The coroner’s court in Carrick-on-Shannon was also told the 29-year-old was not seen by a kidney specialist for 60 hours after being diagnosed with acute kidney failure at Sligo hospital.
Consultant anaesthetist Ronan O’Hare agreed that this was not an “appropriate response”. Later, under cross-examination by Adrienne Egan SC, for the HSE, the consultant said that this issue did not affect Mrs Kivlehan’s overall care.
ICU nurse Anne McWilliams, who accompanied Mrs Kivlehan to Belfast, recalled that when she came on duty that night, Dhara was drowsy and felt cold. An electric blanket had been placed on top of her. Her temperature was unrecordable. She agreed that was “very worrying” and showed that things had got significantly worse.
The Kivlehan family was told that she was being transferred to Belfast. Ambulance control was alerted as the patient was to be brought to Strandhill where the helicopter was based. “The midwife brought up a picture of the baby which I gave to Mrs Kivlehan,” said nurse McWilliams.
Asked whether the consultant Dr O’Hare, who also travelled in the helicopter, had told the winchman “it is only a matter of time” the nurse said she did not know. “My primary concern was Mrs Kivlehan and getting her onto the helicopter which was a task in itself”.
Dr O’Hare told the coroner Eamon MacGowan that he discussed Mrs Kivlehan’s condition on the phone with renal physician Austin Stack on September 23, 2010, the day before the transfer to Belfast. He told Dr Stack, who worked at both Letterkenny and Sligo hospitals, that he had a patient who was “very very ill” with significant renal failure. “He said he would see her the next day,” Dr O’Hare recalled.
Dr O’Hare said he did not know if Dr Stack came to Sligo on September 24 specifically to see Mrs Kivlehan or if he was due in the hospital that day.
She was put on haemo-dialysis after being seen by the renal consultant.
Dr O’Hare confirmed that he had told Michael Kivlehan on the afternoon of Friday, September 24, that it was likely his wife would die. He said she was extremely ill and there had been rapid deterioration on that day.
“It was my opinion that she would not survive and unfortunately that proved to be the outcome,” he told the jury of five men and two women.
Mrs Kivlehan died of multi-organ failure due to HELLP syndrome on September 28, 2010 at the Royal Victoria Hospital.
The consultant said there was no treatment per se for HELLP syndrome, apart from immediate delivery of the baby and Mes Kivlehan had already undergone the caesarean section.
He told Ms Egan that Mrs Kivlehan had been sitting in a chair chatting to staff in the ICU on the evening of September 23, 2010.
She had been “clinically quite well”. Referring to her deterioration the next day, he said “it was quite alarming and something your rarely see in the lifetime of a doctor”. Dr O’Hare said he believed the mortality rate from HELLP was one in 40,000.
He recalled that throughout that Friday he had discussions with ICU colleagues in a number of hospitals about the possibility of transferring the young mother. The consultant told the jury that there was no obstetrics ICU in Ireland because there were not enough cases to warrant it. He had sought advice from St Vincent’s hospital, the established liver centre in Ireland, “but they had no beds”. He contacted a number of other hospitals, including St James’s, the Mater, and hospitals in Galway and Cork and was told either they had no beds or could offer no treatment Sligo was not providing.
Dr O’Hare said that, given Mrs Kivlehan’s condition, there was also the risk of whether she would survive a journey of up to four hours. Paul Glover, an ICU consultant at Belfast’s Royal Victoria Hospital who first saw Mrs Kivlehan on the day she died, said he did not believe any of his colleagues would have accepted her as a patient if there was no chance of survival.
Pressed by Damien Tansey, solicitor for the Kivlehan family, on whether Mrs Kivlehan’s condition was inexorable with no hope when she was admitted to Belfast, Dr Glover said he did not think his colleagues would put her through the procedures if they felt it was “completely futile”.
Dr Glover said that by the time he saw her, Mrs Kivlehan had continued to develop multi-organ failure despite the therapies administered at the hospital. She had severe acute respiratory distress syndrome. Despite maximum medical support “the patient became asystolic and I declared Dhara Kivlehan dead at 14.10 on 28t September 2010”.
The inquest continues.