The country's leading expert in maternity care says if Dhara Kivlehan was transferred earlier to a centre of excellence the outcome in her case 'may have been different'.

The Clinical Director of the National Maternity Hospital Dr Peter Boylan has described the delay in obtaining a specialist renal and liver consult as a material contributor in the 29-year-old's death in September 2010.

Citing the series of delays involved in the care of Mrs Kivlehan at Sligo General Hospital, Dr Boylan has told Sligo Leitrim Coroner’s Court that it is clear that there were unacceptable deficiencies in both her clinical care and at a systemic level.

However, chief among those concerns is a failure by staff in Sligo to consider the possibility of intra-abdominal bleeding following her emergency C-section.

In his statement to the court, he says had this been recognised and dealt with, and an earlier transfer organised, it remains possible that the outcome in this case may have been different. However, he has stipulated that this remains conjecture.

He has described her case as very complicated because, on presentation, she did not show classical symptoms of either PE or HELLP.

He agreed that the emergency C-section was a reasonable course of action but said that afterwards, the fact that all of her problems were attributed to HELLP syndrome was a deficit in her care.

He said it is unacceptable that a liver consult was never sought during Ms Kivlehan’s treatment in Sligo and that ideally staff should have sought a transfer to a centre of excellence straight after delivery.

Dr Boylan has also pointed directly to the lack of intensive care beds at centres of excellence in Dublin and Galway as a key failure, as well as the lack of continuity of care at consultant level which he says is due to insufficient numbers of obstetric consultants on staff at Sligo General Hospital.

Inquest

Last week, the inquest heard evidence of a sequence of delays in the care of the 29 year old, including a 12-hour delay before her first set of blood tests results were accessed after admission; an eight-hour delay before she was transferred into ICU; and a 60-hour delay from when it was queried that she was entering renal failure until she was seen by a kidney specialist.

The court also heard that Ms Kivlehan received an increase in specialised one-to-one level of care following her emergency C-section, even though she was still not in the ICU due to a bed shortage at the time.

On Friday, Consultant Anaesthetist and Critical Care specialist Dr Seamus Crowley said he believes Mrs Kivlehan was suffering from an ongoing "acute kidney injury" but would not agree with the use of the word "failure" to describe it.

The inquest also heard of a number of angry exchanges between Dhara's husband Michael and doctors and nurses at Sligo General Hospital.

Following evidence from the expert witness today, Sligo Leitrim Coroner Eamon MacGowan is expected to hear summary statements from the legal teams present – representing the Kivlehan family and the HSE. The jury is then expected to consider their verdict.

Originally posted at 8:56am