Aishwarya Aswath inquest: Doctor regrets not taking more time

The first doctor to assess seven-year-old Aishwarya Aswath on her fatal trip to Perth Children’s Hospital last year has conceded there was a missed opportunity to recognise there was more going on than he realised during a brief interaction with her.

Aishwarya and her family were waiting in the Pod C area, where patients with health concerns such as gastro and colds wait, after seeing the triage nurse.

Aishwarya Aswath.

At about 5.41pm Aishwarya’s mother approached the emergency department clerk Dita Wells with concerns about white spots in her daughter’s eyes.

The most junior doctor in the emergency department that day, Dr Tony Teo, then came and briefly saw the family in an interaction that lasted about 20 seconds.

He had not checked the nurse’s notes about Aishwarya and thought her only problem was white spots in her right eye which he did not find concerning.

Teo was a registrar in training since February at PCH, who is looking to specialise in paediatrics, and had rotated through the hospital three other times between 2019 and 2020.

Several hospital staff had called in sick on April 3 and Teo said it was busier than usual.

Teo said because of time pressure he did not make a note for other staff that Aishwarya should have her eyes further examined.

He agreed with the family’s lawyer Tim Hammond that on review of CCTV the young girl’s head was floppy before and during his examination of her.

Hammond put it to Teo that nine minutes after the doctor saw Aishwarya she had a heart rate of 150 and a temperature over 38 degrees and that if those symptoms together with her headache, lethargy and body soreness had all been there when he briefly looked at her that they could have indicated sepsis.

Teo agreed with Hammond but also that they could have been signs of dehydration from gastro.

The doctor also agreed with deputy state coroner Sarah Linton that if he had looked at the triage notes he might have changed his approach to the situation; there had been a missed opportunity to recognise what was happening and he regretted not taking more time.

Registered nurse of 11 years Jacqueline Taylor was the first witness on day two of the inquiry and agreed at the time of the young girl’s death from sepsis that the staffing situation was unsustainable.

“There had been an increase in staffing numbers, however, most of those roles were filled by nurses doing double shifts,” she said.

“A lot of people were more exhausted, working more hours, unexpected hours.”

When asked by counsel assisting the coroner, Sarah Tyler, what general lessons the health service should take from the death, Taylor spoke about how more resources had slowly been introduced to a department running under a lot of pressure and a long period of fatigue.

“I still don’t believe we have gotten up to an ideal standard yet,” she said.

The coroner’s court is examining witnesses on a chronological basis reflecting Aishwarya’s attendance at the hospital. Aishwarya died 3½ hours after arriving.

Three-minutes of CCTV footage was played on the inquest’s second day on Thursday, showing Aishwarya’s father Aswath Chavittupara and mother Prasitha Sasidharan take her to the triage desk at 5.32pm.

Taylor assigned Aishwarya as a code 4 (1 being the most serious, 5 the least), which meant she should be seen within an hour for further assessment.

About 200 presentations were made on April 3, 2021, the day Aishwarya died. These included 96 during the afternoon she arrived at PCH.

Taylor was told Aishwarya had been experiencing vomiting and diarrhoea from the day before and the little girl told her she had a headache.

She thought her symptoms were consistent with gastroenteritis but said she was not told Aishwarya had experienced pains over her body in her neck and hands the day before.

Taylor said knowing this may have changed her assessment as she would have been concerned about there being widespread pain. She was also unaware Aishwarya was wearing a nappy.

Ultimately, the nurse told the court she believed assigning of a code 4 was the right score at the moment in time for what was known.

If Aishwarya had been identified as having sepsis, which is difficult to diagnose, she could have been scored a code 2 which would have elicited a more immediate clinical response.

Taylor, who was the only triage nurse on April 3, said if there was more time do thorough assessments including checking vital signs during the triage process then Aishwarya’s care may have been different.

When asked if there was anything different she would do today, Taylor said it would be helpful if the layout for triage was more ideal for checking vital signs.

Aishwarya Aswath died after waiting for help at Perth Children’s Hospital.

There was a perspex screen separating the triage nurse from patients and it took time to come out from behind the desk and through security doors to the waiting room.

PCH has introduced a non-clinical administrative staff member and a triage support nurse since the incident. Taylor said at the time of Aishwarya’s death she had to perform those two roles as well as her own.

Outside of the coroner’s court Australian Nursing Federation WA secretary Janet Reah said Taylor’s testimony had highlighted an appalling lack of staff and basic equipment at the point of triage.

“This was a disaster waiting to happen,” she said.

“It’s not good enough and this is ongoing even now, the nurses are overloaded with extra tasks and not enough staff to do those tasks.

“You can’t do 12 jobs and expect to do a good job.”

The eight-day inquest continues on Friday.