Racial discrimination, poor cultural awareness and a lack of Indigenous representation in hospitals have been identified during a coronial inquest as possible factors leading to the death of a pregnant Riverina woman.
Wiradjuri woman Naomi Jane Williams, 27, was six months' pregnant when she died from a heart attack in early January 2016.
Less than a day before her death, she visited Tumut Hospital for severe pain in her hips.
It was the 18th time in seven months that she went to the hospital for extreme pain, vomiting, nausea, or a combination of those.
She was run through some basic tests, given some Panadol, and sent home just 34 minutes after she arrived.
An autopsy later revealed Ms Williams almost certainly died from sepsis associated with Neisseria meningitidis, a condition that is usually treatable with antibiotics.
The inquest began in Gundagai in September 2018 when a nurse admitted that she did not properly assess Ms Williams before discharging her.
The inquest has also heard from Ms Williams’ best friend Talea Bulger, who said she struggled to get Naomi to go to the hospital after she felt like staff had shrugged her off for months.
In the NSW Coroners Court on Thursday, Deputy State Coroner Harriet Grahame asked: “How hard is it to unpack a perception of poor service as being related to Aboriginality?”
“For example, in this particular case, Naomi Williams went to the doctors many, many times and never got a specialist referral.
“If I look at my own experience as a middle-class woman in the eastern suburbs of Sydney, my perception is that I would've got a referral.
“That's my strong perception.
“I would not have gone 18 times and not get a referral.”
Deakin University professor Yin Paradies, an expert on racism in health, was questioned about his report tendered to the court that examined Indigenous Australians and hospital care.
He said the hospital’s continual referral of Ms Williams to drug and alcohol and mental health treatments, rather than assessing her physical issues, may have been driven by the stereotyping of Indigenous Australians and implicit bias about race.
“There’s evidence of stereotyping Indigenous people as more likely to use drugs and alcohol and so that stereotype is very likely to be present in the minds of many Australians,” he said.
Mr Paradies described implicit bias as holding an unconscious view of certain groups and associating them with certain characteristics.
“It [the incident] seems to suggest that there may be unsafe organisational cultural practices and further investigations were needed," he said.
Mr Paradies said a higher percentage of Indigenous Australians in the health sector and ongoing cultural-awareness training in hospitals were needed to create changes to stem racial discrimination.
However, the inquest heard that the state government had already committed "embedded systematic changes" following the 2011 elections.
The counsel referred to the document Aboriginal Health Services Plan 2013–2016 as evidence.
Family members of Ms Williams attended Wagga Courthouse on Thursday to follow the inquest via video link.
Outside of Wagga Courthouse, Aunty Sue Bulger, cousin of Ms Williams’ mother Sharon, said it was “extremely important to get an answer for what has happened".
“It’s disappointing, no one wants to have to go through this," Ms Bulger said.
“All Aboriginal people would be looking for answers because it has something to do with who we are and how we’re being treated."
The inquest continues.