistance. Dr Rose didn’t notice this and considered that Ivy looked better than when she had seen her earlier in the week.

On 1 June 2012, Ivy’s family was so concerned at the deterioration in her condition that they took her to Narromine Hospital. Ivy was observed by nursing staff to be pale, nauseated and dehydrated and she had low blood pressure. She reported feeling unwell and tired for the past 3-4 weeks with chest and abdominal pain. She had coughed up small amounts of blood stained sputum en route to the Hospital. As is often the case in rural towns, the doctor in the emergency department, Dr Wakista, was a local general practitioner who worked at the same general practice Ivy had attended the previous week. Dr Wakista recorded that Ivy should be transferred to Dubbo Hospital for further investigations because Narromine Hospital lacked the resources to carry out those further investigations. Specifically, he thought Ivy needed a chest x-ray and Narromine Hospital did not have the capability to perform this.

Dr Wakista called Dubbo Hospital and spoke with a Dr Draper. Dr Draper agreed to accept Ivy at Dubbo Hospital, however there was confusion at Narromine Hospital as to whether the transfer should occur immediately. Ivy had a blood test which showed raised liver function and reduced kidney function, both red flags in any clinical setting. Ivy was not transferred immediately and was monitored overnight by nursing staff at Narromine Hospital. From around 2.30am, Ivy’s condition deteriorated significantly. She was urgently transferred to Dubbo Hospital and arrived there at about 4am. Attempts were made to stabilise her but unfortunately she passed away at 7.45am.

Ivy’s case is a reminder of the importance of clear communication in emergency medicine settings and early consideration of whether a patient needs to be transferred. Because patients often present to smaller hospitals, like Narromine Hospital, where facilities are limited it means that doctors and nurses need to consider whether transfer to a bigger hospital should occur and, if so, the clinicians need to be clear on when transfer will happen and arrange it sooner rather than later.

The experts called to give evidence in the inquest agreed that the main lesson to be learnt from Ivy’s death, was that when a sick young patient attends a doctor with the same symptoms repeatedly, and the treatment is not working, then a doctor should contact a colleague for further opinion and perhaps admit the patient to Hospital while getting to the bottom of the symptoms. The other lesson to be learnt is that extra care should be taken when obtaining a medical history and that a doctor should talk to relatives who can give vital information on the patient’s condition.

Our experience

Turner Freeman have acted for numerous clients who have had poor outcomes in rural and regional settings. We know from our experience that rural and regional patients are at a disadvantage because of the lack of resources and expertise to deal with specific medical complaints. This coupled with delays in transfer to bigger hospitals where further investigations can take place can have devastating consequences, like in Ivy’s case.

Get in touch with us

If you have or someone you know has had a poor outcome following medical treatment in rural or regional setting, it is important you get advice as to your legal options.

At Turner Freeman, we have specialist medical negligence lawyers who will assess your case and provide personalised advice regarding your legal entitlements. Our medical negligence lawyers are located across NSW including in our offices in Sydney, Parramatta, Wollongong, Newcastle and Toronto.

If you or someone you know has suffered as a result of medical negligence, we encourage you to call us on 13 43 63 to speak with one of our medical law experts.