The patient could have stayed in hospital at Apia with the extra care from the Careflight doctor and nurse for another 12 hours until the crew were rested.
That would be the logical thing to do - especially if there had been a basic risk management exercise done regarding flight safety v patient safety! But as one who has worked in this industry - that is not how things are done!
Companies bid for these international medivac's, and can be aware of the potential job 1-2 days out. However, once they are awarded the job by the travel insurance company, the scramble button is pushed - usually for time zone reasons late afternoon/early evening (Insurance head offices are in US and Europe signing the checks). From that point on, the insurance company does not want to run the risk that they have an unfavourable outcome (patient dying) when they have already fronted with the cash. This pressure is passed onto the provider to get the patient back to Oz ASAP, regardless.
Just one example. Launched early evening to get a patient out of Honiara. Remote Island, much more remote then Norfolk! Land at mid-night, patient walks on, chatting and obviously in good health. Land back in Oz for breakfast. Crew awake for 24 hours. Remote Island with known forecasting inaccuracies. Risk to patient getting to the airport after dark in Honiara (there had been a head placed on a spike on the road out a few weeks earlier).
Was the flight legal. Yes. Could it have been delayed by 12 hours. Yes.
That is the problem with this industry that CASA needs to address. Commercial pressures. And of course, regulating to at least charter standards!