Heartache as girl, 9, sent home from hospital with ‘tonsillitis’ died just days later
A NINE-year-old girl died just days after being sent home from hospital with what doctors believed was tonsillitis.
Little Riya Hirani was actually battling a Strep A infection amid a national outbreak and suffered a cardiac arrest the following evening.
She passed away five days later, MyLondon reports.
A coroner yesterday concluded her life could have been saved.
A court heard how Riya, from Stanmore, North West London, had a fever, red throat and difficulty getting her words out for three days in December 2022.
After advice from NHS 111, her parents took her to Northwick Park Hospital (NPH), in Harrow, where the senior house officer decided she was “not very sick”.
The youngster was discharged with a diagnosis of viral tonsillitis and instructions to use over-the-counter painkillers – despite her mum Geeta and dad Mukesh’s pleas for a course of antibiotics after reading about Strep A in the news.
The next evening, Geeta spotted white pus in the back of her daughter’s throat and wanted to rush her back to A&E.
As they were heading out the door, Mukesh thought the schoolgirl was choking so patted her on the back.
She collapsed and went into cardiac arrest, suffering severe brain damage that ended her life in Great Ormond Street Hospital (GOSH) five days later.
Only after her death were medics able to confirm she had Group A Streptococcus – a bacterial infection that can be fatal in its most invasive form.
Riya’s death came amid an outbreak across the UK.
Around 30 children are thought to have died from the infection between September 19 and December 30 last year, according to UKHSA data.
At the time, staff at hospitals nationwide were on alert to cases, particularly among children.
Speaking at the inquest, Ms Hirani said: “We were literally leaving [the house] and she stood up and said she could not breathe.
“It was so quick.”
During the proceedings, senior consultants at NPH and GOSH questioned the care Riya received based on her symptoms.
The SHO who assessed the child explained he looked for five criteria when deciding if someone had Strep A.
This included a fever lasting more than 24 hours, an absence of a cough, puss on the tonsils, attending hospital within three days of illness, and severely inflamed tonsils.
Riya met two of these conditions when he saw her, so he concluded she was likely not infected.
But the doctor admitted that had he spotted her throat was “severely red”, he may have raised the issue with a senior doctor, and that he had dismissed her neck pain.
He also said Riya’s heart rate had been 125bpm upon discharge. The normal rate for a child of her age is between 70bpm and 120bpm.
I knew as a mother she was really sick.
Geeta Hirani
In tears, Ms Hirani said: “I knew as a mother she was really sick.
“I remember saying, ‘This could be Strep A’, but I left it for the medical professionals to find out.”
Dr Ehmed Jadou, senior paediatric consultant at NPH, claimed all senior staff would have discharged Riya six months earlier when there was not a rise in Strep A cases to consider.
But due to the climate at the time, he would have “spared a few seconds” to assess her more thoroughly.
Dr Quen Mok, a consultant in paediatric intensive care at GOSH, told the hearing that tests found Riya Influenza B positive, but she suspected there might be another issue.
“Having done 30 years of paediatric care, I had never seen a child with influenza be so sick,” she added.
Riya was sedated and put on a ventilator to prevent further brain injury but she sadly died on December 28.
Her medical cause of death was given as 1A hypoxic ischemic brain injury, 1B out of hospital cardiac arrest, and 1C Strep A and Influenza infections.
Asked if Riya would have survived if granted a course of antibiotics, Dr Mok said: “I do not know. But at least you would have felt it gave her a chance.
“I think if Dr Jadou had seen her, he probably would have admitted Riya and started her on IV.
“Then even if she had a cardiac arrest, it would have been in hospital where treatment is quicker.”
‘BRIGHT AND SMART GIRL’
Giving a narrative conclusion, Coroner Mary Hassell said: “I’m satisfied from all the evidence at the point [Riya] was brought into hospital she was showing signs and symptoms of a bacterial infection and should have been treated as such.
“She should have been admitted and treated with antibiotics.
“I’m not certain what the outcome would have been, but I am satisfied on the balance of probabilities, if Riya had been appropriately treated she would have survived.”
She also made a Prevention of Future Deaths report to avoid the same mistakes being made again and sent a separate letter to Health Secretary Steve Barclay to encourage a new law to allow parents to get a second medical opinion if they are concerned about a misdiagnosis.
It follows the death of 13-year-old Martha Mills, who was battling sepsis at King’s College Hospital in Camberwell in 2021.
Her parents are campaigning to introduce Martha’s rule – giving families the legal right to a second opinion from senior medics in the same hospital if patients are deteriorating rapidly and they feel their concerns are being dismissed.
Coroner Hassell added. “Without a second opinion, future deaths may still occur.”
St Pancras Coroner’s Court was told Riya’s parents had been delighted to fall pregnant by IVF after a 10-year struggle to conceive.
They described their late daughter as a “bright and smart girl”.
Ms Hirani said: “She was very active and loved to sing and dance, and do arts and crafts.
“She adored Lego and would spend hours playing with her little sister, making up characters.
“She had a very mature understanding of the world.”
What are the symptoms?
THERE are four key signs of invasive Group A Strep to watch out for, according to the NHS.
These are:
- A fever (meaning a high temperature above 38°C)
- Severe muscle aches
- Localised muscle tenderness
- Redness at the site of a wound
The invasive version of the disease happens when the bacteria break through the body’s immune defences.
This can happen if you’re already feeling unwell or have an immune system that’s weakened.
Two of the most severe examples of invasive disease are necrotising fasciitis – a very rare but life-threatening infection also called ‘flesh-eating disease’ – and toxic shock syndrome.
Who is at risk?
Some people are at higher risk of contracting the invasive form.
The NHS says those people include anyone who:
- is in close contact with someone who already has it
- is over the age of 65
- is diabetic
- has heart disease or cancer
- has recently had chickenpox
- has HIV
- uses some steroids or intravenous drugs
The time of year can also be a factor. Outbreaks can be rife in late winter and early spring, but the risk remains all year round.
Source: NHS