Kivlehan not seen by specialist for 60 hours after diagnosis

Dhara Kivlehan was not seen by a kidney specialist for 60 hours after being diagnosed with acute kidney failure at Sligo Regional Hospital, an inquest into her death heard yesterday.

Ms Kivlehan (29), who lived with her husband Michael in Dromahair, Co Leitrim, died at the Royal Victoria Hospital, Belfast in September 2010, a week after giving birth at the Sligo hospital.

Consultant anaesthetist Dr Ronan O’Hare agreed the delay in her being seen by the kidney specialist was not an “appropriate response”. However, under cross-examination by Adrienne Egan SC for the HSE, the consultant said this issue did not affect the patient’s overall care.

The Coroner’s Court in Carrick-on-Shannon heard Ms Kivlehan was given a photograph of her newborn baby Dior as she was about to be transferred from Sligo to Belfast, four days before she died.

ICU nurse Anne McWilliams recalled that when she came on duty that night the patient 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 her condition had got significantly worse.

Renal physician

Dr O’Hare told coroner Eamon MacGowan he discussed Ms Kivlehan’s condition on the telephone with renal physician Dr

Austin Stack

on September 23rd, 2010, the day before she was transferred to Belfast.

He told Dr Stack, who worked at both Letterkenny and Sligo hospitals, 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.

He said he did not know if Dr Stack came to Sligo on September 24th specifically to see Ms Kivlehan or if he was due in the hospital that day.

Ms Kivlehan was put on haemodialysis after being seen by the renal consultant.

Rapid deterioration

Dr O’Hare confirmed he had told

Michael Kivlehan

on the afternoon of Friday, September 24th 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.

Ms Kivlehan died of multi- organ failure due to HELLP syndrome on September 28th. The consultant said there was no treatment for the syndrome, apart from immediate delivery of the baby, and Ms Kivlehan had already undergone a Caesarean section. He said HELLP occurred in 0.5-0.9 per cent of pregnancies and was usually associated with severe pre-eclampsia.

He told Ms Egan that Ms Kivlehan had been sitting out in a chair chatting to staff in the ICU on the evening of September 23rd.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 said there was no obstetrics ICU in Ireland because there were not enough cases to warrant it. He contacted a number of hospitals in Dublin, Galway and Cork and was told either that they had no beds or could offer no treatment that Sligo was not providing. Dr O’Hare said it was eventually decided to move her to Belfast.

The inquest continues today.