LONDON – When 8-year-old Sophie Waller cracked a baby tooth eating candy, it set off a chain of events that led to her death.

Sophie had such a fear of dentists that she refused to open her mouth for examination, so doctors at her local hospital took out the tooth in an operation. One of the medical team told a coroner’s inquest that they removed all seven of her other baby teeth at the same time to avoid the need for future procedures.

After the surgery Sophie refused to eat or even open her mouth for her parents, the couple told the inquest. But she was sent home anyway, and starved to death three weeks after the operation.

“No one saw her after she was discharged from hospital,” mother Janet Waller said. “I told (a child psychologist) she was sucking on a watermelon, she told me that was enough for her to survive on.”

The parents said the hospital mishandled Sophie’s follow-up care, referring them to a child psychologist who told them not to worry about Sophie’s plummeting weight. Janet Waller said she also was told to consult her family doctor, who prescribed nutrition drinks over the phone but did not see the girl in person.

Pediatric pathologist Dr. Marie-Ann Brundler said Sophie died at home on Dec. 2, 2005 from kidney failure caused by starvation and dehydration. The inquest was told Sophie weighed 72 pounds (33 kilograms) when she went into hospital and lost a third of that weight before she died.

An official at The Royal Cornwall Hospital in Truro, 250 miles (400 kilometers) southwest of London, said there had been failures in Sophie’s care, and it had changed its procedures.

“The impact of Sophie’s death has been a wide-ranging impact across all of the disciplines that were involved,” John Ellis, a pediatrician at the hospital, told the inquest. “There have been changes.”

The hospital said it would not comment further until the end of the inquest, which was continuing Tuesday to establish the facts behind the girl’s death.

Janet Waller told the inquest in Truro that Sophie had developed a fear of dentists after her tongue was nipped during a checkup, and had refused to let a dentist look at her loose tooth.

“Because Sophie would not open her mouth for examination, I wanted to eliminate any further dental problems,” Tamsin Hearle, a specialist in pediatric dentistry, was quoted as saying by The Times newspaper.

Hearle said the parents signed a consent form for the procedure. The Wallers said they thought they were consenting to one tooth being removed. Janet Waller told the inquest that Sophie was “devastated” when she found out the eight teeth had been removed.

She said that doctors did not adequately take care of Sophie after the girl was sent home from hospital on Nov. 17, 2005, eight days after the operation.

Janet Waller said she and her husband phoned the hospital to express concerned about Sophie’s weight loss and refusal to eat, and were told not to bring her in, but to talk to the community child psychologist assigned to the case.

Sophie’s father, Richard Waller, said he phoned the psychologist “every day, sometimes twice a day, to say how unwell she looked.”

“I kept asking her to come round but she said she would next week and there was nothing to worry about,” he said.

The psychologist, Kerry Davison, told the inquest Tuesday that she spoke to the parents two days before Sophie died and was told she was eating.

“On Nov. 30, Mr. Waller said he was concerned about Sophie’s weight, he passed the phone to Mrs. Waller who seemed more optimistic and said she had been eating fruits and yoghurt,” Davison said.

Ellis, the pediatrician, said Sophie had stopped eating when she had loose teeth in the past, and “it was clear there were psychological issues” around her refusal to eat.

A coroner’s inquest is required in Britain to establish the facts when someone dies unexpectedly, violently or of unknown causes, but has no power to punish anyone. The coroner is expected to rule next week.

The Wallers have criticized the time it has taken to hold the inquest. The coroner’s office said it was a complex case and it took time to gather reports and inquiries from the different agencies involved.

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