Family looks to find an answer to the unbearable grief of losing toddler Ella
Ella Martin suffered nothing more than routine minor childhood illness until her sudden death, aged 3. Her distraught family is hoping an inquest this week can clarify what happened on that fateful day in 2015, writes Health Correspondent .
Ella Martin is dead for almost as long as she lived.
Three years after she passed away in the emergency department (ED) at Cork University Hospital (CUH), her family is searching for answers. Her inquest will take place shortly but the family is not hopeful that anyone will be able to definitively say why Ella died within hours of presenting at an ED.
An expert medico-legal report examining the circumstances states that “Her medical history does not contain any suggestion of a predisposition to the severe illness that led to her death on September 14, 2015.”
Olivia O Callaghan, Ella’s mother, says: “She was running around the day before and was literally gone 24 hours later. She was buried on my 23rd birthday, September 18, 2015.” Olivia is assailed by a shocking set of details each time she opens official correspondence relating to her eldest daughter.
Olivia and her mother Christine chose to talk publicly about Ella to highlight what families go through in their quest for answers. They were unhappy with the initial lack of follow-up from the hospital where Ella died. They are unhappy that tests to establish possible causes appear to take an inordinate length of time. They are unhappy that results of tests do not appear to be communicated in a timely manner.
For instance, Ella’s DNA was sent to the UK for genetic testing in an effort to find an explanation for cause of death. The report on the testing is dated June 6, 2017. Olivia only saw that report eight months later, in February this year. It showed genetic testing had not thrown up anything conclusive.
Olivia says had this information been imparted to her at the time, it could have spared her eight months of worry that some genetic defect could carry her second daughter, Maya, down the same tragic path. Maya was born on June 11, 2017, five days after the lab report was compiled.
“Instead of enjoying her, I was bringing her to the doctor for every little thing.
“She had the vomiting bug last October. I couldn’t watch. In my head I was thinking ‘My child will be gone,” Olivia says.
On the day before Ella’s death, Olivia dropped her daughter to her brother’s house while she went for a manicure. When she picked her up later that day, she thought Ella looked tired.
“We had arranged to meet her dad at Eddie Rockets. She was tired and I thought a 20-minute nap would do her good. We arrived around 6.15pm “I said ‘Wake up, we are meeting Daddy. Come on baby’.” Olivia says Ella opened her eyes and projectile vomited.
“I got an awful fright. The car seat was covered and I used baby wipes to try and clean it up.” As soon as Paul, Ella’s dad arrived, they drove home.
Back in Mahon, Olivia got Ella ready for bed. She vomited again. Then she asked to watch her favourite movie, Box Trolls. Olivia gave her flat 7UP. Later that night she lay on her mother’s bed and laughed as she had her feet tickled. Olivia asked if she wanted to stay in her Mammy’s bed, but Ella declined. She wanted to sleep in her own room.
She slept through the night and Olivia crept about getting ready for the work in the morning, anxious not to disturb her little daughter. She left for work without seeing her.
At around 9.45am, Ella woke and went in search of her grandmother, Christine.
“I asked her how she was and she said she was cold,” Christine says.
Christine lit the fire, gave her granddaughter 7UP and they snuggled up together on the couch. After a while, Christine went to make a cup of tea and Ella asked for a sausage and toast, but didn’t eat much. Her grandmother got her pottie and thought her urine was “a funny colour” and had a strong smell. “I thought maybe she was dehydrated.”
Over the course of the morning, Ella grew more irritable and started complaining of a pain in her tummy and legs. Christine gave her Calpol but she grew more and more agitated. By 1.30pm, she was crying hysterically. Christine opted to bring her to the family GP. His records for September 14, 2015, note “Abdominal pain”, fever and nausea. Her ear, nose and throat were clear of infection. A diagnosis of appendicitis was considered. He referred Ella to the ED.
A medico-legal report by Dr Stephen Conway, consultant in paediatric and infectious diseases at Spire Hospital, Leeds, outlines Ella’s experience in the ED, where she arrived at 2.41pm on September 14, 2015. Dr Conway’s report, says Ella was triaged as “very urgent”. The triage nurse described vomiting and diarrhoea and an increased respiratory rate, but normal temperature.
A separate report from Conor Deasy, consultant in emergency medicine at CUH, says Ella was seen by an experienced critical care and emergency medicine doctor in the ED, who noted she had “decreased responsiveness”. Moreover she did not show the normal pain response when pricked with a needle.
“Clinically, he felt she had sepsis,” Prof Deasy’s report says.
Olivia arrived at the ED, just after 3pm, after her mother had phoned her to tell her Ella was unwell.
“I was there when they did a finger prick blood test. She didn’t even react - and she was normally a wimp. I started crying then, I knew this was not normal,” Olivia says.
Olivia says an IV was inserted. Ella was given antibiotics.
“She said she was cold but she was sweating. She looked like she wanted to sleep. She had her eyes closed.” Prof Deasy’s report says Ella was given a fluid bolus, a relatively large volume of fluid or dose of a drug given intravenously and rapidly to hasten or magnify a response. It is widely administered in the treatment of severe sepsis. Blood test results were described as “strongly suggestive” of, but not unique to sepsis.
Ella was referred to the paediatric team. A retrospective note from the paediatric register says he arrived in the ED resus at 4.30pm and that Ella was “responding to command but not verbalising”. Prof Deasy says at this point, her care was “escalated to the paediatric consultant on-call”.
Olivia says there was just one nurse present as she watched her daughter’s lips go purple.
“Next thing is, she seemed to be gasping for air, trying to mumble something. I was trying to comfort her. Finally, someone put an oxygen mask over her face.” Dr Conway’s report notes that at 5.15pm, “Ella’s eyes deviated to the left and she had a cardiac arrest.” He says nursing notes, written retrospectively at 6.40pm, note that Ella collapsed while she was being reviewed at about 5.10pm. It is Dr Conway’s view, on balance of probabilities, that Ella died for fulminant (severe and sudden onset) septicaemia.
Olivia’s memory of Ella’s final minutes is appalling: “Suddenly, there were people all around her. Her chest was being pumped, there were shots of adrenalin into her neck.
“They spent 37 minutes trying to resuscitate her, and we watched all of that. They didn’t move us into another room until it was all over.” Prof Deasy’s report says: “The ICU consultant, emergency medicine consultant and paediatric consultant were all in attendance with their requisite teams, but despite every effort, resuscitation was unsuccessful and was ceased at 6.05pm.” A postmortem exam was conducted on September 15 by Assistant State Pathologist Dr Margaret Bolster. The main findings were non-specific. It refers to the “sudden and unexpected death of a previously healthy three-year-old girl following a brief illness”.
It says: “No anatomic cause of death.” In the immediate aftermath of Ella’s shockingly unexpected demise, the family heard nothing from CUH.
Christine says the ongoing trauma of Ella’s death had a serious effect on her own daughter. “ I had to call the doctor, I thought she was going to harm herself.”
In April 2016, deeply upset at the lack of communication from the hospital, Olivia wrote to management at CUH to complain. She said a meeting had been promised to go through the details of the care given to Ella, but that, in seven months, she hadn’t received even a phone call.
The response to Olivia’s letter was immediate. CEO Tony McNamara wrote to say the hospital would be in contact “as a matter of urgency” and that her letter was receiving his personal attention.
“The issues that you have set out demand urgent attention and I am arranging for immediate follow-up by senior staff,” he said.
Olivia says a meeting took place with hospital staff, but no one could really explain her daughter’s death. “Most of them couldn’t speak. They didn’t know what to say,” she says.
Dr Conroy’s opinion is that the care given to Ella was to “a reasonable standard”.
Olivia is clinging to the hope that an inquest, scheduled for May 3 after a couple of postponements, will give her greater peace of mind, but she’s under no illusions.
She’s hoping the experts will agree on a cause of death, because she desperately wants to know why her daughter died. Christine, who was looking after Olivia on the day of her death, questions herself endlessly about whether she could have done anything more to save her.
Dr Conroy’s report suggests no one could have foreseen what would happen to Ella. It points out she had no history of significant illness. “She had been a healthy child who had had nothing more than routine minor childhood illness,” he says.
Dr Conroy says if his opinion that Ella died from fulminant sepsis is accepted, nothing could have saved her from the time she presented to the ED, as “the disease process had passed the critical point at which any intervention would on the balance of probabilities have resulted in her survival”.
At this stage, nearly three years on from Ella’s death, Olivia and Christine desperately want a definitive cause. They are hopeful the inquest will provide a forum to tease out other potential causes of death.
They are fearful, they say, of sudden deaths “being brushed under the carpet. As a mother I think it would be wrong not to have an inquest,” Olivia says.
Only when the coroner’s inquiry is over can they get Ella’s official death certificate, to replace the interim cert they have had since April 2016.
