A senior Perth doctor has broken down while telling Aishwarya Aswath's parents he and his colleagues did all they could to save the little girl's life.
Giving evidence on Monday at an inquest into the seven-year-old's death, Perth Children's Hospital emergency department consultant William Hollaway made an emotional address to her father Aswath Chavittupara and mother Prasitha Sasidharan.
"That was a terrible night ... I saw your pain and suffering," said Dr Hollaway, who led efforts to resuscitate Aishwarya as she died of sepsis on Easter Saturday last year.
"I was heartbroken I couldn't save Aishwarya but I want to assure you that every single person at Perth Children's Hospital involved in her resus will never forget her."
Aishwarya, who had presented with a fever, vomiting and diarrhoea, was left in a waiting room for more than 90 minutes upon arrival.
Deputy state coroner Sarah Linton has been told there was intense demand on emergency department staff, including a junior waiting room nurse who was unable to monitor the girl because she was repeatedly called away on other duties.
Dr Hollaway said the hospital was seeing up to 300 patients a day in the months preceding Aishwarya's death despite only having adequate staff for "perhaps half that amount".
"We were completely exhausted," he told the inquest.
"We definitely felt like we were under the pump and there was no end in sight."
He said the response from hospital executives had been "lacking" despite staff having repeatedly raised concerns.
Dr Hollaway became involved in Aishwarya's care around 7pm when approached by a nurse who was concerned the girl appeared unable to take medicine.
After seeing she appeared floppy, Dr Hollaway feared Aishwarya could be suffering from a neurological condition and moved her to a treatment pod.
He then went to review another patient but minutes later was called back to help resuscitate the rapidly deteriorating girl.
Doctors managed to briefly stabilise Aishwarya as she fought what later proved to be an infection related to group A streptococcus.
But while being prepared for intubation, the girl went into cardiac arrest. Doctors tried desperately to save her but she was pronounced dead around 9pm.
An expert witness found the resuscitation efforts had been carried out to the highest standard, counsel assisting Sarah Tyler told the inquest.
Dr Hollaway said while the collective symptoms exhibited by Aishwarya warranted consideration of sepsis protocols, less than 10 per cent of children who experienced them would actually have the life-threatening condition.
He said Aishwarya's deterioration had been unusually rapid and her level of infection later proved to be extremely high.
The inquest earlier heard a statement from nurse Caitlin Wills, who had sought Dr Hollaway's help after seeing Aishwarya in the waiting room.
She said she had felt pressured by management into attending interviews for an internal root cause analysis into Aishwarya's death.
"The process was unpleasant and I felt like I was being interrogated," she said.
Ms Wills was also investigated by the Australian Health Practitioners Regulation Agency, which briefly placed conditions on her registration.
The inquest continues.
