The mother of a seven-year-old girl who died at Perth Children's Hospital says she pleaded with staff to help her daughter but was not taken seriously.
Aishwarya Aswath died in April last year after attending the Perth Children's Hospital (PCH) with a high temperature and cold hands.
The Perth Coroner's Court on Wednesday heard a statement from Aishwarya's mother Prasitha Sasidharan, who described how she grew increasingly worried about her daughter while in the hospital waiting room.
She approached staff five times while they were in the waiting room for almost two hours.
"I begged for someone to come and look at her," Ms Sasidharan said.
"I put my hands together and begged."
Parents pleas 'ignored'
Ms Sasidharan said her pleas went unanswered.
"I feel like I was ignored and not taken seriously," she said.
The court heard from both parents on Wednesday, the start of an eight-day inquest.
In the two days leading up to Aishwarya's death, the parents described how their children played soccer together, ate ice cream and slept together in the living room.
When Aishwarya first complained of a headache, her mother attributed it to the ice cream, air-conditioning, and a late night.
But she continued to deteriorate and her parents decided to take her to PCH.
They chose not to attend the local Midland emergency hospital because they thought she would be better served by the specialist children's facility.
Aishwarya's vision deteriorated
While in the waiting room, they became increasingly concerned as Aishwarya complained to her parents her skin and eyes felt "dirty" and she was having trouble seeing.
Ms Sasidharan said she noticed discolouration in her daughter's eyes.
She again approached the emergency department clerk, which led to a male doctor coming to check Aishwarya's eyes.
In her opening address, counsel assisting the coroner Sarah Tyler said the court would hear evidence this doctor understood that Aishwarya’s mother was concerned about white spots in her child's eyes, but was not aware of her other symptoms and did not have access to the triage notes.
He thought at the time the reason Aishwarya had been brought to the ED was solely an issue with her eye.
He examined Aishwarya's eyes very briefly and formed the view that she did not require urgent medical attention, although she would require a formal eye examination.
Staff 'were rude'
Aishwarya's father Aswath Chavittupara said the doctor "barely made eye contact" with him and his wife.
"He barely spoke to us before leaving," Mr Chavittupara said.
Another nurse came to check her heart rate and blood pressure, but could not get an accurate reading of her blood oxygen saturation due to faulty equipment.
Ms Sasidharan said they waited a long time before they attracted another nurse who tried to get Aishwarya to take some anti-inflammatory pills, but the little girl could not swallow them.
Ms Sasidharan said the nurse appeared to be annoyed with Aishwarya.
"I believe she was very rude," Ms Sasidharan said.
No urgency in medical response
She detailed how they were finally taken out of the waiting room, but there didn't appear to be any urgency, until another staff member assessed Aishwarya and she was taken to the resuscitation area.
Aishwarya's heart stopped beating and staff tried to revive her but to no avail.
Ms Sasidharan said they were told Aishwarya could not be saved.
"We went into the room and begged staff to save her," she said.
After Aishwarya died her father wanted to hold her but was only allowed to do so for a brief time.
In his statement, read to the court, he said there were "many missed opportunities to save her."
Former PCH chief executive Aresh Anwar, who was also formerly in charge of WA's entire Child and Adolescent Health Service, said the hospital was grappling with a rise in mental health presentations and a shortage of staff when Aishwarya died.
Dr Anwar told the inquest Western Australia had traditionally relied on recruiting specialist paediatric nursing staff from overseas.
When COVID struck and borders closed, that supply dried up.
The hospital had expected a drop in presentations in late 2020 and 2021, which happened at the start of COVID in early 2020.
However, Dr Anwar said that did not happen, and instead they saw a rise in non-COVID viral infections and mental health issues during the pandemic – particularly eating disorders.
Dr Anwar said more nurses had been funded in the 12 months after Aishwarya's death, but said this process had been in train in February, two months before she died.
He denied management failed to listen to staff concerns that staffing levels were not adequate.
Coroner Sarah Linton asked Dr Anwar about a drop in presentations to the children's hospital ED following Aishwarya's death, and the reputation of PCH among parents following the incident.
Dr Anwar said it was a "point of regret" for him that the organisation had not reflected to the outside world how seriously it took the findings of the reviews into the incident.
He said her death had reverberated through the organisation.
"There is no-one who hasn't been touched by it, … whose heart wasn't broken by it," he said.
Dr Anwar was also asked about why the hospital executive did not initially sign off on the first internal "root cause" investigation into Aishwarya's death.
He told the court there was a perception that report, which is confidential but has been seen by the ABC, was critical of management.
The report made 11 recommendations, which Dr Anwar said were immediately accepted to prevent any other children coming to harm.
But he said the executive wanted supplementary information before formally signing off on it.
"It was not an attempt to run away or hide by any member of the organisation," Dr Anwar said.
"But we wanted greater certainty."
Hospital changes taking time
He also defended the fact only six of the 30 recommendations made in a second, independent investigation, had so far been implemented.
"We have been respectful … in acknowledging the complexity behind [the recommendations].
"The time doesn't mean there isn't wanting or lack of urgency," he said.
"We have been working very hard … to drive these recommendations forward."
PCH opened in 2018 and Dr Anwar said processes had not been entirely "bedded down" in the new building before COVID hit.
The wards were reconfigured to deal with potential infection.
The court heard Dr Anwar was seconded to deal with the rollout of the COVID vaccine and only retook the helm at the hospital on April 18, two weeks after Aishwarya's death.
Anwar resignation probed
The lawyer for Aishwarya's parents, Tim Hammond, asked why he offered his resignation after her death — an offer that was rejected at the time.
Dr Anwar said he considered himself part of the organisation and hence part of the clinical care pathway, and resigning felt like the "right, honourable thing to do".
He said he realised later it was probably the easier option, and he was pleased he stayed longer.
"I think we have driven tremendous change during that period of time," he said.
Mr Hammond asked what led to his subsequent resignation earlier this month.
Dr Anwar said he resigned for personal reasons.
He said he was embarrassed to say it in front of Aishwarya's parents, but it had been a "pretty gruelling 15 months", with 12-hour days, seven days a week.