I didn't read significant notes on medical chart, confesses doctor

Dr Katherine Astbury said she had not seen a notation on the 31-year-old's charts that would indicate a deterioration in her condition. She also conceded that she had not seen Ms Halappanavar's blood results, which had changed and could have been indicative of severe sepsis.

The consultant obstetrician told the inquest that had she been aware of these details she would have brought forward plans for a termination to the Wednesday morning.

Termination

Dr Astbury had earlier told the inquest that she had been unable to accede to Ms Halappanavar's requests for a termination on the Tuesday because her health was not in any danger and she feared it could become a legal issue.

The court heard that Dr Ikechukwu Uzockwu, known as Dr Ike, had noted a deterioration in Ms Halappanavar's condition at 6.30am on the morning of Wednesday, October 24. He made notes of a "foul-smelling discharge" on her chart along with details of a raised pulse and temperature.

However, despite receiving this chart, Dr Astbury told the inquest she had not read it. The inquest also heard from Dr Anne Helps, a registrar attached to Dr Astbury, that she may not have passed on significant information on the deterioration of Ms Halappanavar to the consultant.

Dr Helps recalled her colleague, Dr Ike, passing on details to her as they switched rounds on Wednesday. She recalled him telling her of a spike in temperature and that Ms Halappanavar felt unwell but said she could not recall receiving any further details from him.

Details of the discharge were included in Dr Ike's notes, which were also handed over, but Dr Helps said: "I can't remember reading those notes." Dr Helps also admitted it was possible she had not mentioned the discharge while reading the notes to Dr Astbury.

Dr Astbury said she would have taken steps to begin a medical termination earlier had she been aware of the issue. She accepted the discharge was a "very significant" finding.

"Obviously it should have been communicated," she said. When it was pointed out that it had been written down on the chart she added, "I should have been aware of it, yes".

Dr Astbury confirmed it was her intention to induce the pregnancy on the Wednesday after forming the opinion that there was a "real and substantial" risk to Ms Halappanavar's life, but said she would have begun this earlier had she been aware of the discharge.

Earlier, Dr Astbury agreed that she felt inhibited and constrained by the laws in Ireland when it came to Ms Halappanavar's case.

When asked by Coroner Ciaran McLoughlin: "Did you think it might be a question of law?", Dr Astbury replied: "Yes."

Dr Astbury defended her decision to hold off on any possible termination, saying: "I am waiting because the law states in the absence of risk to the life of the mother there is no reason to intervene."

Speaking about her interaction with Ms Halappanavar, Dr Astbury said: "I said to her in this country it was not legal to terminate pregnancy on the grounds of poor prognosis for the foetus."

It also emerged that there were longer than four-hour gaps for checking Ms Halappanavar's vital signs at night.

Dr Astbury accepted that these delays were a "system failure" when it was put to her by Dr McLoughlin.

The consultant also accepted that she wasn't aware that the white-cell count had risen to 16.9 and as the results had not been documented, she had no reason to believe there was an abnormality.

Conceding that this also represented a system failure, Dr Astbury said: "I suppose each team should also check their own results."

This point was then stressed by Dr McLoughlin, who said there had been "two system failures" in that the patient was not monitored in four-hourly visits after the spontaneous rupture and, secondly, that the blood count was not related to Dr Astbury.

Ms Halappanavar was transferred to a high-dependency unit after naturally delivering her dead baby daughter, and later was moved on to intensive care where she died.