A senior doctor working on the frontline of one of the country's first deadly COVID outbreaks has told a coronial inquest that aged care residents should have been sent to hospital.
During the three-week-long inquest, James Branley described a "crisis day" in April 2020 where care and infection control were "severely compromised" due to critical staff shortages.
He told the inquest that only days earlier he'd been "looking for help" and offered to stand down from his role at Newmarch, so that the home's operator Anglicare or the Commonwealth Health Department might offer a better way to manage the outbreak.
The NSW Coroner has been investigating 19 COVID-related deaths at Newmarch House, an aged care facility in Sydney's west, in 2020.
More than a third of the home's 97 residents caught the virus, and many were isolated for weeks at a time while staff struggled to keep on top of the outbreak.
Dr Branley, the head of infectious diseases at Nepean Hospital, told the inquest he had assumed the role of lead clinician at Newmarch House around April 12, but said that was as an advisor, not a decision maker.
He had advocated a hospital-in-the-home model of care, having operated that successfully during an influenza outbreak in another home.
But he said it became clear that "failed spectacularly" on April 20, and he asked Anglicare management for help.
"The 20th of April was my crisis day," Dr Branley said.
"It certainly was a day where I not only considered a change of approach … I said, 'It's not working' … I was putting up my hand and saying, 'Change course'."
Dr Branley said, on reflection, they should have started sending sick residents to hospital at that point.
"It was a distressing day and … it was hard to be thinking clearly and making the right decision," he said.
"In retrospect, I should have gone back to Newmarch and done a round of the positive [residents] and picked people and sent them to hospital."
Dr Branley said there were a lot more staff at the home the following day.
Anglicare 'should have taken control', says lawyer
Emily Clarke from Shine Lawyers, who is running a class action on behalf of the families, listened to the entire inquest.
She said the responsibility ultimately lies with the operator of the home, Anglicare.
"The buck does stop with them," she said.
"Anglicare should have taken control of the situation; it became evident that the system and management wasn't working.
"They should have stepped in much earlier on than they did, and established better practices for keeping these residents safe."
Nurse Lorena Bestrin told the inquest things improved once Baptist Care took over the centre's management on April 24.
"As soon as they came, we had a whole army of people and things improved. There was more direction," she said.
'I was looking for help'
Dr Branley detailed an "antagonistic" meeting on April 16, four days before that crisis.
Counsel assisting Simon Buchen SC put to him that the federal Department of Health had raised the prospect of moving COVID-positive patients out of Newmarch.
Dr Branley said his recollection was that the Commonwealth was suggesting they evacuate the entire home, with negative residents to be moved to other aged care facilities.
He explained it had been hard to swab many of the residents with dementia so he was concerned some test results may have been false negatives, and moving them to other aged care homes risked spreading the virus further.
"My views were that I thought what the Commonwealth was proposing was dangerous," he said.
"I was operationally dealing with the problem, and I was looking for help, and what I was getting was not a coherent plan."
In a statement, Anglicare apologised for the distress experienced by residents and their loved ones and acknowledged that the physical separation contributed to that.
But Anglicare declined to answer 7.30's questions while the coroner considers his findings.
NSW Health also declined to comment on the inquest before the coroner delivers his findings.
"Following the Newmarch House outbreak, NSW Health worked with the aged care sector and other key stakeholders to improve preparedness for, and the response to, future outbreaks," a spokesperson said.
In a statement, the federal Department of Health and Aged Care said multiple inquiries have informed how they now manage COVID outbreaks.
"Key changes since the outbreak at Newmarch House in 2020 include the introduction of a requirement for an IPC (infection prevention and control) lead as part of each facility's nursing staff, continued access to in-reach PCR testing and a forward deployment of RAT kits since January 2022, and regular engagement with the Older Person's Advocacy Network including facilitating resident and family engagement in outbreak sites," they said.
Families want better treatment for aged care residents
For Virginia Clarke, whose father Ron Farrell was the second person to die in the outbreak, she hopes the inquest will remind people that COVID is still impacting residents in aged care across the country.
"Look at the daily figures of how many people are still passing away from COVID in aged care," she told the ABC on the final day of the inquest.
"I just think we need to do more for these people, so to me it's not really about the justice, it's about improving and learning lessons from what happened at Newmarch House."
Virginia said she is frustrated by how older people's deaths are often discounted with references to their age and pre-existing conditions.
While her father was 94, he still had plenty he was looking forward to.
"He had already planned … his 95th birthday," Virginia said.
"He wanted a barbecue because he loved barbecues and some of the family that could come were going to come.
"He used to enjoy seeing all his grandchildren and all his great-grandchildren."
Communication with families a key issue
Ron had enjoyed his seven years living at Newmarch House prior to the outbreak.
But cracks were evident, especially in communication, when the virus started to spread.
Ron's family only found out by chance that he had been infected.
"Dad was tested on the Tuesday, we waited all week to hear, we kept making phone calls," Virginia said.
"We spoke to the centre manager on Friday, she just made a courtesy call just to see how we were going.
"And I said we were still waiting to hear what that results were. And she said, 'Oh, you haven't heard? Your father tested positive for COVID'."
Ron died two days later, aged 94.
Issues didn't stop after the initial outbreak
Louise Payne's mother Yvonne Vane caught COVID during the initial outbreak, and she said her family was also informed of her infection by accident.
Yvonne survived, but her daughter said she was never quite the same.
"COVID certainly impacted on her hugely, but it was her mobility, her function, she was very deconditioned, and she never got it back," Louise said
"Then when she was having falls, things weren't being put in place that would limit her risk."
Louise said the communication issues continued, and she has questions about how much operator Anglicare really learned from that initial outbreak.
In July last year, Newmarch House called an ambulance when Yvonne fell ill and she was taken to hospital.
But Louise wasn't called.
"The call I did get was at 10 to three the following morning from a doctor who said that mum had come in about 11 o'clock," Louise said.
"She said, 'I'm sorry, I didn't get to see your mother, she has passed away'.
"That was my biggest fear [during the outbreak] that I would not be able to say goodbye to my mother … and it was realised anyway, because the communication didn't improve. How could that happen?"
Anglicare declined to comment on what happened to Yvonne Vane, despite her death not being subject to the coronial inquest.
The Coroner is due to hand down his findings early next year.
– with reporting from AAP
