A young Aboriginal girl whose family believes she was let down by Victoria's health system was suffering from a particularly rare and deadly complication, a pediatric infectious diseases physician says.
The girl, who has been given the pseudonym Sasha at an inquest, died at Melbourne's Royal Children's Hospital in August 2019 after being admitted to Central Gippsland Health four days earlier.
An autopsy revealed Sasha died from complications of influenza, pneumonia and septicaemia, followed by cardiac and respiratory failure.
Pediatric infectious diseases physician and microbiologist Meryta May gave evidence that Sasha had a rare heart complication called pneumococcal endocarditis and it presented itself in a subtle and unusual way.
The condition has a mortality rate of 20 per cent regardless of treatment, she told the Victorian Coroners Court on Tuesday.
Looking at what doctors documented, it wasn't reasonable for anyone involved in Sasha's care to initially diagnose her with the condition, given there was little clue to what was causing her illness, Dr May said.
Even when she got to the Royal Children's Hospital her condition was not clear - "she really was a diagnostic dilemma at that stage" - and staff only found endocarditis once they did an echocardiogram.
Dr May opined it could have been reasonable for doctors to give Sasha antibiotics immediately upon her admission to Central Gippsland Health.
However, while it may have delayed Sasha's decline, it wouldn't have prevented her death, Dr May suggested.
Pediatrician Chris Pappas told the inquest Sasha's positive blood culture results should have been relayed to medical staff immediately, prompting them to give her antibiotics earlier - although he couldn't be sure that would have changed her outcome.
A doctor gave evidence staff delayed giving Sasha antibiotics because it may have "masked" a surgical presentation and delayed diagnosis.
An abscess in Sasha's heart virtually destroyed part of her aortic valve and led to her heart collapsing.
The microbiologist suggested medical staff should be better educated about how to identify sepsis and communication processes should be improved.
Sasha's pathology results were faxed through rather than phoned into Central Gippsland Health, so there was an hours-long delay in medical staff seeing them.
Boxes on a form relating to patient consent were left unticked, and staff missed several opportunities during Sasha's first 24 hours in hospital to identify she was subject to a child protection order.
Consent for Sasha's medical procedures had to be provided by the Department of Family, Fairness and Housing because of the order, the court was told on Monday.
Sasha's mother claims to have told a nurse at Central Gippsland Health her daughter's father had heart issues.
Sasha's father also told the inquest he had a hereditary heart condition, but no one from the department or hospital sought his medical history.
She was ultimately found to share her father's structural heart valve abnormality.
Dr Pappas said it he were Sasha's treating practitioner and was told about her father's condition and his surgery for it at age 20, he would have considered doing an echocardiogram for the 12-year-old.
Parties to the inquest have until January 27 to file their submissions.
