- Former Australian Health Practitioner Regulation Agency board member Hannah McGlade is concerned about “double standards” in the way Indigenous patients are treated.
- She cited the example of Dhu, an Indigenous woman who died in police custody after complaining about pain. A doctor had cleared her, and there was disagreement within AHPRA about the severity of the doctor’s wrongdoing.
- McGlade is calling for a separate investigation process for medical complaints involving Indigenous people.
- A spokesman for AHPRA said the organisation was half-way through implementing a strategy to improve the system for Aboriginal and Torres Strait Islander people.
WARNING: Aboriginal and Torres Strait Islander readers are warned this article contains images and information about deceased persons.
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. 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.
A coroner found Dhu’s death could have been prevented. Credit:ABC News
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.
The organisation was seeking to “eliminate racism” from healthcare by boosting training for staff and hiring more Indigenous people throughout the organisation, including senior positions, he said.
‘Slap on the wrist’
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.
The treating doctor, 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 a simple course of antibiotics to treat her broken rib, which had become infected, would 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, he almost got off “scot-free”, McGlade said.
There was disagreement within AHPRA about the severity of Naderi’s wrongdoing, McGlade said, so an independent expert was enlisted to assess the treatment.
The expert found that while his conduct was unprofessional, it did not constitute professional misconduct, according to McGlade. A legal firm was prepared to accept this advice 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.
Carol Roe, grandmother of Dhu, who died while being detained for unpaid fines.Credit:Justin McManus
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.
McGlade was not involved in any of AHPRA’s investigations into the nurses who treated Dhu and fears that without her participation, they may have been let off without any action.
“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.”
ABSTARR Consulting chief executive Gregory Phillips, who worked on AHPRA’s 2020-25 cultural safety strategy, said the regulatory response to Dhu’s treatment could be reviewed as a case study to bolster accountability within the regulator.
“The Aboriginal community would rightly question why that is seemingly the only option available for such an egregious case?” he said.
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.
The spokesman said work had commenced on creating a “culturally safe notification process” led by the community but the model had not yet been determined.
“One way we are proposing to do this is by including the perspectives and voices of Aboriginal and Torres Strait Islander peoples throughout,” he said.
“Cultural safety” is defined by AHPRA as equipping health practitioners with the knowledge, skills, attitudes and behaviours needed to deliver healthcare free from racism.
AHPRA’s spokesman outlined a range of initiatives in a statement, including mandatory cultural training delivered to 1430 AHPRA staff over the past two years and work to appoint two Indigenous representatives on all national boards.
“As an agency, we acknowledge that we have much to learn, change and to take action on within the National Scheme for us to realise this goal,” the AHPRA spokesman said.
However, in sectors like mental health, lack of cultural safety was the norm, according to multiple investigators interviewed by The Age and Herald, who provided examples of Indigenous women, who were victims of childhood rape, suicidal or psychotic, treated by male doctors – which has a re-traumatising impact.
A community representative on one of AHPRA’s national boards, who could not be named due to employment obligations, said there was pushback internally towards initiatives to boost cultural awareness due to a perception the industry was already doing enough work in this space.
“People were saying: ‘Why are you making me do this?’” said the board member. “AHPRA has on occasion tried to stymie projects because they don’t want to upset people, they don’t want to be seen as activists.”
Over the past five years, Indigenous community leaders have pushed for a culturally appropriate notification process to be established – where incidents involving Indigenous patients are handled by members of their community or those provided with specific training.
“We need to get to a point where if any Aboriginal person experiences racism in the health system, they feel confident they will be heard and it will be dealt with,” ABSTARR Consulting chief executive Gregory Phillips said. “There’s a major trust-building piece that will only be built if the culturally safe notification system is in place.”
While Phillips paid credit to AHPRA for undertaking work to reduce racism in healthcare, and praised the people working to drive change from the inside, he said he could understand if the community believed the pace of reform was too slow.
“You can say you’re committed, but are you actually putting money and skin in the game?” he said. “Delays mean that cases like Ms Dhu or Naomi Williams [who died of sepsis after being discharged from hospital, treated only with paracetamol] or any number of cases, will be more likely to occur. It’s more lives at risk.”
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