A senior emergency room doctor has broken down as he addressed Aishwarya Aswath's parents directly during his testimony at an inquest into the seven-year-old's death.
Aishwarya died of sepsis after waiting almost two hours for treatment at Perth Children's Hospital in April last year.
The inquest is examining how medical staff missed such a serious illness and why her parents' concerns were not heeded earlier.
At the close of his evidence on Monday, emergency room consultant William Hollaway turned to Aishwarya's parents and told them he was heartbroken he could not save their daughter's life.
"That was a terrible night … I was heartbroken I couldn't save Aishwarya," Dr Hollaway said fighting back tears.
"I want to assure you that every single person involved in her resuscitation will never forget her."
The senior doctor told the hearing the state-of-the-art hospital had half the staff it needed amid an unprecedented rise in cases last year.
'There was no end in sight'
Dr Hollaway said the night Aishwarya was carried into the hospital patient numbers had continued through a spike the previous winter.
"We had gone through one of our busiest winters ever … 300 patients per day to an ED staffed for half of that," he said.
"We were completely exhausted … we definitely felt we were under the pump and there was no end in sight."
Dr Hollaway was the second doctor to assess Aishwarya that night, after he was alerted by an ED waiting room nurse.
He almost immediately escalated her care, taking her out of the waiting room and into one of the ED wards.
The inquest has heard from a number of other medical staff who came into contact with Aishwarya during the two hours she was waiting.
Aishwarya arrived at the hospital just after 5:30pm. She was triaged with a rating of four, which is low on the scale, and put into the section of the waiting room for low-priority patients.
Dr Hollaway told the court he thought that was an appropriate score given her symptoms.
However when he assessed her at about 7:10pm he thought there was a "moderate degree of urgency" at that point.
After being taken to the ward, Aishwarya began to deteriorate rapidly and was taken into a resuscitation area.
Her heart stopped beating and she could not be revived. CPR ceased just after 9pm.
The doctor said Aishwarya's illness was an unusual case in the way she deteriorated so rapidly, however he noted this was common in children who compensated well before crashing.
He gave evidence that results from a blood gas machine that could not be used in the resuscitation area because it was in a cleaning cycle delayed results by 15 minutes.
He said there was now a second machine in the resuscitation area, since Aishwarya's death.
Dr Hollaway also said he was aware of nursing staff raising concerns with management about staffing, and had sat in on a meeting with the executive when these concerns were raised.
He said more staff had been put on since Aishwarya's death.
"We still have long wait times in the waiting room, but it certainly feels a bit safer," Dr Hollaway said.
Nurse tells of lack of hospital support
Earlier on Monday the inquest heard from nurse Caitlin Rose Wills, who approached Dr Hollaway after observing Aishwarya was floppy and had a blank stare while in the waiting room.
Nurse Wills also spoke of being very junior and under a high workload.
She said Aishwarya's death was the first she had experienced of a child in her care in ED, and that she broke down when she was told of her death later that night.
She said when she arrived at work the following day, there were people in the ED she was told were relatives of Aishwarya's.
She said she did not feel supported by the hospital in managing that situation.
The inquest continues.
