Six-year-old Elizabeth Rose Struhs was "very lucky not to have died" after her mother Kerrie did not seek treatment for her then undiagnosed type-1 diabetes, a paediatrician told Queensland's Child Safety Department in August 2019.
"Elizabeth is at extremely high risk of harm in a household where mum has any responsibility of care as she does not believe in medication and refuses to use it," the paediatrician told Child Safety staff by phone.
"She can be close to death again in the future."
Elizabeth had been airlifted to a Brisbane hospital in July 2019 after diabetic ketoacidosis left her in a coma by poisoning her blood and attacking her organs.
After being returned to her family's care, Elizabeth died on January 7, 2022, at her home near Toowoomba, west of Brisbane, while her parents, brother and 11 other members of "the Saints" church group prayed around her.
She had been lying unconscious on the living room floor for days after her parents withheld her insulin, again causing ketoacidosis.
Her inquest in Brisbane on Thursday heard that, as Elizabeth recovered from the 2019 episode, an inter-agency Suspected Child Abuse and Neglect (SCAN) team held meetings.
A Child Safety officer testified she had not spoken with the pediatrician who had warned Elizabeth could fall seriously ill within hours if her mother interfered with her insulin, but was aware of a colleague's notes at the time of the August meeting.
The officer and the pediatrician cannot be named for legal reasons.
After Elizabeth was transferred out of the pediatrician and other Brisbane-based medical staff's care to her local hospital on August 12, they could not attend SCAN meetings without an invitation from Child Safety, the inquest was told.
"I don't think they actually need to be part of the next SCAN meeting," the Child Safety officer emailed colleagues minutes after learning of the hospital transfer.
"Even though they had asked to be there, they shouldn't be invited?" counsel assisting Simon Hamlin-Harris asked on Thursday.
"That would not be my decision," the officer said.
Two days later, with the SCAN team's approval, Elizabeth was discharged into the care of her parents as her father had agreed to treat her diabetes and did not share his wife Kerrie's religious beliefs.
"Our team feel Elizabeth can't be placed in the family household," the Brisbane pediatrician told Child Safety.
"The pressure on dad around such strong religious beliefs will be difficult."
The warning was ominous.
By August 2021, her father had joined his wife's small congregation that had splintered from Pentecostal Christians and named themselves The Saints.
Months after his conversion and backyard baptism, her father agreed to stop giving Elizabeth her insulin.
Both parents and the cult leader are now behind bars.
The eight-day inquest continues.
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