The last doctor to assess Victorian toddler Dio Kemp before she died of septic shock has told an inquest he believed the three-year-old was recovering in her final days.
Dr Danny Leber, a former GP based in Melbourne’s south-eastern suburbs, also conceded other doctors who had previously diagnosed Dio with a viral infection had “some influence” on his assessment of her.
Leber assessed Dio on 26 and 28 November 2019, in the days after she had visited the emergency department of the Monash Medical Centre twice and had been seen by two paediatricians at the hospital’s rapid review clinic.
By the time Dio, who had Down’s syndrome, saw Leber, she had had a fever for about a week and was experiencing diarrhoea and a facial rash.
Leber told a coronial inquest into her death on Thursday that while he was relying on his own judgment during his assessments of Dio, the doctors at Monash had “some influence” on his belief that she had a viral infection.
“She’s already been seen by five doctors in her four visits to the hospital, including two paediatricians and two registrars and one emergency physician, and the results of the test done at Monash confirmed the diagnosis [of a virus],” Leber said.
The inquest heard Leber informed Dio’s mother, Miranda Jowett, to continue giving her paracetamol and keeping her fluids up and either go back to Monash or return to the GP clinic if her fever was not better by the following day.
“Her rash was improving, which I thought was a good sign. Because if it was something like a bacterial infection, you wouldn’t expect the rash to improve,” Leber said.
“That’s why I said if she’s not better by the next day, then she should go back to the emergency department.”
On 28 November, when Dio returned to the GP, he continued to believe she was recovering, despite Jowett reporting swelling on her daughter’s hand.
“Her temperature was improving, her rash was improving. She was drinking adequate amounts of fluid. So I thought she was, at that stage, recovering from her infection,” Leber said.
He said his notes from the consultation indicated Dio was “fully awake and alert during the consultation” and “frequently signing for water”.
Jowett, however, told the inquest on Monday Dio was asleep in her pram throughout the appointment.
She said Leber told her to continue to give Dio paracetamol and to take her to the hospital if her condition worsened. That evening Jowett said Dio refused any dinner and was so sore she didn’t want to be touched or held.
In the early hours of 29 November, Dio’s lips turned blue, her arms were “rock hard swollen” and her heart was racing. She was taken to hospital via ambulance but suffered cardiac arrest and couldn’t be resuscitated.
Her cause of death was sepsis shock.
During cross-examination by Jowett’s lawyer, Leber conceded he did not take Dio out of her pram or check her body for rash during her final assessment.
He also did not measure Dio’s heart rate, breathing, blood pressure or capillary refill time – which can indicate people at risk of shock – though he said these tests were not usually conducted by GPs on children.
“I’ve worked with dozens of GPs over my 30 years of general practice experience and it’s not something that’s done,” Leber said.
A three-person panel of GPs determined Leber’s two assessments of Dio were “insufficient”, with her prolonged fever enough to consider the possibility of a bacterial infection.
However, they agreed the prior specialist care Dio received at the hospital could have led to “bias” by Leber.
Dr Mark Overton, a GP based in Melbourne’s outer south-eastern suburbs, said hospitals in the area had a “bias towards making a diagnosis of [viruses]”.
Overton said he worked in the Monash catchment and GPs in the area were “criticised for giving too many antibiotics”.
“That’s the culture in the area,” he said. “We are our own practitioners and make our own decisions, but it’s when you know that the specialists in the hospital, that’s the ethos, it does influence you.”
The inquest, led by coroner Paresa Spanos, is examining the medical care Dio received and whether Monash complied with guidelines requiring patients who were readmitted within 72 hours to be reviewed and have their working diagnoses reevaluated.
The guidelines were introduced in 2018 after two-year-old Lachlan Black died of septicaemia at the Monash’s emergency department in 2014.
