Misdiagnosed: Michelle Johnson on her wedding day with her mother, Marge.
The mother of journalist Michelle Johnson has urged a coroner to hand down a finding that the misdiagnosis of her daughter's medical condition may have contributed to her death and the death of her baby boy.
Marge Johnson told coroner Phillip Byrne, who has been holding an inquest into Michelle's death, that he should promote a greater awareness among obstetricians of the rare medical condition that killed her daughter.
Mrs Johnson, who was asked on Friday to make submissions to the coroner on the final day of the inquest, said there had been a number of missed opportunities in making the correct diagnosis for Michelle.
She said the coroner should recommend that a clearly visible check list be displayed in hospital emergency departments and birthing wards detailing the 15 causes of a patient's abdominal pain, including the rare splenic artery aneurysm rupture, and that routine imaging be accessible even out of hours in hospitals to conduct ultrasounds.
Michelle, 31, the entertainment editor of theage.com.au who was 32 weeks pregnant with her first child, had been misdiagnosed with severe musculoskeletal pain after complaining of abdominal pain when first admitted to the Royal Women's Hospital on Saturday night, March 20, 2010. She had collapsed after dancing at an engagement party.
The obstetric registrar on duty at the hospital, Natasha Frawley, told the inquest she accepted obstetrician Sze Wey Lee's working diagnosis that Michelle was suffering from severe musculoskeletal pain when they discussed her condition during a phone call just after 1.45am on Sunday, March 21, 2010.
Dr Frawley highlighted the concerning features of Michelle's condition to Dr Lee, including her low blood pressure when she was admitted, the severe and sudden nature of her pain and her inability to comment on foetal movements.
"Dr Lee thought the most likely diagnosis was severe musculoskeletal pain brought on by movement (dancing) at the party. Dr Lee advised me that in late pregnancy, particularly if the patient is overweight, there is more pressure on the joints and severe musculoskeletal pain was the most likely diagnosis," Dr Frawley said.
Dr Frawley claimed Dr Lee told her to admit Michelle and she would review her in the morning.
But Dr Lee, who was the locum covering for Michelle's private obstetrician Samantha Hargreaves that weekend, disputed this, claiming she was not Dr Frawley's boss and could not tell her what to do and there must have been a miscommunication.
Dr Lee claimed she rang the hospital about 11.30am on Sunday and was told there was no private patient of Dr Hargreaves in the hospital. She did not remember Michelle's name.
Michelle decided to go home about 8.15pm without seeing Dr Lee but collapsed a few hours later and was rushed back to the hospital, where she and her son, Charlie, later died.
Dr Lee admitted it had never crossed her mind that Michelle could have been suffering from a splenic artery aneurysm rupture.
Mrs Johnson told the coroner on Friday that she was appalled that Dr Lee did not even know her daughter's name at the time and she felt let down by Dr Hargreaves' practice.
Mrs Johnson said the coroner should recommend locums covering for an obstetrician be given a list of the patients' names they were responsible for during the cover period.
Lawyers for Dr Lee and the hospital urged Mr Byrne not to bring down any adverse finding against them, saying Michelle had suffered from a rare medical condition, there was no indication an ultrasound was needed at the time to conduct further tests, and she had received the appropriate care.
The coroner will hand down his finding at a later date.