A nurse at Northern Beaches Hospital knew two-year-old Joe Massa was critically ill almost immediately after seeing him, a coronial inquest has heard, despite concerns that his condition was not being acted on by doctors.
Senior nurse Felicity Melville told the inquest she recognised that Joe was “very, very unwell” when she began her shift in the emergency department on September 14 2024. The toddler died two days later after suffering cardiac arrest caused by severe bowel complications.
Melville said Joe had dark, sunken eyes and mottled skin when she saw him. She tried to carry out a full set of observations but had to leave his bedside twice to find missing monitor cables and replacement stickers for broken equipment.
She was unable to record his heart rate, but measured a respiratory rate of 57, which was abnormally fast.
Asked whether she believed Joe’s treating doctors were failing to recognise how ill he was, Melville recalled a registrar telling his mother, Elouise Massa, that they would wait for an ultrasound.
“To me that was reassurance, and I wanted action. I wanted immediate action,” she told the inquest.
As another doctor began assessing Joe, Melville escalated her concerns to the nurse unit manager. She then moved him from the paediatric emergency department towards the resuscitation area.
Joe was in a large bed, which Melville said would have slowed them down as they passed through a crowded triage area. She picked him up and placed him on a smaller trolley.
“I’ve picked Joe [up], and Mrs Massa said to me: ‘My son is very sick’, and I said, ‘yes he is, and I’m getting us help’,” Melville recalled.
She told another doctor, “I’m really worried about this child”, and alerted staff in the resuscitation bay. When she found that the paediatric emergency registrar and senior doctor were not there, she used the hospital’s speaker system to call them and located a resuscitation nurse.
Moments later, Joe began having a seizure and went into cardiac arrest. His father, Danny Massa, had just arrived and placed his hand on Joe’s face, Melville said.
Joe Massa’s unusual bowel condition
Joe was taken to Sydney Children’s Hospital, where he remained in cardiac arrest for 30 minutes, depriving his brain of oxygen. He died on September 16 2024.
Dr Andrew Numa, who oversaw his care at the children’s hospital, told the inquest that the arrest was caused by necrotic ischaemic bowel, which he described as “a nasty condition”.
He said Joe had suffered from an “extraordinarily uncommon illness” and that it was “strikingly unusual”. Despite extensive efforts by multiple specialities, doctors found no underlying cause.
A stool sample tested positive for adenovirus, a common flu-like infection. Dr Numa said the virus had been associated in rare cases with intestinal necrosis, but it “could be completely incidental”.
Elouise Massa told the inquest earlier that clinicians had been rude and had not listened to her concerns as Joe’s condition deteriorated. Melville addressed the family during her evidence, saying: “I am so deeply sorry for your loss. Joseph mattered, and he matters now, and he will not be forgotten.”
Joe’s death helped prompt the Minns government’s decision to ban future public-private partnerships in New South Wales healthcare under Joe’s Law.
