Riya HIRANI · Prevention of Future Deaths report

On 30 December 2022, one of my assistant coroners, Jonathan Stevens, commenced an investigation into the death of Riya Hirani, aged 9 years. The investigation concluded at the end of the inquest yesterday. I made a narrative determination, a copy of which I attach.

Riya’s medical cause of death was:
1a hypoxic ischaemic encephalopathy
1b out of hospital cardiac arrest
1c invasive group A streptococcal infection and influenza B infection

Riya died in Great Ormond Street Hospital, having been transferred there from Northwick Park Hospital in Harrow after she presented in cardiac arrest on the evening of 23 December 2023. However, by that point Riya’s condition was irreversible, and she died five days later.

Riya’s mother took her to hospital a full day before Riya’s fatal collapse, because she believed that Riya was very sick. Unfortunately, the junior doctor who examined and assessed Riya failed to appreciate the severity of her condition. Instead of giving her intravenous antibiotics and admitting her to hospital, he diagnosed a virus and discharged her with advice to take over the counter painkillers and a sheet describing the management of sore throats.

I intend to make a PFD report to the medical director of Northwick Park Hospital about the diagnosis and treatment of Riya’s condition. However, I am writing to you both because it seems to me that there is a fundamental issue regarding the lack of appropriate diagnosis and treatment that is apparent locally but relevant nationally.

When Riya’s mother took her to hospital, she did so because it seemed to her that this illness was qualitatively very different from any other that Riya had suffered in her nine years. In short, Riya’s mum was convinced that Riya was extremely ill, she articulated clearly and at every stage in hospital why she thought that Riya was extremely ill, and she even questioned the doctor about whether this could be a group A streptococcal infection. (There was a well publicised outbreak at the time and the hospital had actually received an alert about this.)

I heard at inquest that, even in the middle of the night, there was a consultant available to give a second opinion if this had been requested by medical personnel. However, no thought was given to seeking a second opinion. I think it highly likely that if it had been open to Riya’s family to seek a second opinion at that point, they would have done so without hesitation.

One of the reasons that coroners are local to an area is because this makes them better placed to recognise any local trends.

Although the events bringing the two children to hospital were very different, as I listened to the evidence at Riya’s inquest I noticed some striking similarities between the circumstances of Riya’s treatment and those of Martha Mills. On each occasion a parent’s articulately expressed and ultimately prescient concerns about a previously healthy but rapidly deteriorating child, did not result in appropriate escalation of care.

I heard the inquest touching Martha’s death last year. I am aware from press reports of the attempts of Martha’s mother to enable families in such a situation to have ready access to a second medical opinion. It seems to me that you should be aware of the circumstances of Riya’s death before you decide how to proceed.