A THREE-YEAR-OLD Newton Abbot girl died from acute tonsillitis and empyema – the latter a rare condition – an inquest in Torquay heard on Wednesday.

Erin Carpenter, of Kingskerswell Road, was taken to her GP on February 24, because she was unwell. A viral infection was diagnosed, but the following day her parents Julie and Trevor took her to Torbay Hospital.

There, after being examined by a doctor and a nursing sister, she was diagnosed with tonsillitis, and was allowed to go home. Arrangements made for the parents to contact the paediatric department if there were any problems. But by 6am next day, Erin's condition had rapidly deteriorated and Mr and Mrs Carpenter rushed her into the hospital. She died soon after.

In a statement, Mrs Carpenter said her daughter became ill on February 22 with a high temperature and was off her food. She had given her medication to keep her temperature down and kept giving her fluids. She had developed a rash, was finding it difficult to swallow and her breathing was laboured. Mrs Carpenter said they took her to the accident and emergency department, where a nurse had come out quickly and they were transferred to an emergency room where oxygen was applied through a tube for five minutes and Erin's breathing improved.

She said that the doctor was surprised to see how large the tonsils were. 'They were like balloons and other doctors were called in. We felt at the time it was more for medical purposes than diagnosis,' and she added that the doctor informed them it was tonsillitis and prescribed medication, Erin trying to fight it off and some of it going on the nurse's uniform.

The doctor, Dr Nigel Poland, had felt Erin did not need to stay in and, rather than disrupt the family and as they lived near the hospital, they might as well go home. They were given a direct number to contact the hospital. Mrs Carpenter's statement said that Erin remained tired and washed out and she had cuddled into her dad.

At 7pm she had gone to bed in the couple's bed. They kept checking her and at 9pm Mrs Carpenter went to bed and slept next to her. Later, her dad took her to her own bed and tucked her up. Mrs Carpenter said she woke up at around 6.20am when she heard Erin groan and found her on top of the clothes. 'I quickly got dressed to take her to hospital and I noticed her eyes rolled upwards prior to dressing her. 'We noticed mottling across her body. We drove to the hospital and arrived at 7am. A nurse took one look and tried to resuscitate her for approximately seven minutes. 'There kept being complications and the doctor kept looking at me and I knew we had lost her,' said Mrs Carpenter. Dr John Bridger, consultant pathologist, explained that empyema was a collection of pus in the chest cavity between the chest wall and lung and did not naturally occur. 'I have never seen a child die with an empyema. To me it is rare,' he said. Karen Carroll, a senior paediatric sister, said she saw Erin, who was pale, and her mum said she had been unwell for a couple of days, had been short of breath, had a rash and temperature. She said she was joined by Dr Poland but found no evidence of a rash. The doctor found no wheeze in her chest. Questioned, Ms Carroll said she was not aware of any evidence of empyema at the time. Her temperature was slightly raised, and she was coughing. It was decided to give Erin anti-biotics to treat the tonsillitis and other medication for the temperature. Dr Poland, a middle grade doctor at A and E, said he gave Erin a nebuliser to help her breathing, but, like many children, she refused the mask. She had a slightly raised pulse consistent with pain or anxiety, there was no visible rash and while her throat had two large tonsils they were not touching. 'I do not believe Erin had any signs of shock or dehydration and I did not think she needed requiring admission to hospital. I was extremely distressed to learn of what had happened,' said Dr Poland. Questioned that her mother would say she was labouring in her breathing, Dr Poland replied that there were no signs of that. Consultant paediatrician Dr John Broomhall said empyema came usually as secondary to a chest infection. It was a rare condition and this was a rare way for it to come. Asked if it had been detected how would it have been treated, Dr Broomhall said she would have been admitted, would have had intravenous antibiotics and almost certainly been transferred to a specialised children's hospital in Bristol. 'Empyema is incredibly difficult to detect. It is like a thin film across the lungs,' he said, adding that it was germs from the tonsils spreading throughout the body and the body going into shock,' he said. Dr Broomhall said that on the evidence at 1pm, if he had been called he would not have admitted her. A commissioned report from Dr J R Paskings, an A and E consultant from another hospital, said a sensible decision about her treatment had been made. Torbay and South Devon coroner Ian Arrow recorded a narrative conclusion, saying medical evidence showed she had died from empyema and acute tonsillitis. He told Mr and Mrs Carpenter that it was an incredibly rare condition and would normally be identified in someone suffering from pneumonia. In a statement, South Devon Healthcare NHS Trust said its staff and the trust extended their deepest sympathy to the family. 'The inquest confirmed that the circumstances of Erin's death were extremely rare. 'The coroner heard how the symptoms of her rapidly-developing condition were not apparent when she attended the A and E department. 'The inquest has shown that all that could reasonably have been clinically done was done, given the presenting symptoms,' concluded the statement.