Baby's dehydration was fatal
An Upper Hutt infant who died in Child Youth and Family Service care on Christmas Day six years ago had been severely dehydrated from diarrhoea and suffered a heart attack as a result.
Winter Kaiwaka Hine-Takurua Pira-Walker was only eight months old when she died on December 25, 2008, of a probable cardiac arrythmia associated with hyperkalaemia or high potassium levels in the blood, at her caregiver's Upper Hutt home.
Coroner Ian Smith said in his written findings released today that it was a ''particularly sad case of a loss of a young life''.
''It is clear, in my view, that the caregivers allocated to Winter were very caring and they have (along with Winter's family) felt the loss of this young child.''
He said he accepted that effects from dehydration in infants could be sudden and dramatic, and that CYFS was continually trying to improve its service delivery and its new gateway assessment scheme was one such step.
''I still, however, feel that where the caregiver of a child changes to another caregiver, that at the slightest suspicion of any illness developing, the new caregivers seek and obtain medical advice and check out that child. This is important, in my view, because it will help to bridge the gap where care is broken from the other known providers.''
Winter was born prematurely in April 2008 and developed severe eczema that needed much treatment.
By October that year, CYFS took custody of her and her three-year-old sister, Jeavarney, because of family issues, including domestic violence.
The children were originally placed with the Moeke family but they decided to go away over Christmas and did not plan to take the girls so gave CYFS two weeks to arrange someone else to care for them for that period.
CYFS asked Jolene and Owen Fowke, who were experienced caregivers, to take the children. They agreed and collected them six days before Christmas 2008.
The next day, Winter's three-year-old sister developed diarrhoea and vomiting. Other family members also became sick, and by December 21, Winter developed diarrhoea. Two days later, she seemed wheezier so her new caregivers took her to her GP, Dr Ralph Brock-Smith, who prescribed four medications, including ventolin, a steroid, an antibiotic and an over-the-counter cough medicine.
However, the family only picked up the medicine on December 24.
That day, despite her illness, a planned family access meeting went ahead with a CYFS social worker picking up the children to visit the children's grandparents. During that visit, Winter looked ''sick and dehydrated'' so the CYFS worker cut the visit short and told another staff member to talk to the Fowkes about her condition.
On the girls' return home, Winter was given the medication for the first time and seemed to be improving by the time she went to bed.
About 5am on Christmas Day, one of the Fowkes' older children took Winter to Jolene Fowke. The infant was grizzly and would not take her bottle so her nappy was changed and she was dressed plus given more medicine.
''It was then noticed that Winter's eyes began to roll and she became unresponsive. Emergency services were called and CPR undertaken but Winter could not be revived,'' Smith said.
Perinatal pathologist Dr Jane Zuccollo did an autopsy and was concerned the baby appeared malnourished and severely dehydrated. She was also ''remarkably low weight for her age of eight months''.
She concluded that the baby's high potassium levels were caused by her dehydration, which could cause a heart attack because the heart's cells were very sensitive to high potassium levels.
Winter's potassium levels were so high, Dr Zuccollo initially questioned whether there had been a laboratory error.
Smith said Dr Zuccollo commented that dehydration was difficult to assess in children but they could rapidly die as a result.
Police extensively investigated Winter's death under the code name ''Operation Season'' but decided there were no criminal issues and closed the file.
Winter's plunket nurse said she was developing as a small child for her age but had no issues regarding her care.
Smith said the Fowkes were devastated at Winter's death and still wondered if they could have done something differently.
''Sometimes, the tragedy of her death comes back to remind them every Christmas.''
He said CYFS had established a new ''gateway assessment scheme'', which put more focus on health issues for children and young people in its care.
The Dominion Post