Eight-year-old Elizabeth Rose Struhs died at her family's home near Toowoomba, west of Brisbane, after her parents, brother and 11 other members of "the Saints" church group gathered to pray around her.
Her father, Jason Richard Struhs, had stopped administering her insulin shots days earlier.
A coroners inquest started on Monday into the adequacy and appropriateness of the responses by child safety, health and other government agencies prior to Elizabeth's death on January 7, 2022.
Elizabeth was "minutes from death" when airlifted to Brisbane Children's Hospital in July 2019 after her mother Kerrie Struhs refused to seek treatment for her ill six-year-old, a pediatrician testified.
The girl was subsequently diagnosed with type-1 diabetes.
The pediatrician, who cannot be named for legal reasons, said she had been stonewalled by Queensland's child protection authority over concerns Elizabeth faced "extreme risk of harm including death" if returned to a mother who rejected medical science.
"Elizabeth was in a comatose state and very near to death," the pediatrician said.
Elizabeth's endocrinologist had reported to Child Safety that the mother believed her daughter would be cured of diabetes and would not need insulin to stay alive, the coroner heard.
"It is a life-threatening condition ... if the mother continues to deny treatment, she cannot be in Kerrie's care," the endocrinologist said.
The mother had been a member of "the Saints" for years and had a history of refusing to seek medical or dental treatment for Elizabeth, the coroner heard.
The pediatrician said Child Safety had not received the endocrinologist's report but were aware of its contents when they decided to return Elizabeth home.
She said officials were "stuck on" the idea that Elizabeth would also be cared for by her father, who at the time had not joined the cult.
The two medical specialists saw Jason Richard Struhs as "weak" in the face of pressure from the Saints, the pediatrician testified
The safety plan drawn up by Child Safety relied on the then-six-year-old girl identifying herself if she was unwell, the inquest was told.
"It's not developmentally appropriate", the pediatrician said.
Jason Struhs agreed to a diabetes treatment plan but by January 2022 had been convinced by his wife and the Saints to stop Elizabeth's insulin.
Elizabeth rapidly became unwell, was unable to speak and fell into unconsciousness.
She died on a mattress on her living room floor after her parents and 12 other Saints members gathered around her to pray and sing.
The coroner also heard of an earlier opportunity for officials to intervene, after older sister Jayde Struhs triggered the Struhs family's first contact with child protection services in 2013.
Jayde told her school nurse her parents had become involved in an extreme religion based on the Bible, counsel assisting Simon Hamlyn-Harris said.
A Child Safety manager giving evidence on Monday agreed the then-teenager was concerned for herself and her siblings "about the controlling nature of the religion (and) concerns about things she was required to believe".
Jayde was at a point where she "wanted to get out", Mr Hamlyn-Harris said.
But the manager said no harm was identified.
The system had since changed, and staff now relied more on professional judgement than prescriptive guidelines, the coroner heard.
Jayde fled the family home a year later but remained in contact with her younger sister.
Coroner Ainslie Kirkegaard on Monday acknowledged the loss for Jayde and her family was made worse by public scrutiny, including through the inquest.
Elizabeth's parents are serving 14-year jail terms after they, along with Saints leader Brendan Stevens and 11 others, were found guilty of manslaughter in 2025.
The inquest is due to run for two weeks.
