The doctor who saw Aboriginal woman Ms Dhu on her first appearance at the hospital in Port Hedland after she was arrested for unpaid fines has said she diagnosed the 22-year-old’s pain as for “behavioural gain” because she believed she was playing up some symptoms in order to get pain relief.

Dhu, a 22-year-old Yamatji woman, whose name is not used at her family’s request, died on 4 August 2014, after an infection around a broken rib spread into staphylococcal septicaemia and pneumonia caused her to collapse in advanced septic shock.

She was arrested in Port Hedland, 16,000km north of Perth, Western Australia, on the afternoon of 2 August 2014, over $3,622 in unpaid fines and was expected to be held for about four days to “cut out” those fines as jail time.

About four hours after her arrest, she was taken from the cells at South Hedland police station to the nearby Hedland health campus, after complaining of pain around her ribs, and was seen by emergency department doctor Anne Lang.

Lang told a coronial inquest into Dhu’s death at the Central law courts in Perth on Thursday that Dhu was “agitated” but appeared to have genuine localised pain, which Lang diagnosed as general muscular-skeletal pain after feeling her ribs and not seeing any evidence of trauma.

But she said Dhu was reluctant to tell her how she had broken her ribs two months earlier, why the pain had flared up, and was generally “guarded”, angry, anxious, and “swearing a lot”.

“I accepted that she did have pain but my clinical impression was that she was a normal young lady,” Lang said, adding that her notes, which have been criticised as brief, reflected both the business of the emergency department that night and her believe that Dhu was generally well.

“When I wrote those notes she was so well that I really didn’t place appropriate importance ... I had absolutely no idea that she was as sick as she was.”

Lang said she was told by police that Dhu had been fine when arrested, and that, “after she found out that she would have to spend time incarcerated there was a directly proportional increase with her pain and anxiety”.

She also said Dhu was walking with her body curved over her right ribs in a way that didn’t make sense in someone with broken ribs, which she believed was a “deliberate and abnormal exaggeration. She compared it to a small child exaggerating a limp to get attention from their parents.

“I found her gait to be a little bit artificial, perhaps to be a little bit attention-seeking,” she said. “But that didn’t mean that I didn’t think she had pain in her chest wall.”

State coroner Ros Fogliani earlier refused an application for video footage of Ms Dhu in the hospital waiting room, which included footage of her walking, to be shown in court.

Lawyers for Dhu’s family argued the video footage, taken from the hospital’s CCTV camera, would challenge the statements of Lang and Dr Vafa Naderi, who saw Dhu at hospital the next night. Both Lang and Naderi listed “behavioural issues” as the chief cause for Dhu’s apparent distress, and claimed her behaviour was agitated and aggressive.

Until late last week, the coroner was told that footage did not exist.

“The health department originally told the coroner’s office that there was no CCTV of 2 or 3 August,” Ilona O’Brien, council assisting the coroner, said. “Late last week the court was advised that position was incorrect.”

The diagnosis of behavioural issues was re-issued By Dr Naderi just 18 hours before her death, when she was taken to hospital for the second time with worsening symptoms, and expert witnesses told the coroner on Wednesday a failure to challenge that diagnosis prevented doctors recognising her actual illness and delivering life-saving antibiotics.



Peter Quinlan – counsel for Dhu’s mother and grandmother, Della and Carol Roe – applied to show the video from 2 August to both Lang and emergency department nurse Samantha Dunn, who was also involved in Dhu’s care that night and gave evidence at the inquest on Thursday.

However the state coroner, Ros Fogliani, said the footage was not relevant.

“The relevance of this witness’s evidence concerns how she saw and observed Ms Dhu in the time that Ms Dhu was with her,” Fogliani said. “Other images of Ms Dhu walking through different areas of the hospital are not relevant.”

The CCTV footage the court has seen of Dhu that day, taken from the police station, shows her moaning and crying in pain for at least half an hour before being taken to hospital.

Dunn told the court Dhu’s behaviour was unremarkable. Dhu was “reluctant” to answer questions but not angry, disruptive or emotional. Dunn said she did not see Lang examine Dhu, having walked 30 metres away from the curtain-fronted cubicle to get the diazepam prescribed to calm her apparent anxiety.

Apart from the reluctance to answer questions, Dunn said Dhu appeared accepting and undistressed, both in her physical health and her behaviour. She also said Dhu was “walking normally”, however she said she could not recall a number of details about her examination of Dhu, including a suggestion by police that she had rolled her eyes when Dhu flinched at a light touch.

Quinlan then made a second application for the footage to be shown, arguing Dhu could be clearly seen hunched and walking gingerly through the hospital. That application was also refused, with Fogliani saying she would view the footage privately.

Lang was scheduled to give evidence later on Thursday.

According to the hospital’s senior medical officer, Dr Ganesan Sakarapani, a review of the hospital’s treatment of Dhu found no problem with her treatment on 2 August or 4 August, but did find she had been incorrectly given a low triage score on 3 August, which meant that a full set of observations, including her temperature, which may have indicated signs of infection, were not taken.

Sakarapani was one of the doctors involved in the 53-minute attempt to resuscitate Dhu on 4 August. He told the court on Thursday that she appeared to be already dead when brought in on a wheelchair. Her skin was mottled, turning blue, and cool to touch.

“The fact that she was cool and mottled suggests to me that she had been dead for some time,” Sakarapani said, but added that those symptoms could also be attributed to severe septic shock. “She could be cool and mottled but still conscious.”

Sakarapani rejected the suggestion, made by an earlier expert witness in Indigenous health, that Dhu would have received better care if she was a middle-aged white person, saying that Aboriginal people made up 70% of intake patients at the hospital, despite being just 17% of the local population.

“We do not have a culture of institutionalised racism toward Aboriginal patients at the hospital,” Sakarapani said. “I would completely reject that for our institution.”

The inquest continues.