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13-yo Louis thought he was safe in hospital. But hours after eating breakfast, he died.

Thirteen-year-old Louis Tate lived a normal life, despite being severely allergic to milk, nuts and eggs.

“It was very easy for us, Louis did live a normal life,” his mother Gabrielle Catan told a Melbourne inquest yesterday, ABC reports. “He always had an EpiPen, and had an anaphylaxis action plan”.

He knew how to manage his allergies at school, while visiting friends’ houses, while catching the bus around Melbourne’s city. He knew the drill.

It was his asthma, however, that landed him in Melbourne’s Frankston Hospital on October 22, 2015. He’d had an attack and doctors wanted to keep him overnight for observation.

He thought he was safe in the hospital. So too did his parents, Catlan and Simon Tate.

“He was in hospital, at a place where he should have been safe,” Tate said. “Yet, despite us providing clear and concise communications about his food allergies, he died.”

Now, the inquest into his death is being held at the Coroners Court of Victoria. It’s expect to last three days.

A supplied photograph obtained on December 12, 2017, of Louis Tate. (AAP Image/Supplied by the Tate family)

On the morning of October 23, 2015, Louis woke up in hospital - his mum had gone home in the middle of the night, after sitting with him as he fell asleep.

For breakfast, Louis reportedly asked for Weetbix, a glass of water and soy milk. "I didn't feel I had to say anaphylaxis was a life-threatening condition," Catlan told the coronial inquest yesterday, Seven News reports.

LISTEN: Robin Bailey and Bec Sparrow discuss the seven stages of grief, on The Well. Post continues after. 

She said she called the hospital soon after breakfast was over to see how Louis was doing. The nurse told her he was complaining of a tingling in his mouth, the inquest heard.

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"That's some sort of allergic reaction," Catlan said she told the nurse.

She told the inquest the nurse said he'd eaten "no more than a spoonful" before complaining. "He knew what was going on," Catlan said.

Louis died hours later.

Gabrielle Catan and Simon Tate outside court during the inquest. Image via 7 News.

Hospital protocol at the time mandated children's allergies be recorded on a whiteboard in the kitchen. The nurse in charge of the children's ward Helen Hutchins told the inquest Louis' were not, and he was served regular milk instead.

"The system has now changed and we have a computer system," Hutchins said.

As well as this, nurses were unable to order or administer Louis an EpiPen because the Pen requires a prescription. "Nurses cannot prescribe. If it's not prescribed I can't administer it," Hutchins said.

In the time since Louis' death, Hutchins has pushed for this to change.

Speaking outside court, Louis' father, said "every day is a struggle" and the family wants answers.

"We continue to struggle every day with the emptiness, loss and circumstances surrounding his death," Simon Tate said, ABC reports.

"We strongly believe Louis' death never should have happened. Our hope is that this inquest not only provides us with the many answers we need and deserve, but that it closely examines food safety and anaphylaxis management protocols at Frankston Hospital."

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