A man was confrontational and angry when he sought answers over why his seriously ill wife was not in intensive care six days before she died, a senior doctor told the inquest into her death.
Dhara Kivlehan, 29 and 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 a week earlier and suffered a severe strain of pre-eclampsia.
The inquest at Carrick-on-Shannon courthouse heard consultant anaesthetist Dr Seamus Crowley spoke to husband Michael on the maternity ward the day after she underwent an emergency Caesarian section.
Dr Crowley said he openly questioned if Mrs Kivlehan could have partial Hellp syndrome – the severe and rare variant of pre-eclampsia she was ultimately diagnosed with – 24 hours after the birth of baby Dior.
The consultant said the confrontation with Mr Kivlehan took place as he was discussing case his wife’s case with two other doctors from the obstetrics team, Dr Hind Al Husain and Dr Raouf Sallam.
“I noted his demeanour was confrontational and angry and had tried to explain to Mr Kivlehan that there was no immediate acute indication to admit Mrs Kivlehan to the ICU,” Dr Crowley told the inquest.
The consultant said he had been called to the maternity ward to assess Mrs Kivlehan for admission to ICU and what potential other treatments she needed.
Mr Kivlehan claimed at the opening of the inquest on Monday that Dr Crowley had told him it was difficult to tell if his wife was jaundiced from her appearance because she was Indian.
The Health Service Executive (HSE) said his assessment was much more nuanced than being based on whether a patient had pale or dark skin.
Dr Crowley told the hearing he directed Mrs Kivlehan be cared for on the maternity ward with regular observations and blood tests taken.
“I noted Mr Kivlehan had made frequent references to not trusting doctors and that he had spent time at King’s College Hospital which he said enabled him to understand the blood test results,” the doctor said.
Mr Kivlehan, 35, from Dromahair, Co Leitrim, had been treated in the London hospital for several months a few years earlier after suffering injuries in a road accident while living in the UK.
In his statement to the inquest, Dr Crowley added: “He accused me of patronising him when I openly questioned what ICU care would have to offer over the current care that she was receiving on the ward.”
The consultant said he tried to reassure Mr Kivlehan that he was “simply thinking out loud” to inform him of his thoughts.
“I noted that I was misled by Mr Kivlehan’s attitude and was provoked to ask if he was a nurse or paramedic,” Dr Crowley said.
The consultant said he would agree Mrs Kivlehan was suffering an “ongoing acute kidney injury” on September 22 – the day after the C-section.
Dr Crowley said kidney failure was a diffuse term that he would not use at that stage.
Mrs Kivlehan was battling five problems including kidney failure, liver dysfunction and issues with her blood, water and urine in the days after the C-section.
The inquest heard HSE guidelines state that a patient suffering with problems affecting two organs should be cared for in an intensive care unit.
Mrs Kivlehan’s widower is attending the hearing with his mother and father, Michael Senior and Susan.
The couple’s son Dior had his fourth birthday on Sunday.
A jury of five men and two women are hearing several days of evidence on how his wife died.
Mr Kivlehan and his son were awarded almost €1m last year after the Health Service Executive (HSE) apologised for shortcomings in her 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 of Ireland after Attorney General Maire Whelan intervened to ask Belfast coroner Dr John Leckey if he would agree to a change in jurisdiction.
Ms Kivlehan was suffering from the severe variant of pre-eclampsia called Hellp (Haemolysis, Elevated Liver Enzymes and Low Platelets) in Sligo.
The results of blood tests taken the afternoon she was admitted on September 20 2010, which showed “grossly abnormal liver function and grossly abnormal kidney function”, were not followed up by her doctors or reported back by the laboratory for another 12 hours.
Baby Dior was delivered by C-section shortly before 6am the following day.