Inquest told of child's catastrophic blood loss

A young haemophiliac lost one and a half times his blood count following surgery on his second birthday, it emerged tonight.

Pierce Nowlan had 1,200 millilitres of fluid drained from his chest after medics punctured an artery while trying to insert a canula, an inquest heard.

Dublin City Coroner’s Court heard the little boy – who received five units of blood – normally carried just 875mls of blood.

Pierce was admitted to Our Lady’s Hospital for Sick Children, Crumlin, on October 11, 2004, to have a device fitted into a vein that would have allowed the regular injection of a blood-clotting agent.

During the procedure the subclavian vein, on the left side of his chest, was inadvertently punctured, causing internal bleeding which went unnoticed for over an hour.

The oxygen flow to his brain was adversely impacted, leaving him brain damaged. He died three days later.

Paediatric surgeon Dr Alan Mortell had no concerns over the child’s welfare during surgery, the inquest heard.

He said he had carried out the procedure a number of times and had no evidence the toddler was in difficulty during or after the procedure. He also had no knowledge of any concerns over the child’s blood pressure or blood gas levels or told of any bleeding from the puncture wound.

Coroner Dr Brian Farrell heard that six to eight attempts were made on the vein in the child’s chest by consultant anaesthetist Dr Martina Healy, but were unsuccessful.

Dr Mortell said he was aware at least one hit had punctured the chest vein, but pressure had been applied to it for five minutes. A line was instead successfully entered into the jugular vein in the neck.

Records by the anaesthetist taken during the procedure, referred to at the hearing, revealed changes in Pierce’s vitals and a bleed.

“I didn’t have any indication he was in serious difficulty at the time I left,” said Dr Mortell. "The procedure in my mind had gone according to plan apart from one artery hit. I was not aware of him being in any serious condition when I left the theatre.”

Surgical registrar Feilim Murphy was called to the recovery room to care for Pierce and within 10 minutes 600mls of blood was drained from the left side of the youngster’s chest.

Pierce, who he described as being “obviously unwell” had suffered a cardiac arrest, with internal cardiac massage and aggressive resuscitation carried out to save the youngster.

Professor Martin Corbally, who was in charge of Pierce’s care, did not carry out the surgery but said he had successfully completed vascular access procedures before and had never come across such complications.

The consultant paediatric surgeon said he had complete confidence in Dr Mortell, but denied ever being told by Dr Healy that she had punctured the youngster’s artery.

Within hours the child’s condition worsened dramatically with the surgical team forced to carry out a thorocotomy. More than 1,200mls of blood had been drained from his chest.

“I would not have left the hospital if I was told any patient was ill or needed my attention,” said Prof. Corbally, who returned to the hospital shortly after 9pm to see to Pierce.

“Pierce lost a significant amount of blood, but that was replaced with five units of blood and two and a half litres of fluid.

“There is no such thing as minor surgery, especially with haemophilia.”

The inquest is being held in full after Pierce’s parents Stephen and Jean Nowlan, of Carrigmore Green, Saggart, Co Dublin, called on Minister for Justice Michael McDowell to change legislation that restricted the coroner to call in just two medical witnesses in any one case, including a pathologist.

An amendment to the Coroner’s Act followed last December, allowing for more than two medical practitioners to give evidence at an inquest.

More medical witnesses will give evidence when the inquest resumes next week.