The father of the seven-year-old girl who died of sepsis after waiting almost two hours to be admitted to hospital wants clarification on parts of the coroner's report on her death, and a change of power in the WA Health Department.
The state's deputy coroner handed down her long-awaited findings into the death of Aishwarya Aswath on Friday.
Aishwarya's parents Aswath Chavittupara and Prasitha Sasidharan said the report reflected what they have been saying over the two years since they took their daughter to the emergency department at Perth Children's Hospital (PCH) in April 2021.
"We will not be disputing any of the coroner's finding and we don't want to challenge them but at the same time we need some clarification on certain sections of the report," Mr Chavittupara said.
"We will be writing to the coroner and will ask for an explanation."
Coroner Sarah Linton made five recommendations, including mandated patient-to-staff ratios in all public hospitals and a dedicated resuscitation team to be stationed at PCH emergency.
Other measures included changes to the record keeping system in state hospitals and new triage policies.
Time for new department head
Over the duration of the coronial inquest into Aishwarya's death, the health portfolio was handed from Roger Cook to Amber-Jade Sanderson, but the Health Department's director general remained the same.
David Russell-Weisz was appointed to the role in 2015, but Aishwarya's father said if the state government was serious about making changes to the health system in the wake of his daughter's death, it might be time for a change of power.
"Sometimes when we look at changing the game, we try to find a new captain," Mr Chavittupara said.
"And maybe I think it's time for people who've got the power, they need to look into that direction."
Dr Russell-Weisz said he respected the views of the family but was committed to implementing the coroner's recommendations.
"I don't resile from taking the hard decisions and seeing these very, very difficult and challenging times through," he said.
Debate over ratios
Mr Chavittupara said he was not surprised by the recommendations in the report, which he labelled basic, but said the most pressing issue was the lack of staff.
"The issue about staffing is not new," he said.
"The staffing ratio that we're talking about now has been highlighted in the last two years, that should have been taken care of by the government by now."
Frontline staff told the inquest last year that the nurse-to-patient ratio in the ED was "insane" on the evening of Aishwarya's death.
The Child and Adolescent Health Service (CAHS), which runs PCH, accepted the coroner's recommendation of mandating a 1:4 nursing staff to patient ratio.
CAHS board chair, Rosanna Capolingua, said the current ratios were unclear.
"We don't count at the moment, we don't measure it in a patient-to-nurse ratio, but we can definitely do that," she told ABC Radio Perth.
"Then we will know how much more we need to recruit to get up to that number."
The Health Minister Amber-Jade Sanderson said an audit to implement the ratios was underway, but she could not provide Aishwarya's parents with a firm date on their implementation.
"That audit will be complete at the end of march. Perth Children's Hospital emergency department will go to the front of the queue," she said.
"I should imagine they will be implemented as soon as practically possible, I would like to say this year."
The Australian Nursing Federation WA secretary, Janet Reah, said the current model that measures the ratios can be fiddled with, which can skew the statistics.
"You need transparent nurse-to-patient ratios where anyone can walk in and say there is one nurse to three patients," she said.
Dedicated resuscitation team
Ms Linton recommended CAHS implement a dedicated resuscitation team, which the state government said was already in place.
The inquest heard from the nurse who assessed Aishwarya while she was in the waiting room, and was also filling an informal role as a "floater nurse".
Her assessment was interrupted when she was required to attend an emergency resuscitation incident, which left Aishwarya unattended in the waiting room.
Dr Capolingua said nurses had already been assigned to the dedicated resuscitation team.
"They can work and help their colleagues on a regular basis but when there's a [resuscitation] and they go out of that team, they're not actually depleting the team.
"It's a very different ED as far as numbers are concerned to what it was on the night that Aishwarya was there."
The nurses union has disputed that claim and said more staff needed to be recruited as nurses were being taken from the floor to fill the roles.
"You cannot keep putting nurses in main ED to look after patients and then expect them to go off and attend resuscitation events without there being a detriment to the care of the children coming to the hospital," Ms Reah said.
'A chance is a chance': Father
The report found there was a "small possibility" earlier treatment could have saved Aishwarya's life.
Mr Chavittupara said the specific likelihood of his daughter's survival was not relevant, but the fact there was a chance at all should have been the focus.
"As a father I know my daughter better than all of these people put together and there was a chance that they could have saved Aishwarya and they should have saved Aishwarya," he said.
"They shouldn't have mentioned a small chance or a big chance, a chance is a chance.
"If they had come out and apologised on day one, that would have been it, we never would have fought the way we did now."
The Health Minister said she hoped the family understood the processes the government was going through to make improvements.
"I think in the aftermath, perhaps it could have been handled better and I'm sorry for that," Ms Sanderson said.