Tag: Savita Halappanavar

Here we go again

398da10300000578-3855638-image-a-34_1476972817707

A number of mainstream media outlets are reporting on the tragic case of a Sicilian woman, Valentina Milluzzo who became pregnant with twins following IVF treatment and then died after miscarrying them.

Scant detail has been reported, but according to reports, Mrs Milluzzo was admitted to the Cannizzaro hospital in Catania, Sicily, after falling ill and going into labour at just 19 weeks in pregnancy, on September 29 where she remained in a stable condition for a couple of weeks.

On October 15 her condition worsened and one baby was then stillborn, Mrs Milluzzo’s condition then rapidly deteriorated, her family then asked for the other baby to be aborted, doctors refused supposedly on the grounds of conscientious objection, then it appears that the other baby was miscarried, shortly after which poor Valentina Miluzzo died too.

The various media reports seem muddled. In the Daily Mail the family’s lawyer allegedly reported that one of the unborn twins was suffering from from a ‘breathing complication’. This doesn’t stack up because a baby in utero does not actually breathe through their nose and mouth, but rather exchanges oxygen and carbon dioxide with the mother through the placenta and umbilical cord. Clearly there was some kind of complication causing foetal distress which may have led to the miscarriage, but ‘breathing difficulty’ seems to be an overly-simplistic term. That said, this could simply be a translation error. But in any event the account in the Daily Mail, has the doctor refusing to abort both babies.

The BBC has a similar account, namely the doctor apparently refused to intervene to abort both babies after one got into difficulty, but the Guardian claims that having given birth to one stillborn baby, poor Valentina was in agony for 12 hours with the doctors refusing to intervene on the grounds that the other baby was still alive. The family begged for the doctors to abort the other child to save her life, the doctors refused and shortly afterwards the baby was born dead and Mrs Milluzzo died of septic shock.

The Guardian of course carries a photograph of pro-life nuns, just in case you hadn’t got with the programme about these evil Catholic types. It also runs a load of irrelevant copy with implied supposition about the recent decline in abortions in Italy being due to a shortage of doctors willing to perform them and whether or not Italy actually has enough people to carry out abortions because, shock horror, there’s a high rate of conscientious objectors. A decline in abortions, can never be seen as positive news now can it, and what this unsubtle inference fails to mention is Italy’s catastrophically declining birth rate. Maybe, just maybe, fewer women are getting pregnant and those who do actually want to keep their babies?!

First off, nobody should be blamed or jump to conclusions because the fact is that we do not know what happened. Of course the family would have been enormously distressed by the way events unfolded and one cannot blame them for wishing medics to take whatever action necessary to save the life of their beloved wife and daughter.

But in this situation, when we have the very sketchiest of facts, it is a revolting political opportunism that wishes to capitalise on a terrible tragedy of a woman, who is not yet buried, to claim, as the profiteers at International Planned Parenthood Federation (who  make money from abortion) have done, that the right of medics to conscientiously object to abortion, puts women at risk and must be removed. Medics are not disrespecting the law, they are acting in accordance with it. Italian law in common with other European laws, allows for abortion in certain specific prescribed circumstances, and also allows doctors who feel that their remit is to save lives not end them, to opt out. Freedom of conscience ought to take primacy. Nobody should be coerced by the law into carrying out acts which they find to be morally abhorrent.

In the case of a woman who has achieved a much-wanted pregnancy via IVF, one can well understand the reticence of doctors to abort the child, if there was a chance that they might survive. Secondly, and perhaps more importantly, in the case of miscarriage, the best clinical approach is to conservatively manage a miscarriage, which negates the risks and complications of surgery. It’s not clear how aborting the surviving twin would actually have saved her life – an unborn baby is not some kind of toxin, poisoning a woman’s system from within.

There seem to be several terrible parallels with the case of Savita Halappanavar going on here. Both women would appear to have died of septic shock. The HSE inquiry ruled that Mrs Halapannaver died of sepsis which went undiagnosed for too long. An abortion would not have saved her life, but prompt administration of antibiotics could well have done, though sepsis does require extremely swift diagnosis and intervention.

Dr Sam Coulter-Smith, master of the Rotunda hospital in Dublin commented that Ireland’s pro-life laws had little to do with Mrs Hlappanavar’s death and echoed the view of most gynaecologists saying

 “I think most of us who work in obstetrics and gynaecology, there may be individual differences, but the majority would be of the view that if the health is such a risk that there is a risk of death and we are dealing with a foetus that is not viable, there is only one answer to that question, we bring the pregnancy to an end.”

Here are the known facts. At 22 weeks, Mrs Milluzzo’s much-wanted child was viable and potentially had a chance of life. Abortion is not on the protocols of treatment for pregnant women with sepsis. Patients and family wishes must of course be taken into account, but the fact that they may have been understandably begging for a course of treatment which they believed was the best chance of saving this woman’s life, does not mean that aborting the baby was the correct medical solution. Wishing to save both the life of the baby and the mother, if at all possible, does not mean that the doctors were negligent, uncaring or adopting a rigourist approach.

The hospital is strongly disputing the family’s account. They have said the following:

“There was no conscientious objection on behalf of the doctor that intervened in this case because there was no voluntary termination of the pregnancy, but (the miscarriage) was forced by the grave circumstances…I rule out that a doctor could have told the family what they say he told them.”

Italian law forbids doctors to withhold life-saving treatment when a mother’s life is at risk. This has been reiterated by a national association of Catholic doctors who said that when a mother’s life is at risk, doctors must do whatever is necessary to save it.

Regardless of what may or may have been said to the family by the doctor (and I think we also have to allow for misunderstandings, especially in such a traumatic situation) there is nothing as yet, which demonstrates that doctors wilfully refused to save the life of a dying pregnant woman and sacrificed her for the sake of her unborn child. We do not have enough evidence and we should not speculate or seek to vilify the doctors, who were the ones actually dealing with the situation and who had the medical knowledge to ascertain the best course of action. Presumably when Mrs Milluzzo went into hospital she was hoping that the doctors would do everything possible to save her children. The request for an abortion was a response to ease suffering and save her life when her condition deteriorated, but chances are that by this stage it was already too late.

There are always two sides to every story, what happened to innocent until proven guilty?

But sadly, that won’t stop the pro-choice bandwagon from using this story as further proof of the uncaring pro-lifers forcing women to die for the sake of their unborn children and trying to remove the conscience rights of doctors, even though tragic cases such as these are very few and far between. With an absence of backstreet butchery upon which to hang the need for compassion, any maternal death with any possible tenuous link to abortion must be milked to ensure every drop of righteous indignation and anger is directed at those who wish to protect the lives of the unborn, who must be portrayed as uncaring misogynists. Especially if they happen to be doctors.

Valentina Milluzzo was a beautiful woman with everything to look forward to. May she and her babies rest in peace.

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

Savita verdict – medical misadventure

SavitaPicVigil_large

Before going any further, we should all remember Savita’s husband Parveen Halappanavar in our thoughts and prayers. Today, the date that the inquest returned its verdict of medical misadventure following the death of his wife, they should have been celebrating their fifth wedding anniversary together with their newborn baby girl due to be be named Prasa. May they rest in peace.

There are already many disingenuous headlines in the press, stating that the inquest has ruled medical mismanagement, following the denial of an abortion to Savita, as if the two events are linked.

First of all, Savita was not denied an abortion, rather a termination of pregnancy. Though it may seem semantic, this is an important distinction. Though medically they both refer to the same end result, the term abortion is widely understood in the context of a woman who does not wish to have a baby. With women such as Savita, a termination of pregnancy is the more correct phrase, because the pregnancy and baby were accepted and welcomed. Savita wished for her pregnancy to be terminated swiftly when it became clear that she was miscarrying. She didn’t want to abort her unborn child, she wanted her miscarriage to be brought to a quick conclusion.

Savita’s request for her pregnancy to be terminated must be seen in the context of her miscarriage. The explanation given at the inquest, that this was not carried out because of the law, is an unsatisfactory one. The implication being that though there was a good medical reason to terminate the pregnancy, the law disallowed this.

Dr Katherine Astbury testified that on the Monday and the Tuesday, Savita did not appear to be unwell, though she was emotionally distressed. In these circumstances, Dr Astbury is quite correct, Irish law would not allow for a termination to take place, because there appeared to be no risk to Savita’s life. This is actually fairly reasonable. Poor prognosis for the foetus would not allow for a termination, because Ireland rightly places equal value on all life, born and unborn alike. That someone has a poor prognosis is not grounds to kill them. Patients who are given a diagnosis of a terminal or incurable disease are not then killed because the outlook looks bleak and neither are the elderly, much as people might agitate for euthanasia. Whilst there is life, there is always hope and when we take into account the fact that Savita’s pregnancy was a wanted one, so long as a life is not deemed to be at risk, then it is not morally acceptable to kill an unborn baby on the grounds that he or she is as likely going to die soon anyway.

The request to terminate the pregnancy from Savita, should not have determined what was in her best medical interests. All other things being equal, normal medical protocols dictate a conservative management (i.e. wait and see) approach. On a personal note, I can well imagine her distress and her physical pain. I was readmitted into hospital a week after my eldest child was born, suffering from retained infected placenta. When I apologised to the registrar in A&E for crying because I was in so much pain, his response was ‘madam, you have a uterine infection, it is going to hurt a lot’. In my case, despite my entreaties, they didn’t take me in for surgery for 4 days (it was Easter bank holiday weekend) preferring instead to administer IV antibiotics to cure the infection first and to see if the product would pass. Nine years on, I can still remember the pain vividly, but at least I was given the correct antibiotic treatment, though my desire to have a D&C and be back home was ignored. I can’t begin to imagine what Savita went through, especially when she had the ultrasound and could hear the heartbeat of her baby, whom she knew was shortly to die. It must have been awful for her and her husband, let’s not forget that.

But this question of abortion or termination is nonetheless the source of much misinformation. Speaking at the inquest Dr Astbury stated that had she known about Savita’s blood results on Monday or Tuesday, then she would have taken a different decision and terminated Savita’s pregnancy forthwith. Which begs the obvious question, why didn’t she? We know from the inquest that the blood test results taken from Savita at 6.33pm on the Sunday evening were immediately processed and were available on the hospital’s computer system at 6.37pm. They were not accessed until 5.24pm the next day, by an unidentified member of staff and Dr Astbury herself did not look at them until 11.24pm on the Wednesday morning, by which time Savita’s condition had severely deteriorated.

It is this delay that proved fatal for Savita. If a termination had been required, then Irish law allowed for this, the medical guidelines state that delivery of an unviable foetus may be expedited where there is real and substantial risk to the life of the woman. Sepsis would count as such a risk. Savita’s bloodcount was 16.9 (normal range 4.3 – 10.8) which should have rang alarm bells. She was definitely exhibiting signs of an infection which merited urgent further investigation which would have thrown up the presence of E.Coli. Real and substantial risk, are often confused with immediate. A woman does not have be in her death throes or dying for a real and substantial risk to be identified, simply that if a termination is not performed, there is a real and substantial risk that she will die.

With hindsight, this perhaps was the case with Savita, as she was at risk of chorioamnionitis (inflammation of the foetal membranes), once the membranes had broken on Sunday. Once this has happened there is a 30 – 40% risk of infection, which is why she was prescribed general oral antibiotics on the Monday evening. Had Dr Astbury thought Savita was at risk of this, or was exhibiting signs, then why were no further diagnostic tests peformed, in this case an amniocentesis would have confirmed whether or not chorioamnionitis was present. Regular monitoring to identify trends in the white blood cells count is also crucial.

What has confused the issue further is that Dr Peter Boylan, a doctor with a publicly stated position opposing abortion restrictions, testified as an expert witness stating that had Savita been allowed a termination earlier, it would have saved her life. It’s very difficult to know that with any certainty without recourse to a time machine. In any event the post mortem showed that it was the E.Coli bacteria that led to septic shock. The baby was not poisoning Savita’s bloodstream, though chorioamnionitis if diagnosed, requires delivery. If the baby had died then the placenta needed to be removed in order to halt the rapid of spread of infection spread via its dead blood cells. Bacterial chorio-amnionitis is exceedingly rare.

What we do know though, is that in 40 years there have been 5 cases of septic abortions, no patients have died and Savita’s case was very rare. Every year in Ireland there are sadly 14,000 miscarriages, many of them carrying an infection risk, and no maternal deaths on record where the obstetrician felt that the law was inhibiting them. Dr Sam Coulter Smith, master of the Rotunda Hospital in Dublin, says that he has terminated a pregnancy in four instances where women had been diagnosed with sepsis and in all of them the baby did not survive. It’s difficult to see then, how Irish law can be said to be putting women at risk.

The failure of Dr Astbury to discuss abortion outside of legal terms is what has proved troubling in this case. A surgical abortion would have carried with it real risks of further infection which could have proved fatal, and had Savita been given the drug misoprostel to induce delivery, this would not necessarily have made delivery any swifter or negated the need for surgical intervention. Faced with a fully dilated cervix and ruptured membranes, the medics could thought that delivery was imminent and there was therefore no need for further medical intervention at this point. They were therefore wholly wrong not to discuss this in medical terms with Savita and her her husband. Anyone would be cross if their request for a certain type of medical treatment was refused purely on legal grounds.

What is important is that today’s inquest ruled that there was medical mismanagement in the death of Savita Halappanavar. The jury had the option to deliver an a narrative verdict which would not have attributed a cause. Despite the verdict which implies failures in medical care, the judge, Dr McLoughlin, has thrown further confusion into the mix by stating the verdict did not mean that deficiencies or systems failures in University Hospital Galway contributed to Ms Halappanavar’s death; these were just findings in relation to the management of her care.

That seems to imply that there was nothing wrong with the general systems in place at University Hospital Galway, simply that the management of Savita’s individual care was unsatisfactory as we can see. One cannot help but wonder whether or not this is about offloading any legal liability that the hospital may incur in terms of compensation that might be due? After all, it was a galloping sepsis that killed Savita, stemming from the E.coli, ESBL bacteria that entered her bloodstream from the urinary tract and one that is antibiotic resistant. No-one can say with any certainty whether, even had the care been perfect, she would have survived this. Perhaps that is what the coroner is trying to convey, medical misadventure was a factor in relation to her care, but not necessarily in her death. It’s no wonder Parveen is still in the dark.

What urgently needs to be addressed is the factors behind the poor care. Did the law really make Dr Astbury too afraid to check blood results, which needed further analysis or carry out further diagnostic tests? Was the law behind the lack of regular observations, the lack of communication and the failure to realise that paracetamol administered as a painkiller could mask other symptoms? Did the law cause staff to forget that infection requires a low burden of proof? Or was it the effects of austerity measures on an already overstretched hospital struggling with lack of resources? What caused the glaring omissions and can any law be expected to cover every single permutation that might arise in the management of pregnancy or childbirth, or is this simply that medical guidelines need to be more precise and explicit?

Here is the list of the coroner’s recommendations which the jury all unanimously and strongly endorsed

* 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 to 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 the subject of an inquiry.

Savita’s request for a termination to have been accepted and acted upon, simply by dint of her wishes. would have required Ireland to have legislation which is much more liberal than even that in the UK, which in practice, allows abortion on demand.
It’s no wonder that the clamours for a repeal of the Eight Amendment of the Irish Constitution, (which defends the right to life of the unborn) have already started. None of which addresses the reasons behind the catastrophic failures in care.
Savita’s treatment timeline can be accessed here.

Postscript

One thing that should be emphasised is how rare it is to have a miscarriage at 17 weeks. 0.5% of single pregnancies in women with no history of recurrent miscarriages end in spontaneous second trimester foetal loss. Sepsis is still thankfully rare. Whilst it should be on the radar as a possibility, most maternity staff will not be panicking about the possibility of sepsis when a pregnant woman presents with a UTI. In the incidence of a UTI, blood samples are tested and antibiotics administered. A normal reaction to a UTI would not be to terminate the pregnancy as a precautionary measure. UTIs are serious if left untreated but no medical protocols would consider them as a real and substantial risk to life. Even with a suspected UTI there was no reason (in the absence of blood results) for medical staff to believe that Savita was dying.

I would be seriously concerned if any medic proposed termination of pregnancy as being necessary as a precautionary measure, unless it was in the most serious and grave of circumstances. Nowhere in NICE guidelines is termination mentioned as a treatment for a bacterial infection. Savita’s death should not prompt pregnant women diagnosed with a UTI to seek abortion and neither should they worry about contracting sepsis. One thing that should be remembered is the importance of scrupulous personal hygiene in terms of preventing the spread of bacteria such as E.coli.

Savita: Some more facts (For the hard of understanding)

There’s a fabulous phrase from Blackadder goes Forth, that would make for a very witty inscription on a tombstone and which I employ on frequent occasions when discussing pro-abortion advocates. Uttered by General Melchett (Stephen Fry before he manifested the symptoms of irrepressible smugness) whilst discussing the progress of the Great War, he tragically and comically sums up the attitude of those directing the war, thus:

If all else fails, a total Pig-Headed unwillingness to look facts in the face will see us through

I’m thinking in particular of the continued propagation of the idea that Catholic dogma played its part in the death of Savita Halappanavar, and the insistence that a timely abortion would have saved her life.

I’m going to spell this out very simply for the terminally hard of understanding.

Sunday 21st October 2012.

Savita was admitted to Galway University Hospital. She was suffering from backache and during the day had experienced some distressing blood and fluid loss. The hospital took bloods and examined her. The blood results that would have indicated that she had an infection were never followed up on, and Savita did not manifest obvious signs of infection. Sepsis is a deadly disease with a rapid progression which medical staff need to be hyper-vigilant about when dealing with pregnant women. Its symptoms can easily be masked by other symptoms in pregnancy, such as backache, raised temperature and generally feeling unwell. Savita had a history of back problems and had herself misdiagnosed her pain earlier in the day.

Savita would appear to have been suffering from a Urinary Tract Infection, (UTI) which are very common in pregnancy, need antibiotics to treat them, but are not necessarily life threatening. Let’s add into the mix that University College Hospital Galway, was over-stretched in terms of staffing and resources, this report in 2011 names it as the worst performing hospital in Ireland for the second consecutive month with calls for the Health Minister to intervene. The hospital seems to have been suffering from chronic shortages, which is something we should bear in mind before pointing the finger.

There is no reason at this point, to believe that Savita needed an abortion, let alone that her life might be at risk.

Upon examination it appears that Savita’s membranes are bulging and her cervix can’t be felt, meaning that a miscarriage is sadly imminent. There is no reason to believe that she is at risk of infection or that she needs an abortion. Later on, in the early hours of Monday morning, her membranes rupture. Again, there is no need to think that she may need unnecessary surgery, this seems like a regular miscarriage.

Monday 22nd October 2012

By 10pm on that evening, Savita’s waters had been ruptured for a full 22 hours. She was on antibiotics every six hours. It’s not clear when these were started, it should however have been from the moment the membranes ruptured and ideally based on the results of the blood culture taken on Sunday evening.

Tuesday 23 october 2012

At 8.20 am Savita is seen by Dr Astbury who informed her that ‘that the legal position in Ireland did not permit me to terminate the pregnancy in her case at that time.’ Savita is, at that point very distressed and requesting an abortion to put an end to her ordeal. No-one can blame her. She knows that she is miscarrying her baby and wants the whole thing to be over.

My take on this, is that Dr Astbury obviously sympathises. I think that she doesn’t want to take personal responsibility, or appear harsh and uncaring, nor does she want to cast the hospital in a bad light, there is no medical reason, or so it would seem, for an abortion, this isn’t life or death, they probably didn’t have a theatre or staff available at short notice and so she fell back on the letter of the law as an explanation. It’s fair to say that the law would not allow for an abortion in these circumstances, the foetal heartbeat is present, the patient seems comfortable and stable and no doubt many of the staff would have felt uncomfortable, given that this was not medically necessary, but it seems that there was no discussion as to why the hospital were taking the conservative management approach, one that would be taken in hospitals around the world. Hospitals do not deliver pregnant women the moment their membranes rupture, they can very often be sent home to get some rest in comfort, before being readmitted within the next 48 hours, depending on protocols and individual circumstances. It seems very remiss that Dr Astbury explains this in such a perfunctory and legalistic way. Surely Savita was owed more of an explanation?

If there was a clinical need for an abortion, why did Dr Asbury not consult with any of her colleagues? In any event, Savita was described as being “upset, but not unwell”.

Later on Dr Astbury testified that had she had access to Savita’s blood results earlier, then she would have taken theraputic intervention, i.e, an abortion, earlier. So how does this delay in terms of diagnosis and identifying the infection, equate with being the fault of Catholicism or uncertainty surrounding the legal situation?

But what does not make sense, is that if an infection is present or suspected, it is a contraindication for surgery – why invade a sterile uterus with instruments and risk flooding the body with further infection? Conservative management is always the default option in the treatment of miscarriages.

Wednesday 24 October 2012

This is the day that things begin to unravel for poor Savita. At 7am her pulse is 160 per minute (normal resting heart rate is usually between 60 and 80). Her blood pressure is 100/60 mm (normal is 120/80). Her temperature is 39.6 and in addition foul smelling discharge is present, suggesting infection. The doctor on duty concurs she is suffering from probable sepsis.

An hour and half later, 8.25 am, Dr Astbury and team see Savita on their ward rounds. Swabs are taken to determine what exact infection is present. According to the Irish Times, Dr Astbury testifies thus:

At this point her temperature had come down to 37.9 degrees and her pulse to 144bpm. She said she discussed with Ms Halappanavar the concern that she had inflamed foetal membranes due to infection.

“I also informed Ms Halappanavar that if we did not identify another source of infection or if she did not continue to improve we might have no option but to consider a termination regardless of the foetal heart.”

Mr Halappanavar has said he had no knowledge this discussion had taken place. In his statement he said he was at the hospital with his wife throughout Wednesday.

Subsequent to this, Savita deteriorates further, Dr Astbury consults with a colleague who agrees that delivery is medically necessary, a scan confirms that the baby has died, she is taken into theatre where she delivers, is subsequently transferred to HDU and then ICU and dies following further subsequent deterioration just after midnight on Sunday 28 October 2012.

Savita’s husband has no recollection of the conversation that a termination might be needed regardless of the presence of a foetal heartbeat.

Let’s leave aside the comments from the midwife, who was discussing abortions in a cultural context, Ireland’s Catholicism in relation to India’s Hinduism, in response to Savita’s request for an abortion. These obviously do not dictate care. Also Savita’s request for abortion should not be considered a factor. Patients’ wishes, whilst often taken into account, do not dictate what is best medical practice, as I learnt when I was refused the option of being able to deliver my youngest baby naturally. The doctors understood, they sympathised, they could see I was distressed and terrified and they did what they could to help me be comfortable, but ultimately they would not agree to the course of action that I requested, because it was deemed to be unsafe, and interestingly more unsafe for the baby than for me. I could not force them to act against my best medical interests.

Why would an abortion be required if the Dr could not find the source of the infection? It is clear that the baby could not have been the source of the infection. This is biologically impossible. A baby would not suddenly become infected and pass this onto the mother. The baby is in a sterile environment, even after the membranes have ruptured. The inflamed foetal membranes referred to, or to give it the correct medical term, chorioamnionitis, had not been identified. If this was the concern, which would require delivery, why wasn’t this possibility examined for sooner? It all seems like amateur guesswork. Finding the source of the infection, and treating the infection is a wholly different issue as to why the baby would need to be delivered. Plus we know that Savita presented with infection at the hospital, prior to the rupture of the membranes.

And here’s the absolute crunch. Four key failures. The blood test results performed on Savita on the Sunday evening admission, were ready at 6.37pm that evening, but not read until 5.25pm the next day. They were not then accessed again until after sepsis had been diagnosed and Savita’s condition was rapidly deteriorating, two days later. When Savita started shivering at 4.15am on the Wednesday morning, the first obvious signs that sepsis was raging through her body, her vital signs should have been checked. They were not. The blood culture sample taken from Savita at 8:29 am on Wednesday 24th October was processed onto the computer system by microbiology at 9.54 am but not reviewed by Dr Astbury until 11:20am. The lab also reported that the 2nd key sepsis test should have been performed on the ward, it was not. This a lactate serum test which could have definitively confirmed the presence of sepsis. The sample was taken at 6am on the Wednesday morning and stored in an inappropriate bottle before being sent to the lab who could not process it. The lab would not, in any event have carried out this test which should have been performed at a point of care unit on the ward.

The antibiotic treatment administered to Savita between 7am and 1pm was ineffective as it was erythromycin, a variant that is resistant to E-coli, the infection that pathology determined killed her. Broader spectrum antibiotics would have been a better choice.

The indications that Savita had sepsis were subtle and overlooked, by staff who were not deliberately negligent, but who were overstretched and under-resourced.

Catholics and pro-lifers have been writing today of the horrors of Kermit Gosnell. Pro-choicers have been calling his case an exception from which no broader conclusions can be drawn. Why then, in the case of Savita Halappanavar, and in the face of all evidence to the contrary in this one-off extraordinary case, under which Irish law allowed for an abortion, are they claiming that this is evidence that the law is causing women to die in droves?

Savita died from an E.coli infection, which the likelihood is, entered her urinary tract and bloodstream, causing her to miscarry. It was this bacteria that killed her and prompt identification of it, along with the correct antibiotics that could have saved her life. Aborting her baby would have made no difference to the progress of the disease and would have risked further infection and hastened death.

As well as holding the hospital to account, Parveen should be asking questions of the pro-choicers who have chosen to cynically exploit this tragedy for their own ends. The baby did not kill Savita, the E.Coli did.

Savita, Sepsis and Statistics

Much crucial detail from the inquest into the tragic death of Savita Halappanavar is emerging in the media, which is being seized upon and manipulated by opponents of Ireland’s pro-life laws as well as those with an anti-Catholic or militant secular agenda.

The inference is clear – Catholic dogma is responsible for the death of a pregnant woman from sepsis, as evidenced, according to one tweeter, by the presence of a religious statue outside of Galway University College Hospital and the fact that many of the wards are named after saints. Something of a non-sequitur. Clearly the presence of religious symbolism, a reflection of Ireland’s cultural heritage, is indicative that patients can expect a substandard level of care, where medically unsafe and morally dubious dogma overrides the best clinical interests of the patients. Anyone attending St Thomas’s or Bart’s hospitals in London had better be on their guard!

Let’s start with the stats.

Here’s a table showing the maternal mortality ratio, the number of maternal deaths per 100,000 live births from the Guardian’s datablog, where ‘facts are sacred’.

Screen Shot 2013-04-10 at 22.52.28

So, the one of the highest rates of maternal mortality occurs in the US which rather disproves the claim that liberal abortion legislation is safer for women. Ireland, that country where women are deprived of abortion, has one of the lowest maternal death rates in the world, official stats show that on average 4,000 women in the Republic travel to the UK for an abortion every year, a figure that has been steadily decreasing from a high of 6,600 in 2001, so the blame for the UK’s relatively poor performance in the area of maternal health care, can hardly be explained away as being an Irish export. Pro-life Chile has the lowest maternal death rate in Latin America and Poland, another pro-life country also fares well.

Furthermore, more than 100 mothers have died in childbirth in London in the last five years, twice the rate of that of the rest of the country. Whilst we are all screaming about the first maternal death in 17 years at a hospital in Galway, where is the outrage about the lamentable situation in the UK, due to a desperate shortage of midwives? Surely anyone who identifies themselves as ‘pro-woman’ should be demanding to know how the government intends to remedy this increasing problem, aside from disincentivising those who may want more than two children?

Whilst on the subject of outrage, where were the candlelit vigils and expressions of anger over the death of Jessie-Maye Barlow, God rest her soul, the 19 year old mother of one, who died from septic shock following an abortion in September 2012, the inquest acknowledging that BPAS had not followed up on their aftercare and thus the fact that Jessie-Maye had failed to pass all the ‘products of conception’ was missed, leading to her death? Where were the protestations of anger that a beautiful young mother of one, with her entire life in front of her died as a direct result of medical negligence on behalf of an abortion clinic that was too busy to follow basic protocols regarding patient care?

Sepsis

Savita Halappanavar died from sepsis. According to the Royal College of Obstetricians and Gynaecologists, between 2003 and 2005 there were five maternal deaths in the UK of pregnant women from sepsis, with a baby under 24 weeks gestation. “Sadly, substandard care was identified in many of the cases, in particular lack of recognition of the signs of sepsis and a lack of guidelines on the investigation and management of genital tract sepsis. Between 2006 and 2008 sepsis rose to be the leading cause of direct maternal deaths in the UK, with deaths due to group A streptococcal infection (GAS) rising to 13 women. Severe sepsis with acute organ dysfunction has a mortality rate of 20 to 40%, which increases to 60% if septic shock develops. Studies in the non-pregnant population have found that the survival rates following sepsis are related to early recognition and initiation of treatment.”

In 2012 the RCOG published green top guidelines for treatment of sepsis in pregnancy. The guidelines state

The signs and symptoms of sepsis in pregnant women may be less distinctive than in the non- pregnant population and are not necessarily present in all cases; therefore, a high index of suspicion is necessary.

The diagnosis of sepsis must be confirmed by blood cultures and early swift administration of broad spectrum antibiotics are the key to the survival of the patient, alongside regular monitoring.

Crucially and unfortunately, this did not happen in the case of Savita, who was admitted into the hospital on the evening of Sunday 21st October. Blood tests that were taken that night, which were never followed up on, showed an elevated white blood cell count which would have been one of the key indicators that infection and indeed sepsis was present.

Whilst oral antibiotics appear to have been started on the Monday night, following the spontaneous rupture of membranes, an infection of the severity of Savita’s would have required intravenous administration. The consultant obstetrician has described the situation as a systems failure on multiple counts, not only were the blood results not followed up on, but also, the vital regular observations which may have alerted the staff to the presence of an infection sooner, were not carried out at regular intervals throughout the night, which is why the infection was only picked up in the early hours of the Wednesday morning, after Savita had taken a dramatic turn for the worse, a doctor who had come to check on her on the Tuesday evening, saw she was asleep and so left her. Once Savita’s membranes had ruptured (in the early hours of Monday morning) then she should have been checked every 4 hours for signs of infection.

The RCOG guidelines state that all staff should be aware of the signs and symptoms of potential sepsis and the rapid and potentially lethal course of the disease, which is often less distinctive in pregnant women. Therefore whilst one can reasonably assume that care was lacking, notably in the failure to follow up on the results of the blood tests, the narrative that University College Hospital Galway were knowingly refusing to treat a woman with a severe and life-threatening infection in order to prioritise the life of her baby, due to Catholic dogma reflected in the law, is an erroneous one. As the consultant testified, had they known about the sepsis or infection, they would have intervened much sooner, however Savita’s symptoms did not physically manifest until the early hours of Wednesday morning, over 48 hours since she was first admitted, whilst the signs may have been present, i.e. a slightly elevated temperature and raised pulse rate, this could also have been due to other factors, such as anxiety and it is only with hindsight and in the light of the missing bloodwork, that this can be identified as being the start of the infection.

Speaking to the inquest, Savita’s husband has reported that doctors seemed nonchalant on Tuesday, certainly there was no cause for concern, or reason to think that her life might be at stake.

 

Abortion to treat Sepsis – a red herring

Savita’s sepsis stemmed from an antibiotic resistant strain of E-coli, an issue that is in itself concerning. Pathology has indicated that the infection most likely originated in her urinary tract and tallies with the backache that she complained of, prior to admission to hospital. Aborting the baby would not have cured Savita of her infection and indeed in these situations, surgery is to be avoided if at all possible, as it runs the very real risk of spreading the infection further and causing death.

Whilst the hospital had failed to spot the infection, they had noted that an inevitable miscarriage was taking place. Savita, understandably, was very distressed, and wished for her ordeal to be over, as opposed to the interminable wait for nature to take its course and allegedly requested an abortion on the Tuesday morning, following the ultrasound to determine the baby’s progress.

Upon admission to hospital on the Sunday night, it was noted that no cervix could be felt, hence Savita was fully dilated and hence the premature delivery of the baby was imminent, which would mean that the baby would not survive. Later on, her membranes ruptured, meaning that the protective sac of fluid surrounding the baby completely drained, a situation which would likely result in the death of the baby and spontaneous natural delivery.

This is where the confusion sets in, which is being exploited to the max by the abortion lobby. Firstly, that Savita was fully dilated, was as a direct result of the infection which was in her urinary tract. The unborn baby was in a sterile sac of waters and therefore not the cause of the infection. The dilated cervix did not cause her infection either. An open or dilated cervix will not cause an infection, as any woman who has ever had more than one baby, or indeed a smear test will testify. Once you have had a baby, the cervix never fully closes. When I was pregnant with my eldest child, I was dilated by 2cm for a good week before I delivered. An open cervix does not make one more ripe for infection.

The infection risk is posed when the membranes or waters have ruptured, normally hospitals will be wanting a woman to deliver within 48 hours of this occurring in order to minimise risk of infection to the newborn baby. Clearly in Savita’s case this would not have applied, but if her waters broke on the Sunday night, it was not unreasonable for no action to have been taken on the Tuesday, the medics obviously thought that delivery or natural miscarriage would take place swiftly and that conservative management was the safest option in the circumstances.

Whilst Savita may have requested a termination, this may well not have been in her best medical interests.

The unborn baby was not the cause of the sepsis and so there was no good reason to terminate it as Savita’s life did not seem to be at risk. Dr. Hema Divakar, President-elect of the Federation of Obstetric and Gynaecological Societies of India speaking to the Hindu Times said:

“Delay or refusal to terminate the pregnancy does not in itself seem to be the cause of death. Even if the law permitted it, it is not as if her life would have been saved because of termination. Severe septicaemia with disseminated intravascular coagulation (DIC), a life-threatening bleeding disorder which is a complication of sepsis, major organ damage and loss of the mother’s blood due to severe infection, is the cause of death in Savita’s case. This is what seems to have happened and this is a sequence which cannot be reversed just by terminating the pregnancy.”

Catholicism and the law

It seems to me that there is something of a cop-out or buck passing exercise going on here. Dr Katherine Astbury, the doctor in charge of Savita’s care, told the inquest that in Ireland it is not legal to terminate a foetus on the grounds of poor prognosis for the foetus, but also admitted that she did not once clarify the legal situation with her colleagues or think to do so.

The law in Ireland does not prevent a termination from being carried out, if the life of the mother is at risk and as Dr Astbury testified, had she known the severity of the situation she would have intervened earlier, although from what we know now, an abortion could well have made the situation a lot worse. It seems obvious, that Dr Astbury perhaps sought to take shelter in the law as opposed to exercise her own moral and clinical judgement. No law can be formulated that will cover all the possible permutations and complications that might arise from real-life pregnancy management and so doctors can’t ever be entirely freed from having to make theraputic and ethical decisions. Whilst doctors might have to work within the law, they also need to exercise clinical judgement which will invariably and inevitably involve ethics.

The law in Ireland is clear, section 21:4 of the Medical Council Guide for Registered Practitioners says this:

“In current obstetrical practice, rare complications can arise where therapeutic intervention (including termination of a pregnancy) is required at a stage when, due to extreme immaturity of the baby, there may be little or no hope of the baby surviving. In these exceptional circumstances, it may be necessary to intervene to terminate the pregnancy to protect the life of the mother, while making every effort to preserve the life of the baby.”

So there was no legal reason why the pregnancy could not have been terminated were Savita’s life deemed to be at risk. One has to wonder why Dr Astbury couched her response to Savita’s request in purely legal terms? This was not simply about what the law proscribed, but medically speaking, conservative management of delivery is the safest approach, in the absence of any other pressing clinical factors. Theatre was obviously felt to be unnecessary at this stage, the cervix had dilated, the membranes had ruptured, delivery could not be far off, there was still a foetal heartbeat, the prognosis for the baby was poor, but there was no pressing need to abort medically, as well as legally. Why were the medical reasons not explained to her – that it was presented purely in legal terms seems to be a total failure of communication and gave the Halappanavar’s the impression that best clinical practice was being hampered by the law. The only people qualified to judge on whether or not an abortion should be performed were the doctors, not the lawyers and if any conflict had been perceived, why was this not instantaneously taken up with the hospital’s legal team, who would have been well versed in the ethics.

The Irish Catholic Bishops, responding to the case, said this:

The Catholic Church has never taught that the life of a child in the womb should be preferred to that of a mother. By virtue of their common humanity, a mother and her unborn baby are both sacred with an equal right to life.

– Where a seriously ill pregnant woman needs medical treatment which may put the life of her baby at risk, such treatments are ethically permissible provided every effort has been made to save the life of both the mother and her baby.

Which is why the conjecture over potential situations coming from all sides is unhelpful. Catholic teaching is very clear. Mother and baby have an equal right to life, whilst a baby must never be directly killed in order to save the life of a mother (and I cannot envisage a single situation where that would be necessary), a mother may receive treatment such as in the case of an ectopic pregnancy or a cancer diagnosis, which may put the life of her unborn baby at risk, or may end a baby’s life as an indirect consequence.

‘This is a Catholic country’

This was the comment made by Ann Maria Burke, a midwife manager, in response to a conversation with Savita, who stated that in India, a Hindu country, an abortion would be possible. Now is not the place to discuss India’s abortion record, especially when it comes to baby girls or how that reflects Hinduism, which treats all life as sacred, but as Ms Burke now admits, the remark was regrettable and had nothing to do with medical care. The remark perhaps smacks of racism, or was made in the context of a general conversation pertaining to religious and cultural attitudes, but tellingly the midwife was not directing the care of Mrs Halpannavar, nor was she dictating hospital policy. She was trying to explain the reason behind Ireland’s pro-life laws, which whilst they might stem from and be in accordance with Ireland’s Catholic history, do not indicate that Ireland is currently a country that is governed by those in accordance with the Catholic Church, quite the opposite Enda Kenny the current Taoiseach is doing all that he can to put distance between himself and the Vatican. Moreover Catholic moral theology would not sanction the delivery of a non viable baby as a direct cure for a pregnant woman, and is therefore slightly at odds with the letter of Irish law.

Conclusion

Had the initial blood tests been followed up on, and 4 hourly observations undertaken, then perhaps the tragedy may not have unfolded in the way that it did. What seems clear is that the infection was present upon admittance to hospital and that it is unlikely that an abortion would have cured the infection and potentially could have hastened Savita’s death. The unborn baby could not have been the source of the infection and by the time that the infection was noted, things had already progressed too far. The infection was obviously incredibly aggressive and Savita’s condition deteriorated so rapidly on Wednesday 24 October, that the decision as to whether or not to abort became moot. According to the inquest, septic shock was diagnosed at 1.20pm, two hours later, Savita’s already dead baby was delivered in theatre, so the conservative approach would have been the correct one, nature had taken its course swiftly, within the normal 48 hour window.

There is no indication that the hospital was ignoring the plight or symptoms of a critically ill woman with sepsis in order to rigorously follow the letter of the law regarding her unborn baby, when the law already allowed for an abortion to take place in these circumstances. Until the early hours of Wednesday morning, there was no obvious manifestation of infection, to those caring for her. It was only then that seriousness of the situation became glaringly apparent.

The issues here are about an awareness of sepsis. That is what Parveen Halappanavar, Savita’s husband should be angry about. This is the issue that he should fight for in his wife’s memory, as well as suing the hospital for their negligence in following up on her blood tests. Understandably he wanted his wife’s distress to be alleviated by an abortion, a procedure that may well not have been in her best interests either physically or emotionally. That the hospital could only explain this in legal terms is as great a dereliction of care and duty as it was not to have chased her blood results or carried out her observations.

Ireland’s abortion laws may change as a result, unborn babies will die and no action will be taken to address the urgent problem of sepsis diagnoses, nor indeed the worrying spread of ESBL bacteria that killed Savita. Abortion won’t cure sepsis or aid its diagnosis. It may however mean that more women and babies are exposed to the deadly bacteria. Savita’s memory deserves better.

The real scandal

A few days ago, the freelance writer Ruari McCallion posted some thought-provoking comments in response to my thoughts on the case of Savita Halappanavar reminding me not to be too hasty in terms of my assumptions. He has written an incendiary guest blogpost on Mark Lambert’s blog. I’ve reposted it in full below.

The point of my post the other day was to note that just because poor Savita asked for an abortion to end her distress, this does not mean that this would have been the best clinical treatment for her or that her request should have overridden medical judgement. As Clare says, sometimes doctors have to refuse our requests, years of training and experience qualify them to be able to make these judgement calls, based not on ideology but in the best long term interests of the patient. Clare begged for a sterilisation and was quite correctly refused, not being able to freely consent, in the same vein, I had a meltdown at my pre-op the day before Theodora’s birth and refused to sign the consent form for a cesarian. I wanted to deliver a baby naturally two weeks later, despite the fact that it would have been unsafe, the placenta was beginning to fail, the baby’s growth had tailed off and I’d had two previous sections. Sometimes the fear, pain and distress involved in any critical medical emergencies can blind us to other considerations. In my case, I was so terrified and phobic of going back into the dreaded operating theatre, that I put the mantra of patient choice, of “you must do what I tell you, my wishes are paramount” before the safety of my baby and myself.

So it’s quite iniquitous of Michael Nugent to say pernicious things like this:

Some ghouls from the anti-choice campaign seem to delight in the idea that Savita might possibly have died from something unrelated to the doctors refusing to give her the abortion she requested.

That’s the whole point. It seems increasingly possible that Savita died from something unrelated to the premature induction of the baby. She was not asking for abortion but for a specific course of treatment knowing her baby was not going to survive; we can make our wishes known, but we cannot impose our will upon those treating us. Being able to dictate which procedures, surgeries and drugs should be administered to us, is not a basic human right.

This story is truly scandalous. India has no right to dictate Ireland’s abortion policy whilst they refuse to address their horrific issues of gendercide or do anything to address the dowry system, which is illegal in name only. Dowry violence which does so much to engender the devaluation and debasement of women and encourages a thriving illicit sex selective abortion industry, rarely incurs any penalties or prosecution in India. Added to the fact that the Indian subcontinent has played a major role in spreading the ESBL organisms behind Savita’s infection, their hypocrisy is astounding.

Pro-choicers must not be allowed to subvert this case to allow wholesale abortion in Ireland, a country which is a global leader in maternity care and death rates.

Anyway, here’s Ruari’s view:

Who Stands to Gain from Tragedy?

If you can’t find evidence of a conspiracy then you aren’t looking hard enough…

There is a need to stop this side of David Icke (WELL this side of David Icke) but, sometimes, conspiracy theories turn out to hold water.

The death of Savita Halappanavar is a tragedy that became a catastrophe for her family – that much is crystal clear and pretty much everyone can agree on it. But then things get murkier and murkier. There are agendas at work and the hint of something rather nasty at large.

Mrs Halappanavar died of an antibiotic-resistant infection, specifically e.coli ESBL. She did not die from an abortion, from being denied an abortion, from Catholic teaching or from a confused legal system in Ireland.

WHAT IS IT?

ESBL stands for Extended Spectrum Beta-Lactamase positive gram negative bacteria. It is resistant to most strains of antibiotics. One of my informants told me: “… the antibiotics given were to no avail…two things can happen if it doesn’t respond to treatment. Either the body’s immune system deals with it in the normal way and wins or the bug defeats the immune system and the patient develops an overwhelming septicaemia, leading to septic shock. The kidneys start to fail and the blood pressure starts to fall.” They then go on and die – the mortality rate is massive.

The great concern – or what should be the concern – is that e.Coli ESBL and other antibiotic-resistant infections are now at large in the community. Previously, such things were limited to identifiably higher-risk areas: hospitals themselves; food processing (slaughterhouses in particular); and farms, where slurry is often used as a fertilizer. But Mrs Halappanavar was a dentist.

AGENDA-DRIVEN FIRESTORM

Instead of being concerned that untreatable infections are in the community as a whole and spreading, the debate has been hijacked by special-interest groups. But it is worse than that.

It is proving to be very difficult to get the truth of the fatal infection into the mainstream news media; they are only interested in the abortion angle – if they remain interested at all. As for the medics I have spoken to – they are all concerned for their careers. Getting information has been like pulling teeth. I cannot mention names or attribute their comments even to ‘a doctor/nurse/paramedic at x/y/z hospital/surgery/healthcare trust’. I can’t even mention the area they live and practice; they are frightened of being traced and found out. That could have been put down to the fear that they were passing on hearsay and gossip – but the same story has come from multiple sources. It passes the usual tests of corroboration.

FEAR MAKES FOOLS OF US ALL

I am getting a message pretty loud and clear that speaking out about this, that going public with the ‘wrong’ message may very well impact upon an individual’s career. “Most people are afraid to comment…” one of my informants has said. Some of my informants are coming towards the end of their careers and are slightly more inclined to speak out but even then there is a great deal of caution. There appears to be real, tangible fear.

Is it a conspiracy? Well, in my experience, you don’t often find doctors and nurses so frightened for their jobs. Patient confidentiality is always respected, of course, but there is so much out in the open now that confidentiality is not an issue. It is odd – very odd – that the ‘pro-choice’ group whose press release triggered off this furore seems to have known about the incident for some days, had access to medical information that was not at the time in the public domain and was, therefore, supposedly confidential. It had the chance to tee up its members and supporters that a major story was about to break.

FOLLOW THE MONEY….

It happened shortly after a Marie Stopes facility opened in Northern Ireland, and soon after an RTE broadcast of an undercover investigation that revealed pregnancy advisory services are behaving in an illegal and dangerous manner. One of my informants has pointed out that the consultant in charge of the deceased lady is actually English and mentioned casually that it was unusual to see people coming in from the UK – that the traffic is usually the other way. “…it may be because she has an agenda”, they said. They may be appallingly right. As someone said, there is a lot of money to be made from abortions, as the UK and US experience demonstrates.

The tragedy of Mrs Halappanavar and the ensuing fuss has arrived very conveniently to overwhelm the negative programme – who now remembers it at all – in a tide of prejudice, misinformation and lynch-mob hysteria.

I had to ask some rather distasteful questions to get to the truth and got some fleas in my ear for suggesting the possibility of racism or gender-selective illegally-procured abortion! And then the gates began to crack open, the information started to flow but the fear of my informants has become almost tangible. The enquiry looked like the sort of stitch-up from the old days; it was almost laughable. Now the widowed husband has got a lawyer and is involved in setting the terms of reference of the enquiry – which hasn’t even started yet. If his wishes are not abided by, then he will not allow his deceased wife’s records to be released. I hesitate before making this observation but, of course, if no-one is responsible, if it was a tragic death that was unpreventable, then some interests will be frustrated. There are interests in finding someone or something to blame. Which means that there will be horsetrading going on to make sure it lands in the ‘right’ place. As I said, if you can’t find evidence of a conspiracy then you aren’t looking hard enough.

GET THE MESSAGE OUT

A Doctor Clair, from Cork, has had the courage to speak out publicly, in the form of a letter to the Irish examiner that was published on Tuesday 20 November. He is almost alone at the moment but one hopes his letter will get wider publicity. Readers of this blog should disseminate it as widely as they can.