A five-year-old girl suffering from a rare syndrome that caused her to vomit repeatedly should have been immediately admitted to hospital after a tonsillitis operation when she suffered the illness, a coroner has said.
The family of Amber Milnes, who had cyclic vomiting syndrome (CVS), have expressed concern that she was not kept in hospital overnight after the procedure due to her condition and say she should have been readmitted the next morning when she started vomiting.
Amber suffered infection and bleeding and died four days after a 38-minute tonsillectomy at the Royal Cornwall Hospital in Truro.
At the end of the two-day inquest, senior coroner Andrew Cox said: “Potential complications could have been immediately anticipated by the onset of the CVS episode by the operation and it was sensible for Amber to be kept overnight. Once she started vomiting, I am of the view that she should have been readmitted immediately.”
The coroner said that the surgeon who performed the operation, Kel Anyanwu, should have consulted with colleagues who knew more about CVS than he did.
Cox said: “My view is that Mr Anyanwu should have spoken to pediatric colleagues before the operation, as they had little knowledge of CVS. This may have influenced the decision regarding discharge or readmission.
“Since Mr Anyanwu did not fully understand the implications of the CVS, it had to be recognized that the parents could not provide fully informed consent. This is clearly undesirable and an issue for the Trust to be involved in on the board.”
However, Cox said he was not able to say whether Amber’s death could have been prevented if she had been kept in the hospital overnight or readmitted sooner.
Amber, from the village of St Just in Roseland, Cornwall, had to undergo the procedure on April 5, 2023 because she had sleep apnea. Within a few hours he was discharged home and on the morning of April 6 he began vomiting.
Her parents phoned the hospital and were advised to wait and see how Amber was getting on and to call back if she did not stop being sick, the inquest in Truro heard. Amber vomited about 20 times and her parents took her back to the hospital at 10 pm on April 6.
Cornwall Coroner’s Court heard that on April 9, Amber suffered an infection in the area of her throat where her tonsils had been removed and bleeding.
Anyanwu told the inquiry that he had worked at the hospital for 25 years and had never seen a death from tonsillectomy before.
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Asked about the decision to discharge Amber after the operation, he said, “The conversation was let’s see how she’s managing after three, four, five hours. The assumption was that if she was OK, she’d probably be OK. The decision was made later when we saw her, that she was OK, she could go.”
Anyannu described the 38-minute operation as “quiet in terms of blood loss” and said he had not seen active signs of infection at the time.
Amber’s parents, Lewis and Seretta Milnes, described their daughter as “the happiest little girl” and said she faced medical treatments with courage.
They said: “Amber was and always will be our magical little princess. She was also a very brave person, and these qualities came to the fore when her health began to deteriorate at the age of two.
“Once she started vomiting, she was in and out of the hospital regularly, which was hard for her, hard for all of us, but she endured it all. Amber was very strong and that’s all she did when she felt sick.”
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