The inquest into the death of 2-year-old Hineihana Sosefina Mausii has heard a child in her condition would almost certainly not be discharged from Dunedin Hospital now.
The toddler died on Sunday, 29 September, 2013, after being twice discharged from the hospital's emergency department in the three days before her death.
An autopsy later found the girl had acute myeloid leukaemia.
Hineihana first presented to Dunedin Hospital's emergency department shortly after midnight on 27 September, 2013. She had been sick for several days and her mother noticed she had a cough and a runny nose.
The child had a fever - her temperature was first recorded at 38.5°C but soon increased to 39.3°C - and an elevated heart rate.
After the use of cooling techniques and the administration of paracetamol and ibuprofen, her temperature and heart rate reduced and she was sent home at 3.35am with the instruction to return if there were any concerns.
The discharging doctor requested the paediatric department call the family to follow up, but this did not happen.
Hineihana continued to be lethargic throughout Friday and Saturday, and refused food.
On Saturday she had three bouts of diarrhoea and began to make a wheezing noise when exhaling. Her wheezing worsened and her mother took her back to the emergency department shortly after 9pm that day.
After being assessed by a junior doctor, whose superior did not personally assess Hineihana, the toddler was sent home shortly after 10pm.
At about 1pm on Sunday she stopped breathing. Her mother called an ambulance and she was taken to the emergency department, but attempts to resuscitate her were unsuccessful.
Southern DHB's chief medical officer, Nigel Millar, took the stand in the Dunedin District Court this morning.
He reiterated the earlier apology from the Southern DHB to Hineihana's family.
Marie Taylor-Cyphers, counsel assisting the coroner, asked Dr Millar - who started in his role at SDHB in 2016 - if he was "close to certain a child in these circumstances would not be discharged now"?
He responded: "Yes".
During cross examination Chris Medlicott, lawyer for Hineihana's family, read an account from Hineihana's mother of her impression of visiting the emergency department.
She would "have to live" with accepting her child's discharge from the hospital.
"I was told she was going to be fine and I believed it," Mr Medlicott said reading the mother's words.
"I believed she was going to be okay because that's what they told me."
Upon being discharged for a second time, she "apologised to the nurse because I felt like we were wasting their time".
"[Hineihana's father] wasn't pleased about being asked to take Hineihana home. [He] asked 'What are you going to do if something happens to her because of her breathing'. I butted in and said 'The doctor said she's going to be fine'. He nodded and ushered us out the door."
Dr Millar responded: "It's tragic and deeply distressing to read and not at all what I want to happen in our hospital".
He said he had no doubt the doctors involved in her care would have "reflected deeply" on what took place.
Changes to attitude and culture at the hospital, including the implementation of a speak-up programme, meant if practitioners had concerns about a patient's care - even if those decisions were made by a senior - those concerns could now be aired, Dr Millar said.
"There's been a determined effort to improve the culture, for want of a better word, in our health system.
"We have set a common set of values - which are kind, open, positive and communicative."
Policies had also changed in the aftermath of Hineihana's death, Dr Millar said.
Following Dr Millar's evidence, coroner Brigitte Windley adjourned the inquest and called for all further written submissions to be made to her by 23 August.