A culture of fear, health workers at breaking point, and the sick and elderly being left to fend for themselves in a system in crisis.
Those are some of the damning findings from an inquiry into medical care in regional, rural and remote NSW, tabled in state parliament on Thursday.
The upper house report made 44 recommendations, including an urgent review of the rural workforce and funding arrangements, along with better engagement with rural communities.
The year-long inquiry received 720 submissions and held 15 hearings.
Witnesses spoke of emergency departments without doctors, patients dying on bathroom floors, and cooks and cleaners taking on caring duties in understaffed hospitals.
Journalists Jamelle Wells and Liz Hayes' stories of their fathers' untimely deaths due to poor treatment and medical errors in the rural system helped trigger the inquiry.
They say the experience has been incredibly painful.
"The loss of our fathers, Allan Wells and Bryan Ryan, to a rural health system that we now know is deeply flawed is unforgivable," the pair said in a statement.
"Country people deserve better. These are people's lives. They matter."
In the report, Labor committee chair Greg Donnelly says there is a disconnect between NSW Health decisions and the reality in rural areas.
Staff are at breaking point and there is a culture of fear of speaking out about a system in crisis, Mr Donnelly says.
The report found country people have poorer health outcomes, inferior access to services and face greater financial barriers to care, compared to their city counterparts.
Indigenous people are reluctant to seek care due to racism and the lack of culturally appropriate services.
"This is a situation that can and should not be seen as acceptable," Mr Donnelly said.
Since the inquiry, the NSW government has appointed Bronnie Taylor as minister for regional health and established a regional division within NSW Health.
Ms Taylor says she will carefully consider the recommendations, and is committed to applying a rural perspective on every decision.
Her top priorities are strengthening the workforce, improving transport options, and working with the federal government on expanding the GP workforce.
"These issues with workforce are multifactorial. If there was an easy solution, we would have done that," she told reporters.
"We need to be able to look at it in a courageous way and a different way."
Premier Dominic Perrottet says spending on rural health is at an all-time high.
"Right across the board we've seen record investments, but we could always do better," he said.
While both the state and federal governments have oversight, opposition health spokesman Ryan Park said each needs to listen to rural people and stop shifting blame.
"I want to see wholesale change in NSW Health ... to put a real focus, front and centre, on the health care needs of those living outside our major metropolitan cities," Mr Park told reporters.
The report also recommends reviews of various funding structures for medical transport, as well as a second inquiry in two years to monitor progress.
Independent MP for Murray, Helen Dalton, who has been vocal about the poor state of healthcare in her southwest electorate, says more reviews will only delay change.
"The NSW government has six months to prepare a response.
"That's far too long. People are dying now."
Australian Associated Press