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The Canberra Times
The Canberra Times
Lucy Bladen

Calls for formal inquiry into Canberra's paediatric services

Rozalia Spadafora in her official preschool portrait from this year. The five-year-old died at Canberra Hospital in July. Picture supplied

ACT Health Minister Rachel Stephen-Smith has dismissed calls to conduct a formal inquiry into paediatric services in the territory at this stage.

The call has come as the mother of five-year-old Rozalia Spadafora, who tragically died at Canberra Hospital in July, has spoken out about comments and communication from the Health Minister following the death of her daughter.

Rozalia's distraught mother Katrina Spadafora said she had spent every waking moment going over the "horrific night" of her daughter's death.

She recently received Rozalia's school photo where she was beaming into the camera and was wearing a T-shirt that said "happy".

"It was her first and last school photo," Mrs Spadafora said.

Ms Stephen-Smith confirmed Canberra Health Services was conducting a review into the death of Rozalia. She said this was a process always conducted following an unexpected death.

Mrs Spadafora said she had been left in the dark about this review and whether it would be released once it was completed.

Ms Stephen-Smith has since said the family would be contacted for a meeting once the review was finished. She said any recommendations would be acted on as quickly as possible.

"The Spadafora family will be invited to a meeting to discuss the outcomes of the review once it is completed. After this communication with the Spadafora family, any improvement activities arising from the review will be shared publicly," Ms Stephen-Smith said.

"Any findings and recommendations will be acted on as quickly as possible."

A coronial inquest is under way into the death of Rozalia.

There has also been a push for Ms Stephen-Smith to announce a formal inquiry into paediatric services in the ACT but she has ruled this out.

The territory's opposition is calling for the inquiry. It is understood some health workers have supported this.

Canberra Liberals' health spokeswoman Leanne Castley said Canberrans had been shocked by the devastating deaths of children and the government needed to ensure the best possible care was available in the territory.

Rozalia's death has shocked the Canberra community. Picture supplied

"Parents and carers are understandably thinking 'this could have been my child'," she said.

"The inquiry needs to examine where the demand is and where are the gaps.

"This would be the most appropriate tribute to these grieving families to show the government genuinely cares about improving health care for children. It cannot wait for a coronial inquest that will happen sometime next year."

Ms Castley said it should focus on the fact there are no paediatric speciality areas in cardiology and neurology in Canberra.

However, Ms Stephen-Smith has rejected an inquiry at this stage. She said an external review of paediatric services was conducted in late 2021.

"Given the amount of work that has already been done and is currently underway in regard to paediatric services, I am not convinced that a formal inquiry is required or would be helpful at this time," Ms Stephen-Smith said.

"An external review of paediatric services was conducted in late 2021 and CHS continues to work through the recommendations from that review."

The death of Rozalia has prompted calls for urgent change. Rozalia died at Canberra Hospital on July 5 after suffering from the viral infection myocarditis.

Mrs Spadafora said she took her daughter to the emergency department on the evening of July 4 after her general practitioner recommended urgent blood tests but she had to wait eight hours for the test.

Rozalia with her grandparents, parents, cousins, aunty and uncle. Katrina Spadafora (second from the right) says she spends every waking moment thinking of the horrific night her daughter died. Picture supplied

The results of that first test were inconclusive because the doctor was unable to extract enough blood. A second blood test was not taken until 5am on July 5 - 10 hours after Rozalia had arrived at the hospital.

She was diagnosed with influenza A at 9am - 14 hours after she arrived at the hospital.

Mrs Spadafora said they were informed at 12pm on that Rozalia would need to be transported to Sydney to receive treatment.

She never made it to Sydney. Rozalia died that night after suffering a cardiac arrest.

Mrs Spadafora said she was told by staff the helicopter would not land at the hospital and Rozalia would need to be transported by ambulance to the Canberra Airport where she would board the helicopter.

Health authorities have since confirmed to The Canberra Times the helicopter did land at the hospital. It is not known why the helicopter did not transport Rozalia.

"On the day in question, records indicate that the helicopter landed at Canberra Hospital. We apologise if a miscommunication led the family to understand otherwise," a Canberra Health Services spokesman said.

There have also been calls for Canberra Health Services to increase paediatric doctors and staff in the territory. Rozalia was supposed to travel to Sydney for treatment as there are no paediatric cardiologists in the nation's capital.

Ms Stephen-Smith said ACT Health was considering opportunities to expand and strengthen paediatric services.

"I am currently considering how we can best ensure this work is transparent, accountable and draws on independent expertise," she said.

Mrs Spadafora has also been critical of the communication from the Canberra Hospital following Rozalia's death and wanted to respond to comments made by the Health Minister.

Ms Stephen-Smith was asked by opposition health spokeswoman Leanne Castley in question time last month why she hadn't contacted the family.

The Health Minister responded that she did not know the family had expected her to reach out and she would not want to intrude on their grief as she was a stranger.

Ms Stephen-Smith emailed Mrs Spadafora following this exchange. She offered her deepest sympathies in the letter and she could only imagine the pain experienced by the family but said she did not want to intrude on the family.

"I was very sorry to hear that it caused you distress not to hear from me directly and disappointed that Ms Castley did not contact me after she met with you last week," Ms Stephen-Smith said.

"I would never wish to intrude on a grieving family at such a difficult time."

But Mrs Spadafora said she wanted to make it clear the family did not expect condolences; they wanted to know why the family had not received support. She also wanted to make it clear she had not reached out to the opposition.

Ms Stephen-Smith also revealed in the letter that a review was underway into how Canberra Health Services communicate with families when a critical incident investigation is underway.

Statement from Katrina Spadafora

"I would like to clarify something from the start, my family or I, never expected or asked for the Health Minister's condolences or a visit, this arose following the Minister's statement:

'I also want to assure people that the staff that were involved in this are receiving support and the hospital is very conscious of ensuring that those staff receive the debriefing and support that they require.'

My question was: Where was support for my family? Why did the hospital staff need support? How could they be more traumatised than Rozalia's family and what we endured and witnessed during those 30 hours at the Canberra Hospital.

The Health Minister has continued to say that she has offered condolences to the family however no communication was received from the Health Minister until an email on August 2 and only after she was questioned in parliament. This was one month after Rozalia passed away.

Let me be specifically clear about this, Leanne Castley tracked me down, she asked someone I know if she could meet with me to hear Rozalia's story and show her support, which I accepted.

I go over that horrific night every waking moment asking myself why was Rozalia ignored by the staff that night? Was I being punished for not going home when I was asked to by the staff twice?

The Health Minister said in a radio interview: 'There is no evidence in the public domain the actions of Canberra Hospital could have delivered a different outcome here'.

Let's step through the facts:

  • We arrived at Canberra Hospital at 7pm
  • The first blood tests were at 3am and were inconclusive,
  • The second blood tests were at 4am
  • The diagnosis of Influenza A was not until 9am

So that's 14 hours after our arrival. If doctors and nurses are aware that children deteriorate at a more rapid pace than adults then wouldn't those initial 14 hours of no action, be a matter between life or death?"

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