A girl who died from a meningococcal infection would have survived had she been given a course of antibiotics in hospital hours before her death, an inquest heard.
Four-year-old Gracie Foster was booked in for a routine op to remove her enlarged tonsils three years ago.
-> I took her away to die: Little girl died of infection hours after being sent home from hospital
But the surgery at Chesterfield Royal Hospital, Derbyshire., was cancelled when she became unwell on the ward, her mother Michelle Foster told an inquest on Monday.
Miss Foster described how a consultant paediatrician told her Gracie had a viral infection and sent her home.
But within hours, her daughter became much worse and was taken to Sheffield Children's Hospital where she died the same day.
Chesterfield Coroners' Court heard Dr Tim Ubhi, a consultant paediatrician, reviewed Gracie to see if she required antibiotics.
Giving evidence on Tuesday, he said the checks came after being told Gracie had been diagnosed with tonsillitis and discharged from hospital following the cancellation of her operation.
Dr Ubhi checked Gracie's tonsils but did not view her medical history or carry out any further observations or examinations.
He told an inquest how this was because he was not undertaking a full referral and was simply responding to a request by a nurse to make an assessment on whether Gracie needed antibiotics.
-> Son killed his own mother by repeatedly smashing her over head with claw hammer in Yorkshire home
Dr Ubhi said: "It was a casual request for a child who had been discharged and diagnosed.
"The nurse who was doing it was doing it out of good intentions. "In retrospect, I wish I had done more but I answered the question that I was asked and I answered it fully.
"Had I on my examination felt there were any significant signs of sepsis I would have acted on them."
Dr Ubhi said that had it been a full referral then he would have checked Gracie's full medical history and carried out further examinations and observations and she would have been kept in hospital.
Dr Ubhi, a lecturer for undergraduate paediatricians, was asked on the balance of probabilities, whether Gracie would have survived had this happened.
He replied: "If we had given her antibiotics at 3pm she would have survived."
Senior coroner, Dr Robert Hunter then asked Dr Ubhi whether they could agree that Gracie was 'in the intermediate category for risk of serious illness at the very least'.
He added: "Yes, I agree."
"She ticked a number of the boxes to suggest meningococcal septicaemia."
Dr Ubhi added that after reflecting on that day in October 2015 'there were 10 different factors that contributed to her sad demise' and 'systematic errors' at the Royal at the time.
But he believed these to have been addressed.
Earlier on Tuesday, the inquest heard evidence from Shereen Macdonald, the nurse who asked Dr Ubhi to assess Gracie to see if she needed antibiotics.
The court heard that Ms Macdonald did take Gracie's temperature but did not carry out a formal clinical review which was described as 'basic nursing care'.
But Ms Macdonald did give 'safety net' advice to Gracie's mum, Michelle, informing her to come back to hospital if her daughter's condition deteriorated and gave advice on times for her next dosage of paracetamol and ibuprofen.
The inquest previously heard Gracie arrived at the Royal hospital and was her normal 'chatty' self, even looking forward to going to her grandmother's home for treats after her op.
But as the morning went on she became 'mardy' and let out a cry while in the playroom before becoming sleepy.
Her condition worsened and she complained of a sore throat, a headache and she had a high temperature recorded as 40.1.
-> Hand over your keys or we'll stab your kids: Masked gang laughed as they threatened six-year-old boy
She vomited 30 seconds after taking her pre-operation medication. As a result, her operation was cancelled and her mum carried her out of the hospital 'floppy'.
Ms Foster, believing her daughter had a minor viral infection, took Gracie to her grandmother's while she went to her son's school disco.
But sadly Gracie's condition worsened and she died that evening at Sheffield Children's Hospital after she continued to vomit and her grandmother found two non-blanching spots on her body.
Yesterday Ms Foster told the inquest how she had unknowingly taken her daughter out of hospital 'to die'.
A post-mortem concluded that Gracie died of Waterhouse-Friderichsen syndrome, meningococcaemia and neisseria meningitidis infection.
The inquest concludes on Friday.