TWO days of intense testimony at the coronial inquest into Emerald toddler Ryan Saunders' death has raised suggestions of an intimidated staff environment.
Monday heard three doctors and a nurse claim they were hesitant to press the head of paediatrics Dr Peter Roper to give Ryan stronger pain medication because, as registrar Dr Pauline Higgins said, "he had been quite stern".
The inquest heard it was standard procedure to gradually increase the strength of the medication, beginning with Nurofen and Panadol, before codeine was eventually prescribed more than 17 hours after Ryan was airlifted to the Rockhampton Base Hospital from Emerald.
It would be another five hours, at around 4.30pm, that morphine was given to the child who, the inquest was told, was heard crying continually throughout the paediatric ward.
But Dr Roper defended his decision to withhold the morphine and said by giving the strong opiate, critical pain symptoms may have been masked and further hindered Ryan's diagnosis.
He also countered sworn testimony that Ryan was crying continually, and instead told the inquest he was subdued when he entered Room 13, where Ryan was.
"Yes, they were very reluctant to go ahead with the lumbar puncture and as I said previously, the father started crying outside," Dr Roper said.
He said Ryan was sitting on Mrs Saunders' lap after she had calmed him down, and as such, Dr Roper did not see Ryan crying.
"I think I first saw him in the ward and the lights were dim so I couldn't see him clearly," Dr Roper said.
"What struck me was... he was very reluctant to move and his knees were bent.
"When I saw him, he didn't make any noise."
The inquest heard Ryan had been diagnosed with mumps on the Thursday before he was admitted to the Emerald Hospital three days later.
He had a temperature of 38.7 degrees recorded in the Rockhampton emergency department.
Dr Roper said because Ryan's temperature never went above 39 degrees, a widely recognised benchmark indicator of bacterial infection, he was more inclined to believe he had a viral infection.
"The other thing that points to a viral infection is a four-day history, but if you had a bacterial infection, it would indicate rapid progress," he said.
"There is no agreed standard in Australia but it's a fairly recognised level that if it is above 39 degrees in a child under three years (it is bacterial)."
Dr Roper told the inquest Terry Saunders had become so emotional he left the room, and gave him the impression the parents were reluctant to let him administer more tests.
But he added to his statement and said: "If I thought there was a clinical need, I would have performed the tests anyway."
Senior health officer support Dr Gezina Roos told the inquest on Monday she submitted her resignation soon after Ryan's death in protest to the 24-hour shifts staff were required to work.
Dr Roper said Dr Roos' resignation was not related to Ryan's death.
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