Staff at Sligo Regional Hospital tried in vain to find a bed for Dhara Kivlehan at a number of hospitals before she was airlifted to Belfast’s Royal Victoria hospital, an inquest into her death heard in Carrick-on- Shannon yesterday.
Ms Kivlehan died in Belfast from multi-organ failure related to Hellp, a syndrome associated with severe pre-eclampsia, on September 28th, 2010, a week after her baby, son Dior, was born in the Sligo hospital.
From India, Ms Kivlehan lived in Dromahair, Co Leitrim, with her husband Michael.
Roger Murray, solicitor for the Kivlehan family, put it to consultant obstetrician Dr Raoulf Sallam that Ms Kivlehan was “at death’s door” when she was airlifted from Sligo to Belfast and asked why she was not transferred for 36 hours after full-blown Hellp syndrome was diagnosed in Sligo.
No bed in ICU
Dr Sallam said efforts had been made on September 24th to transfer the 29-year-old to a specialist unit but there was no bed in Dublin, Cork and Galway. She went to Belfast by helicopter at 11pm.
A jury of five men and two women heard there was no bed in the intensive unit in Sligo for Ms Kivlehan when her baby was delivered by Caesarean section early on September 21st.
Dr Sallam said the plan was the new mother would recover in ICU but, as there wasn’t a bed, she had one-to-one care in the maternity ward.
The consultant said when he saw her at 8.15am on September 22nd, he requested she go to ICU but she was not moved there for almost eight hours.
Asked why it took so long for the transfer to Belfast, Dr Sallam said it was up to the ICU consultant to transfer her. He agreed he had co-responsibility for her after she went to ICU.
He disputed that he had told Michael Kivlehan that everything had been done that could be done for Ms Kivlehan by the obstetrics team in Sligo, but that he was unhappy with what had been done in ICU.
Mr Murray put it to Dr Sallam that the Kivlehan family had been given to understand that because Ms Kivlehan was not transferred until late on September 29th a chance had been lost and that Ms Kivlehan, who suffered multi-organ failure, was “beyond repair”.
The consultant said it was “difficult to judge these things”.
In his evidence Dr Sallam said it was an “error” that blood tests taken when Ms Kivlehan was admitted on September 20th were not reviewed for 12 hours. He said under normal circumstances, if there was a high suspicion of serious problems, results should be traced quickly by whoever took them.
Results showed Ms Kivlehan was battling kidney failure, liver dysfunction and had issues with blood clotting and urine. In a statement Dr Sallam said that at 4.10am on September 21st, he was contacted by a registrar who told him Ms Kivlehan was in early labour but had “significantly abnormal” liver function results. He asked for an urgent repeat of the blood tests.
Although she did not have protein in her urine, a pre-eclampsia symptom, she was treated as having it and given magnesium sulphate.
Repeat tests showed deterioration of kidney and liver and the consultant said he asked the registrar to discuss delivery by Caesarean with Ms Kivlehan and her husband. Their son was delivered just before 6am on September 21st. Dr Sallam said abnormal blood results can resolve after delivery.
Earlier coroner Eamon MacGowan heard that obstetric registrar Dr Hind Al Husain found Ms Kivlehan was in acute renal failure on September 22nd, six days before her death.
The coroner’s court heard that Dr Hind asked a midwife at 1pm that day to record that she was anxious that Ms Kivlehan be transferred to the ICU .
Blurred vision
Midwife Maireád Beirne was assigned to give one-to-one care to Ms Kivlehan. She said Ms Kivlehan “was too drowsy to hold the baby”. Midwife Geraldine Melvin said when she relieved Ms Beirne that morning Ms Kivlehan appeared very weak and complained of blurred vision.
Mr Kivlehan and his son were awarded €800,000 last year after the HSE apologised for shortcomings in care.
The inquest continues today.
