Naomi Williams’s partner tells inquest she was ‘begging for help’ before she died

Just days before Naomi Williams died after being sent home from Tumut hospital without seeing a doctor, she and Michael Lampe were celebrating Christmas and talking about their dream life that was beginning to come together.

“That dream was shattered by an instant on New Year’s Day when I watched the love of my life and my baby die in front of my eyes,” Lampe told a coronial inquiry on Friday.

Williams, a 27-year-old Wiradjuri woman and disability caseworker, died in 2016 at the Tumut hospital in regional New South Wales, from a treatable infection.

Williams was six months in to a high-risk pregnancy when she presented with severe pain, but was given two Panadol and sent home 34 minutes later without seeing a doctor.

Her condition deteriorated and 15 hours later she died from sepsis associated with the bacterium Neisseria Meningitidis.

On Friday, an inquest into Williams’s death heard the final evidence from witnesses, as well as statements from the family, two of whom performed a Wiradjuri dance “about speaking the truth”. Other family members in Wagga Wagga watched on via videolink.

In his statement, Lampe told the inquest Williams “could light up a room just by walking in”.

“She was always happy and sharing my life with Naomi was never boring. And she was one of the most honest people I have ever met.”

Lampe said he had heard nurses tell the inquest that Williams looked well when they saw her the day she died, and that other experts had relied on their evidence.

“That’s all well and good but I want you to know that I will forever be haunted by the pain and suffering that I saw Nay go through before and after she went to Tumut hospital on the first of January 2016,” he told the inquest.

“Nay was begging for help. When I look back and read the text messages that she sent that night – asking for help with her pain – it makes me sick to my stomach.”

Lampe reminded the inquiry Williams had been to the hospital 18 times in the previous six months, begging for help.

“She would come home and tell me how tired she was of just being ignored – just being turned away. She felt like nobody was there listening to her.”

On previous visits Williams had also been referred to drug and alcohol services and mental health services despite having no drug or alcohol problems, which her family had lodged complaints about.

Williams’s mother, Sharon, told the inquest her daughter was an outgoing young woman, passionate about social justice and excited about the arrival of her first child, and highly respected as a “hardworking Wiradjuri woman”.

“My daughter, like most of us here, was an Australian citizen with rights to appropriate healthcare, but the system let my daughter down.”

When Williams sought medical care “no one listened to her, and no one helped her”.

Sharon Williams said after the death the family was “treated with contempt” and their grieving community and its cultural protocols were treated with disrespect and a lack of compassion.

“My daughter and grandson are gone but our people are forever and we must be seen.”

Sharon Williams said the Wiradjuri word “Yindyamarra” meant “to respect and to honour” and that was why the family had come to the inquest, despite the trauma involved.

Earlier on Friday, the inquest heard from Maria Roche, a hospital group manager for the region encompassing Tumut.

Roche was unable to answer numerous questions about the state of Aboriginal healthcare, procedures and training at the time of Williams’s death or whether problems had been addressed since.

Roche said there was “a gap” in liaison services provided by Aboriginal health workers, who currently were not employed 24 hours a day, but she had no awareness of whether the gap was being addressed.

Roche said she was not aware of the high number of Williams’s presentations until after her death, which indicated a serious problem at the hospital and showed they were not meeting Williams’s needs.

Through their lawyer, the Williams family put several propositions to Roche about improving relationships with the Aboriginal community and increasing its involvement in delivery of healthcare.

“That’s exactly what we need,” Roche said, breaking down in tears.

Roche was asked if there was anything she wanted to say to the family, who felt they were mistreated by staff after Williams’s death.

“I’m sorry, and I want it to change,” she said.

At the end of her evidence, Roche expressed her condolences to Williams’s family.

“I welcome the suggestions you put forward here. I really honestly welcome them.”

On Thursday the inquest had heard evidence of “implicit racial bias” against Indigenous people in Australia’s hospital system.

On Wednesday two nurses said that Williams, as a pregnant woman showing those symptoms, should have been seen by a doctor.

Speaking outside the court, Williams’s cousin, Prof Anita Heiss, said the family hoped the inquest would result in Tumut hospital taking responsibility, and would prompt systemic change across the health system in the way Indigenous people are treated.

“Our healthcare is as important as any other Australians healthcare. We deserve the same treatment when we present at hospital.”

The inquest, which began last year in Gundagai, before the final three days in Lidcombe, ended on Friday. Grahame told the family the court would like to travel to Tumut to deliver the findings on 3 July.