Husband 'lost light of his life'
A widower whose wife died days after giving birth has told an inquest into her death he has lost the light of his life.
Dhara Kivlehan, 28 and originally from India, died from multi-organ failure in Belfast's Royal Victoria Hospital on 28 September 2010 after suffering a severe strain of pre-eclampsia.
She had been airlifted four days earlier from Sligo General Hospital.
As the full inquest into her death opened in Carrick-on-Shannon courthouse, Michael Kivlehan, 34, revealed the devastation his wife's death has wreaked on him personally as he raises their son Dior.
In a statement read to the hearing, Mr Kivlehan said: "I lost the light of my life the day Dhara died.
"I do my best to raise Dior as a single dad but it's difficult."
A week shy of the four-year anniversary of his wife's death, and a day after their son's fourth birthday, Mr Kivlehan added from the witness box: "I need and Dior deserves answers to how Dhara died."
A jury of five men and two women have been sworn in to hear several days of evidence on how Mrs Kivlehan died.
The jury heard the couple met while Mr Kivlehan was working in real estate in London and Dhara was studying fashion.
They moved to Co Leitrim for a quieter way of life and married in 2005 and planned to raise their family near where Mr Kivlehan was brought up in Dromahair, the inquest heard.
The couple ate only organic food, exercised regularly and neither of them drank or smoked, Mr Kivlehan said.
"It's very important to me personally and for Dhara to know what happened to his mother and my wife in Sligo General Hospital," Mr Kivlehan told the inquest.
"I have had no answers of how our care was then, or now to this day.
"The ordeal I went through myself as a single dad, a first time dad - I, hand on heart, would not like any other man or child to be put in the same position and then left to deal with it."
Mr Kivlehan and Dior were awarded almost one million euro last year after the Health Service Executive (HSE) apologised for shortcomings in the young mother's care.
He criticised the four-year delay in the inquest taking place.
Mr Kivlehan added: "It's left a very bitter taste in my mouth, the struggle we have had just to get any bits of information of our care."
He told the jury his wife was unrecognisable in the days before she was airlifted from Sligo to the Royal in Belfast.
Mr Kivlehan told the hearing that he told a senior doctor involved in her care in Sligo, Dr Seamus Crowley, that he believed his wife was jaundiced.
He said her entire body was swollen in the days after she underwent a caesarean section, that her skin was yellow and that her eyes were "the colour of a budgie".
Mr Kivlehan said he had been told his wife would be taken to intensive care after the birth but was instead moved to a darkened maternity ward.
Adrienne Egan, senior counsel for the HSE, told the inquest Mrs Kivlehan was receiving "higher care" in the days after the birth.
She said this involved being cared for in a room beside the nurses' station, a dedicated nurse to look after her, blood tests every three hours and observations every hour.
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 amid concern that medics from Sligo could not be compelled north of the border, and after attorney general Maire Whelan intervened to ask Belfast coroner Dr John Leckey if he would agree to a change in jurisdiction.
Mrs Kivlehan was suffering from a 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.
The inquest also heard Mr Kivlehan asked Dr Crowley about his wife's condition and the possibility that she had become jaundiced after the C-section.
"He (Dr Crowley) said it was difficult to tell (jaundice) if someone is Indian. I was too stunned to respond," Mr Kivlehan said.
Ms Egan, for the HSE, told the inquest that Dr Crowley's assessment was much more nuanced than whether a patient had pale or dark skin.
She said tests for billirubin, which identifies damage to the liver, had been ordered which would be more conclusive than a physical examination of a patient's skin.
Mr Kivlehan told the hearing that his only objection to the treatment administered by Dr Crowley was his demeanour and that he initially ignored him and patronised him.
The widower said he felt that he had been ignored to the point that Dr Crowley "mistook me for the parish priest".
"He ignored me, he refused to give me his name. He seemed to be a very high authority figure and didn't seem to want to answer my questions," Mr Kivlehan said.
"The way I was spoken to by that man, I'm woken up many times by it."
Mr Kivlehan added: "The only concern I had was the way the man spoke to me."
The inquest heard detail of the autopsy which concluded that Mrs Kivlehan died from multiple organ failure following a clinical diagnosis of the Hellp syndrome.
Dr Brian Herron, a pathologist with the Belfast Trust hospital group and 27 years medical experience who compiled the post mortem report, told the hearing he had never seen a case before.
The inquest heard the mortality rate for the condition is less than 1% and Dr Herron suggested he was only aware of three or four investigations into cases of Hellp in the last 10 years.
"I've never heard of one in Northern Ireland, there are very few cases in maternal deaths I presume in the Republic and in Northern Ireland," Dr Herron said.
Dr Herron said he could not determine if liver failure had caused kidney failure or if damage to one organ could have caused damage in another.
Catherine Mulhern, a midwife with 17 years experience including 12 years working in Sligo General, told the inquest she cared for Mrs Kivlehan when she was moved into the labour ward at 2.20am on September 21.
Ms Mulhern said she assessed Mrs Kivlehan and gave her the pain killer pethidine, commonly used for women in labour, and a drug to stop her vomiting before checking the results of blood tests ordered on admission.
Several tests on the first set of blood samples had revealed serious issues with Mrs Kivlehan's liver, the inquest heard.
Ms Mulhern said she has subsequently learned that pethidine should not be administered where there is liver disease.
The inquest heard that the HSE claim that Ms Mulhern was not in possession of the first set of blood test results when she administered the pain killer.
The midwife also said she took blood samples for a new set of tests after checking the first results.
"I felt that we needed a more recent picture of the bloods again seeing as the ones we had were of the previous day," Ms Mulhern said.
The inquest also heard that a doctor who was involved in Mrs Kivlehan's care in Sligo cannot be located to give evidence at the hearing.
Ms Mulhern agreed that Mrs Kivlehan was dangerously ill when she was being cared for in the labour ward and that it would have been normal for the doctor who ordered blood tests to examine the results.
"It's normal for the doctor to look up blood results, they need to be looked up," the midwife said.
Ms Mulhern said all the usual signals of pre-eclampsia were not evident when Mrs Kivlehan was brought under her care including blood pressure, protein in the urine, headaches, gastric pain and visual disturbances.
She said that in 2010 the normal procedure when a pregnant woman was facing a potential diagnosis of Hellp was to deliver the baby and administer a dose of magnesium sulphate.
The inquest also heard, however, that the medicine can cause a build-up of magnesium in a patient's system if they are suffering kidney problems.
The blood tests carried out on Mrs Kivlehan's admission indicated both kidney and liver issues.
Other tests which would have identified a build-up of magnesium were not carried out until 30 hours after the medicine was administered, the inquest heard.
The hearing resumes on Wednesday with at least another 12 witnesses to give evidence.