THE family of six-year-old Layla-Rose Ermenekli said they are heartbroken after an inquest found the death of their dancing angel could have been prevented.

Area coroner Lisa Hashmi said there was a 'catalogue of errors and omissions' including delayed medical review, misdiagnosis of a rash as a bruise, and assumptions made.

Pennine Acute Hospitals NHS Trust, which oversees the Royal Oldham Hospital, apologised to the family for several 'missed opportunities'.

The trust's internal investigation - a Root Cause Analysis (RCA) was described as comprehensive, candid and transparent. The hospital trust also outlined practices and procedures that have and are being put in place to prevent a reoccurrence and to ensure patient safety.

But barrister Angela Georgiou, representing the Limeside family, said the care Layla-Rose was given in her final two to three hours, was all 'too little too late' which resulted in an 'irretrievable situation'.

Parents Ricky and Kirsty Ermenekli, both aged 32, vowed to continue with their campaign to fight for Layla's Law - for the MenB vaccine to be extended to all children.

Mum-of-three Mrs Ermenekli said: “Obviously when Layla-Rose died, I was heartbroken but today just confirmed that I can be more heartbroken because she could have been here. Knowing that just hurts more.

"She was failed far worse than I thought she was.

"It is so important that early signs – the golden hour – are got before sepsis gets through the blood and causes a barrier where it won’t get any better.

“Had Layla-Rose gained that when she got to A&E, it would have stopped the sepsis."

Mrs Ermenekli rushed her daughter to the Royal Oldham Hospital on February 3, 2017, with a high temperature, headache and stomach ache.

She arrived at 8.29pm and was seen by a triage nurse at 8.55pm and categorised as priority 2, amber rating, which meant she should have been seen within 15 minutes.

At the inquest, Dr Harsha Rajanna said the first he knew of the child being on the ward was when she came up as next on the list at 10.45pm.

The Oasis Academy Limeside pupil died at the hospital at 4.55am the following day after contracting meningitis meningococcal septicaemia.

Mrs Ermenekli told the court: "I felt the doctor was not listening to me or taking me seriously. I felt like I was being looked on as a paranoid mother.

"I was not kept informed about developments."

Following the inquest, she advised parents: "Do not let them brush you off as a paranoid parent.

"My advice is to nag and to believe in your own instincts."

Dr Rajanna said he noted a 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.

Further evidence given included that he had noticed a bruise on Layla-Rose's left hip while examining her on a trolley. He said that her mother told him she had run into a table. Mrs Ermenekli, however, told the court Layla-Rose had leg pain and was treated on the bed.

In her summing up, the coroner said she found Dr Rajanna's evidence 'confused and confusing' and rejected his evidence that he had stood Layla-Rose on a trolley to examine her.

She said: "Most of his evidence was discredited. Further, I found he was less than honest with his colleagues at the medical handover. I know not why.

"The doctor's lack of communication, record keeping and blatant disregard for concerns raised by Dr Imogen Buck was the catalyst to the catastrophic events that followed, and materially affected others' decision-making and actions. They understandably relied upon what he had written and what he said."

Giving evidence, Dr Rajanna said: "It is not too difficult to confuse between a bruise and a rash."

The coroner added that other medical staff 'inadequately checked' Layla-Rose for a rash.

Dr Buck correctly identified the markings on Layla-Rose's body as a non-blanching rash.

Recording a narrative conclusion, the coroner said: "The key causal issues were the difficulties surrounding triage and escalation, delayed medical review in the early stages of admission, the nature and extent of that examination, lack of observations, assumptions made, the misdiagnosis of the rash as a bruise, the misdiagnosis of a primary cause or focus of the infection and a lack of top-to-toe examination by both the medical and nursing staff, particularly in the early parts of Layla-Rose's admission. There was clear non-compliance with policy and procedure.

"I accept the counsel's submission for the family that resuscitation of the sepsis pathway could and should have been instigated at 9.05pm. This would have averted the cascade effect and Layla-Rose Ermenekli would more likely than not have survived."

The coroner hailed Pennine Acute's RCA as comprehensive, candid and transparent, and said significant steps have been taken and continue to be taken to prevent a reoccurrence of the tragic circumstances surrounding Layla-Rose's death.

Trust bosses apologised to the family during the two-day inquest at Heywood Coroner's Court, which concluded today (March 7).

Dr Prakash Kamath, consultant paediatrician and clinical director at the Royal Oldham, said: "I'm sorry."

He said: "There were a number of missed opportunities, especially the delayed triage. Then the poor documentation, the amber rating, missed opportunities with Dr Rajanna's assessment and being of the opinion that everything was normal.

"There were other missed opportunities at 23.20pm including that she was in pain - an indication that septicemia was really progressing at this time."

The court heard that events after 10.45pm were not causally linked to Layla-Rose's death.

In Miss Georgiou's closing submissions she said: "It was all too little too late because at the end, the cascade had taken effect."

Dr Kamath told the court that the trust's paediatric department had not had any serious incidents recorded in the past 12 months.

A new paediatric children's board for the Royal Oldham Hospital is also in the infant stages of development.

A&E consultant Dr Tom Leckie said: "I would like to send my condolences to Layla-Rose’s family. We have taken stock of what has happened. We realise that we need a systems approach to help our staff. We have thought very long and hard about how to improve safety as best as we can."

Pennine Acute bosses said the paediatric emergency department has been a challenge for the team since it opened in and is an area they are working to improve.

Clinical matron Julie Winterbottom said staffing had been stepped up, with an additional one trained nurse per shift, with three shifts per day. The trust had also improved handovers, communication, documentation and regular observations.

The coroner said in the summing up: "On the thrust of the evidence, Layla-Rose's death was preventable and avoidable had action been taken in the early stages of the admission.

"The deceased died as a result of the complications arising as a result of sepsis. If timely treatment and intervention had been instigated within the first hour, then more likely than not, she would have survived this episode of rapidly developing infection."