Doctor should be investigated over Indigenous man who died after hospital misdiagnosis, NSW coroner says
A doctor who misdiagnosed an Indigenous man as suffering from complications linked to excessive cannabis use should be referred to the New South Wales healthcare watchdog, a coroner overseeing the inquest into his subsequent deathhas found.
Ricky “Dougie” Hampson died from ruptured stomach ulcers on 16 August 2021, less than 24 hours after he was discharged from Dubbo Base hospital in western NSW.
The 36-year-old Kamilaroi-Dunghutti man and father of eight was wrongly diagnosed with the drug-related condition cannabinoid hyperemesis syndrome despite lacking key symptoms of nausea and vomiting.
In delivering her inquest findings on Tuesday, the deputy state coroner
Erin Kennedy recommended emergency doctor Sokol Nushaj be referred to the Health Care Complaints Commission for potential unsatisfactory professional conduct.
“Dougie’s death was preventable,” she told a large group of family members and supporters in court to hear the findings.
Kennedy did not find any specific racial bias – either conscious or unconscious – played a part in Hampson’s death but noted Aboriginality was an important factor to consider when delivering healthcare.
“No real attention was actually given to Dougie’s Aboriginality,” the coroner said.
“The concept of colourblind treatment does not work in a section of our community that are prone to far worse outcomes.”
Nushaj earlier told the inquest that
“cognitive bias” led him to misdiagnose Hampson, saying he recognised symptoms of agitation and pain and closed his mind to other alternatives.
Hampson’s family welcomed the findings, with his father, Rick Hampson, telling reporters: “Me and my family are so outraged at the thought of Dougie being surrounded by so many doctors, nurses, medical professionals for 18 hours who had the skills, resources and knowledge to save his life.”
Nushaj, who was overseeing a busy department at the height of the Covid-19 pandemic, said Dougie Hampson’s history of cannabis use and blood test results influenced the diagnosis.
As a result of the misdiagnosis, Hampson was administered the seda
tive droperidol which the inquest concluded masked his pain and made further diagnosis unreliable.
Among the recommendations made by the inquest was that the Western NSW Local Health District consider establishing a standing Indigenous consultation and advisory group.
It also recommended NSW Health consider whether it should amend its practices to ensure all medical and nursing clinicians are advised of the Aboriginal or Torres Strait Islander status of patients.