One of the main concerns that parents Casey Quigley and Granville Sheridan raised, was that they were “not told what signs to look out for”, following a heart operation, although children’s community nurse Erica Johnson says it is “something she would have brought up with parents”.
Day one of the inquest heard that before Louella was born a test revealed that she had a chromosome abnormality, and her parents were “advised that doctors couldn’t say how that might affect her”.
The inquest heard that after a doctor had listened to her heart, that they were not happy with how she was, and they wanted to transfer her to Alder Hey Children’s hospital, after discovering that her heart blood vessel was too narrow.
In a statement Miss Quigley said: “We were really shocked that she was going to have this done.
“I don’t think we were told just how difficult her situation was.”
Following surgery on February 25 to close Louella’s heart, her lungs collapsed, and she was transferred to the high dependency unit, where she was fed on a nasogastric tube, and her parents were shown how to use this.
Louella was then discharged on March 15 with follow up appointments discussed.
Louella was taken to Royal Bolton Hospital in April after a visit by a community nurse, when the baby "didn't look well" and oxygen saturation levels were down.
Miss Quigley said: “We were told the surgery was a success and there was nothing to worry about.
“We weren’t told what changing features we should look out for, when, or how to contact the hospital.”
Miss Johnson said that at the time there wasn’t any “written information to provide the parents with”, but there has since been a leaflet produced with the information of what to look out.
She added: “We spent time trying to make the information digestible to the family.
“A lot of information that we provide with these visits is usually during the early visits, and we reiterate that with every visit.
“The first time I met the family we talked about her breathing and what it normally looks like, signs of breathing to look out for, and gave an example of what they had to look for.
“We are aware that there is so much information that we provide, so they can refer back to the leaflets now.”
When asked by JMW solicitor Louise Green - representing Miss Quigley – what signs were discussed that would be worrying and how parents should react, Miss Johnson said: “I explained what I was looking for on every visit, such as any signs of blue around the mouth, increased work of breathing and sucking in at the neck, breathing tube problems, alertness, any worrying rashes.
“It was never a list of things; I would spend time explaining what those meant and why they were important.
“The information would have been relevant to the visit.”
The inquest also heard that Louella also tested positive for Covid-19 after a second test.
And concerns were raised by Coroner Professor John Pollard as to why a request to escalate Louella’s case was not given her cardiac surgery and testing positive for Covid-19.
Dr Thomas Webster says he ‘does not recall a conversation about escalation’ but that he was satisfied with the ‘observation chart’, which he checked a couple of times as well as previous checks from nurses and doctors discussed with him, which showed Louella was stable.
He said: “The results of her observations did not suggest it was a fatal deterioration.
“We rely on nursing staff, and just because she has given that information it doesn’t mean we need to review that patient.”
The inquest also heard that the monitor observing Louella’s heart rate, respiratory rate, oxygen rate, blood pressure, with the variable time set, was ‘muted’, but it was emphasised that this is not the only method of monitoring a patient.
Dr Webster said, “switching off alarms can not be justified” but that this “did not bring the level of care below what was acceptable”.
Dr Sameer Misra said that if the “if the change is so sudden” the monitor may not have had time to look at it all, causing it “not to go off”.
The inquest is expected to continue for another two days.