Toddler clings to life after mum ‘forced’ to invoke obscure care rule

Footage reveals the horrifying sight a Queensland mum was confronted with before she called Ryan’s Rule. WARNING: DISTURBING CONTENT

• Editor’s view: Every parent’s nightmare
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A Caboolture mother claims Queensland Health failed her toddler, who is now potentially brain-damaged and fighting for life in intensive care after contracting the usually harmless hand, foot and mouth disease.

Carly Mulheran has detailed her daughter Zara’s shocking deterioration over the space of a month, leading to her invoking Ryan’s Rule at Queensland Children’s Hospital on March 25 after watching her daughter turn blue in front of medical staff.

Photos and distressing video have been revealed showing Zara’s distress in the moments just before Carly called the Ryan’s Rule.
Under Ryan’s Rule a clinical review was undertaken and Zara was rushed into the ICU where she had her first cardiac arrest.

The 20-month-old was admitted to Queensland Children’s Hospital after Ms Mulheran observed 11 days of repeated unexplained vomiting, a high heart rate and raging fever.

Zara Mulheran was in the Queensland Children's Hospital when her mother Carly invoked Ryan's Rule.

The morning of March 25 Ms Mulheran said she arrived at the ward at 6am after staying with her other four children overnight to find her daughter blue in the face, screaming and struggling to breath.

“I was told by nurses they had given one round of Endon and that she had been screaming in pain for 11 hours, ‘she has been like this since we started at 7pm’ and that was when I arrived in the morning,” she said.

The distraught mother said she then called Ryan’s Rule at 6.25am. A short time later Zara was moved to ICU where suffered a 12-minute cardiac arrest.

She has been left with possible brain damage and a significantly injured bowel that will potentially require surgery.

Ms Mulheran believes Zara will not survive any surgery, and has considered signing a “do not resuscitate” order for the 20-month-old.

“I wholeheartedly believe that if I hadn’t called Ryan’s Rule when I did, my child would have died before she was moved to the ICU,” Ms Mulheran said.

“It shouldn’t take a parent with only some medical knowledge to call for better care for their child. It wasn't hard to see, my Zara was blue, something was clearly very wrong.

“I shouldn't be demanding care for an already sick child.”

Zara Mulheran

Queensland Health Minister Shannon Fentiman on Tuesday said an investigation would discover whether Queensland Health failed Zara.

“We don’t know,” she said.

“Obviously there will be a clinical review, this case is very complicated, but I think what we can all agree on is it is absolutely heartbreaking and we are all sending our very best wishes to little Zara and her mum Carly.

“If there are any recommendations from a clinical review of course we will implement them.”

Ms Fentiman said it was a “heartbreaking case” and acknowledged Ryan’s Rule had been called.

“Parents know their kids the best and when parents feel maybe that their concerns are not being heard they should absolutely call Ryan’s Rule, which then triggers a second opinion — that happened in this case,” she said.

“I know she’s very unwell. I think the entire Queensland community is thinking of her and her family. She is in very good hands though.”

Ryan’s Rule is named for Central Queensland toddler Ryan Saunders, who died in 2007 of an undiagnosed Streptococcal infection.

It is a three-step process enabling patients or their family or carer to raise concerns if a patient’s health is not improving as expected.

Zara, a twin, has battled health concerns since birth, primarily hyperinsulinism, a genetic disorder in which the insulin cells of the pancreas create too much insulin.

When noticing Zara’s heart was racing “like she had just run a marathon” and had a fever as high as 40C on February 23, Ms Mulheran took her to Caboolture Hospital. She was admitted overnight, with blood cultures taken, and tested positive for hand, foot and mouth disease.

Ms Mulheran says she was not told of the diagnosis until well over a week later.

Zara was discharged on February 24, and Ms Mulheran claims she was still ill and running a fever.

On March 12 Zara began vomiting, up to three times a day at random.

Becoming increasingly worried, Ms Mulheran took Zara to the Morayfield Urgent Care centre on March 20. She was prescribed a round of strong anti-nausea medication.

Ms Mulheran said she made six requests of QCH between March 12 and March 23 for her daughter to be seen regarding the random vomiting, but was denied every time.

Zara Mulheran, 20 months old, is now on life support at Queensland Children's Hospital.

On March 23 Ms Mulheran rushed Zara to the QCH emergency department, where she was admitted to a medical ward.

She remained in the ward until the morning of March 25, when after Zara received one round of the opioid Oxycodone, Ms Mulheran invoked Ryan’s Rule.

A team conducted the clinical review and a nurse from that team made a MET Call, where a patient is deemed to be critically ill and needing urgent medical care.

Zara was moved to the ICU.

After Zara was transferred to the ICU, she went into cardiac arrest and doctors and nurses were forced to perform CPR for 12½ minutes.

Ms Mulheran recalled how she watched on helplessly while her daughter was worked on by staff.

“To watch your child go through CPR as a toddler, to press on her chest that hard, no parent should have to watch that, and to not be able to do anything made it that much worse,” she said.

After Zara regained a faint heartbeat, Ms Mulheran said staff informed her that her heart was failing due to a hand, foot and mouth infection.

Carly Mulheran outside the Queensland Children's Hospital, South Brisbane. Picture: Liam Kidston

Zara had a second cardiac arrest on Easter Sunday in the ICU ward, ultimately further limiting oxygen to her brain and her already injured bowel.

“I have been left with two choices; to sign a ‘do not resuscitate’ form saying that next time she goes into cardiac arrest to not do anything or to put her on a heart transplant list that she might not even be eligible for in Melbourne and move my entire family and life there,” Ms Mulheran said.

“The system and Queensland Health have failed her, I have been failed by Queensland Health.

“I have always been adamant that she will show me what path she wishes to go down and I have always stood by quality of life and the truth is that she doesn't have one right now.

“In my head I don’t think I would allow them to resuscitate, but in my mum heart I can’t make that decision. How could you?”

Ms Mulheran said Zara’s case was a reminder to parents to fight for their kids.

“I am the mother of five children, my oldest is eight,” she said. “We have lived with hand, foot and mouth disease multiple times and I know what to look for. Just about every child you walk past at one time or another would have had it but no one knew it could turn into this, that any virus for that matter could impact a heart like this.

Zara Mulheran has battled health problems since birth.

“I just want other parents to know that if your child doesn’t get better, push for more.

“You can be told that just because it is viral it is nothing to worry about, but this can happen, you can end up with a child on life support.”

Metro North Health said it was saddened to hear of Zara’s condition and “our thoughts are with her family”.

“Metro North are co-operating with all healthcare providers to provide information regarding the patient’s care at Caboolture Hospital.

“All patients are discharged with after-care plans to ensure they receive the appropriate follow-up treatment.

“Our records indicate the results of the test were provided to the family within a week, this time frame between blood testing and receiving the results is a typical one.”

A QCH spokesman said no child in need of clinical care was ever turned away.

“While we cannot comment on the specific details due to patient confidentiality, it is standard practice following a Ryan’s Rule for clinical teams to engage directly with a family to look at what occurred and what improvements can be made in future,” they said.

“Due to the complex nature of this case, a clinical review is also under way.”

A GoFundMe campaign has been set up for Zara