A racist medical regulator?

Rubbish! It is easy to cry "racism" when a minority person suffers harm but the facts in the case below mainly suggest a communication breakdown and the doctor concerned was unfairly treated.

The authorities in the matter of Aboriginal Miss Dhu were not negligent. Seeing that she was ill, they took her to hospital several times. The doctors however had difficulty finding what was wrong, not because of ill-will but because of the characteristic difficulty Aborigines have in communicating with whites.

For instance, it is a reflexive custom for Aborigines to say what they think their questioner wants to hear. So a question such as "Are you OK now?" would get a Yes reply even if such a reply were inaccurate.

And it does appear that her repeated unsuccessful visits to hospital had made the guards impatient and suspicious, which is why they were a bit rough with her towards the end but which is also an understandable response in the circumstances.

Clearly, nobody was aware of the difficulties that communication with Aborigines can pose. So if there are any lessons to be learned it is to improve that understanding, either by employing experienced Aboriginal intermediaries or by having all staff trained by people who really know Aborigines and their culture well. It really is an art.

I note that the doctor who saw her was from India. That could well have amplified the communication difficulties. One often hears of problems arising from a "communication breakdown" but this would appear to be a particularly unfortunate example of it

The doctor who declared a young Indigenous woman fit for police custody shortly before her death was almost cleared of professional misconduct by the national healthcare regulator, in what insiders say is one example of systemic racism within the organisation.

Noongar woman Hannah McGlade, a former board member at the Australian Health Practitioner Regulation Agency (AHPRA), is one of those concerned about the case and said she was speaking out to draw attention to “double standards” in the way Indigenous patients and practitioners were treated.
Former AHPRA board member Hannah McGlade has accused the national healthcare regulator of racism.

Former AHPRA board member Hannah McGlade has accused the national healthcare regulator of racism. Credit:Tony McDonough

McGlade resigned from AHPRA about five months ago after an unsatisfactory response when she raised concerns internally. She is now calling for reform, including the implementation of a separate investigation process for medical complaints involving Indigenous people.

“Aboriginal people are dying in this country because of racism in healthcare,” McGlade said. “AHPRA has a long way to go in addressing its own culture of racism.”

The allegations come after The Age and The Sydney Morning Herald revealed this week that AHPRA is grappling with ongoing claims of bullying, a “toxic” workplace culture and pressure to work through a backlog of complaints that investigators fear is putting the public at risk.

AHPRA chiefs declined an interview on Tuesday, but a spokesman said the organisation was half-way through implementing a strategy to improve the system for Aboriginal and Torres Strait Islander people.

McGlade was the only Indigenous representative on AHPRA’s national medical board during the regulator’s investigation into the medical treatment of Dhu, a 22-year-old Indigenous woman who died in police custody in South Hedland, Western Australia, in 2014.

The death of Dhu, whose first name has been withheld for cultural reasons, triggered national protests and debate around institutionalised racism.

After being arrested and detained for unpaid fines, Dhu complained about pain and was taken to the hospital where her symptoms were dismissed as exaggerated or faked.

One treating doctor involved in assessing her, Vafa Naderi, failed to check her vitals or order an X-ray but instead noted “behavioural issues” and declared her fit for police custody.

The 2016 coronial inquiry would later find an early prescription of antibiotics to treat her broken rib, which had become infected, could have saved her life, and the doctors had made judgments based on preconceived ideas about Indigenous people.

However, when AHPRA conducted its own investigation into Naderi, an independent expert found while his conduct was unprofessional, it did not constitute professional misconduct, according to McGlade. There was disagreement between AHPRA boards about how to proceed. A legal firm was prepared to accept the expert’s advice, and pursue lighter disciplinary action, until McGlade intervened.

“I was the only member of the medical board who said: ‘This is not right. His conduct was so serious, it contributed to the death of a young woman. This is professional misconduct’,” McGlade said in rare public comments on AHPRA’s board deliberations.

McGlade had challenged the board and AHPRA’s commitment to reconciliation and had been asked to leave the room, accused of having a conflict of interest because she was Aboriginal, she said. But McGlade persisted and eventually persuaded the board to push for harsher action.

“It took the only Aboriginal person with a backbone to say – is that fair? Is that the right decision?” she said.

AHPRA ultimately referred Naderi to the WA State Administrative Tribunal and in June last year, Naderi was fined $30,000 – the highest penalty available under the law.

But he was not deregistered, nor were the nurses involved in Dhu’s treatment, who similarly failed to take her concerns seriously.

“That doctor got a slap on the wrist and he was still working,” said Dhu’s grandmother, Carol Roe, who gave permission for Dhu’s image to be used.

“My granddaughter was in agony. They should have looked after her, treated her with respect.”

A spokesman for AHPRA did not respond to questions about McGlade’s comments or penalties for the nurses who treated Dhu, but said her death “demonstrates the serious and tragic consequences of racism in our health and justice system”, and highlighted the regulator’s work to penalise Naderi.


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