A Pregnant Aboriginal Woman Looked Healthy Two Days Before Infection That Killed Her, Doctor Says
"I can still remember her vividly in my mind now. She was so happy."
A pregnant Aboriginal woman looked happy, well, and “the best she’d ever been” at a medical appointment just two days before she died from sepsis, according to a doctor who was treating her.
Naomi Williams was 27 and six months pregnant when she and her unborn baby died on the afternoon of January 1, 2016 in the small Australian country town of Tumut. She had suffered a cardiac arrest caused by an overwhelming sepsis infection.
Williams had been at Tumut Hospital 15 hours earlier, turning up at the emergency department just after midnight, where she stayed for 34 minutes, was given some Panadol, and then went home.
A coronial inquest into her death is underway in Gundagai, a small town 40km from Tumut in southwest New South Wales, before deputy state coroner Harriet Grahame.
The inquest is considering a number of issues, including: whether there were signs of Williams’ sepsis when she arrived at hospital that night, or whether it could not have been foreseen; her multiple previous visits to the hospital with symptoms of vomiting and nausea; and if she should have been identified as a high risk patient earlier in her pregnancy.
Dr Elizabeth Golez, who saw Williams several times in the eight months prior to her death, said she remembers “vividly” how well Williams seemed at an appointment on December 30.
“She was walking in, in a sundress, and she was so happy,” Golez told the Gundagai court on Wednesday morning. “I was surprised with how she [looked]. I can still remember her vividly in my mind now. She was so happy, the best she’s ever been.”
Williams had been to Tumut Hospital 18 times in the eight months leading up to her death, repeatedly complaining of symptoms including vomiting, nausea and abdominal pain. In most cases, she was given anti-nausea medication and fluids, and offered drug and alcohol and mental health counselling.
She had tested positive in June for Helicobacter pylori, a stomach bacteria that can cause pain and nausea, and was in September diagnosed with hyperemesis gravidarum, better known as excessive morning sickness.
In July, Williams’ mother Sharon had written to the head of nursing staff at Tumut Hospital saying her daughter needed specialist referral for her ongoing symptoms of vomiting, nausea and pain, and that the repeated referrals to drug and alcohol counselling were adding to her stress.
Golez said she had initially referred Williams for a drug and alcohol review to find out if cannabis withdrawal was a possible contributor to her symptoms. After the review came back in July saying Williams had no issues with substance dependency, Golez had a follow up conversation with Williams about her use of cannabis for pain relief.
“Trying to get the patient off anything is still best practice,” she told the court, adding that she believed cannabis use was still one of the factors causing Williams’ symptoms.
Golez said she referred Williams for a drug and alcohol review a second time in September because she had fallen pregnant. “In pregnancy we have zero tolerance for alcohol, zero tolerance for smoking and zero tolerance for illicit drugs,” she said.
Questioned over why she did not refer Williams to a gastroenterologist over her multiple complaints of vomiting and nausea, Golez said she had wanted to refer Williams as an inpatient in mid-July, transferring her from one hospital to another, but could not as Williams left the hospital against medical advice.
She then did not see Williams for about six weeks. When she next saw her in early September, Williams was pregnant, which “changed the picture” in terms of specialist referrals, Golez said.
Asked by Grahame "Did you ever have the thought 'I don’t really know what’s going on here, I think I need some help'?", Golez replied "yes".
"What did you do about the thought?" asked Grahame.
"I tried to keep her [in hospital]," Golez replied. "Keeping them in for observation and knowing where they’re going will guide us in knowing what we need to do."
On December 17 Golez referred Williams to Canberra Hospital as a high risk pregnancy after she lost four kilograms from her pre-pregnancy weight.
She told the inquest that she had hoped Williams would go to Canberra for treatment, and was delighted to see her looking well on December 30.
Golez said, based on her experience, that if it was not for the sepsis infection Williams would have gone on to have a good pregnancy.
“If she didn’t have that infection she could go through with it and have a healthy baby,” she said.
She said she found news of the death “shocking”.
Counsel assisting the coroner Lesley Whalan SC told the inquest on Monday that there is substantial evidence Williams had a perception of the staff at Tumut Hospital not taking her illnesses seriously, and that “no-one knew what was wrong with her”.
There is conflicting evidence regarding how sick Williams was when she arrived at the Tumut Hospital emergency department 15 hours before her death.
On Tuesday, the inquest heard from nursing staff that observations of her vital signs taken at 12:20am that morning had fallen just outside the danger zone that indicates a risk of future deterioration.
One nurse told the inquest she would have contacted the on-call doctor if the vital signs had actually been in that danger zone.
Local witnesses are giving evidence to the inquest in Gundagai until Friday, and the proceedings will resume in 2019 to hear from expert witnesses in Sydney.