A THREE-MONTH-OLD baby girl who died at home just hours after being discharged from hospital passed away from natural causes, a coroner has ruled.
Alexia Carnall-Cotterell had already stopped breathing twice when her worried mum Nikki took her to Sheffield Children’s Hospital, her inquest heard.
She was wheezing and coughing, but was discharged at 2am. Alexia died five hours later after going into cardiac arrest.
At the inquest, at the Sheffield Coroner’s Court, Upperthorpe, two expert witnesses clashed over her discharge from hospital.
Dr Stephen Conway of Leeds Teaching Hospitals NHS Trust, and Dr Ian Maconochie, lead consultant in paediatric emergency medicine at St Mary’s Hospital, London, both gave evidence.
Dr Conway argued Alexia, of Batemoor, should not have been discharged when she was and criticised the care by junior doctor Syeeda Alam, who examined the tot.
He claimed she had failed to find out about the child’s social circumstances – namely that Alexia would be going home to sleep on the couch with her single mother – which could have led to the deterioration of her condition.
The inquest heard Dr Alam failed to carry out vital signs observations on the baby before she left just after 2am.
Alexia’s heart rate, breathing rate and temperature had been taken twice, but the final assessment, in which Dr Alam looked only for signs of respiratory illness, was carried out as the medic passed Nikki in the corridor.
Dr Conway said: “No attempt was made to understand where Alexia was going after she was discharged at 2am, which is not a sensible time to discharge a young child.
“I don’t think a high or even reasonable standard of care was given by Dr Alam in her final assessment.”
But Dr Maconochie said he believed staff had acted appropriately and in accordance with guidelines.
He said: “In emergency departments, social concerns are not a reason for admission, unless there is a safeguarding issue.
“This was a well-nourished, otherwise well child and the fact she had visited a GP earlier in the day showed a degree of parental concern.
“I think the discharge was reasonable, despite the fact it was 2am.
“The other important feature is observations were performed during her stay in hospital and her heart rate was within normal limits.”
The inquest began in June, when the court heard a post-mortem had found the cause of death to be acute bronchitis and early bronchio-pneumonia.
It was adjourned after calls for further medical evidence and reopened this week.
Julian Fox, South Yorkshire assistant deputy coroner, said: “The views of these two experts seem irreconcilable.
“I have had the advantage of hearing evidence from the doctors and nurses and they all impressed me with their concern to do the right thing for Alexia.
“The junior doctor on duty, although inexperienced, sought advice from a senior.
“For that reason I prefer the evidence of Dr Maconochie and the most appropriate verdict is it is more likely than not Alexia died from natural causes.”