Girl (4) who died of strep A complications may have survived if clinicians acted on evidence, inquest hears

A four-year-old girl who died of complications from invasive strep A infection less than 12 hours after being discharged from Temple Street children’s hospital last December may have survived if clinicians had acted on evidence of her having a sustained, elevated heartrate, an inquest has heard.

The inquest into the death of Ahana Singh, who had moved to Ireland with her parents just two months before her death, recorded a verdict of medical misadventure. She died on December 3rd, 2022, at her home at Venetian Hall, Killester, Co Dublin after her mother Nalini performed CPR and tried in vain to resuscitate her.

“The moment I began CPR, blood came from her mouth and nose,” Ms Singh told the sitting of Dublin District Coroner’s Court, describing her husband Varun’s feelings of helplessness as their daughter lost consciousness.

“Definitely nothing can bring her back, but I hope some changes happen, and no other child goes the way Ahana died,” Ms Singh said following the conclusion of the hearing. “I’m actually numb, and blank, heartbroken at the same time.”

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The inquest, sitting before coroner Dr Clare Keane, heard on Tuesday that on three occasions during Ahana’s hospital visit on the evening of December 2nd, 2022, into December 3rd, she was recorded as having tachycardia, or an elevated heartrate. Under guidelines for treatment of sepsis, the inquest heard, tachycardia unexplained by fever is a “red flag” for the onset of sepsis.

Dr John O’Neill, a pathologist who conducted a postmortem into Ahana’s death, said that the cause of death was invasive Group A streptococcus leading to sepsis, with human metapneumoniavirus as a likely contributory factor.

Ahana was eventually seen by Dr Solmi Lee in Temple Street Children’s Hospital, a specialist registrar in emergency medicine, a short time after midnight, who noted Ahana as being febrile, making grunting noises, and having dry lips. She advised that Ahana rehydrate and take Calpol.

Dr Lee discharged Ahana at 5am, diagnosing the young girl with a viral illness. Dr Lee told the inquest that she did not check on readings of Ahana’s vital signs before sanctioning her discharge. “I didn’t actually go back to check on the vitals that were done an hour previously,” she said.

Dr Lee said that many children had presented at the hospital with similar symptoms to Ahana, and had improved with “simple treatment”.

Dr Roisin McNamara, a consultant at Temple Street, agreed that if Ahana’s observations had been reviewed following the 4am reading, that steps for the treatment of possible sepsis would have been enacted.

Dr McNamara agreed with Sara Antoniotti SC, instructed by Rachael Liston for the bereaved family, it was most likely that Ahana would not have died had if she had received early intervention treatment in the management of sepsis.

“The information was there, it just wasn’t realised,” Dr Clare Keane, the coroner conducting the hearing, said.

Dr McNamara said that last winter had been a “extremely difficult” period at the hospital, and that on the night in question, there were four nurses on shift in the emergency department, including two junior nurses and an agency nurse.

She suggested that the “communication shortfall” that occurred in Ahana’s case may have been linked to the heavy workload clinicians faced with on the night in question.

After being discharged from the hospital, Ahana and her parents returned home to Killester, but later on December 3rd, her “voice became thin” and she fell unresponsive. The Singhs called the emergency services, and Mrs Singh conducted CPR on her daughter.

When paramedics connected to Dublin Fire Brigade attended to Ahana in her bedroom after 4pm, they surmised that there was “no more” that could be done for the young girl. Tom McLoughlin, an advance paramedic with the fire service, made the decision to cease resuscitation effort.

Dr Keane “completely and wholeheartedly” said she would endorse the recommendations of an incident review report on Ahana’s death, conducted by Children’s Health Ireland. These recommendations included a need for increased staffing.

Dr Keane also recommended for the implementation of a policy mandating that vital signs of a patient be reviewed before discharge from hospital.

Mr Rory White BL, for Children’s Health Ireland, apologised to the bereaved family, acknowledging the hurt “of the very tragic death” of Ahana.

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