Vomiting toddler sent home from hospital with ibruprofen… and dies just 22 hours later
Michelle's respiratory rate and pulse rate was not taken again before she had been discharged – a procedure now implemented by the hospital



11:50 GMT, 19 July 2012

Michelle Fernando, just five days before she died from pneumonia and septicaemia

Michelle Fernando, just five days before she died from pneumonia and septicaemia

A two-year-old girl died just 22 hours after doctors sent her home from hospital with ibuprofen, an inquest heard.

Michelle Fernando began displaying flu-like symptoms one week after her mother Uthpala, 27, fell ill swine flu.

Her concerned father Rashid, 30, took her to Bristol Children’s Hospital but doctors sent her home with the painkiller and advised her parents to give her plenty of water.

Michelle suddenly stopped breathing the following day and she was rushed back to hospital by ambulance but pronounced dead on arrival.

Traces of the deadly swine flu virus were found in her nose and throat but a pathologist ruled that she died of pneumonia and septicaemia.

The inquest at Flax Bourton Coroner’s Court, near Bristol, heard how doctors examined the toddler but sent her home after diagnosing a viral infection on November 17, 2009. But the next night she started having difficulty breathing.

When her parents dialled 999, they were told the problems did not sound life-threatening, and an ambulance would arrive in up to 20 minutes.

But moments later Michelle stopped breathing and they called 999 again – and the ambulance arrived minutes later. Michelle was rushed to hospital but pronounced dead on arrival.

Avon coroner Maria Voisin heard a post-mortem examination found the medical cause of death was pneumonia and septicaemia.

Traces of swine flu, otherwise known as the H1N1virus, were found in Michelle’s nose and throat.

An investigation was launched straight after the toddler’s unexpected death, with the hospital trust carrying out a child death review.

Dr Thomas Allport, who practices at Bristol Children’s Hospital and specialises in paediatrics, chaired the review.

He told the coroner that it was possible the pneumonia was already established in Michelle’s body when she was first examined at the hospital.

However, he said she had had a 'very reassuring respiratory examination that pointed away from pneumonia' before she was sent home.

Grieving: Uthpala Fernando with her son Marlon. Daughter Michelle died in 2009

Grieving: Uthpala Fernando with her son Marlon. Daughter Michelle died in 2009

Dr Allport also said it was 'very unlikely' septicaemia was established in her body when doctors saw her.

Dr Jon Kim, the doctor who first examined Michelle at the children’s hospital, also gave evidence at the inquest.

Ms Voisin heard that the toddler’s respiratory rate and pulse rate had been high when she was admitted – which could have been a sign of pneumonia. But while she was waiting and was given water for her dehydration the rates lowered back to normal.

Dr Kim said when he examined the toddler her rates were normal and her parents were more concerned about her diarrhoea and vomiting – not common signs of pneumonia.

He was asked by the coroner whether he should have re-taken the toddler’s respiratory rate and pulse rates before she had been discharged.

Dr Kim replied that the toddler was correctly managed but re-taking these observations was something that had been implemented at the hospital following the review.

Michelle Fernando aged 18 months

Michelle Fernando aged 18 months

Michelle pictured at 18months. Her parents rang for an ambulance when she developed breathing problems a day after being sent home from hospital

Paul Eland, of Great Western Ambulance Service, explained why an ambulance had not been dispatched urgently after Mr and Mrs Fernando’s initial call.

He said that this was due to the way operators had been told to handle calls during the swine flu pandemic.

Because Michelle was not displaying certain 'priority symptoms' her case was not classed as an emergency.

However, he explained that when her parents made a second call, an ambulance was on the scene in four minutes.

The Bristol Royal Hospital for Children

Michaelle was treated at the Bristol Royal Hospital for Children

Mr Eland said since Michelle’s death, and independently of it, the handling of such calls had been reviewed and she would now have been classed as a priority due to her age.

Recording a verdict of natural
causes, Ms Voisin said: 'Michelle Fernando attended hospital on November
17, 2009, presenting as an unwell two-year-old.

'The medical review at the time did not identify her as having a serious illness and so she was discharged.

'On November 18 she died from natural causes.'

Mr and Mrs Fernando. originally from Sri Lanka, were unavailable for comment after the inquest. But speaking after their daughter’s death in 2009, the couple said if Michelle hadn’t been sent home she would 'still be alive'.

Uthpala, who also has son Marlon, four said: 'Even when my husband explained I had swine flu they didn’t take it seriously.

died within 24 hours of them sending her home from hospital and if they
hadn’t done that she would still be alive. She was a very beautiful,
very active girl.

'I don’t know why they didn’t take it seriously. Maybe it’s because we are from another country, because we are foreigners.'