Farmer Rodney Thomas Smith was stoic. He hadn’t seen a doctor for a decade and preferred to pull his own teeth rather than see a dentist. Mid-morning on Friday, November 26, 2021, the 74-year-old had been separating a scrub fire on his Foxton farm and later told a doctor he’d been overwhelmed by the heat and had lain down for a moment. But he denied catching fire, telling the doctor who would later treat his burns that he’d gotten on his bike and headed back to his house. An inquest this week into Smith’s subsequent death as a result of injuries from that fire heard his wife later said it was out of character for her husband to be managing a scrub fire alone. Describing events that day, she’d told a doctor her husband had come home, changed his clothes and returned to the fire, insisting there was no need for her to call emergency services. She told the doctor she’d feared her husband had suffered a stroke about the time of the fire, because he’d seemed confused, telling her he thought she was out, when he knew she wasn’t. And she’d explained he disliked doctors, but she had called emergency services four hours after the fires, when she discovered him sitting on the ground by the farm shed, even though he insisted she shouldn’t. Once alerted, an ambulance and a rescue helicopter arrived at the farm, with the decision made to transport Smith to Palmerston North Hospital, rather than fly him to the burns unit at Hutt Hospital. Arriving at the hospital in the late afternoon, his family was told his injuries weren’t life-threatening. The inquest heard that despite being unwell, he didn’t look that way. It was only when blood results showed how critically ill Smith was that he was transferred to Hutt Hospital several hours later and then moved to Wellington Hospital the following day, where he died two days after the fire. The inquest heard Smith’s injuries were so severe that efforts were made to send him to the national burns unit at Middlemore Hospital in Auckland, but a combination of bad weather and his deteriorating condition prevented that from happening. Coroner Mary-Anne Borrowdale is presiding over the inquest into Rodney Thomas Smith's death in 2021. Photo/ Ministry of Justice At the inquest in the Wellington District Court this week, Coroner Mary-Anne Borrowdale is considering a number of issues, including the decision to transport him by ambulance and the medical services he received, including whether the delay in identifying his significant chest injuries compromised Smith’s chance of survival. She is considering whether Smith’s chances of survival were compromised by being driven to Palmerston North Hospital rather than being flown directly to Hutt Hospital. The coroner will also look at whether burns patient care in the Lower North Island is suboptimal because of the lack of a co-located burns unit and ICU. The early stages of organ failure Dr David Prisk, the medical director at Palmerston North Hospital’s Emergency Department (ED), told the inquest that, having reviewed the clinical notes, Smith’s treatment in the ED that day for his burns was generally appropriate. Smith was seen by a doctor shortly after his arrival, and Prisk told the inquest that while the farmer’s burns were initially underestimated, they were revised. A chest X-ray wasn’t ordered because it wasn’t deemed necessary, as his chest injuries and rib fractures weren’t initially detected. Prisk told the coroner a chest X-ray should have been done because Smith had burns to his face and low oxygen saturation. But he explained that, at the time, staff had focused on the burns because the chest injuries were deemed relatively minor. During his evidence, the doctor said Smith may have benefited from an air ambulance transfer to Hutt Hospital. “Mr Smith appeared to be fit and healthy; he was an elderly man and had suffered extensive and significant burns, which occurred some hours before he received cooling measures by his wife and initial tre...