11 Consultants disagree with expert Boylan on Savita Halappanavar case

Last week I received an awful lot of flack on Twitter and in other places, for my writing on the case of Savita Halapannavar. The main criticisms seemed to be that being neither Irish nor a qualified medic, I had no right or authority upon which to pass comment.

Every single medical fact I commented upon was not made without reference to highly experienced qualified doctors and midwives, all of whom were in disagreement with Dr Boylan, whose testimony that a termination would almost certainly have saved Savita’s life, was widely quoted by the pro-abort activists as being proof that the law needed to change, as it was, in his opinion, responsible for her death.

The reason that this case has needed to be scrutinised in intricate detail, is because it was so quickly seized upon by those championing abortion in Ireland, as being definitive proof that lack of abortion was leading to unnecessary deaths. What I am more than qualified to state, is that abortion devastates lives and causes infinite pain and hurt to many women, (and men) as well as ending the lives of their babies. By all accounts Savita was a lively caring, compassionate woman. The last thing she would have wanted was for more pregnant women to be vulnerable as a result of her death.

I have just received a copy of the following press release from John McGuirk which I have replicated in full.

Ends

Dear Sir:

The recent inquest on Ms Savita Halappanavar has raised important issues about hospital infection in obstetrics. Much of the public attention appears to have been directed at the expert opinion of Dr Peter Boylan who suggested that Irish law prevented necessary treatment to save Ms Halappanavar’s life. We would suggest that that this is a personal view, not an expert one.

Furthermore, it is impossible for Dr. Boylan, or for any doctor, to predict with certainty the clinical course and outcome in the case of Savita Halappanavar where sepsis arose from the virulent and multi drug-resistant organism, E.coli ESBL.

What we can say with certainty is that where ruptured membranes are accompanied by any clinical or bio-chemical marker of infection, Irish obstetricians understand that they can intervene with early delivery of the baby if necessary. Unfortunately, the inquest shows that in Galway University Hospital the diagnosis of chorioamnionitis was delayed and relevant information was not noted and acted upon.

The facts as produced at the inquest show this tragic case to be primarily about the management of sepsis, and Dr Boylan’s opinion on the effect of Irish law did not appear to be shared by the Coroner, or the jury, of the Inquest.

Obstetric sepsis is unfortunately on the increase and is now the leading cause of maternal death reported in the UK Confidential Enquiry into Maternal Deaths. Additionally there are many well-documented fatalities from sepsis in women following termination of pregnancy. To concentrate on the legal position regarding abortion in the light of such a case as that in Galway does not assist our services to pregnant women.

It is clear that maternal mortality in developed countries is rising, in the USA, Canada, Britain, Denmark, Netherlands and other European countries. The last Confidential Enquiry in Britain (which now includes Ireland) recommended a “return to basics” and stated that many maternal deaths are related to failure to observe simple clinical signs such as fever, headache and changes in pulse rate and blood pressure. Many of the failings highlighted in Galway have been described before in these and other reports.

The additional problem of multi-resistant organisms causing infection, largely as a result of antibiotic use and abuse, is a serious cause of concern and may lead to higher death rates in all areas of medicine.

Ireland’s maternal health record is one of the best in the world in terms of our low rate of maternal death (including Galway hospital). The case in Galway was one of the worst cases of sepsis ever experienced in that hospital, and the diagnosis of ESBL septicaemia was almost unprecedented amongst Irish maternity units.

It is important that all obstetrical units in Ireland reflect on the findings of the events in Galway and learn how to improve care for pregnant women. To reduce it to a polemical argument about abortion may lead to more – not fewer – deaths in the future.

Yours sincerely,

Dr. John Monaghan, DCH FRCPI FRCOG Consultant Obstetrician/Gynecologist

Dr. Cyril Thornton, MB BCh MRCOG Consultant Obstetrician/Gynecologist

Dr. Eamon Mc Guinness, MB BCh MRCOG Consultant Obstetrician/Gynecologist

Dr. Trevor Hayes, MB BCh FRCS MRCOG Consultant Obstetrician/Gynecologist

Dr. Chris King, MB DCH MRCOG Consultant Obstetrician/Gynecologist

Dr. Eileen Reilly, MB ChB MRCOG Consultant Obstetrician/Gynecologist

Prof John Bonnar, MD FRCPI FRCOG Professor Emeritus Obstetrics & Gynaecology

Prof Eamon O’Dwyer, MB MAO LLB FRCPI FRCOG Professor Emeritus Obstetrics & Gynaecology

Prof Stephen Cusack, MB BCh FRCSI Consultant in Emergency Medicine

Dr. Rory Page, MB BCh FFA RCSI Consultant Anaesthetist

Dr. James Clair, MB BCh PhD FRCPath Consultant Microbiologist

2 thoughts on “11 Consultants disagree with expert Boylan on Savita Halappanavar case

  1. Did you see this ?

    Savita’s death may have been due to resistant bacteria strain

    Dr James Clair, Consultant Microbiologist, UCC
    The Irish Examiner, Tuesday, 20th November 2012

    Concerning the unfortunate death of Savita Halappanavar, I fear that the main problem is being missed.

    The Irish media reported last week that this young woman most likely died from septicaemia due to an ESBL E. coli strain.

    ESBL, or Extended Spectrum Beta-Lactamase positive gram negative bacteria, are now spreading rapidly within the Irish population.

    The significance of these organisms is in the fact that they are resistant to almost all available antibiotics.

    We had a media frenzy over the last decade about MRSA but we had at least ten antibiotics capable of inhibiting this organism.

    In contrast we have only a few antibiotics (if we are lucky) active against ESBL positive organisms, and these are third line antibiotics which must be used sparingly.

    Deaths have already occurred due to these organisms and the potential for many more deaths is very real. ESBL positive organisms present a far greater threat than MRSA ever did or will.

    I feel confident that the doctors in Galway would have followed accepted procedures for dealing with the clinical problems that emerged. When signs of infection first develop, doctors are usually forced to used antibiotics blindly, often with broad spectrum intravenous antibiotics.

    The problem with ESBL organisms is that they are very resistant and thus a tragedy can result.

    It appears to me that the problem was an unforeseen ESBL infection rather than an issue of obstetric mishandling.

    In my experience of over 30 years with clinical antibiotic use, ESBL antibiotic resistance is by far the most worrying development that I have experienced.

    The insult to the Irish medical service is added to by the suggestion that the Indian Embassy is upset with the lack of abortion services in Ireland.

    This insult is further compounded by the fact the Indian subcontinent has played a major role in the spread of ESBL positive organisms.

    If the Minister for Health wants to preserve lives, young and old he would do better to put a lot more resources into monitoring and controlling the spread of ESBL positive bacteria rather than responding to a pressure group who obviously have an ambition to turn our superb obstetricians into little more than paid killers.

    http://www.irishexaminer.com/opinion/letters/savitas-death-may-have-been-due-to-resistant-bacteria-strain-214431.html

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