A grieving Western Sydney father has rejected the findings of an internal probe into the treatment of his daughter, which relies on a document that cannot be found.
Early last year, Dua Ali's family took her to Blacktown Hospital because she had been coughing and vomiting.
The 21-year-old was initially diagnosed with food poisoning and discharged after a few hours.
Ms Ali was, however, readmitted later that day, then died the next morning after surgery for an aortic dissection, a serious heart event.
An internal review by the Western Sydney Local Health District given to the family late last year claims Ms Ali's mother, Asma Siddiqa, signed a discharge against medical advice form when she first took her home from hospital in the early hours of February 1, 2022, citing a reference to it in medical notes.
However, the health district admitted the actual form can not be found.
Ms Ali's father, Dr Asif Ali, said his wife was adamant she did not sign the form.
"How can they insist on something which was never signed, and which does not exist, but they blatantly still say it was there," he said, from Islamabad, where he is working.
"Because if they accept that it wasn't signed, then the whole blame goes to the department for discharging her when she was not well.
"[My wife] said that this was never ever brought to her for a signature … she was worried so much about Dua she was thinking they might stay for a long time."
Ms Ali lived with disabilities, including Turner syndrome, which put her at a higher risk for aortic dissection.
In about 50 pages of medical records from Ms Ali's admissions over the less-than-48-hour period, there is one reference to the form, which states: "[Mother] has signed the DAMA form but is waiting for doctor to come see her."
The serious adverse event review (SAER) conducted after her death also mentions the reference to the form, but said, "the SAER team was unable to locate this document".
"The SAER team noted that a discharge summary was completed after the patient left the ED," the report stated.
Medical negligence lawyer Ngaire Watson said the fact the form could not be produced was a serious issue.
"If the hospital can't produce the form that they claim that she signed, then that's a significant problem for the hospital, even though there's a reference to it in the medical record," she said.
"Particularly given that they claim it was a signed document and signed by the mother.
"From the family's point of view, it's obviously really offensive and very distressing for them to be essentially blamed for going home with Dua."
Ms Watson also raised the legitimacy of any form signed in the absence of an interpreter.
Ms Ali was non-verbal and her mother, Ms Siddiqa, speaks limited English.
Her son, Ms Ali's brother, had come to the hospital to act as an interpreter but was refused entry due to COVID-19 visitor restrictions.
In response to an earlier ABC story, the Western Sydney Local Health District apologised that visitor exemptions were not explained to the family.
An interpreter is referenced several times in the records for Ms Ali's second admission.
But there appears to be no reference to one being used during her initial admission, during which it's claimed her mother signed the DAMA form.
"If English was not [Ms Siddiqa's] first language and she was being asked to sign a form, then you have to be concerned whether she actually understood the nature of the form that she was signing," Ms Watson said.
"So that would also raise further legal issues about whether that form was understood by her, and if there was no interpreter involved in the process, then it is highly problematic."
The SAER review did make several recommendations, including adhering to processes to ensure a carer or family member can remain with patients living with disability, and ensuring compliance with policies around providing documented evidence of discharge against medical advice forms.
Dr Ali complained to the Health Care Complaints Commission about his daughter's treatment and is also considering legal action.
The Western Sydney Local Health District would not facilitate an interview with the CEO while the government was in caretaker mode ahead of the upcoming NSW election, and declined to answer detailed questions — including whether the DAMA form has since been found.
"This matter has been referred by Dr Ali to the Health Care Complaints Commission, an independent statutory body that investigates complaints relating to health care," a spokesperson said.
"While the HCCC assesses the complaint, it is not appropriate to make further comment."
Dr Ali said the process has traumatised his family.
"This report didn't serve the purpose, instead it actually added more to our pain," he said.
"One day we feel that we are surviving. But the next day, it starts again, we can't actually cope.
"This wasn't a person who you can easily live without."
