A haemophiliac child lost one-and-a-half times his blood volume following a routine operation on his second birthday at Our Lady of Lourdes Hospital for Sick Children in Crumlin, Dublin, an inquest has heard.
Pierce Nowlan, of Carrigmore Green, Saggart, Co Dublin, had an artery punctured during the procedure and died three days later from brain damage due to lack of oxygen on October 14th, 2004.
Pierce's parents, Stephen and Jean Nowlan, met with Minister for Justice Michael McDowell and initiated an amendment to the Coroner's Act in December that allows for more than two medical practitioners to give evidence at any one inquest.
Some 23 medical clinicians were involved in the care of Pierce. The most senior consultant involved in Pierce's care told Dublin City Coroner's Court yesterday that he was not immediately informed by medical staff about the punctured artery.
He said he would not have left the hospital had he known. "I was not made aware of any such problem. I would not have left the hospital if I thought anything needed my attention," said Prof Martin Corbally, consultant paediatric surgeon at Crumlin hospital.
Dr Alan Mortell told the court he had no concerns for Pierce's welfare following the puncturing of one of his arteries during a procedure he undertook with Dr Martina Healy. "I was aware of the punctuation but not made aware of any concerns during the procedure about bleeding."
Dr Mortell and Dr Healy were attempting to fit a device into one of Pierce's veins which would have allowed the regular injection into his blood stream of a clotting agent. But during the procedure his subclavian artery was punctured in the left side of his chest causing a bleed.
"It resulted in three or four punctures," Dr Mortell added. As the two doctors were unable to fit the device to his subclavian vein, they managed to successfully perform open surgery and attach it to a vein in his neck. Dr Mortell said that punctuation of arteries would occur "fairly frequently" during such a procedure and rarely resulted in serious consequences. Prof Corbally told the court he had carried out the procedure "thousands of times" and only a small fraction of cases "would result in fatal consequences".
However, when questioned by Raymond Bradley, solicitor for the Nowlan family, he said it was "probably true" that because Pierce was a haemophiliac he would be at higher risk.
"There is no such thing as a minor operation if you are a haemophiliac," he said.
Dr Mortell said he was unsure whether he informed Prof Corbally about the punctuation.
In the hours following the procedure, an X-ray confirmed that Pierce sustained a significant amount of internal bleeding in his chest. Dr Healy asked the advice of consultant surgeon Freddie Wood. "I advised a chest drain straight away," he said. Mr Wood added that Dr Healy expressed concern over this advice. But about 30 minutes later following consultation with Prof Corbally, surgical registrar Felim Murphy, on Dr Healy's direction, carried out the chest drain, the court heard.
Aware of the situation, Prof Corbally then returned to the hospital. "When I got back, approximately 1,200ml of blood had been drained. He'd lost one-and-a-half times his blood volume," Prof Corbally said. Pierce had received a number of blood and fluid transfusions.
Many more medical witnesses will be heard before the resumed inquest next Thursday.