Boy, 4, was probably septic when seen by medical staff, inquest hears

A four-year-old boy who had been taken to hospital four times in a week was “probably” septic while he was seen by medical staff in the hours before he died, an inquest heard.

Daniel Klosi died from sepsis at the Royal Free Hospital in Camden , north London , on April 2 last year, having been taken to the hospital four times in a week, including twice in one day, by his anxious parents.

As a trainee GP with little experience in paediatrics, Dr Gautham Benoy said he could see that Daniel was an “unwell child” when he saw him on the evening of April 1.

Dr Benoy accepted that Daniel was “probably” septic or “probably at the earliest stages,” as he gave evidence at the inquest into the child’s death at East London Coroner’s Court on Wednesday.

During the hearing, at which a number of medical staff gave evidence, coroner Mary Hassell said it may appear that “a child is admitted at 5pmish septic, and that isn’t recognised until 9.15pm”.

Dr Benoy, who was working at the hospital and was called as the number of acutely unwell patients in A&E was backing up, said he could see Daniel was an unwell child, with sunken eyes, cracked lips, and that he looked likely to be severely dehydrated.

Dr Benoy also said he had abdominal pain and appeared “quite restless and appeared in distress when I tried to examine him”.

He also believed he was possibly “at risk of sepsis” and some of the features to look out for included lethargy, rash, fever, blood pressure and heart rate.

The coroner told Dr Benoy that Daniel had no rash or elevated heart rate, which he saw as a “reassuring features”, but he would not know what lethargy for this child looked like.

Dr Benoy, who said he wanted to get assistance from a consultant, said: “I thought he was definitely a very unwell child and needed further treatment. I thought he needed admission and was at risk of sepsis.”

He said Daniel had pulled out a cannula, which was being used for bloods and fluids, as he was “quite distressed”.

Dr Benoy said: “Learning from this experience, it surprised me how quickly he deteriorated. I did not expect that would happen.”

Dr Benoy turned to Daniel’s parents as he answered a question on whether it would have been appropriate for him to have spoken to them to try to allay their concerns.

He told them: “I understand. I am sorry for everything you have been through.”

Dr Amisha Singh, who works in consultant paediatrics, had been on a busy shift seeing patients in A&E and paediatrics.

She saw Daniel some time between 9pm and 9.15pm and about 30 minutes after he had been seen by Dr Benoy.

Among the issues that had been raised was a local infection, a query of appendicitis and dehydration, the court heard.

Dr Singh added: “I did not think there was any indication that the child was septic at that time.”

The coroner asked: “Do you think the reality is that when Dr Benoy saw Daniel, he was septic?”

Dr Singh replied: “With what we know now in terms of the information, yes he would have been.”

The coroner wondered whether in hindsight, and including everything that is now known, including Daniel’s death, if it is possible the child was septic when he arrived for his fourth visit or even his third visit.

On the possibility of it being the third visit, Dr Singh said: “ Sepsis can progress very rapidly. I do not know I’m afraid.”

She was later asked whether Dr Benoy had made a mistake or the child’s condition had got worse.

She said: “I would say that he got worse.”

Daniel’s father, Kastriot Klosi, previously remembered his son as a “lively boy” with no health issues other than his autism.

On March 26 he and Daniel’s mother, Lindita Alushi, noticed Daniel was “wheezing and had a barking cough”, and took him to the Royal Free emergency department, where he was diagnosed with crepitation of the lungs.

They returned on March 30 when a doctor and nurse said Daniel had picked up a virus, and that he should “go home and rest”, the father’s inquest statement said.

The parents called 111 and were booked in for triage at the hospital on April 1 after Daniel “suddenly stopped eating and drinking”, and he was seen at about 1pm.

Mr Klosi said he was “told his chest was clear and he was suffering from a virus” but “felt as if the doctor was fixated on telling me Daniel had a virus rather than finding out what the real problem was”.

After Daniel was again discharged, the family, of Kentish Town , north London, went back at about 4.30pm and he started “deteriorating” in front of them, his nose, hands and feet “turning purple” and his lips becoming cracked and blue.