A doctor involved in the care of a haemophiliac child who had an operation on his second birthday at Our Lady of Lourdes Hospital for Sick Children in Crumlin, Dublin, had intended the procedure "transform his life," an inquest has heard.
Pierce Nowlan, of Carrigmore Green, Saggart, Co Dublin, had an artery punctured during the procedure and died three days later from brain damage due to lack of oxygen on October 14th, 2004.
Pierce's parents, Stephen and Jean Nowlan, met Minister for Justice Michael McDowell and initiated an amendment to the Coroner's Act in December that allows for more than two medical practitioners to give evidence at any one inquest.
Prof Owen Smith, consultant paediatric haematologist at the hospital, told Dublin City Coroner's Court yesterday that Pierce urgently needed the procedure as he had reached the age of "bleeding mortality risk" for a haemophiliac. Prof Smith said that as Pierce had reached an age of "increased mobility" he was "sustaining more bleeds".
The operation to fit a device into one of Pierce's veins would have allowed the regular injection into his bloodstream of a clotting agent. Prof Smith said the operation "really transforms the life of these children".
Pierce had developed inhibitors, an antibody that attacks treatment that attempts to stop bleeding. As he had inhibitors, the operation to attach a device to one of his veins was made more complex and had rarely been undertaken at the hospital.
"He was one of the first with inhibitors who had the operation. This is a rare event," Prof Smith added.
During the procedure, Pierce's subclavian artery was punctured in the left side of his chest causing a bleed. As operating doctors were unable to fit the device to his subclavian vein, they managed to successfully perform open surgery and attach it to a vein in his neck.
Dr Mohamad Alagtal, who assisted the operation undertaken by Dr Alan Mortell and Dr Martina Healy, told the court yesterday that he saw fresh blood following the punctuation of the artery by Dr Healy. "Blood was coming back. She advanced the guide-wire." After a few attempts she stopped. At least on two occasions there was blood coming back. "It looked like arterial blood, fresh and bright," Dr Alagtal said.
Dr Mortell told the inquest last Thursday that while using a guide-wire Dr Healy directed "six to eight passes resulting in three or four punctures of vessels".Following the procedure, Pierce was rushed to the recovery room. In the hours following the procedure, an X-ray confirmed that he sustained a significant amount of internal bleeding in his chest. A blood chest drain was carried out, as were numerous blood transfusions. This resulted in Pierce losing one-and-a-half times his blood volume in the following hours.
Clinical nurse Deirdre Sweetman attended to Pierce in the recovery room and said it "was not normal to receive an unstable child in the recovery room".
She added that she noticed Pierce "was trying to open his eyes". Pierce sustained cardiac arrest at 9.35pm that night and despite aggressive resuscitation and cardiac massage he died three days later.
The inquest resumes today.