AN INQUEST HAS heard that staff at a children’s hospital in Dublin failed to react to a number of “red flags” that a young girl, who died 12 hours after being discharged from its emergency department, had sepsis.
A verdict of medical misadventure was returned in relation to the death of four-year-old Ahana Singh at her home at Venetian Hall Apartments in Killester, Dublin on 3 December 2022. She had moved with her parents from India to Ireland just two months earlier.
A sitting of Dublin District Coroner’s Court heard evidence of how blood was coming out of the girl’s nose and mouth as her parents were trying to resuscitate her.
She had become unresponsive after returning home from Children’s Health Ireland at Temple Street in Dublin where she had been diagnosed with a suspected chest infection.
Lawyers for Ahana’s parents, Varun and Nalini Singh, claimed staff had failed to react to a number of “red flags” that the young girl had sepsis including a persistent fast heartbeat while she was in the hospital.
At the outset of the hearing today, counsel for CHI, Rory White BL, apologised for the care that had been provided to the girl at Temple Street as well as the hurt that arose out of her tragic death.
White noted a review commissioned into the circumstances of her death had already contained an apology.
Postmortem results showed Ahana died from Strep A infection, which can lead to sepsis, with a severe form of pneumonia as a contributory factor.
It was the second case before coroner Clare Keane in the space of a week to hear evidence that there had been delays by staff at Temple Street in considering that a child, who subsequently died, had sepsis.
Phoenix Graham-Hayden (2) from Malahide, Co Dublin had died in the hospital on November 3, 2022 from Strep A infection just over 48 hours after being sent home from its emergency department.
Ahana’s parents described how their daughter, who had no previous medical conditions, became unwell in the week before her death with a cough and a fever.
Ms Singh recounted how her daughter vomited for the first time in her life in a taxi on the way to Temple Street.
She claimed a doctor told her that Ahana had a chest infection and “only time will solve it.”
Her daughter was discharged around 5am on 3 December last year with a prescription for medicine to treat fever, pain and vomiting.
“There was no tests carried out, even though all the symptoms occurred inside the hospital,” her husband told the inquest.
Within a few hours of returning home, Ms Singh said her daughter became unconscious and her lips had gone blue.
She fought back tears as she recalled trying to clear blood away from her daughter as she tried to resuscitate her while lying on a blood-stained sheet.
“The moment I began CPR, blood came for her mouth, nose and through her teeth,” she sobbed before adding: “We tried everything.”
The inquest heard the couple were unable to see their daughter for the rest of the day in order to allow gardaí to determine that there had been no foul play.
Questioned by her counsel, Sara Antoniotti SC, Ms Singh said they were never told by hospital staff that Ahana had a fast heart rate.
A triage nurse, Eithne Friery, said she had assessed Ahana as not warranting consideration of sepsis as, although she had a fast pulse, she “did not appear unwell.”
The inquest heard that the categorisation of the girl’s condition meant she should have been examined by a doctor within an hour but it took 3 hours and 50 minutes before it happened.
The nurse, who revealed she only learnt about Ahana’s death a few months ago, said she had advised Ms Singh to come back to her if her daughter’s condition deteriorated while waiting to be seen by a doctor.
She repeatedly stressed that the volume of children seeking treatment in the hospital meant it was difficult for staff to check that they were seen within recommended timelines.
The nurse admitted she had not recorded that Ahana had a temperature of 40ºC the previous day as she would only take note of what she would clinically observe herself.
She told Antoniotti that she had not informed Ahana’s mother about her fast heartbeat as such information was “irrelevant” to parents.
Solmi Lee, a registrar who examined Ahana, told the inquest that a majority of children attending the hospital at the time with similar symptoms did not have sepsis and had responded well to treatment.
Dr Lee said she had not wanted to “jump into IV fluids and antibiotics straight away” in the care of Ahana and did not want to “over-investigate or over-treat” her.
While she had considered sepsis, Dr Lee accepted it was not based on the girl’s elevated heart rate.
Dr Lee said when she saw Ahana a second time she was looking better and had taken fluids so she felt that she had to make a decision “there and then” on what to do.
She accepted she had discharged the girl without checking her vital signs but explained she had repeated an examination of the girl’s physical signs which had been a concern.
Questioned if hospital staff had received any training about sepsis recognition during November 2022 following the death of another child in similar circumstances, Dr Lee recalled there had been an internal review for “learning points” but was unsure when it had taken place.
A consultant in emergency medicine at Temple Street, Róisín McNamara, accepted that Ahana would probably have survived if she had got early intervention to treat sepsis as “the information was there.”
However, Dr McNamara stressed that it was “an extremely virulent, rapidly-evolving infection”.
She also outlined how a number of changes had taken place in the hospital following Ahana’s death including increased staffing levels which had resulted in patients being monitored more frequently.
However, Dr McNamara accepted there was still room for improvement in monitoring of children who have a prolonged stay in emergency departments.
The consultant claimed last winter had been extremely difficult in all emergency departments with 162 children having presented in Temple Street over the 24-hour period that Ahana had been there.
Returning a verdict of medical misadventure, coroner Dr Clare Keane said she would endorse the recommendations contained in the internal hospital report into Ahana’s death.
She welcomed that some changes had already been implemented while others including a system which would flag abnormal vital signs in a patient were due to be introduced in early 2024.
At the same time, the coroner observed that ultimately staff treating Ahana had the necessary information to diagnose sepsis “which unfortunately was not recognised.”
Dr Keane called for a mandatory review of a patient’s vital signs prior to discharge from emergency departments.
Speaking on behalf of Ahana’s parents, Antoniotti said they hoped “nothing similar will ever happen to another family.”
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