Doctor breaks down at inquest into Tatenda Mukwata's death at Kerry hospital
At Tatenda After Died A 21 Baby Healthy Kerry April Who Birth University To Mukwata Hospital Giving On
A South African obstetrician gynaecologist who had been working in Ireland for just three months at the time Tatenda Mukwata died in University Hospital Kerry broke down at her inquest on Tuesday, asking if he could meet her family.
Dr Fahad Hendricks was assigned to the high-risk ante-natal clinic and was working his third 24-hour shift in less than a week on April 20. At 17.30 he went to meet Tatenda, with whom he had “a good rapport”.
He was excited to see her as both were from Southern Africa, Dr Hendricks said, breaking down and pausing in reading his deposition. Ms Mukwata's Caesarian had been ”uncomplicated” and there was normal blood loss and no haemorrhage.
At 22.55, paged by concerned nurses, he noticed her low pallor and suspected septic shock. He had thought there might be a surgical bleed but found no evidence and nothing to indicate it. The wound dressing was clean, there was no vaginal bleeding and the uterus was contracting.
Tatenda was awake and smiling. He suspected clinical shock and sepsis. He had based this on the fact she had two spikes in temperature and she was immuno-compromised.
“I trained in South Africa. 30% of women in ante-natal clinics are HIV positive, immuno-suppressed,” he said. He was not aware of the drop in haemoglobin. "In all honesty, I did not check," Hendricks replied to Dr John O’Mahony, SC, for the Mukwata family.
But had he been aware of the drop, he probably would have repeated the blood sample, and his suspicion of intra-abdominal bleeding strengthened and he would probably have taken steps to have her taken to theatre for operation, he told the inquest.
There were emotional scenes as Dr Hendricks asked to meet the family of Tatenda and he was crying and being comforted at the back of the courtroom as the jury left for their lunch break.
The third day of Ms Mukwata's inquest heard that staff at UHK had carried out four C-sections on the night she died, in a "challenging shift" for nurses and clinicians.
Nurses raised concern about Tatenda Mukwata’s dramatic drop in blood pressure and condition and raised the possibility that she was bleeding with clinicians, the inquest was told.
However the nurses’ suspicion "was overruled" by the clinicians the inquest heard. Instead, the obstetricians, gynaecologists and anaesthetists decided it was sepsis.
In an apology read out at the start of the resumed inquest on Monday, the hospital apologised to the family of Ms Mukwata “for the failings of care afforded to Tatenda at this hospital on April 20 and 21, 2022”.
Earlier intervention would probably have prevented Tatenda’s death, the hospital acknowledged.
The mother of three lived in a direct provision centre in Kenmare. She died at 2am after giving birth six hours earlier to her fourth daughter Eva who was delivered by Caesarean section. She had bled to death but the fact she was hemorrhaging after the Caesarian went undetected.
The inquest has heard a key indicator of postpartum maternal hemorrhage — dropped levels of haemoglobin which indicate blood volume — had not been recognised and the surgical team went on suspicion of sepsis, based on no sign of external bleeding. The severe internal bleeding was not recognised.
The obstetrician who carried out the Caesarian had found no external evidence of bleeding and suspected sepsis. The inquest also heard the lab had not paged or alerted clinicians about the haemoglobin drops, as it normally would.
ICU nurse Siobhan O Nuallain, in her deposition read to the inquest, told how there was high hospital activity on the night and five wards were working with a deficit of one nurse. Staff were being redeployed.
She and another nurse queried was there a possibility Ms Mukwata was bleeding after seeing her vital signs were not stable and blood pressure was dropping. Theatre staff also escalated the concerns
However the anaesthetic, obstetric and gynaecological team ruled bleeding out in favour of sepsis and decided "collectively" that the patient required ICU care. Dr Mary McCaffrey, the senior consultant, had been informed.
Other nurses too gave similar evidence of having escalated their concerns about internal bleeding with the clinicians, to no avail. Charmaine Dennehy, senior staff nurse, said there had been "real concern" about Tatenda, but it was out of their remit to do anything.
She reassured the family they had ensured Tatenda was comfortable and cared for and had never been left alone.
Asked about the impact on them as nurses, Nurse Dennehy said: "It was a major blow. We were all very, very upset."
The inquest continues.