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Alarming communication breakdown

Dr Katherine Astbury: Turned down request for termination as no clear risk to patient's life.

While the death of Savita Halappanavar has shone a spotlight on Ireland’s abortion laws, this week’s inquest into the scandal has highlighted an equally worrying problem: A lack of communication between medics meant to ensure the health of the 31-year-old dentist.

The inquest cannot apportion any blame for the young mother-to-be’s death.

However, the fact a series of opportunities to address the ticking time-bomb of her deteriorating condition were missed should act as a wake-up call to how other pregnant women are treated in Irish hospitals.

- SUNDAY, OCT 21: Savita and her husband Praveen attend Galway University Hospital over concerns about her pregnancy.

They are seen by consultant obstetrician, Dr Katherine Astbury, who takes Savita’s bloods. The results — which indicate an unusually high white blood cell count, a sign of septicaemia — are not given to Savita’s medical team for almost a day. When they are provided, they are not acted on.

While a foetal heartbeat is found by Dr Olufoyeke Olatunbosum, the medical team do not check Savita for the leaking of amniotic fluid.

There is disagreement between a registrar and Dr Astbury over whether any hope remains for a safe pregnancy.

- MONDAY, OCT 22: Savita’s waters break just after midday, at 12.30pm. At this stage, Dr Astbury believes there is no risk to life and puts her on antibiotics to reduce infection risk.

The results of Savita’s blood tests, which would have confirmed a growing risk to her health, are not immediately acted on.

- TUESDAY, OCT 23: Savita asks Dr Astbury for a termination, but the senior medic says this is not possible, as a foetal heartbeat remains and there is — in her view — no clear risk to the patient’s life.

Senior midwife manager Ann Marie Burke makes the infamous "Ireland is a Catholic country" remark at 11.45am. She later explains to the inquest that this comment was made to explain the chequered history of the abortion debate in Ireland.

At 7.35pm, a student nurse checks Savita’s pulse and finds that it is elevated. Ms Burke is informed and alleges she attempted to tell senior house officer Dr Ikechukwu Uzockwu of the development. He denies this and said in his view Savita’s vital signs were normal. Savita is not examined until the following morning, despite concerns her health was deteriorating.

- WEDNESDAY, OCT 24: Dr Uzockwu visits Savita at 1am to check on her condition. However, she is asleep and he decides not to wake her. This is against hospital policy.

A midwife gives Savita paracetamol at 4.15am after finding that she is shivering. While this is an indicator of septicaemia, it is put down to a broken radiator. The patient is given a blanket, but her heart rate is not taken.

At 6.30am, Dr Uzockwu finds that Savita’s temperature is raised and her heart beat is double its level when she came to hospital. He notes a bad-smelling discharge from her vagina and suggests she may be suffering from chorioamnionitis, an inflammation of the foetal membranes due to infection. He orders tests and puts her on a stronger antibiotic. He and other medics are not aware of the high white cell blood count result.

At 8.25am, Dr Astbury visits Savita. She does not read the notes from the previous hours and is not told about the discharge which indicates a serious infection. The medic expresses concern that she has chorioamnionitis, but orders tests to rule out a urinary tract infection.

A termination is now considered in order to protect Savita’s health. The patient is diagnosed to be suffering from sepsis, but not severe sepsis, as her blood pressure is not low.

Crucially, tests are taken to understand Savita’s lactate level, which would indicate she is going into a potentially fatal septic shock. These tests are put in the wrong bottle and, as such, are ignored.

Between 1pm and 5pm, Savita’s condition deteriorates even further. Dr Astbury consults with another colleague and decides to terminate the pregnancy. She is then transferred to the high-dependency unit.

- THURSDAY, OCT 25: At 3pm Savita is rushed to intensive care and put on a ventilator. Doctors now know she is suffering from septic shock.

- FRIDAY, OCT 26: Her blood tests are checked and it is confirmed she is suffering from septicaemia due to E.coli ESBL, which is highly resistant to the first antibiotic Savita was given.

Praveen is approached by Dr Michael Scully, who asks if he will allow Savita to take part in a British clinical study.

During the inquest, Praveen explained: "I was not comfortable with it, but he said it would help other patients in the future. This was not what I was expecting. I thought the meeting was about Savita’s health and I was very disappointed."

- SUNDAY, OCT 28: At 12.45am, Savita goes into cardiac arrest and passes away.