Staff at a north London hospital missed and made incomplete medical checks on a four-year-old boy in the days before he died from sepsis, an inquest has heard.
Daniel Klosi died at the Royal Free Hospital in Camden on April 2 last year having been taken to the hospital four times in a week, including twice in one day, by his parents.
His family and several staff members who helped care for Daniel gave evidence at an inquest into his death at Poplar Coroner’s Court on Tuesday.
In a statement read out in court, Kastriot Klosi, Daniel’s father, described his son, who had autism, as a “lively boy” with no other health issues.
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On March 26 he and Daniel’s mother, Lindita Alushi, noticed Daniel was “wheezing and had a barking cough” and took him to the Royal Free emergency department, where he was diagnosed with crepitation of the lungs.
They returned on March 30 when a doctor and nurse insisted Daniel had picked up a virus, and said he should “go home and rest”, the statement said.
The parents called 111 and were booked in for triage at the hospital on April 1 after Daniel “suddenly stopped eating and drinking”, and he was seen at around 1pm.
“I was told his chest was clear and he was suffering from a virus,” Mr Klosi said.
“I was really concerned and I felt as if the doctor was fixated on telling me Daniel had a virus rather than finding out what the real problem was.”
After Daniel was again discharged,the family, of Kentish Town, north London, went back at around 4.30pm and he started “deteriorating” in front of them, with his nose, hands and feet “turning purple” and his lips becoming cracked and blue.
Daniel died in the early hours of April 2.
Dr Shrabhi Agarwal, an emergency physician in the A&E department, first saw Daniel at around 3.30am on March 31.
She told the inquest Daniel looked “a bit unhappy” but not clinically unwell, and his chest “seemed clear”.
The doctor took a viral swab at around 3.30am and said his temperature was “normal again” around an hour later.
“Because all the swabs were negative and Daniel was feeling better, I decided to discharge them,” Dr Agarwal said.
She told the inquest she decided not to book a blood test because there were “no concerning signs”.
The court heard that the last set of medical observations of Daniel during the visit were at 4.30am, but he was not discharged until 8am.
Coroner Mary Hassell asked: “That really is too long a gap, isn’t it?”
“Yes,” Dr Agarwal said.
Asked if it is good practice to have another set of observations before patients leave, Ms Agarwal replied: “Yes.”
Asked if she should have asked for more observations, she said: “Yes, I should have.”
Asked by Ms Hassell if she would have done anything differently, Dr Agarwal replied: “In hindsight, maybe we could have started him on antibiotics earlier.”
The witness added: “At that time I followed all the guidelines, all the protocols. I made a decision based on my examination and findings.”
Dr Mudhen Al-Adnani, the pathologist who conducted the post-mortem examination on Daniel, told the inquest the boy’s left lung was “heavy” and that he had pneumonia.
Dr Al-Adnani gave the cause of death as sepsis after the infection had breached Daniel’s bloodstream, which he said could take “from several hours to several days” to show.
Lucy Parker, who was Daniel’s triage nurse at the Royal Free on the morning of April 1, told the inquest she could not perform a full set of observations of Daniel “due to his distress”, adding: “With those observations I did manage to obtain, there were no immediate alarm bells ringing.”
This meant readings of Daniel’s heart rate and blood pressure were not taken or logged.
Asked by Ms Hassell what was causing the distress, she replied: “It is difficult to say.”
She added that some of her colleagues tried to repeat some of the observations.
Asked whether she may record a patient’s complexion, with Daniel’s parents expressing concern that he looked pale, she said: “I may.”
Asked by the coroner why she had not made a note of Daniel’s earlier hospital visit on March 26, which she knew about, Ms Parker said there was “limited space on the triage to write certain information” and did not believe it was an error.
Ms Parker told the inquest she had seen Daniel at different times walking around the department, opening and closing doors and being carried by his father.
Daniel a looked “a bit more uncomfortable” on his fourth visit later that day and the department was very busy that afternoon, Ms Parker said.
Dr Kavita Sumaria, a paediatric consultant, met Daniel and his father as she was finishing her morning shift on April 1 after noticing the boy had been waiting for four hours to be seen.
She told the inquest she found them both asleep in a sofa chair and woke them for a discussion about taking some tests.
Dr Sumaria said: “To my assessment I thought he [Daniel] had been a child who had been worse the previous night and was starting to improve.”
She told the court she did not realise at the time that it was Daniel’s third visit to the hospital, and that she did not read the triage medical notes logged for him.
“I thought I had a clear picture of what was going on – in retrospect, that obviously was not the case,” she said.
Ms Hassell said: “I find it very difficult to understand your thinking in all of this consultation.
The coroner said one interpretation of the evidence was that the consultant had been working with “one hand tied behind your back”, adding: “The only person responsible for having half a story was you.”
Asked by Ms Hassell if she thought administering antibiotics to Daniel at 3.30pm that day would have saved him, Dr Sumaria replied: “I cannot quantify it.”
The witness told the court she felt there was an “agreement” between her and Daniel’s father when she diagnosed and discharged the boy, but she “may have misinterpreted that”.
The inquest will continue on Wednesday.
