Savita inquest verdict expected on wedding anniversary day

A verdict from the inquest into Savita Halappanavar's death is expected today, the day when she would have been celebrating her wedding anniversary.

Widower Praveen Halappanavar said he was optimistic and looking forward to the end of the hearing. A verdict is expected this afternoon.

He said the question of why his wife died is still on his mind and he believes the inquest is giving him the answers he was looking for.

"The coroner has been kind enough to cross certain borders I suppose," he said.

"More than what we expected for sure."

Mr Halappanavar said the last two weeks have been very tough and he has been in touch with his parents-in-laws in India every morning and night.

"Today was actually our wedding anniversary so it's even more, very hard," he said.

"Hopefully, there's some bright days ahead and something good comes out of it."

Mrs Halappanavar was 17 weeks pregnant when admitted to University Hospital Galway on October 21 last year with an inevitable miscarriage.

The 31-year-old dentist died a week later in intensive care from multi-organ failure from septic shock and E.coli, four days after she delivered a dead foetus.

It is the second poignant date to hit the widower after he was given a health service internal review of his wife's death on March 30, the day their baby Prasa had been due.

Galway coroner Ciaran MacLoughlin is to summed up the inquest evidence this morning before directing the jury.

He told the jury of six men and five women that they could return a verdict of medical misadventure or a narrative.

The coroner said a narrative verdict would simply find that Savita Halappanavar was 17 weeks pregnant when admitted to hospital with a pending miscarriage, that her membranes ruptured and she developed sepsis, severe sepsis and septic shock and died.

He told the jury they have an option of returning a verdict of misadventure if they find there were "system failures or deficiencies" in her medical care before she died.

Dr MacLoughlin warned that neither verdict could put blame on any person or persons.

He also gave the jury the option of making nine recommendations based on evidence heard during the inquest.

Dr MacLoughlin spoke to the jury for almost 20 minutes, his voice shaking as he spoke of Mrs Halappanavar's days.

He outlined her treatment from the day she was admitted, the system failures that have been admitted by staff, and spoke of how Mrs Halappanavar "was in peril of her life" as she contracted sepsis.

"The life of this vibrant woman ebbed away," he said.

The coroner promised Mr Halappanavar an open and transparent inquiry when it opened two weeks ago and said he had heard from 36 witnesses - family, friends and experts in their fields - about her treatment.

He gave the jury their options for a verdict and offered them nine recommendations they could consider.

"It is not for the court to recommend a change of the law but the Oireachtas (Irish Parliament) may take countenance of these procedures," he said.

The recommendations are:

* The Medical Council should say exactly when a doctor can intervene to save the life of a mother, which will remove doubt or fear from the doctor and also reassure the public;

* Blood samples are properly followed up;

* Protocol in the management of sepsis and guidelines introduced for all medical personal;

* Proper communication between staff with dedicated handover set aside on change of shift;

* Protocol for dealing with sepsis to be written by microbiology departments;

* Modified early warning score charts be adopted by all staff;

* Early and effective communication with patients and their relatives when they are being cared for in hospital to ensure treatment plan is understood;

* Medical notes and nursing notes to be kept separately;

* No additions or amendments to be made to the medical notes of the dead person who is subject to an inquiry.

Leading obstetrician Peter Boylan claimed at the inquest that Mrs Halappanavar would probably still be alive if the law in Ireland allowed an abortion as she miscarried before there was a real risk to her life, by which time it was too late to save her.

He outlined a number of deficiencies in her care, but stressed that none on its own was likely to have resulted in Mrs Halappanavar's death.

Her consultant, obstetrician Katherine Astbury, previously admitted there were "system failures" but claims she could not carry out an abortion because of Irish law which states there must be a significant risk to the life, not health, of a woman.

The Government has pledged to publish new abortion laws in July, which will include the threat of suicide as a risk to life and a combination of legislation and regulations for doctors to abide by in cases where there may be uncertainty.

Elsewhere, the coroner's court heard the cause of death was septic shock, E.coli in the bloodstream - the ESBL strain which is resistant to most antibiotics - and miscarriage.