Never alone: Gayle Woodford's legacy to remote area nurses

Updated

The alarming circumstances surrounding Gayle Woodford's death raise the question: Are we doing enough to keep our remote area nurses safe? Australian Story investigates.

The last time Keith Woodford saw his wife was just after 9 o'clock on the evening of March 23, 2016. She was sitting in bed reading as he strapped on his sleep apnoea mask and lay down. The oxygen expanded into his lungs, pushing him into a deep sleep.

What is believed to have happened after Keith drifted off is now recorded in court documents and forever etched in his mind. Gayle Woodford, 56, was the nurse on duty at the health clinic in the remote South Australian community of Fregon. Somehow alerted to the presence of a visitor, she left their bed before 11:30pm. She went to the front door of their home which was surrounded by a ground-to-roof security cage, designed to put a physical barrier between nurses and patients. There she found a man who says he wanted some Panadol for his sick grandmother.

When Keith Woodford woke at 6:00am, Gayle wasn't beside him. At first, he didn't worry; it wasn't unusual for her to be called out to patients overnight. But when he phoned the clinic around 9:00am and another nurse told him they hadn't seen Gayle and didn't know where the ambulance was, he felt a twinge of panic. He drove out to Fregon airstrip, thinking she might be there readying a patient for an evacuation. The airstrip was empty.

About 10:30am the police called the clinic: they had found the ambulance and there was blood in it. There was no sign of Gayle. At home again, Keith found his wife's medical bag and work pants on the bedroom floor. "I knew she was in trouble," says Keith. "I just kept wishing or thinking, 'She's jumped out. She'll be all right. She's very smart. She's very quick'."

On Easter Saturday, three days after she was reported missing, Gayle Woodford's body was found in a scrubland grave about 1.5 kilometres from Fregon.

Gayle's death has left a family shattered, a community traumatised, and spurred a campaign to increase security for Australia's remote area nurses (RANs). In November, the South Australian parliament passed a new law, dubbed "Gayle's Law" that will bring in a raft of changes related to remote nurse safety, most importantly, that on-call nurses will never work alone.

And now, for the first time, Gayle Woodford's colleagues have spoken out about how they flagged their concerns about being alone on call before her death. A number of nurses have told Australian Story that they raised their concerns with Nganampa Health Council, which operates Fregon clinic and six others across the APY Lands (Anangu Pitjantjatjara Yankunytjatjara). "There was very much this culture of, 'this is how it is and if you don't like it, you don't work for us' says Belinda Schultz, 27, a close friend and colleague of Gayle's.

These accusations are emphatically rejected by the organisation. "I completely dispute that," says Professor Paul Torzillo, medical director of Nganampa Health Council. "Can you allay everybody's concerns about personal safety? No you can't, but were they dismissed or not taken seriously? Absolutely not."

"There was a general sense, particularly amongst the three of us [nurses] in Fregon, that something was going to happen to one of us eventually," says Belinda. "Obviously nothing like what happened to Gayle."

Remote nursing for 'adrenaline junkies'

There are about 1,000 remote area nurses in Australia, mostly women, and their work is challenging. Doctors are often not present, clinics can be chaotically busy, and they can be called upon for everything from a toothache or a wound needing stitches, to medical evacuation, childbirth or domestic violence-related injuries. And they love it.

"Whatever came in the door you had to deal with," says Belinda, who taught herself to suture on a patient, remote nursing manual by her side. "You have to be a bit of an adrenalin junkie … otherwise you just don't survive out there."

Fregon sits on a red dust plain beside a dry creek bed, and is home to about 220 close-knit kin. It is one of six communities in the APY Lands, a 103,000-square kilometre patch of country the size of Iceland in the north-west corner of South Australia that's closer to Alice Springs than Adelaide.

The Anangu Pitjantjatjara Yankunytjatjara Lands is known to those familiar with it as The Lands. Anangu living here share strong cultural bonds that are reinforced by close ties to their ancestral lands. It's a place where people who have little pool resources and organise large, vibrant sports carnivals and ceremonies. The Lands also has a proud artistic tradition and its artists are acclaimed internationally.

But it is also a corner of the outback plagued by grief over the premature loss of loved ones. And where the social wellbeing of communities is continuously threatened by violence. Violence that could, at times, spill over to the clinic.

Former Nganampa doctor Phil Humphris says with no permanent police presence in Fregon, clinic staff were exposed. "A common situation would be a domestic violence situation where we are looking after the woman who had been hit and the man would come and be incredibly angry that we were there looking after the woman," he says.

"It would regularly happen in Fregon, that you would barricade in the clinic. Lock the doors," says Belinda.

The fastest police response is 90 minutes away. A 2010 report by former remote area nurse turned Flinders University academic Sue Lenthall, found that remote area nurses experienced more psychological distress than police officers. Yet another report, co-authored by Ms Lenthall, showed remote area nurses were exposed to high levels of violence.

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'If you don't feel safe, don't open the cage'

On the night of March 23, 2016, Gayle Woodford's last consultation at the Fregon clinic was at 8:36pm. She closed the patient record at 8:39pm, jumped in the clinic vehicle which doubled as its ambulance, and drove the few hundred metres home. By about 9:00pm she was beside her husband in bed. She knew that, as the on-call nurse, she could be woken at any hour and for any reason — from somebody with a headache, to a car crash or a critically ill patient requiring evacuation.

The ambulance was parked outside the house and the porch light was on. "We were always told, 'if you don't feel safe, don't open the cage', which is hard to do in practice," says Tessa Wilkie, a locum nurse and former colleague of Gayle's.

"[But] if you have a situation where you know that someone is injured, I guess, [as] nurses, your first instinct is to help that person."

If there was one area of disagreement that the other nurses had with Gayle, it was that she did too much. She was a soft touch. "Gayle was a hands-on nurse. She just loved her job — there's no other way to explain it," says Keith Woodford, who fell in love with Gayle's warm-hearted smile.

They married in 1979 and settled in the seaside village of Stansbury on South Australia's picturesque Yorke Peninsula. The couple ran the butcher's shop there and had two children Alison and Gary. Gayle was energetic and always had a project on the go. She built wood-framed fish tanks from scratch, worked with Gary to turn an old backyard shed into a teen retreat, and was a talented dressmaker. The couple also shared curious minds and a passion for people and travel. "We just liked going to different places and having a look around," Keith says. They decided when their kids were grown they'd work their way up the centre of Australia and then down the western flank. A nursing job came up in Fregon.

Nganampa Health Council medical director Professor Paul Torzillo recalls interviewing Gayle Woodford for a job with the organisation. He remembers telling Gayle that he thought she would be very good at the job and would enjoy it.

"Both those things turned out to be right," he says.

Gayle thrived in Fregon. The couple settled in, their travel plans on hold. Early in the mornings she worked to transform her yard of buffel grass and bindies into an elegant native garden. She spent time in Alice Springs, training to become a diabetes educator — a critical skill given the high levels of the disease in remote communities. And quietly, Gayle worked with local teacher Ann Ramzan to ensure that the senior girls at the local school were cared for. "Whenever I had any problems I would take a girl over and see Gayle and know that she would drop everything and deal with it straight away," says Ann, who remembers Gayle as a "tiny little slim blonde thing".

Gayle found her work so rewarding, she stayed in Fregon in spite of a traumatic personal experience. About 18 months before her death, she was sexually assaulted. She was on call one evening and raking leaves in her garden when a man drove up and asked for a bandaid. He grabbed her by the breast and told her he wanted to have sex with her. Keith suggested to his wife that it was time to think about moving. Gayle told him that she hadn't finished her work. She said she wasn't going to let one person push her out of the community. "In hindsight, I should have said more," says Keith.

A violent sexual offender

On 17 September 2015, Dudley Davey, 34, was released from Port Augusta prison with a one-way bus ticket to Marla, gateway to the APY Lands. Davey, who had been born in Alice Springs and moved to Fregon when he was six years old, had spent most of his adult life in jail, in part for a string of sex offences. This time he'd served almost 30 months for a brazen sexual assault of an unconscious woman opposite the casino in Adelaide in front of several witnesses who intervened.

There were several opportunities at which the arms of the South Australian criminal justice system could have applied to have Davey indefinitely detained after this offence. The prosecutor or magistrate's court could have applied to the Attorney-General when Davey was sentenced, but they didn't. And nor did Department for Correctional Services South Australia make any application the entire time Davey was serving out his sentence.

In response to questions from Australian Story, Correctional Services says: "Since the time of this offender's most recent, most serious offending the department has taken steps to strengthen and systemise our review of potential s23 candidates and referral processes to the Attorney-General."

Australian Story has learned Davey never attended any sexual offenders courses while he was in prison. Correctional Services says long stints on remand and short time to serve, coupled with Davey's "cognitive impairments, functional illiteracy, and language barriers", meant that the department's intensive rehabilitation programs were neither available nor suitable.

A 2002 court psychologist's report concludes there had been an absence of sexual pathology treatment services provided to Dudley Davey, and that "it is imperative that such services are mobilised for him."

In the days leading up to Easter 2016, Davey had been to Alice Springs and bought a stash of ice. By the time he arrived at Gayle Woodford's home on the night of March 23, he had been on a three-day bender.

Security concerns

When it's fully staffed, three nurses run the 24-hour health service in Fregon. The night call nurse sleeps the following day, while her colleagues handle the steady flow of patients at the clinic.

Gayle Woodford's former colleagues Belinda Schultz, Kate Waddleton and Linda Murphy say that when it came to safety around on-call work, Nganampa Health Council sent mixed messages. On the one hand senior management encouraged nurses not to open the cage if they felt unsafe, to send men who presented alone away to fetch a female relative, or to call a second staff member for back up. Nurses say it was often impractical.

"If you call out a colleague every time you felt a little bit of fear or a bit frightened you'd be calling them all the time," says Belinda. "You knew that if you wake your colleague up that that was then two people that were out of the clinic the next day, leaving one person to run the clinic on their own."

The nurses say they also felt enormous pressure to take every after-hours patient to the clinic for assessment, no matter how minor the complaint. "It's that real, dare I say it, male attitude of grin and bear it. If you can't hack it, leave," Kate says.

Professor Torzillo as well as other senior staff, say the allegations are completely untrue. Professor Torzillo says of the hundreds of people that Nganampa has employed, this is a minority view. "There was never pressure to do anything where people felt they might be at risk. Absolutely not," he says.

Professor Torzillo says the organisation had safety policies around on-call work, but that it was up to a nurse's personal risk assessment as to whether or not to step outside the cage and treat somebody. "Within the resources that the organisation had, we would've always tried to do the best we could," he says. "Staff safety is our primary concern."

It is widely acknowledged that Nganampa delivers an exceptional primary health service. Since the organisation started in 1983, 16 per cent of babies on the Lands had a low birth weight. Thirty-four years later, that figure has halved, the immunisation rate is better than the national average, and syphilis is non-existent — in spite of a current nationwide epidemic.

The desperate search for Gayle

Some hours after Keith noticed his wife was missing, Police Rescue arrived from Adelaide, joining their air wing colleagues, the homicide squad, local police officers and volunteers. Nurses, teachers and other remote service personnel also started searching. And in Fregon the entire community mobilised. Young men jumped on dirt bikes, trackers fanned out across the Lands, and a group of Fregon women set up a vigil outside Keith and Gayle's house.

"We were all hoping that she would come out of the desert, thirsty, perhaps dishevelled, dirty. Something traumatic happened to her. But we all hoped that she was going to appear," recalls Glynis Johns, a former colleague and close friend of Gayle's.



Those searching for Gayle faced a disorienting landscape that, to an untrained eye, seemed barely to change from one kilometre to the next. After a false report that sent police searching 200 kilometres away near the township of Marla, they returned to a spot just off the road where the ambulance's GPS record showed the vehicle had stopped for half an hour. On Saturday, March 26, Gayle Woodford's body was found.

What is known about what happened that night comes from two sources, the GPS data from the ambulance and the testimony of Dudley Davey. He says he told Gayle his grandmother needed a painkiller. In her sentencing remarks, the honourable Justice Vanstone acknowledged the sequence of events was unclear but was satisfied Davey "tricked her into opening the security cage … [and] immediately overpowered her".

Davey says they drove the ambulance out of Fregon and stopped in scrubland where he raped her. She managed to flee into the bush but Davey waited in the dark next to the vehicle and overpowered her when she returned a little while later. He drove a short distance before Gayle jumped from the vehicle and again tried to flee. It was then that Davey caught and murdered her.

On the June 8, 2017, Davey was sentenced to life with a non-parole period of 32 years for the murder and rape of Gayle Woodford. In November, he lost an appeal against his sentence.

More than a thousand people attended Gayle's funeral in Stansbury. A group of Anangu made the 1,277 kilometre trip to say goodbye. Parents lifted their children to touch a photograph of her smiling face as a line of mourners filed by.

Former community constable Carl Roberts says the people of Fregon are still trying to recover from Gayle's death. "People still speak of her today and in regards to what great things she had done out here," he says.

In the days and weeks that followed, elders at the arts centre set to work on a large canvas for Keith Woodford. As they worked, the artists reflected on the terrible events and what led to them. The senior women and men also began to strategise ways to better protect the community.

"The reality is there's an empowered group of elders constantly negotiating with non-Indigenous service providers to get traction on solutions they know will work," says APY Art Centre Collective manager Skye O'Meara. "The old people know what they need to do."

Nganampa's reaction to Gayle's death was swift. They successfully applied for a million dollars in federal funding to implement a community escort system which stopped patients going directly to nurses' houses after hours. They also brought in external consultants to conduct a security review. The review found that overall, with the exception of a number of minor improvements, the health service "applies a robust and effective physical security regime that if properly implemented is considered of an appropriate standard".

Nurses unite

After Gayle's death, a small group of nurses who'd been vocal about remote area nurse safety began to organise online. They called themselves RAN Core.

"None of us actually knew Gayle, but we all had that feeling that it could have been us," says Donna Smith, who is one of the five RAN Core activists.

Their work contributed to the passage of a bill in the South Australian Parliament, "Gayle's Law", in November 2017. The Northern Territory government has also introduced policy mandating that nurses have back-up on call-outs.

Keith Woodford was in the South Australian Parliament to see "Gayle's Law" passed, but nothing will take away his torment. He often visits his wife's grave. It's one of the largest headstones in the small Stansbury cemetery, a tall, commanding slab of black granite that looks out towards St Vincent Gulf. "I do miss Gayle every day. Every single day," he says. Keith Woodford won't stop until Gayle's Law has rolled out across the country.

Watch Australian Story's Final Call on ABC iview.

Credits:

Producer: Mayeta Clark

Editor: Stephanie Wood

Photography: Chris Lockyer, Woodford family, Mayeta Clark and supplied

Digital producer: Megan Mackander

Topics: murder-and-manslaughter, doctors-and-medical-professionals, fregon-872, adelaide-5000, alice-springs-0870

First posted