The specialist who treated 10-year-old Tamar Stitt's liver tumour has revealed the young girl's mother never spoke to doctors at Princess Margaret Hospital again after the cancer diagnosis was confirmed.
Tamar died in November 2009, two months after her parents Trevor and Arely took her to El Salvador in defiance of doctors in Perth, who told them the girl would die without the treatment.
Instead, they began alternative therapies in South America, including placing red clay on her body and administering dandelion tea.
WA health authorities had attempted to have a court order chemotherapy for Tamar, but her mother Arely took her to South America on the eve of the scheduled court hearing.
An inquest is being held to probe how Tamar died, and whether the chemotherapy could have saved her.
Giving evidence, Dr Angela Alessandri said at just the second meeting with experts after Tamar's admission to hospital, the Stitts questioned what would happen if they refused chemotherapy.
From then until Tamar left the country, Mrs Stitt never spoke to Dr Alessandri again.
"I stressed very clearly (to Mr Stitt) that without chemotherapy and surgery Tamar would not survive," Dr Alessandri said.
"I felt very uncomfortable not being able to talk to Mrs Stitt again, at all."
After starting their daughter on a series of herbal remedies including Triplex and Golden Seal, Tamar's father told Dr Alessandri his wife was very opposed to chemotherapy treatment.
Despite repeated urgings - and being told Tamar had a 50 per cent chance of survival with chemotherapy - her parents continued to refuse the drugs.
The inquest continues.