Savita: the truth
Staff should have considered performing abortion, even before couple requested it
HOSPITAL staff should have considered a potentially life-saving abortion for Savita Halappanavar days before her tragic death, an official probe has found.
THE mother-to-be (31) died of a massive infection seven days after being admitted to hospital.
But the infection that contributed to her death was not diagnosed for three days, during which her condition deteriorated rapidly.
The investigation, set up by Health Minister James Reilly after Ms Halappanavar's husband Praveen claimed they'd been refused an abortion, even though their unborn child was miscarrying, has uncovered a litany of medical failures.
Today the Herald can reveal for the first time the extracts from the findings of a draft report into the circumstances surrounding her death, including how:
• Tests showing possible blood infection on the day Ms Halappanavar was admitted were never followed up by staff.
• There was a lack of clarity among key staff about who was responsible for acting on these blood-test results.
• There is no record of a review of pulse, blood pressure, temperature or the ordering of any investigations to check for the early possibility of infection.
• Doctors were often too busy caring for other patients to deal immediately with Ms Halappanavar, whose condition grew progressively worse as time went on.
• To prevent the spread of infection, staff should have considered performing an abortion – even before the couple requested it – but this never happened.
• A lack of clear guidelines on the issue of abortion was a contributory factor.
Indian-born Ms Halappanavar was 17 weeks pregnant when she was admitted to hospital on Sunday, October 21, last.
During her hospital stay she developed severe blood poisoning. But crucial signs that the infection was present were initially missed by hospital staff, according to the draft report.
On the day she was admitted, Savita and her husband Praveen were informed that a miscarriage, the most likely cause of which was infection, was inevitable.
The distraught couple repeatedly asked for a termination from the following Tuesday, however staff turned down the request, telling the couple that, as a result of the laws governing abortion, their "hands were tied".
Instead, doctors chose to "await events", and seven days after she was admitted Ms Halappanavar died. The circumstances of her death sparked international protests and re-ignited the debate about Ireland's abortion laws.
Mr Halappanavar said he and his wife asked that a termination be carried out but were told this couldn't be done because the foetal heartbeat was still present and that: "This is a Catholic country".
An extract from the draft report says there was too much emphasis with the foetal heartbeat and not enough on the mother's health. It says that the absence of legislation in which abortions can be carried out was a contributory factor.
But it also says that the diagnosis of sepsis was missed for three days by medical staff.
The draft report was complied by a team of experts led by internationally respected Professor Sabaratnam Arulkumaran.
The Herald understands the Minister for Health, James Reilly, has warned Fine Gael members to expect its publication "within days".
A Government source close to the department said: "This is a comprehensive report into what was a very tragic situation."
The hard-hitting findings will place the abortion issue back in the spotlight and put pressure on the Government to fully legislate for terminations, particularly in cases where a miscarriage is deemed inevitable. The draft report identifies a number of other controversial incidents that occurred during Savita's period of care at UHG.
On the day she was admitted, a specialist registrar ordered a full blood count. While Savita's bloods were duly taken, the investigation team found that there was "a clear lack of clarity" about who was responsible for following up and acting on these blood test results.
This is in spite of the fact that the bloods showed an elevated white cell count, which is a red flag for suspected blood poisoning – a potentially life-threatening complication.
The report states: "At interview, Specialist Registrar 1 stated that it was not his/her responsibility to follow up the results as the SHO (junior doctor) took the samples he requested. SHO 1 stated that they took samples under instruction and therefore it was not his/her responsibility to follow-up the results.
"Staff Nurse/Midwife 2 stated that it is not their responsibility to follow up results."
Unfortunately, this was not the only error identified by the investigation, which interviewed close to 30 staff members.
On several occasions, staff treating Savita missed signs that she was developing a blood poisoning infection. It was also found that a "lack of knowledge" among staff about quick-fire techniques to make a diagnosis of sepsis/blood poisoning was an issue. There was also a difference in the recollections of a telephone call between a junior doctor and a specialist registrar concerning a conversation about Savita's rising temperature on the morning of Wednesday, October 24.
During an interview with the investigation team, the specialist registrar said: "I do not recall being advised of the patient's heart rate or blood pressure.
For the first episode of a 'spike of temperature' the management was adequate; it may have been different if I was aware of the blood pressure and heart rate parameters."
However, the junior doctor told the investigation: "I discussed my findings and he/she didn't tell me to do anything extra. I gave her the vital signs, pulse, temperature. I stated all of the facts."
The investigation noted that the implementation of proper verbal and documented communication mechanisms were necessary in light of Savita's death.
In the draft findings, the records and interviews confirmed that from the time of Savita's admission, up to the morning of October 24 – when a bacterial infection was identified – the doctors' plan was to "await events" and to monitor the foetal heartbeat in case an "accelerated delivery" might be possible.
However, the investigation team found no evidence of a comprehensive review of management options, including an earlier termination to reduce the risk of infection and blood poisoning.
Such a move would have potentially avoided the rapid deterioration in Savita's clinical condition.
The investigation team also found that even before the family requested a termination, the clinical situation indicated a "significant and increasing risk to the mother" was present and carrying out an abortion should have been considered whether or not requested by the patient.
"The patient progressed from sepsis to septic shock within four hours (likened to falling from a cliff) and this could have been avoided by earlier termination of pregnancy knowing that – without termination – the prognosis for the fetus and potentially the patient was poor."
There was "an apparent over-emphasis" on the need not to intervene until the foetal heart stopped altogether with an under-emphasis on the need to monitor Savita and manage the risk of infection.