Delay in reviewing blood test ‘a mistake’

A senior doctor who treated a woman who died from multi-organ failure days after a caesarean section has said a 12-hour delay in reviewing her first set of blood tests was a mistake.

Delay in reviewing blood test ‘a mistake’

Dhara Kivlehan, originally from India, died in Belfast’s Royal Victoria Hospital on September 28, 2010, after being airlifted from Sligo hospital where she had given birth and suffered a severe strain of pre- eclampsia.

The inquest at Carrick- on-Shannon courthouse was told a range of blood tests over the first 36 hours of her care examined 17 parameters and showed kidney failure and liver dysfunction.

The 29-year-old first-time mother was also suffering serious issues with her blood, such as clotting, according to the results.

Dr Raouf Sallam, a consultant obstetrician and gynaecologist, said that tests taken on her admission to Sligo on September 20, 2010, should have been reviewed as soon as possible.

“There’s an error happened here. These results should have been reviewed and acted upon,” he said.

The inquest heard blood samples were sent to the laboratory at 4.30pm on September 20, 2010, and were available on an internal computer system for doctors and nurses by 5.23pm.

They were not reviewed for 12 hours, according to medical records.

Dr Sallam said: “The normal circumstance is that if there’s a high suspicion of serious problems, these bloods should be traced quickly by whoever took them.”

The consultant, who went on to work at South Tipperary General Hospital, was in the theatre when the Kivlehan’s baby, Dior, who turned four last Sunday, was delivered by C-section.

He told the inquest the delivery was classed as a category two caesarean as there were concerns the mother’s or baby’s health was being compromised but there was no immediate threat to life.

Medics acted as though Mrs Kivlehan was suffering pre-eclampsia, which occurs in 15% of pregnancies, the inquest was told.

Mrs Kivlehan went on to suffer a severe variant called Hellp (haemolysis, elevated liver enzymes and low platelets) which occurs in 5 to 10% of pre-eclamptic pregnancies. The inquest heard the young mother showed signs of acute kidney failure and liver dysfunction on the day she had a caesarean section.

A midwife revealed that a registrar on the obstetrics team, Dr Hind Al Husain, wanted her concerns recorded that Mrs Kivlehan should be in the intensive care unit the day after the delivery.

“Dr Hind was anxious about the urinary output,” Mairéad Beirne said.

Lawyer for the Kivlehan family, Roger Murray told the inquest there was an “evidential lacuna” in relation to Dr Al Husain.

Ms Beirne, who cared only for Mrs Kivlehan on a one-to-one basis and her baby Dior on September 22, the day after the C-section, said she would have expected the young mother to have been transferred to intensive care but it was not her decision.

The inquest heard HSE guidelines state that a patient suffering with problems affecting two organs should be cared for in an intensive care unit. It was 4pm on September 22, when the transfer took place.

The midwife said she constantly tried to keep Mrs Kivlehan’s husband Michael informed about her care throughout the day, but said she was not aware of all thedetails of a conversation he had with a senior consultant, Dr Seamus Crowley.

Mr Kivlehan told the inquest on Monday that Dr Crowley said it was difficult to tell if Mrs Kivlehan was jaundiced from appearance because she was Indian.

The HSE claim his assessment was much more nuanced than being based on whether a patient had pale or dark skin.

The inquest is taking place in the week leading up to the fourth anniversary of Mrs Kivlehan’s death.

Her widower, 35-year-old Michael Kivlehan, from Dromahair, Co Leitrim, is attending the hearing with his parents.

A jury of five men and two women are hearing several days of evidence on how Mrs Kivlehan died.

Mr Kivlehan and his son were awarded almost €1m last year after the HSE apologised for shortcomings in the young mother’s care.

Twelve doctors and seven midwives were involved in Ms Kivlehan’s care in Sligo,as well as a number of doctors and nurses in Belfast.

Although Mrs Kivlehan died in Belfast, the inquest was moved to the Republic after Attorney General Máire Whelan intervened.

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