"Unconscious racial bias affecting triage decisions"

Unfortunately, I’d like to raise what I feel is another case of institutionalised racism at Broome Hospital ED. As a former employee of a healthcare facility and as an Aboriginal person, it was extremely disappointing to witness how racism seemingly continues to manifest as a significant barrier to safe and timely care for our Aboriginal people.

I am a medical professional, and received a phone call from my parent who lives 2 hours out of Broome. I was immediately concerned by their symptoms, vomiting for 8 hours and in severe left flank pain. I made the decision to take a day off work to drive a total 4 hour round trip to bring them into Broome Hospital ED, by this point they were having chills and I was worried about systemic kidney infection.

I handed over directly to the triage nurse flagging all of the above and that the last time they told me they wanted to go to Broome ED was when they suffered a heart attack and required stenting at a tertiary centre. My parent was triaged as a category 4. Despite their urinalysis also confirming infection during our wait, they proceeded as a Cat 4 and we waited for almost 3 hours in the waiting room. They received simple analgesia only during that time.

Once in the department the doctor recognised the likely severity of my parent's condition, arranged bloods and a CT scan which confirmed a 10mm infected, obstructed stone. They were given morphine approximately 5 hours after presentation. They were admitted to the high dependency unit and then was transferred to a tertiary centre overnight for urgent surgery.

This experience has caused me to reflect on the barriers to timely care. Living rurally, access already poses a significant delay to this but I believe the added anxiety of whether or not the severity of your illness will be taken seriously because of your race is a massive barrier as to why Aboriginal people struggle to access healthcare and when they do work up the courage to present, I feel that experiences that minimise or disregard the severity puts them at significant risk of deterioration and bad outcomes. I presented with my parent in the hope I could articulate the seriousness of their condition, given their previous experience presenting alone with a heart attack wasn’t triaged urgently either.

I recall we had an ED nurse acknowledge ‘you got a bit neglected there’ which was both validating and deeply concerning to hear. Even with a health background I feel I wasn’t able to adequately advocate for my family, worried speaking up may hinder their care further. So we mostly stayed quiet, said thank you a thousand times in the hope they’d give my parent what they needed.

Now that they're safe I feel it’s time to voice my concerns out of fear this will happen again to another countrymen. One who may not have family to advocate for them and, I believe, as a result suffer poor outcomes.

My concern is, I understand the signs and history were all there to warrant a higher triage category, there were multiple red flags and when such a condition requires urgent, timely intervention I feel reflecting on how that could have been improved is really important. I felt I emphasised the salient points but I felt only the non-urgent aspects of the history and observations were considered. This had a ripple effect on all the care that followed as their condition deteriorated over the proceeding hours. It was clear to me that the staff were surprised when the severity of my parent's condition was confirmed with objective imaging, but none of this was a surprise to us as their family, we had these exact concerns from the moment of presentation.

I felt this was a classic presentation of renal colic and I don’t think the mistake here lies in a lack of knowledge of the medicine but more so a lack of knowledge of unconscious racism. I believe that this is how systemic racism manifests in health care services and service delivery and I feel that as long as this is not addressed, our Aboriginal people will continue to suffer because of it.