The former head of Perth Children's Hospital admits staff were exhausted, lacking morale and worried about patient safety around the time of Aishwarya Aswath's death.
Seven-year-old Aishwarya died of sepsis in April last year, hours after presenting to the hospital's emergency department with a fever and unusually cold hands.
She was left in a waiting room for more than 90 minutes, despite her parents pleading with staff to escalate her care as her condition deteriorated.
Counsel assisting the coroner Sarah Tyler on Wednesday said the inquest would examine how trained professionals could have missed the warning signs of such a serious illness.
Her father Aswath Chavittupara and mother Prasitha Sasidharan have said staff were rude and dismissive and showed little urgency to address their concerns.
Aishwarya was triaged in the second-least serious category by a nurse who did not take any physical observations when she arrived at the hospital around 5.30pm on Easter Saturday.
A doctor who had not seen the triage notes briefly inspected Aishwarya after Ms Sasidharan became alarmed about white spots in the girl's eyes but judged that she did not require urgent medical attention.
A registered nurse who subsequently examined Aishwarya recorded family concern as zero, which Ms Tyler noted "does not appear to reflect the reality".
Despite recommendations to consider implementing sepsis protocols if a child's temperature exceeds 38.5C, the nurse did not find Aishwarya's 38.8C "unusually concerning" and didn't investigate further.
Another registered nurse arrived just after 7pm to give ibuprofen to Aishwarya, who was described by her father as being "very floppy" and barely able to lift her head.
In a statement read by Ms Tyler on his behalf, Mr Chavittupara described the staff member as "the rudest nurse that I've ever come across".
He said she had appeared frustrated with Aishwarya and urged her to take the medicine.
The nurse sought an emergency department consultant who inspected the girl, and Aishwarya was moved to an assessment bed and then a resuscitation area.
She was pronounced dead around 9pm despite aggressive resuscitation efforts, having succumbed to an infection related to group A streptococcus.
Aishwarya's father said the family's pleas to escalate her care earlier had fallen on deaf ears.
"We were worried about being kicked out of the hospital for being rude but we were worried about Aishwarya," Mr Chavittupara said in his statement.
The inquest later heard evidence from the hospital's then-boss, former Child and Adolescent Health Service chief executive Aresh Anwar.
Dr Anwar the health system had been struggling with a post-COVID-19 surge in demand after many nurses left the industry and others were asked to work double shifts.
In a letter sent to their union last March, nurses claimed their concerns about patient safety had been ignored by hospital executives.
Dr Anwar denied this but acknowledged his communication with staff could have been better.
He offered his resignation after Aishwarya's death, believing it was the "honourable" course of action, but was asked to remain.
Dr Anwar cited personal reasons for having stepped down earlier this month, saying Aishwarya's passing had left everyone at the hospital heartbroken.
More than 20 witnesses are scheduled to give evidence before deputy state coroner Sarah Linton, including staff who treated Aishwarya.
The inquest continues.
