Saturday 21 October 2017

Savita would have been saved by early termination, says expert

Caroline Crawford

Caroline Crawford

SAVITA Halappanavar would most likely have lived had she received a termination within two days of her admission to Galway University Hospital, an expert witness told her inquest.

However, Dr Peter Boylan said that under Irish law this could not have been carried out because there was "not a real and substantial risk to her life at that stage".

The former master of the National Maternity Hospital in Dublin said that in his opinion the 31-year-old woman would have survived had the termination been carried out on the Monday or Tuesday.

"Had Mrs Halappanavar's pregnancy been terminated on Monday, October 22 or Tuesday, October 23, it is highly likely on the balance of probability that she would not have died. Termination at that time was not a practical proposition because of the law," he said.

He told the inquest that he did not believe carrying out a termination on Mrs Halappanavar from Wednesday onwards would have saved her life as her condition was too serious at that stage.

"The real problem was the inability to terminate the pregnancy prior to Mrs Halappanavar developing a real and substantial risk of death.

"By that stage it was, effectively, too late to save her life," he said.

Dr Boylan said that from 6.30am on Wednesday she was seriously ill, enough to justify a termination. However, he said that any termination from 9.30am on Wednesday onwards was unlikely to have made a difference to the outcome.

The consultant told the court that the medical team treating Mrs Halappanavar had to await the arrival of sepsis before intervening. Severe sepsis carries a chance of death of up to 40pc and can be considered "a reasonable risk to the mother", he said.

Dr Boylan stressed the difficulties faced by doctors working in Ireland when it came to the current legislation surrounding terminations here.

The maternity expert also raised a number of deficiencies in care in Mrs Halappanavar's case, including a failure to record the initial white blood count or repeat the test; the failure to record three of the four vital signs; the poor quality of medical notes; and failure to carry out a medical review early on the Wednesday.

"There are a number of deficiencies in care which I have outlined above, none of which, on their own, is likely to have resulted in Mrs Halappanavar's death.

"Cumulatively however they resulted in a delay in appropriate treatment of several hours and it is well known that each hour delay in appropriate treatment increases the mortality rate by 6pc. Nevertheless, I think there is a strong argument that even if appropriate intervention had commenced in the early hours of October 24 that the outcome would not have been any different," he added.

Replying to this, coroner Dr Ciaran McLoughlin said: "Every hour delay increases the risk by 6pc. There were seven hours so the risk was increased by 42pc."

Alerted

Dr Boylan agreed that while Mrs Halappanavar had sepsis from the early hours of Wednesday morning, severe sepsis had only set in by 10.30am, two hours after Dr Katherine Astbury had carried out her ward rounds.

He told the court that it was not clear to him why a doctor was not alerted at 10.30am.

Dr Boylan agreed with Eileen Barrington, counsel for Dr Astbury, that there was a two-fold test when it came to carrying out terminations in Ireland. That there must be a real and substantial risk to the life of the mother and that that risk is only capable of being avoided by the termination.

Earlier the inquest heard that Mrs Halappanavar's full vital signs were not taken for a critical nine-and-a-half hours in the run up to finally being diagnosed with sepsis.

The last full vital signs were recorded at 9pm on Tuesday, October 23. They were not taken in full again until 6am on Wednesday.

During that time, Mrs Halappanavar's temperature was recorded twice.

Dr McLoughlin was questioning Dr Ikechukwu Uzockwu, a senior house registrar who treated Mrs Halappanavar from Tuesday night until Wednesday morning. Concerns about recording the vital signs were also raised by Dr Boylan, who said that had Mrs Halappanavar's pulse and blood pressure been taken at 4.15am on Wednesday it "would likely have generated a request for medical review".

Speaking about nurse Miriam Dunleavy's decision not to take Mrs Halappanavar's pulse at 4.15am on Wednesday morning, when she found her to be shivery with her teeth chattering, Dr Boylan said: "In retrospect it was probably an error of judgment."

Dr Ike was one of two witnesses who was recalled to give evidence yesterday after he and a midwife gave differing versions of events. The inquest also heard from midwife Ann Maria Burke, who contested evidence from Dr Ike that she had not informed him of a change in the vital signs.

Ms Burke insisted that on the evening of Tuesday, October 23, she had called Dr Ike to make him aware that Savita had an elevated pulse.

Dr Ike has insisted he was told all of the vital signs were normal. Savita Halappanavar (31) died on October 28 at Galway University Hospital. She was 17 weeks pregnant when she was admitted to the hospital a week earlier suffering a miscarriage.

Irish Independent

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