Mother denies guilt at disability led her to forget pregnancy risks advice

A WOMAN with a psychiatric illness has denied that “guilt” about her daughter being born with disabilities had led her to “expel from her mind” advice about risks to the foetus from the prescription drugs during pregnancy.

Had she been told there were serious risks to the foetus from Epilim (an anti-epileptic drug also used as a mood stabiliser), she would have ceased using it in pregnancy, Lisa McGillin said.

She was replying to questions in the continuing action by her daughter Rebecca, who was born in 2001 with a deformed hand and other disabilities consistent with Sodium Valproate Syndrome.

It is alleged that Rebecca, suing through her father Barry, Gainsborough Avenue, Malahide, Co Dublin, suffered the injuries as a result of negligent treatment of her mother Lisa by two doctors, consultant psychiatrist Prof Patricia Casey and obstetrician Dr Mary Holohan, relating to her pregnancy. The claims are denied.

Ms McGillin yesterday said she was not responsible for Rebecca’s injuries because she was given “incorrect treatment”. However, she still felt guilty about them and was in court because “someone is responsible”.

Mr Justice John Quirke said mothers always felt guilty when something happened to their children even when “not a shred of guilt” attached.

Pat Hanratty SC, for Dr Holohan, said no one was saying Ms McGillin was responsible, she was not, but he was suggesting her guilty feelings meant she had expelled from her mind the fact that she had been advised about the risks from Epilim. Ms McGillin said if she had been told to come off Epilim she would have done so, but she was not so advised.

She also denied it was “implausible” to say she would have stopped taking Epilim during pregnancy as she had resumed taking Lithium before the end of the first 12 weeks of pregnancy when she had prior information about risks to the foetus in the first three months from Lithium.

She said she had gone off Lithium at the outset of pregnancy but had a relapse of her illness before the first three months of pregnancy were over and had taken Lithium then after consulting with Prof Casey.

She said Prof Casey had not discussed with her a number of documents relating to the effects of Lithium in pregnancy. She agreed documents were posted to her by Prof Casey in September 1998 and in August 2000, a month after she became pregnant. She disagreed that it was clear from those documents that Lithium represented a danger in pregnancy.

She did not recognise one particular document about the effects of anti-epileptic drugs on the foetus allegedly sent to her in September 1998 and included in her file when it was sent to her solicitors by Prof Casey. She had informally discussed her medication with Prof Casey at every visit but did not discuss the documents, she said. She had trusted Prof Casey’s advice concerning her medication and also trusted Dr Holohan.

Before she became pregnant, Lithium was the drug Prof Casey and Dr Holohan were worried about but Prof Casey also told her there was new research on Lithium indicating it was not as dangerous as previously believed, she said.

She agreed that Dr Holohan, before her pregnancy, discussed with her the risks of heart valve defects and cleft palate from her medication. She also accepted she was mistaken in thinking the cleft palate issues related to Lithium rather than Epilim.

When Mr Hanratty said Dr Holohan would testify that she told Ms McGillin that Lithium was associated with an increased risk of congenital heart disease in the foetus, Ms McGillin said there was “very little made” of the heart valve issue.

She agreed it was a serious issue but said Prof Casey had told her it could be corrected by surgery. She agreed Dr Holohan had referred to a risk of Epstein’s anomaly from Lithium but she did not know that babies who had that condition would die within 10 years. She said Dr Holohan told her taking a high dose of folic acid meant Epilim would not be a problem.

Mr Hanratty said Dr Holohan would say she told Ms McGillin there was an increased risk of neural tube defects, cleft palate and cleft lip from Epilim and never said that risk would be negated by high doses of folic acid.

Ms McGillin also denied Mr Hanratty’s suggestion that hospital records showed she could not be correct in stating she had ceased taking all drugs four months into her pregnancy.

Dr Holohan would say that Ms McGillin was on Lithium and Epilim in December 2000, some six months into pregnancy, and that there was Epilim in her system when Rebecca was born in April 2001. Mr Hanratty also said hospital records of January 29th, 2001, showed a serum Lithium level in Ms McGillin’s blood consistent with her continuing to take Lithium.

Ms McGillin said she had been on Lithium for years and there could be “residues” in her system.

The case resumes on Tuesday.