'Full and fearless' inquest under way into death of dancing angel Layla-Rose Ermenekli

Little Layla-Rose was rushed to A&E with a high temperature, headache and stomach ache on Friday, February 3, 2017.

The Oasis Academy Limeside pupil died at the Royal Oldham Hospital at 4.55am on February 4 after contracting meningitis meningococcal septicaemia.

The Pennine Acute Hospitals NHS Trust, which oversees the Royal Oldham, carried out an internal investigation which found there were ‘missed opportunities to identify the severity’ of Layla-Rose’s illness by doctors at the hospital.

The family, from Limeside, in Oldham, attended an inquest at Heywood Coroner’s Court today (March 6).

Area coroner Lisa Hashmi said: “It came to light after the death was registered that there were a number of concerns arising, in particular as a result of the very candid internal investigation conducted by the Pennine Acute Hospitals NHS Trust.

“Upon receipt of that document, the coroner opened a fresh investigation into Layla-Rose’s death. That investigation was commenced on September 13, 2017. An inquest opened on September 21, 2017.

“There must be a full and fearless inquiry into this child’s death.”

Layla-Rose arrived at the Royal Oldham Hospital at 8.29pm and was placed on Triage Priority 2 at 8.55pm, which means she should have been seen in around 10 minutes.

The inquest heard that Layla-Rose and her mum Kirsty Ermenekli were not seen by a doctor until 10.45pm on Friday, February 3.

Two expert consultant paediatricians gave evidence. Dr Steven Conway said: “Layla-Rose would have needed treatment before she came into hospital at 9pm for her to have survived if she had had a rash at that stage.

Dr Sandie Bohin said: “Had policies and procedures been undertaken in a timely way, I think that there is, on the balance of probabilities, a good chance that the cascade could have been halted.”

The registrar who oversaw Layla-Rose’s care - Dr Harsha Rajanna - began his shift at 9pm.

When the coroner asked why he took so long to see Layla-Rose, Dr Rajanna said: “I cannot recall any concerns raised in the handover. It is usually the triage nurses who determine who should be seen first.

“I did not go through the entire list of patients. I looked at the first to be seen.

“I got to Layla-Rose when she came up as next on the list at 10.45pm. That was the first I knew of her being on the department.”

Dr Rajanna said he noted her temperature of 38.1C and heart rate of 135. He said it was elevated but that the heart rate matched the temperature and said there was no obvious concern.

The inquest heard that Dr Rajanna then examined Layla-Rose. He claimed he stood her on a trolley and noticed a bruise on her left hip. Dr Rajanna said he asked Mrs Ermenekli about the bruising and was told Layla-Rose had run into a table.

However, in cross-examination, the family’s legal representative Angela Georgiou said: “Mum rather disagrees with your recollection. She says she informed you the child was complaining of leg pain. She could not stand up and did not get up on the trolley but sat up on the couch. Could she be right?”

Dr Rajannan replied: “I very well remember standing Layla-Rose up.”

The inquest heard that Dr Rajanna did not count Layla-Rose’s respiratory rate because ‘it had been taken by nurses in the previous observation’ and did not take bloods.

He said: “Apart from her being sick, there was nothing abnormal. I thought it was most likely a viral illness.

“After that I had a conversation with the nurse who said her temperature had not gone down. I asked Dr Imogen Buck to check with the family to see if the bruise was the same.”

When asked by the coroner whether he reviewed the bruise, Dr Rajanna said: “No, I would not expect anything to be different."

In evidence given by Dr Buck she said she had explained to Dr Rajannan that she had seen a non-blanching rash on Layla-Rose that she was concerned about.

The coroner said: “What you described as a bruise and Dr Buck describes as a rash – they are quite different. Did that not make you think that sounds quite a lot different to what I saw earlier?”

Dr Rajannan replied: “It is not too difficult to confuse between those two.”

Dr Buck said: “He informed me he had seen this rash and other red spots and did not think it was a non-blanching rash to be concerned about.”

When the coroner asked Dr Buck if she was happy with that decision she replied: “I came to Dr Rajannan but he was so confident that Layla-Rose was stable, that I felt comfortable that Layla-Rose was okay. I was reassured by his experience.

“He did not inform me to go and speak with Layla-Rose’s mother. I would have had that conversation with her had he asked me.”

Dr Rajannan examined Layla-Rose at 10.45pm when she was sick. She continued to vomit four times throughout the night.

Dr Rajannan said: “I accept the findings of the Root Cause Analysis (RCA) and the failings relating to your care.

“I met with a senior consultant to develop my learning and I discussed it with my supervisor in detail to understand the outcomes or how best I could learn from what has happened.

“I would improve communication in a case where a child had no obvious infection.

“It seems like what I wanted to explain has not come across.”

A nurse giving evidence at the inquest, Lauren Edwards, also said she agreed with the trust’s RCA report that there were a number of missed opportunities.