A senior intensive care doctor has told the family of his former patient he had "deep and enduring sadness" over her death.
Canberra Hospital senior specialist Dr Simon Robertson gave evidence at the coronial inquest into five-year-old Rozalia Spadafora on Monday.
Rozalia died at the hospital on July 5, 2022 after going into cardiac arrest.
Dr Robertson said the young girl needed to be treated at Westmead Hospital in Sydney, and agreed she may have had a chance at survival if her care was not compromised by delays.
ICU not equipped for children: doctor
While giving evidence on Monday, the intensive care unit (ICU) doctor said Canberra Hospital was not equipped to properly care for very sick children.
He said the ICU specialists were trained in adults, who present very differently and require different interventions to children.
However, Dr Robertson said that even if Canberra Hospital had a paediatric intensive care unit, Rozalia would have still been required to travel to Sydney to survive because she needed advanced cardiac support.
Dr Robertson was trying to stabilise the child so she could be transported via the Sydney Hospital Network's Newborn and Paediatric Emergency Transport Service.
ICU never reviewed Rozalia, doc says
A first year intensive care registrar who was asked to look over Rozalia Spadafora on the morning of July 5 said he did not know the normal observational ranges for children, and had little experience with paediatric support patients at the time.
A registrar is a doctor undergoing training in a specialty.
The doctor was the more junior of two intensive care doctors who came to see Rozalia when she was in a resuscitation bay on the morning of July 5.
Paediatrician Callum Jarvis previously told the court he had ordered an intensive care review over the phone to discuss the possibility of giving Rozalia medication for her heart.
Dr Jarvis said he understood the ICU doctors did not want to review the girl because they did not usually treat children.
However, the intensive care doctor said he thought he was being asked to discuss Rozalia's risk of fluid overload and insisted there was no mention of her heart. Rozalia was receiving a lot of fluid because doctors suspected she was dehydrated.
"We didn't review [her]," he said.
He said he did not look at Rozalia's charts and does not remember reading her observations. There were no notes recorded of this conversation.
The doctor said he ended his shift soon after that conversation with Dr Jarvis, and during handover told the day team to check whether the paediatric team wanted Rozalia to be reviewed.
Deterioration
Dr Robertson, who did not get involved in Rozalia's care until the afternoon of July 5, said if an intensive care doctor had all the information about the girl's condition in the morning they would have escalated her care.
Dr Robertson tried to prepare Rozalia for transport to Sydney.
Part of that preparation, while necessary, was almost "inhumane", "very confronting" and "very distressing", Dr Robertson told the court.
However, he said Rozalia seemed to have improved when last saw her at about 6pm. He recalled having to interrupt her while she watched Bluey on an iPad to put an intravenous line back in at about 5pm.
While a lawyer for the Spadafora family, Dan Shillington, suggested Rozalia never watched Bluey, Dr Robertson insisted she was awake and moving around when he left.
Dr Robertson, who was on call, returned to the hospital later that evening after being told Rozalia's condition had deteriorated. He wanted to intubate her.
"Rozalia made some gasping movements and stopped moving in the bed. That's the point at which her heart rate started to move down," Dr Robertson said.
Rozalia died after attempts to resuscitate her were unsuccessful.
Before leaving the court, Dr Robertson addressed the room where many members of the Spadafora family watched on emotionally.
"I'd just like to express my deep and enduring sadness," he said.
"I'm just so terribly sorry."
