No evidence from midwife at Savita inquest

Crucial evidence from the midwife who cared for Indian dentist Savita Halappanavar as she fell critically ill will not be given to her inquest, it has been confirmed.

The nurse, who has not been named and may hold vital information on why a doctor did not check the 31-year-old, has been certified not to give a statement, answer questions or attend hearings, coroner Dr Ciaran MacLoughlin revealed.

No explanation has been given publicly for the midwife’s absence.

She was caring for Mrs Halappanavar on the morning of Wednesday October 24 as her condition rapidly deteriorated.

Expert witness Peter Boylan told the inquest the midwife may have been able to clarify why a doctor was not called to attend to Mrs Halappanavar before 1pm when she was already in septic shock.

Her blood tests were known by 10.36am that day and showed an unusually low white blood cell count.

Mr Boylan said charts revealed Savita’s blood pressure dropped every time her vitals were checked between 8am and 10.30am that day indicating severe sepsis.

“It is not clear why there was not a request for a doctor to review Mrs Halappanavar by then,” Mr Boylan said.

“I notice no statement is available from the midwife caring for Mrs Halappanavar all through that morning.

“The lack of a statement from the nurse caring for Mrs Halappanavar on the morning gives rise to a deficit in reaching an understanding the sequence of events that morning.”

Mr Boylan said poor quality and retrospective notes on the Wednesday after Dr Astbury’s ward wound at 8.30am, and the lack of a statement from the midwife, were not helpful in understanding what happened.

The coroner said there was “nothing he could do” about the midwife’s absence.

When Dr Astbury was called to the ward after lunch she got a second opinion and took the decision to terminate the pregnancy, even with a foetal heartbeat.

Mrs Halappanavar delivered the foetus naturally three hours later.

Highlighting deficiencies in care, Mr Boylan said there was also a clear conflict of evidence between another midwife and a doctor on events the night before Mrs Halappanavar’s condition deteriorated.

Clinical midwife manager Ann Maria Burke and Dr Ikechukwu Uzochkwu, senior house officer in obstetrics and gynaecology, were both recalled over “irreconcilable differences” in their evidence last week to Galway coroner’s court.

The senior midwife said she is “100% certain” she told the doctor of Mrs Halappanavar’s elevated pulse rate of 114 and 110 beats per minute before her shift ended at about 8pm on the Tuesday night.

However, the doctor remains adamant he was only told the patient was weak but that her vitals were fine during a call he believes he received between 9pm and 11pm.

“That is still my evidence,” he said, adding he did not know which midwife had called him.

Dr Ikechukwu said he went to see the patient at 1am in the early hours of Wednesday, but Mrs Halappanavar was sleeping so he did not examine her or her chart as he was told by staff her vital signs were normal.

Mr Boylan said it was “perfectly reasonable” that he did not wake Mrs Halappanavar at that time as she was distressed at the pending loss of her child and should not have been disturbed.

The on-call medic was called again at 6.30am – almost 24 hours after his shift started – when her condition deteriorated so much she was diagnosed suspected sepsis from chorioamnionitis, an infection of the foetal membrane.

Eugene Gleeson, senior counsel for widower Praveen, argued there was no way of knowing if Mrs Halappanavar’s vital signs were normal overnight as they had not been checked.

“It’s absolutely clear that from 9pm to 6.30am only one vital sign out of the four was recorded,” he said.