Inquest sought into death after childbirth

The widower of an Indian national who died in 2010 at the Royal Victoria Hospital in Belfast, one week after giving birth at Sligo General Hospital, has written to the Attorney General asking for a direction to the Sligo coroner to hold an inquest into her death.

Michael Kivlehan, from Dromohair, Co Leitrim, is alleging 23 counts of negligence in the care of his late wife, Dhara Kivlehan, at the hospital in September 2010. Through his solicitor he filed a personal injuries summons in the High Court in November 2011 against the Health Service Executive. The HSE filed its defence in February this year, rejecting the claims.

Dhara Kivlehan, nee Shandhu (28), originally from Gujarat in northwestern India, was due to have her first baby at Sligo General Hospital on September 10th, 2010.

She was first admitted to the Sligo hospital on August 15th, 2010, with decreased foetal movement and abdominal and back pain. She was discharged two days later and seen a number of times as an outpatient.

The summons against the HSE, which draws on Mrs Kivlehan's medical notes, states that she went over her due date and on September 16th, 2010 was booked for induction of labour on September 22nd. She was admitted on September 20th with swollen lower limbs and severe abdominal and back pain. According to the summons, she was by then showing signs of "severe pre-eclampsia".

Abdominal pain
With worsening abdominal pain she was transferred to the delivery suite at 2am on September 22nd. At 5.25am her son, Dior, was born by emergency caesarean section. She was returned to the maternity ward at about 10.15 am, and was, according to notes, "confused and hypotensive" with an elevated pulse. Transfer to the intensive care unit (ICU) was requested "if possible", according to the notes.

A “raised white cell count” was recorded that afternoon, according to the notes, and antibiotics were commenced. “A diagnosis of pregnancy-related renal failure and HELLP syndrome was made.”

HELLP is a life-threatening obstetric complication, usually a severe complication of pre-eclampsia.

At 4.45pm on September 24th, 2010, according to the notes, she was transferred to ICU. At 7.30pm, she was seen by a consultant anaesthetist who “noted that she continued to deteriorate”.

“Diagnosis was of HELLP syndrome with haemolysis, acute renal failure, hyponutremia, gross oedema and ascites,” according to the notes.

She was transferred by air to the Royal Victoria Hospital in Belfast, late on the evening of September 24th.

“By that stage she was seriously ill” and despite intensive efforts she died on the afternoon of September 28th, 2010.

Among the negligences alleged in Ms Kivlehan’s care at Sligo General Hospital are failure to diagnose pre-eclampsia and HELLP syndrome at the earliest opportunity; failure to react to blood test results when they became available; failure to realise the need for immediate delivery of the baby on the afternoon of September20th, 2010; failure to react to indications of renal failure; and failure to have Dhara seen by doctors of sufficient expertise.

Mr Kivlehan, originally from Dromohair, had met Dhara Shandhu in London in 2001 where she was studying fashion design. He was a businessman working in several continents. They married and moved back to Dromohair in 2008. She was a senior sales manager with the fashion retailer Next in Sligo and had just been appointed store manager before she died.

Although an inquest was initially expected to be held in Belfast in June 2011, Dr John Lecky, the senior coroner for Northern Ireland, wrote to Mr Kivlehan with his view there was no need for an inquest as by the time Ms Kivlehan had been transferred into Northern Ireland her death was as a result of natural causes.

Roger Murray, solicitor for Mr Kivlehan, has since made "repeated requests" to the coroner for Sligo/Leitrim, Dr Desmond Moran, to hold an inquest into Mr Kivlehan's wife's death, with no reply.

“In the last seven months we have written to him seven times, on the following dates: November 15th, 2012, January 29th, 2013, February 7th, 2013, March 15th, 2013, April 3th, 2013, April 18th, 2013, and April 30th, 2013,” said Mr Murray. He has now written to the Attorney General requesting that her office directs an inquest to be held.

Dr Moran, when contacted by The Irish Times , said: "She didn't die in my area. I am going through the file." Asked whether the fact that she died outside Sligo/Leitrim meant he could not hold an inquest, he said: "I'm not saying that. I can't comment any further."

Precedents
The 1962 Coroners Act is silent on whether an inquest may or may not be held in cases where a death takes place outside the coroner's area. There have, however, been precedents for such inquests. In March 2009 Dublin coroner's court heard an inquest into the death of Andrew Hanlon (20), who had been shot dead in Oregon, USA, the previous year.

A spokesman for the Attorney General's office confirmed Mr Kivlehan's request for a direction to the Sligo coroner had been received.

Legal proceedings
A HSE spokesman said the executive could not comment on the case as it was a subject of legal proceedings.

Mr Kivlehan said that, although his two-year-old son was “beautiful and well”, he felt his life had been “destroyed” by the loss of his wife.

He has had to give up work to look after his son. The house he and Dhara had bought and were renovating in Dromohair lies unfinished and he and Dior live behind it in a mobile home. His only income is a widow’s pension. “I just want to bring Dior to India. I’m ready to go, but I can’t leave until we have the inquest and find out what happened.”