A ‘strikingly unusual’ condition. But this nurse knew instantly Joe Massa was very unwell

Two-year-old Joe Massa died of a “strikingly unusual” complication, but signs that the toddler was critically ill were instantly recognised by a nurse who bypassed doctors to raise the alarm, a coronial inquest has heard.

Joe’s death in September 2024 galvanised the Minns government’s plans to end the Northern Beaches Hospital’s public-private partnership model after his mother, Elouise Massa, reported that she had repeatedly tried to alert staff to her son’s worsening condition.

Senior nurse Felicity Melville started her shift as team leader at 10am on September 14 in the Northern Beaches Hospital’s emergency department, almost three hours after Elouise Massa brought Joe in.

On Thursday, through tears, Melville told the inquest that as soon as she saw Joe she knew that he was “very, very unwell. It was instantly obvious to me”, describing Joe’s dark and sunken eyes and mottled skin.

Melville said she tried to perform a full set of observations on the toddler, and had to leave Joe’s bedside twice to find missing monitor cables and replacements for broken stickers used to monitor heart rate and saturation readings. Melville said the equipment often went missing or broke.

She could not record Joe’s heart rate, but recorded an abnormally fast respiratory rate of 57.

When asked on Thursday whether she had the impression that Joe’s treating doctors were not recognising Joe’s condition as she was, Melville recalled a registrar telling Elouise Massa that they would wait for an ultrasound.

“To me that was reassurance, and I wanted action. I wanted immediate action,” she said.

Melville said that as another doctor began assessing Joe, she escalated the matter to her nurse unit manager, then wheeled Joe in his bed out of paediatric ED towards the resuscitation area.

“There was no direct conversation between either of the doctors and myself about going to resus [sic], or asking me to sort of intervene anyway,” she said.

Melville said Joe’s large bed would have slowed them down through a crowded triage area, so she scooped him up and put 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.

Melville said she told another doctor, “I’m really worried about this child”. The doctor responded and came to Joe’s bedside in the resuscitation bay.

She said she called the paediatric ED, but the registrar and senior doctor were not there, so she used the hospital’s speaker system to alert them. She then found a resuscitation nurse nearby.

Moments later, Joe began seizing and went into cardiac arrest.

Melville recalled through tears that Joe’s father, Danny Massa, had arrived and put his hand to Joe’s face just as he arrested.

Joe was rushed to the Sydney Children’s Hospital, where he suffered cardiac arrest for 30 minutes, depriving his brain of oxygen. He died on September 16, 2024.

On Friday, the doctor who oversaw Joe’s care at the Children’s Hospital said Joe’s cardiac arrest was caused by necrotic ischaemic bowel, “a nasty condition”.

Dr Andrew Numa said Joe’s presentation was an “extraordinarily uncommon illness”.

“It’s strikingly unusual,” Numa said, and despite extensive efforts by multiple specialities, they identified no underlying cause.

A stool sample tested positive for adenovirus, a common flu-like infection, which has been associated in rare circumstances with intestinal necrosis, “but it could be completely incidental”, Numa said.

On Monday, Elouise Massa held a tiny pair of her son’s shoes as she spoke on the first day of the inquest. She said clinicians at the hospital were rude and did not listen to her concerns as Joe’s condition rapidly deteriorated.

Melville addressed Joe’s family directly on Thursday, saying: “I am so deeply sorry for your loss. Joseph mattered, and he matters now, and he will not be forgotten.”

Under Joe’s Law, the Minns government banned future public-private partnerships in NSW’s healthcare system.

Start the day with a summary of the day’s most important and interesting stories, analysis and insights. Sign up for our Morning Edition newsletter.