A West Australian doctor who failed to properly examine an Aboriginal woman before she died in custody has been found guilty of professional misconduct but allowed to continue practising.
Yamatji woman Ms Dhu, whose first name is not used for cultural reasons, died two days after being locked up at South Hedland Police Station in August 2014.
She had been arrested for unpaid fines totalling $3622.
The 22-year-old died during her third visit in as many days to the Hedland Health Campus from staphylococcal septicaemia and pneumonia after an infection in her fractured ribs - caused by her partner - spread to her lungs.
A coroner ruled she had been treated inhumanely by police while in custody.
Vafa Naderi examined Ms Dhu on her second visit to hospital the day before her death but missed her high heart rate, which had been recorded by the triage nurse.
He also didn't take her temperature or order an X-ray, instead making reference in his notes to "withdrawal from drugs" and "behavioural issues".
Dr Naderi subsequently declared Ms Dhu to be fit for custody.
Coroner Ros Fogliani in 2016 said Ms Dhu's death could have been prevented if her illness had been diagnosed earlier and she had been given antibiotics, adding that her overall care was below expected standards.
The Medical Board of Australia pursued action against Dr Naderi before WA's State Administrative Tribunal, accusing him of professional misconduct.
The tribunal on Friday found Dr Naderi's behaviour constituted such a finding and ordered him to pay a fine of $30,000 to the medical board, as well as paying its costs.
Dr Naderi was also ordered to complete a report demonstrating how he had incorporated lessons from the incident into his practice.
In a statement to the ABC, Ms Dhu's grandmother Carol Roe described the sanction as inadequate.
"The family are appalled that a fine and a reprimand imposed on a medical practitioner is the price paid for letting a 22-year-old Aboriginal woman, who had been a victim of domestic violence, die of neglect in police custody, without providing care or treatment," she said.
An agreed statement of facts said Dr Naderi had been "genuine in his attempts" to assess Ms Dhu but had made errors in his assessment.
Dr Naderi, who was first registered as a medical practitioner in 1995, had dedicated much of his career to emergency medical treatment of Aboriginal people.
"The respondent takes full responsibility for his actions ... he is remorseful about the catastrophic outcome for Ms Dhu and has insight into his management," the statement said.
Dr Naderi did not have any other disciplinary history before or after his treatment of Ms Dhu.
It was agreed he had promoted sepsis care and education in his current role as director of clinical teaching at Hedland Health Campus.
The Australian Health Practitioner Regulation Agency and the Medical Board of Australia cited Dr Naderi's "deep remorse" in their decision not to pursue cancelling his registration.
"Tragically, Ms Dhu did not receive the standard of care she should have rightly expected from Dr Naderi," they said.
"It fell substantially below acceptable standards."
Legislation to overhaul WA's much-criticised unpaid fines regime passed state parliament last year.
Fine defaulters are no longer immediately taken into custody and warrants for imprisonment can only be issued by a magistrate under strict circumstances.
Australian Associated Press