Obstetrician admits system failures to Savita inquest

The consultant at the centre of the treatment of Savita Halappanavar who died in a University Hospital Galway after a miscarriage has admitted there were system failures in her care.

Savita was 17 weeks pregnant when she was admitted to the hospital on Sunday, October 21, and died a week later.

Consultant obstetrician Dr Katherine Astbury told an inquest she was unaware of blood test abnormalities as they had not been passed on to her team from the weekend staff on-call.

She also confirmed Mrs Halappanavar’s clinical signs were not checked every four hours after her membranes ruptured in the early hours of Monday morning, which was a breach of hospital policy.

And she revealed that on the day the patient finally miscarried – Wednesday October 24 – she did not know a junior colleague had put on her chart that he suspected Mrs Halappanavar was suffering from sepsis caused by chorioamnionitis, an infection of the foetal membrane.

The senior medic was asked by Galway coroner Dr Ciaran MacLoughlin if aspects of Mrs Halappanavar’s care could be seen as system failures.

“Yes,” she replied.

Mrs Halappanavar, 31, was rushed to intensive care within hours of the delivery, where she remained in a critical condition until her death from a heart attack caused by septicaemia due to E coli.

Dr Astbury has denied she refused Mrs Halappanavar’s pleas for a termination a day earlier because “Ireland is a Catholic country”.

The medic told her inquest that she could not induce delivery when asked as there was not a risk to Mrs Halappanavar’s life and she was restricted by Ireland’s abortion law.

“She was well,” said Dr Astbury under cross examination.

“There was no risk to her life.

“If you need to give somebody medication to deliver and there’s a foetal heartbeat my understanding is that legally you are considered to be terminating.”

The coroner quizzed Dr Astbury about Medical Council guidelines, which refer to terminating a pregnancy only if there is a real and substantial risk to the life of a mother, as distinct from the health.

She said her understanding was they relate to a life-threatening condition or illness such as cancer, usually unrelated to the pregnancy, that requires treatment.

Dr MacLoughlin asked if there was confusion over the interpretation of the guidelines.

“There’s no law to tell you what is permitted or not permitted,” she replied.

Dr MacLoughlin said: “So it’s a question of law?”

“Yes,” she replied.

Dr Astbury denied three requests were made for a termination, and insisted that when she told Mrs Halappanavar she could not abort the baby on the Tuesday she used the words “in this country it is not legal to terminate a pregnancy in grounds of poor prognosis of the foetus” and never mentioned religion.

The doctor agreed that in other jurisdictions, like England, her patient would have been offered a termination if the prognosis of her foetus was poor.

“The law in Ireland does not permit termination even if there’s no prospect of viability,” she added.

“That would be my understanding of the legal position based on the legal judgement in the X-case and the Medical Council guidelines.”

Dr Astbury spoke in a loud, clear voice as she addressed lawyers’ questions while widower Praveen Halappanavar, who claims she made the Catholic remark, sat with his friend, a Galway-based consultant Dr CVR Prasad.

Eugene Gleeson, senior counsel for Mr Halappanavar, attempted to asked was it a “geographical mischance” that Savita found herself in this dreadful situation but was stopped by the coroner.

He also criticised her medical care and claimed there were 10 hours that her condition was not addressed despite a midwife insisting she reported trachycardia, an abnormally fast heart rate at 114 beats per minute, to a doctor before 9pm on Tuesday night.

Another midwife found her shivering and with a high temperature at 4.30am and by 6.30am the duty doctor was called who raised concerns over her vitals and suspected sepsis caused by chorioamnionitis, an infection of the foetal membrane.

Dr Astbury said that when she examined Mrs Halappanavar at 8.30am her vitals had dropped and she believed she had sepsis, not severe sepsis, and admitted her registrar Dr Anne Helps did not read the earlier entry reporting a foul smelling discharge from the patient’s vagina, a sign of chorioamnionitis.

The senior obstetrician insisted had she known this she would have started the steps for a termination then regardless of a heartbeat, instead of ordering tests to check for a urine infection and deciding to terminate at 1pm when severe sepsis was diagnosed.

“If someone has chorioamnionitis you only get the chorioamnionitis out by delivering the foetus,” she added.

Mrs Halapannavar was taken to theatre after 3pm that day where she naturally delivered her dead baby daughter.

She was transferred to the high dependency unit and later on to intensive care where she died.

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