An "extreme" religious group was reported as a potential danger almost a decade before they killed a young girl by withholding her diabetes medication, a coroner has heard.
But authorities found no signs of harm after being alerted by the girl's older sister in 2013, an inquest was told.
Eight-year-old Elizabeth Rose Struhs died on January 7, 2022, 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 insulin shots for her type-1 diabetes days earlier.
Her sister Jayde Struhs on Monday attended the start of a coroner's inquest into the adequacy and appropriateness of the responses by child safety, health and other government agencies prior to Elizabeth's death.
Jayde Struhs knew nothing of what was going on at the time of her sister's death after fleeing the family home for Brisbane about eight years earlier, aged 16.
However, she triggered the Struhs family's first contact with child protection services in 2013, the coroner was told.
Jayde Struhs had told her school nurse her parents "had become involved in an extreme religion based on the Bible", counsel assisting Simon Hamlyn-Harris said on Monday.
He asked the first witness, a department of child safety manager who can't be named for legal reasons, about the initial contact with authorities.
"Jayde was concerned for herself and her siblings about the controlling nature of the religion, concerns about things she was required to believe?" he asked.
The manager agreed.
Elizabeth's mother Kerrie Struhs had been a member of "the Saints" for years and had refused to seek medical or dental treatment for her daughters, believing that God would heal them, the coroner heard.
Jayde Struhs was "at a point where she wanted to get out", Mr Hamlyn-Harris said.
But the manager said no harm was identified and the then-girl's report didn't amount to a "detrimental effect of significant nature" or require a child-safety notification.
The system had since changed, and staff now relied more on professional judgement than prescriptive guidelines, the coroner heard.
Elizabeth almost died in 2019 after her mother refused to seek treatment for the six-year-old's then-undiagnosed type-1 diabetes.
Her father eventually took his unconscious daughter to hospital but, by January 2022, had been convinced 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 Saints claimed Elizabeth would be healed or resurrected from death.
Elizabeth's parents in 2025 received 14-year jail terms at Brisbane Supreme Court after being found guilty of manslaughter.
The Saints leader Brendan Stevens was jailed for 13 years and described as a "highly dangerous individual" by Justice Martin Burns.
Coroner Ainslie Kirkegaard on Monday acknowledged the loss of Jayde Struhs and her family was made worse by public scrutiny, including through the inquest.
"However, this is an opportunity to identify how we could have better protected Elizabeth," she said.
The inquest is due to run for two weeks.
