Pressures on Western Australia’s hospital system are expected to be laid bare as an inquest begins into the death of seven-year-old Aishwarya Aswath.

Aishwarya died of sepsis in April last year after presenting to the Perth Children’s Hospital emergency department with a fever.

Within 20 minutes of arriving, her hands were cold, her eyes were discoloured and her respiratory rate and heart rate were significantly elevated.

But a review by WA’s Child and Adolescent Health Service found the severity of her condition wasn’t recognised until an hour and 17 minutes later, despite Aishwarya’s parents having pleaded with staff to escalate the girl’s care.

She was pronounced dead within two hours of entering a resuscitation bay, having succumbed to an infection related to group A streptococcus.

The review found emergency department staff had missed a “cascade” of opportunities to provide more suitable treatment.

It highlighted a half-hour period where it was left to one nurse to watch over eight waiting room cubicles as Aishwarya continued to deteriorate.

The inquest into her death begins on Wednesday, with deputy state coroner Sarah Linton expected to hear evidence over eight days.

Aishwarya’s parents Aswath Chavittupara and Prasitha Sasidharan have expressed hope the inquest will provide a clearer picture of the circumstances of their daughter’s death and delve into failings within the health system.

The inquest’s start comes less than a fortnight after the resignation of former Child and Adolescent Health Service chief executive Aresh Anwar.

Dr Anwar had been in the role that oversees Perth Children’s Hospital at the time of Aishwarya’s death.

The McGowan government has since replaced several of the health service’s board members and recently appointed a new executive director to address “cultural challenges” at the hospital.

An independent report last year found staff at Perth Children’s Hospital had been “exhausted and demoralised” in the lead-up to Aishwarya’s death.

The Australian Commission on Safety and Quality in Health Care described the emergency department’s triage and waiting areas as vulnerable and “suboptimally staffed”.

Staff had been raising concerns about the safety of children in the waiting room since at least October 2020.

The McGowan government provided funding for additional staff to monitor patients in the waiting areas in last year’s state budget.

-AAP