Coroner rules death of eight-year-old girl was preventable

A Victorian coroner has ruled that the death of eight-year-old Amrita Varshini Lanka at Monash Children’s Hospital in April 2022 was preventable. Deputy State Coroner Paresa Spanos criticized the response of an emergency department doctor during the inquest.

Amrita presented at the hospital with stomach pain, nausea, and vomiting. While initial tests ruled out appendicitis, she later developed lymphocytic myocarditis, an inflammation of the heart muscle. Despite an abnormal electrocardiogram (ECG) and signs of deterioration, including elevated lactate, the coroner found that medical staff failed to appreciate the severity of her condition.

Emergency department registrar Patrick Tan reportedly determined the child did not look unwell and did not attend to her again until her condition had significantly worsened. Following a brief cardiac arrest, an attempt was made to transfer Amrita to the Royal Children’s Hospital, but she suffered a prolonged cardiac arrest during the process and died.