Consultant admits systems failures at hospital
Katherine Astbury agreed yesterday that the requirement to observe Ms Halappanavar every four hours after she had suffered ruptured membranes had not been carried out. Dr Astbury also admitted that she had not been informed of an abnormal white cell count in a blood test.
The inquest into the death of the 31-year-old Indian dentist heard in addition, that because of a lack of communication, vital information concerning a foul-smelling discharge had not been brought to her attention for several hours after it had been noted in her chart by another doctor.
And in a clear conflict of evidence, a midwife insisted yesterday that she had phoned a doctor to advise him that Mrs Halappanavar’s pulse rate was elevated. The doctor had earlier denied receiving the call.
The inquest heard evidence on Tuesday that a registrar had failed to review Mrs Halappanavar after being told she was suffering from chorioamnionitis — inflammation of the foetal membranes due to a bacterial infection.
Medical notes in the case also came under the microscope yesterday. Ciaran MacLoughlin remarked that, in his time as a coroner, he had never seen so many retrospective notes made to medical records.
On the third day of the inquest, Dr Astbury was cross-examined on the evidence given in her statement late on Tuesday.
She explained that when she reviewed Mrs Halappanavar on Oct 23, the patient was very upset. When she had enquired about medication for a termination, she had explained that the legal position in Ireland did not permit her to terminate the pregnancy at that time.
Mrs Halappanavar was well and there was no suggestion of a risk to her life, so she could not offer her a termination then.
Asked if she had used the phrase “… because this is a Catholic country”, Dr Astbury said it was not something she would say.
Overnight Mrs Halappanavar became very unwell and developed sepsis, but a blood test showing abnormal white cells taken more than two days earlier had not been brought to her attention.
“Yes, there was a systems failure,” she told the coroner, but added that she would have repeated the test if she had known the result.
Dr Astbury also acknowledged a systems failure when it emerged that her patient had only been observed on five rather than six occasions daily.
Asked about notes concerning the foul-smelling discharge which had been written on her chart, Dr Astbury said she was not aware of this. When it was put to her that it was available to her on the patient’s chart, Dr Astbury replied, “I should have been aware of it.”
Midwife manager Ann Maria Burke was questioned by the coroner on the evidence of senior house officer, Dr Ikechukwu Uzockwu. He had said that on Oct 23, Mrs Halappanavar was complaining of weakness, but her blood pressure and temperature were within normal range.
He had not received any communication about an elevated pulse, he told the inquest on Tuesday.
Ms Burke yesterday insisted that she had “definitely” told him about the pulse rate. Cross-examined later she said: “I’m absolutely certain I told him about the elevated pulse rate”.
The inquest continues.
