Each time the inquest into the death of Aishwarya Aswath at Perth’s Children’s Hospital is shown CCTV of the little girl waiting quietly in the emergency department, it feels as though you can see her growing ever more ill in her father’s arms.
The seven-year-old’s head lolls back. Her little feet hang limp.
And each time the footage plays, a medical practitioner is right there in the frame.
So it’s easy to ask why doctors and nurses missed what with hindsight appear to be the signs of the terrible infection that would ultimately stop her heart.
But it’s just not that simple.
What the inquest has revealed is the incredible pressure staff were under at the $1.2 billion hospital, which was touted as a state-of-the-art facility when it opened just three years earlier.
Aishwarya’s parents are at pains to emphasise they don’t blame individuals, but are concerned how the system as a whole failed their daughter.
Liberal leader David Honey said staff were hurting.
“I’ve actually spoken with a large number of staff and their distress is visceral,” he said.
“They are utterly overwhelmed … many of them, if not most of them, have been put on what’s called a holiday roster, they’re called in at any hour of the day or night they have no routine in their lives.”
Hospital resourcing is one of the key issues the inquest will delve into, along with whether Aishwarya’s death was preventable and if she was triaged appropriately.
So far, each medical practitioner who has given evidence has told how terribly understaffed the emergency department was that night.
The court heard triage nurse Jacqueline Taylor was essentially doing three jobs.
She had to see patients and assign them a triage score, but escort critical cases through to the ED waiting room and let people in and out.
Barrister Tim Hammond described Ms Taylor’s job that night as “triage nurse, concierge and an escort role”.
Mr Taylor told the court the whole department was fatigued and under pressure after a long period of requiring more resources.
Dr Tony Teo, who was asked by a clerk to examine the little girl’s eyes, spoke of the acute pressure of knowing 10 other patients were waiting for him when he briefly turned away to check Aishwarya.
Then there was the waiting room nurse who couldn’t complete her assessment of Aishwarya because she was called away for almost an hour to other urgent patient needs.
Shortly after Aishwarya’s death, the number of nurses at PCH almost doubled from 68 full-time positions to 129.
The nurse’s union has maintained the hospital executive was made aware of the pressures staff were under, but failed to act until after there was a tragedy.
Right at the start of his evidence, former child and adolescent health chief executive Aresh Anwar stressed the organisation was “acutely aware” of the staffing challenges the hospital faced.
He told the court that in early 2021, the hospital executive had escalated those concerns to the Department of Health, and it was not the case staff concerns had fallen on deaf ears.
COVID had dried up the pool of casual staff to boost staff numbers, and border closures had prevented the recruitment of specialist staff from overseas.
He said the organisation tried to respond but had “limited capacity”.
Dr Anwar also denied budgetary constraints were to blame, saying he woke up every day to deliver high level health services to the people of WA.
“I don’t get up every morning to deliver a squared-off budget,” he said.
Family spokesman Suresh Rajan says Aishwarya’s parents just want to make sure that whatever systemic failures the inquest reveals, they are addressed.
“It goes to is whether or not we as people, residents in Western Australia, can have any confidence in taking our children to this hospital with a potentially fatal illness,” he said.
Every time the CCTV of Aishwarya’s final moments is played in the coroner’s court, the little girl’s parents leave the room.
“I don’t have the courage to revisit the last moments of my daughter’s struggle … as I was pleading for help,” Aishwarya’s mother told the court in a statement.
It remains to be seen whether the Western Australian government has the courage not to look away.