‘Number of failures’ made by Kent NHS trust in care of girl, six, inquest hears

An investigation into the death of a six-year-old girl has concluded that an NHS hospital made a “number of failures” in her care before she died.

However, a coroner found there was no evidence to suggest the trust directly caused or contributed to Maya Siek’s death in December 2022.

Maya was given antibiotics for suspected tonsillitis and was sent home from Queen Elizabeth the Queen Mother Hospital in Margate, Kent, two days before she died of heart failure following sepsis.

A series of failures “could have happened differently” by East Kent Hospitals University NHS Foundation Trust, which runs the hospital, coroner Catherine Wood ruled. She added that she was unsure whether earlier treatment by the trust “could or would have made a difference”.

The trust’s failures included its failure to keep Maya in hospital on the night of December 19 and to inform all members of the team treating her of her sepsis diagnosis when she returned the next day.

Maya had a persistently high heart rate during her hospital stay, but the trust failed to adequately monitor her vital signs and contact the South Thames Retrieval Service, an intensive care service that takes seriously ill children from local hospitals to intensive care units.

Staff also failed to discuss sepsis guidelines with Maya’s parents, Magda Wisniewska and Rajratan Bande.

“There were a number of failures at the trust in relation to Maya’s management,” Wood told the inquest at Oakwood House in Maidstone. “Overall, her condition did not appear to have escalated as it should have.”

The inquest heard Maya was a “well-groomed little girl” who had “a zest for life” before she collapsed and was taken to the hospital’s A&E department by Wisniewska on December 19, 2022.

The doctors determined she might have tonsillitis and discharged her with some antibiotics, but she collapsed again on the way out of the hospital. After further ECG and blood tests were carried out, she was sent home, with advice to return if her condition worsened, the inquest heard.

This decision to fire Maya was “inappropriate,” Wood said. When Maya was returned the next day after ‘going downhill’ during the night, she was diagnosed with sepsis. Tests also showed flu.

The inquest heard that nurses had not documented genuine admission notes about the diagnosis on December 20, although Wood ruled these were “non-causal deficiencies”.

Maya suffered from other “chronic conditions,” such as problems with fatty liver disease related to obesity and a thickened heart wall. On December 21, she was given a dose of high-strength sodium chloride at around 2 a.m., but after plans for blood scans were not carried out that morning, Maya went into cardiac arrest.

Despite resuscitation efforts, she died that day.

The coroner accepted the cause of death as heart failure (acute myocardial necrosis), in addition to the presence of Maya’s other chronic conditions and influenza.

Wood said that “despite the abundance of evidence we’ve heard, we still don’t really have the full answers,” adding that she was unsure whether earlier treatment by the trust “could or would have made a difference to make”.

In a statement after the hearing, Wisniewska said she had been “completely let down” by the hospital she had entrusted to care for Maya. She said: “The trust did not fully appreciate what was happening to her and there were errors in the treatment which left it incomplete.

“Our lives have been destroyed and our family will never be the same without her.”