Five-year-old girl died four days after having tonsils removed, inquest told

A five-year-old girl who died in hospital four days after having her tonsils removed was her family’s “magical little princess”, an inquest heard.

Amber Milnes, from St Just in Roseland, Cornwall, underwent the procedure at the Royal Cornwall Hospital in Truro on April 5 2023 due to sleep apnoea.

An inquest heard Amber’s parents believed she would remain in hospital overnight after the operation as she had cyclical vomiting syndrome, a rare condition.

However, Amber was discharged home hours after the procedure and began vomiting in the early morning of April 6. She was admitted back to the hospital that evening.

Cornwall Coroner’s Court heard Amber suffered a fatal haemorrhage, likely caused by an infection in the part of her throat where her tonsils had been removed, at about 3am on April 9.

In a pen portrait read to the two-day hearing, Amber’s parents Lewis and Sereta Milnes described how their daughter was the “happiest little girl” who bravely dealt with medical treatment.

They said: “Amber was and always will be our magical little princess. She lit up our home with her singing, her dancing, her laughter and her heart of gold.

“Bam, as everyone would call her, was the girliest of girls who loved doing girly stuff, like playing with princesses and babies. She absolutely loved music and singing.

“She filled our family home with love and fun as she sang and pranced around and when we were out on the road in the car the music didn’t stop.”

They told how Amber was “cuddly, affectionate and very, very caring”, helping family members if they were not feeling well by holding their hand and stroking their head.

“Amber was the happiest little girl, and almost always smiling, but she was also a very brave person, and those qualities came to the fore when she first started getting poorly at the age of two,” they said.

“Once she had started vomiting, she was in and out of hospital on a regular basis, which was tough on her, tough on us all, but she took it all in her stride.

“Amber was so strong and when she felt sick she just got on with it.

“When she had to go into hospital, it was her choice because she was ready to go in, with no fuss and because she knew the doctors and nurses wanted to make her feel better.”

The inquest heard Amber was referred to the hospital to have her tonsils and adenoids removed as she had been suffering with sleep apnoea.

Mrs Milnes, in a statement read to the inquest, said she had repeatedly stated that Amber would need to stay in hospital after the operation because of her cyclical vomiting syndrome.

She described the rare condition as “horrible”, causing Amber to violently retch and vomit every 10 minutes for hours at a time.

Amber arrived at the hospital at 12pm on April 5 and underwent the operation before being discharged home at about 9pm, to the “surprise” of her parents, Mrs Milnes said.

In the early hours of April 6, Amber began vomiting. Her parents rang the hospital and were advised to “wait and see” how Amber did and to call back if she did not stop being sick, they told the inquest.

Amber vomited around 20 times the following day, with her parents bringing her back to the hospital at 10pm.

She was given intravenous medication to stop her being sick and found to have a chest infection at about 2am on April 7.

However, at about midnight that day, the intravenous line failed and she was instead administered medication orally – which she could not take because of being sick, Mrs Milnes said.

Intravenous medication was started at 2.45pm on April 8, meaning Amber had not had fluids, pain relief, antibiotics or anti-sickness drugs for 14 hours, her mother added.

Amber went to sleep but awoke at 3am and suffered a haemorrhage, with doctors unable to resuscitate her.

She was pronounced dead at 4.37am on April 9.

Dr Andrew Bamber, a consultant in paediatric and perinatal pathology, gave Amber’s cause of death as a massive haemorrhage with aspiration of blood, surgical site infection and enlarged tonsils.

He said damage to a blood vessel in her throat, where the operation took place, was likely to have been caused by a later infection rather than during the procedure.

Kel Anyanwu, the surgeon who carried out the operation, said he had worked at the hospital for 25 years and had never seen a death from a tonsillectomy before.

He confirmed that the consent form Amber’s parents signed did not mention risk of death and described her case as “unique”.

When asked about the decision to discharge Amber after the operation, he said: “The conversation was let’s see how she’s managing three, four, five hours after.

“The assumption was that if she was fine, she will probably be ok. The decision was made later when we saw her, that she is fine, she can go.”

Mr Anyanwu described the operation, which took 38 minutes, as “quiet in terms of blood loss” and said he had not seen any active signs of infection at the time.

The inquest continues.