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Denise Booth tends to her sister’s grave every evening before the sun goes down.
“We miss her,” Denise says quietly.
“Miss her ways. And her smiles and that.”
WARNING: Aboriginal and Torres Strait Islander readers are advised that this article contains images of a person who has died, used with the permission of their family.
So many graves in Doomadgee cemetery belong to young people like Yvette “Betty” Booth.
Just two months before she died, the teenager was diagnosed with an illness that has all but disappeared in most of Australia.
Denise has the illness too. It’s called rheumatic heart disease (RHD).
Betty was supposed to get weekly check-ups and urgent surgery, but that never happened.
She visited Doomadgee Hospital’s emergency department 12 times in under two months.
On some of those occasions, she was given Panadol through a security grate and sent away.
Her family is heartbroken and angry.
“We are human beings, you know?” says Betty’s uncle, Martin Evans.
“We want to get the same treatment as the next person.
“What happened at that hospital — it’s just not right.”
Betty’s death is one of three in the space of a year uncovered by Four Corners in an investigation into health care in this remote town.
When doctor Bo Remenyi visited Doomadgee in July 2019 to screen children for RHD, she recognised Betty Booth and her family right away.
Dr Remenyi started her medical career in the remote north-west Queensland town and the plight of RHD patients had inspired her to specialise in paediatric cardiology.
She had treated Betty as a baby 18 years earlier and even babysat her.
When she examined Betty, now aged 18, Dr Remenyi quickly realised Betty had severe RHD.
Betty needed urgent surgery to repair the valves in her heart.
Dr Remenyi’s team left detailed instructions for her care and multiple health bodies — including Doomadgee Hospital’s doctors and director of nursing — were emailed Betty’s referral to a cardiology service.
Despite this, no record of her illness was kept on Doomadgee Hospital’s file.
Betty was supposed to be reviewed weekly, but that never happened.
‘The shut-up pill’
Betty first went to the hospital four days after her diagnosis, at 11pm with a cough, fever and vomiting.
She was given Panadol and treatment for dehydration and sent home to return in daylight hours.
On that occasion, staff took her temperature and pulse, but that wouldn’t always be the case.
Dr Remenyi says it’s not unusual for patients who go to the hospital on weekends and after hours not to be properly assessed.
“The conversation takes place over a cage, without actually touching the patient or examining the patient or giving that real opportunity to discuss the symptoms,” she says.
Betty would go on to visit the emergency department 12 times, with symptoms including difficulty breathing, fever, an abnormally high heart rate, and coughing up blood.
But she was given paracetamol (and once, antibiotics) – often handed through the locked after-hours security window – and sent away.
On some of these occasions, hospital staff did not carry out basic vital signs observations that are routine in other hospitals – taking temperature, pulse, oxygen saturations.
“How many times can you present, with the same symptoms, pressing symptoms, coughing up blood, shortness of breath, tachycardia, and each time the outcome is not different?” Dr Remenyi says.
She says Betty’s care represents “clearly, a failure of the health system”.
An independent review of Betty’s care would later say, “generally patients do not present in the middle of the night for no reason, and it is rare for them to present frequently at that time”.
Vicki Wade, director of lobby group RHD Australia, says the use of paracetamol in this way is disappointingly widespread in remote Aboriginal communities.
“We know that it’s not the right treatment, but unfortunately, Panadol’s easy to give out, so you know, people will get the Panadol and we’ll say, ‘oh, that’s the shut-up pill’,” she says.
Four Corners investigates how the health system has failed women like Betty, tonight on ABC TV and iview.
‘They are supposed to be professionals’
After multiple presentations to Doomadgee Hospital in August 2019, Betty went to Townsville, where her mother was having an operation.
Townsville Hospital was also aware of Betty’s diagnosis and while there was toing and froing between medical services and Betty to try to set a date for her surgery, it never happened.
When Betty returned to Doomadgee after three weeks, she fell desperately ill again.
Marilyn Haala, a relative who was staying at Betty’s house that weekend, noticed Betty’s face and neck were “all swollen”. Swelling can be a serious warning sign of heart failure.
“She was sick, she just kept coughing — she didn’t look good,” Ms Haala says.
“She was struggling to breathe.”
The family decided Betty should go to the hospital, but when Betty’s sister took her to the emergency department, her family says she was again sent home with Panadol.
“An 18-year-old girl should not be sent home with Panadol,” Mr Evans says.
“They are supposed to be the professionals, check her file for goodness sake.”
Weenie George, the mother of Betty’s best friend, says this practice was commonplace at the hospital.
“They don’t treat them and check them,” Ms George says.
“They just send them home. They don’t do their job at night.”
Monday, September 23
Weenie’s husband Terrence and daughter Shakaya both had rheumatic heart disease, so when Betty turned up to their house, they knew the signs of a very unwell patient.
“She was looking a bit puffy in the face. She was breathless talking to me and Terrence,” Weenie George says.
Terrence George says when Betty sat down on their verandah, he said: “You look sick, Bubba, you better go to the hospital”.
That’s what Betty did. She never came home.
In the afternoon, a nurse recorded Betty had a fever and a fast and irregular heartbeat.
But critically, yet again, there was no alert on the hospital’s online system to show Betty had severe RHD and required urgent surgery.
By 4:45pm, Betty had been waiting for hours, seriously ill, and staff finally decided she should fly out, but she was categorised as “low dependency”, meaning staff had up to six hours to get her on a flight.
An hour later, a plane was ordered from Townsville, 850 kilometres away, instead of the closest big hospital, Mount Isa.
Marilyn Haala and her husband Clennon Bob were pacing around outside the hospital, “stressing out”.
“I wanted to go in to see her,” Mr Bob says.
“No-one would let me go in, even the nurse or the doctors.”
Within an hour, Betty deteriorated badly.
By the time a Royal Flying Doctor Service plane finally landed at Doomadgee, Betty Booth had been dead for almost two hours.
“[The] doctor that was treating her, came out and gave us the bad news: Betty didn’t make it,” Mr Bob says, slowly shaking his head.
“It broke both of our hearts,” Ms Haala says, weeping.
She says it is still painful to talk about Betty, but she hopes it will help other young people in the Doomadgee community with RHD.
“Because what they did there, they just going to keep killing people,” Ms Haala says.
A long wait for answers
Just three months after diagnosing Betty, Dr Remenyi returned to Doomadgee for the teenager’s funeral.
“To see Betty, who was a young, enthusiastic, caring, compassionate young woman with a bright future – to see her in a coffin … devastating,” Dr Remenyi says.
“I felt angry that in 20 years, nothing had changed.
“I became a paediatric cardiologist because I wanted to stop young women, specifically, dying from rheumatic heart disease.
“When I diagnosed Betty with rheumatic heart disease, I felt really positive.
“I felt like I could change the trajectory of her life.
“Now I’m seeing her in a coffin … I felt responsible.”
A community protest followed Betty’s death. Locals were angry and demanded answers.
The local area health service promised an independent review into what went wrong, but the family heard nothing for almost two years.
In August 2021, shortly after Four Corners began making calls about this story, Betty’s mother Norma Mick suddenly heard from the local area health service, asking her to come for a meeting to discuss a report into Betty’s death.
Ms Mick was shocked to see the report was dated March 2020 – 17 months before.
In all that time, nobody at Doomadgee Hospital or in the health department had thought to share the report with the family.
It catalogued a series of failures that preceded Betty’s death.
Treated ‘like dogs’
The “Betty’s Story” report found Doomadgee Hospital had “clinical risk and poor governance”, low expectations for Aboriginal patients’ health, and an unwelcoming hospital environment.
“[It feels] like they treat us like animals,” Ms Haala says, angrily.
“It’s the truth.”
Other locals cited in the report said the hospital treated them “like dogs”.
Dr Remenyi says there’s a division between health services and the community.
“It’s racism … one group of people thinking potentially that they are better than the other,” she says.
Pat Turner, who heads the National Aboriginal Community Controlled Health Organisation (NACCHO), the peak body in indigenous community health, says it’s inexcusable for a patient to be repeatedly turned away like Betty was.
“If I present to an emergency department and I’ve got serious symptoms, I don’t want to be handed Panadol through the grate.”
“I want a full triage and I want to have all the work done that any other Australian has a right to expect.
“The racism is absolutely out there, and it has to stop.”
Despite the high incidence of RHD in Doomadgee for decades, the “Betty’s Story” report found staff at the hospital had “limited understanding of rheumatic heart disease”.
The disease, which had all but disappeared in white Australia by the 1990s, now almost exclusively affects Aboriginal Australians.
What is RHD?
- It’s caused when repeated strep A infections in the throat or skin sores are not adequately treated, and they develop rheumatic fever
- Getting rheumatic fever repeatedly damages the valves in the heart and leads to RHD, which can cause heart failure, stroke and death
- It thrives in poverty – where poor housing and living conditions can allow the strep bug to spread
Rates of RHD have risen from 67 cases in 100,000 in 2014 to 81 cases in 100,000 in 2019.
But the incidence of RHD in Doomadgee’s children is far greater — 4,400 cases in 100,000.
That’s higher than sub-Saharan Africa.
“It is an appalling statistic in a country as capable and competent as Australia,” Pat Turner says.
“We stand back and watch children, time after time again, year after year, decade after decade, having still the same end result,” Dr Remenyi says, “Which is dying far too young.”
Within a year of Betty Booth’s death, two other young women with RHD died after seeking treatment in Doomadgee.
One of them was 17-year old Shakaya George, daughter of Weenie and Terrence George, the other was Shakaya’s aunt, Adele Sandy.
“They’re not helping us,” Ms Haala says of the hospital.
“They’re killing us.”
After being contacted by Four Corners, the Queensland coroner announced on Friday it would hold an inquest into the women’s deaths, including “the adequacy of the care and treatment received”.
Queensland Health Minister Yvette D’Ath told Four Corners in a statement that all three cases were under investigation by North West Hospital and Health Service.
“I would also expect any allegations about the standard of care delivered at Doomadgee Hospital to be investigated,” she said.
Follow the investigation into the deaths of these three women tonight on Four Corners on ABC TV and ABC iview.