Punctured artery lead to two-year-old's hospital death

A two-year-old boy, who was a severe haemophiliac, died as a result of heavy blood loss when an artery was punctured in a hospital operation, an inquest heard tonight.

Stephen Nowlan, the father of Pierce, said the consultant anaesthetist told him afterwards that she would not have carried out the procedure to insert the device the same way if she had known he was a severe haemophiliac.

However, Dr Martina Healy, who carried out part of the procedure, at Our Lady’s Hospital for Sick Children in Crumlin, to insert an implantation device into a vein for the administration of a clotting agent, said she knew Pierce suffered from the blood clotting problem before the operation.

Mr Nowlan, who is from Carrigmore Green, Saggart, Co Dublin said: “Dr Healy came up and introduced herself she said she was very sorry nothing like this had ever happened before, she said if she had known he was a severe haemophiliac she would have done it a different way.”

He told the Dublin City Coroner’s Court: “Then she started explaining what way she would have done it. I remember it distinctly.”

He added: “It is only a pity that I hadn’t a video camera.”

Mr Nowlan, who was accompanied by his wife Jean, told the inquest the operation was carried out on Pierce on October 11, 2004 – the date of his second birthday.

The court heard a statement from Professor Martin Corbally, who was associate professor of paediatric surgery at the hospital, was carrying out an operation on a neo-natal patient at the time Pierce was brought down to surgery.

Prof Corbally said another doctor performed the surgery on Pierce, and he said the anaesthetist was also involved as they have practice in the procedure.

“It is our normal practice to ask the consultant anaesthetist to insert it,” he said.

Dr Healy said it was not her decision to do the operation through the “blind” procedure, where a needle is inserted into the chest to find the subclavian vein.

Prof Corbally said he went into the operating theatre on two or more occasions and looked over the other surgeon’s shoulder. He claimed he was not aware there was damage to another blood vessel during the operation.

Dr Healy said she believed that Prof Corbally was aware of the puncturing of the subclavian artery during the operation before he left the hospital.

She said the inadvertent puncture of the artery would occur in around one out of every 35 of these type of operations.

Dr Healy said the team became aware the artery had been ruptured but Pierce had not shown any major signs of difficulties until afterwards in the recovery room.

She said after the operation the two-year-old was pale and she was concerned there was ongoing bleeding into the chest area.

A barrister for the Nowlan family queried why it took over an hour, or until around 7.55pm, for Pierce’s chest to be drained after another consultant had recommended it.

Dr Healy said it was up to the surgical team to insert the chest drain.

However, despite several units of blood being administered the boy’s condition continued to deteriorate and he suffered a heart attack at around 9.30pm. He was declared brain dead three days later on October 14, 2004.

Dr Healy said that following Pierce’s death the hospital carried out an internal and external review and decided not to use this approach to the procedure in haemophiliacs.

The pathologist, Dr Michael McDermott, told the inquest that the two-year-old had died from brain damage as a result of major blood loss as a consequence of an artery being punctured during a procedure three days earlier.

He said a small puncture wound, around one millimetre in size, was found in the sub-clavian artery and there was a haemorrhage around the area.

The coroner, Dr Brian Farrell, said Pierce’s case illustrated the difficulties with the current legislation around medical inquests, which allow only two medical practitioners to give evidence.

A barrister for the Nowlan family had said this raised difficulties with the inquest, as there were 23 medical practitioners involved in the case.

“I would ask again an amendment be brought forward by the Government to abolish the restrictions as soon as possible,” the coroner said, as he adjourned the case.