A misdiagnosis of a marijuana-induced condition could have prevented an Indigenous man getting the treatment he needed to save him, an inquest has heard.
Thirty-six-year-old Kamilaroi Dunghutti man Ricky Hampson Jr - known to family and friends as Dougie - died on August 16, 2021, less than a day after being discharged from Dubbo hospital in NSW.
He had presented to hospital on the evening of August 14 experiencing "10 out of 10" pain after feeling a "popping" sensation in his abdomen.
He was discharged the next morning, without receiving any scans, and was found dead the next day. An autopsy revealed he had two lacerated ulcers in his stomach.
Mr Hampson Jr's family believe if he had received adequate treatment he would still be alive.
Diagnosis associated with daily cannabis use
Giving evidence before a coronial inquest on February 27, 2024, a junior doctor who attended to Mr Hampson Jr when he first arrived in hospital said he appeared to be in distress and was "intermittently writhing and yelling in pain".
She said when she spoke to Mr Hampson Jr just after 5pm, he told her he had felt something pop in his abdomen before the sudden onset of pain.
"At the time I wouldn't recognise the significance of that but it was something specific he told me so I thought I should document it," the young doctor told the court.
The doctor had only been working at Dubbo hospital for six weeks before the afternoon Mr Hampson Jr attended and had only been working as a doctor for a year. She was still in training.
After examining Mr Hampson Jr and asking him questions about his health history, the young doctor formed an impression he was experiencing "undifferentiated abdominal pain".
She then reported what she had found to her supervisor, a consultant working at Dubbo Hospital. This information included a disclosure by Mr Hampson that he had smoked cannabis that morning.
The young doctor said her supervisor suggested a diagnosis of Cannabinoid Hyperemesis Syndrome, a rare condition that leads to repeated and severe bouts of vomiting, nausea and abdominal pain. It only occurs in daily long-term users of marijuana.
Her supervisor had not personally examined Mr Hampson Jr.
"I do remember the diagnoses of Cannabinoid Hyperemesis Syndrome being mentioned," she said.
"I asked about it and [my supervisor] told me what it was... he said it was related to withdrawal symptoms if you havent smoked cannabis."
She said, following that conversation, she had the impression her supervisor believed there was no other cause for Mr Hampson Jr's abdominal pain.
Administration of anti-nausea medication "unusual"
At some point after this conversation, droperidol - an anti-nausea medication which also acts as a sedative - was administered to Mr Hampson Jr.
The young doctor told the court she did not order the drug to be administered and said the drug was not recorded on Mr Hampson Jr's charts. She said the use of a schedule four drug not being charted is "unusual".
The young doctor said she asked her supervisor why Mr Hampson Jr had been given the drug and was told it was to do with his diagnosis of Cannabinoid Hyperemesis Syndrome.
"When I found out droperidol was being used I wasn't sure why... but I asked my supervisor and accepted what he said," she said.
After a second examination of Mr Hampson Jr and another conversation with her supervisor at around 7pm, the young doctor wrote up and signed discharge notes. The notes suggested he be given fluids, reviewed and discharged.
However, after further examination of Mr Hampson Jr the young doctor grew worried and the plans were changed to transfer him to the short stay unit.
"My understanding of the plan was he was going to stay in Short Stay overnight both for monitoring and his vitals and that it was safe for him to go home... he was a bit vulnerable," she said.
"I became aware that he didn't have a phone or wallet and he told me he was couch surfing and it was quite late at night."
This review wasn't recorded in any of the medical notes. Mr Hampson Jr was not given any CT scans or x-rays.
The young doctor examined Mr Hampson Jr one last time before finishing her shift at midnight. This time, she says, her supervisor was with her.
"I remember my supervisor speaking to him and having a look at him, and then we left," she said.
Asked by counsel representing Mr Hampson Jr's parents if she would do anything differently if she could go back in time, the young doctor said she would.
"I could have considered the differentials more and been more assertive when asking about the rationale," she said.
She also conceded that not updating the discharge notes was her wrongdoing.
"It was a mistake on my behalf," she said.
"I prepared this as a draft discharge summary but towards the end of my shift the plan had changed... I expected that over the next shift as he was discharged he would be checked over and it would be updated."
Medication also used to sedate "agitated" patients
Speaking to the court on Monday, February 26, Alison Sayers, a junior nurse who attended to Mr Hampson Jr recalled overhearing a conversation between the two doctors.
She said she questioned the diagnosis as Mr Hampson Jr was not experiencing nausea or vomiting but was reassured that the condition sometimes presents with only abdominal pain.
Ms Sayers said, aside from admitting he "smoked two cones this morning", Mr Hampson Jr disclosed no further information about his history of marijuana use.
"I was trying to minimise the amount of questions I was asking Mr Hampson as he was in a significant amount of pain... he was moaning and groaning," she told the court.
In her evidence the young doctor also said she was not aware of any other information about Mr Hampson Jr's marijuana use being recorded.
Asked about the administration of droperidol, Ms Sayers said she believed it was done by one of the doctors.
She said while the drug was often used for the treatment of nausea and vomiting and it was "quite effective in deescalating patients who were mentally unwell" or to "calm them".
"Mr Hampson was escalated in pain but not aggressive in any way," she said, asked by counsel for Mr Hampson Jr's parents what his demeanor had been like.
"I can still recall to this day what Mr Hampson appeared like in his pain."
The young doctor who attended to Mr Hampson Jr agreed he was in pain but not agitated.
The inquest into the death of Ricky Hampson Jr will continue at Dubbo court on Wednesday, February 27.
