The inquest


The inquest into the death of Savita Halappanavar ended on Friday and Praveen Halappanavar still doesn’t have answers. He told us what he thinks of the whole thing.

The medical care she received was in no way different to staying home. Medicine is all about preventing the natural history of the disease, and improving patients’ lives and health. And look what they did. She was just left there to die. We were never – we were always kept in the dark. If Savita had known her life was at risk she would have jumped off the bed and seeked a different hospital. She was, we were never told, and it’s horrendous, it’s barbaric and inhuman the way Savita was treated in that hospital.

It’s very striking. She might as well have stayed home. They went to the hospital, naturally thinking that they would find there what you’re supposed to get at hospitals – treatment. They didn’t get that, and they weren’t even told they weren’t getting that. She was just left there to die. The medical staff went through insulting mocking motions of treating her – they stuck her in a bed, they took her vital signs, there were medical people around – but they didn’t do what they needed to do to prevent her from dying. They refused to interfere with the natural course of the disease. They decided, without telling much less asking the patient and her husband, that the risk wasn’t big enough for them to do anything about it. It is, indeed, horrendous and barbaric and inhuman.

The Independent reports:

The inquest had heard evidence from an expert witness that the only thing that could have saved Savita was a termination within a day or two of being admitted to hospital, and by the time it was lawful to perform a termination, she was beyond saving.

“An extremely rare condition had been dealt with as best as possible by hospital staff on duty,” he said, referring to the blood poisoning caused by E.coli that ravaged through her with frightening speed, causing her death by multi-organ failure.

Barrister Eileen Barrington said there was “no basis in fact or law” to call for the accountability of her client, Dr Katherine Astbury, the consultant responsible for Savita’s care while in hospital.

Everyone had done their best. No one could be reproached, as was frequently pointed out an inquest is not allowed to point fingers; that is for the civil and criminal courts.

No, everyone had not done their best. Maybe that’s not their fault, maybe it’s the fault of the law, but they did not do their best. Their best would have been a prompt termination, and they didn’t do that. It’s a lie to call what they did “their best.” That’s the whole point. It’s very sub-optimal, nonstandard, inadequate, bad treatment to refuse to terminate a protracted miscarriage. Do not ever call that “best.”

It cites the inquest’s expert witness, Peter Boylan, former Master of the National Maternity Hospital.

Mr Boylan made no criticism of Dr Astbury, Savita’s consultant. According to his assessment, the biggest factor affecting her treatment of Savita was beyond her control. In his medical report, Mr Boylan said: “The real problem was the inability to terminate the pregnancy, prior to Ms Halappanavar developing a real and substantial risk of death. By that time, it was effectively too late to save her life.”

Had this been done on the Monday or Tuesday, he said it was highly likely that Savita would be alive. But Dr Astbury, like other doctors, was hampered by the law, which prohibits termination unless there is a real risk to the mother’s life.

The disturbing (to put it feebly) thing about that is that outside Ireland the risk is considered real and substantial. That’s why the standard of care with PRM is prompt termination: because of the risk of infection. The Irish law is deeply, disturbingly fucked up.

Comments

  1. says

    Mr Boylan made no criticism of Dr Astbury, Savita’s consultant.

    Well fuck him then.

    In his medical report, Mr Boylan said: “The real problem was the inability to terminate the pregnancy, prior to Ms Halappanavar developing a real and substantial risk of death.

    The real problem is this: A doctor chooses to work in a hospital where medieval mythology supersedes medical best practice, so when a patient develops say, chorioamnionitis, the doctor feels bound to adhere to hospital policy rather than to established standards of medical care.

    That doctor needs to be deregistered and fired, and the hospital admin staff who enabled and enforced this practice need to be indicted for murder.

    That’s what needs to happen here.

  2. says

    Rorschach, I’m going to be charitable and assume you don’t really follow the case; Dr. Boylan has been excellent, even in the face of deception attempts by hard line Catholics. His radio debate today was brilliant –

    http://www.broadsheet.ie/2013/04/21/dr-peter-boylan-and-breda-obrien-the-transcript/

    Presumably you’re also unaware that Irish abortion law is a shambles that young people from Ireland like myself are actively fighting hard to change that. And yes, the law resticts women from getting the care they need and deserve. This was predicted back in 1983, when the 8th ammendment passed. If you’re interested, I wrote about it last year;

    http://3menmakeatiger.blogspot.co.uk/2012/02/20-years-since-x-case-irelands-eternal.html

    Just a point that pointing fingers is easy, and it’s easy to point them the wrong direction too.

    I understand your frustration, but easy finger pointing usually leads to the wrong targets and you’ve bascially

  3. says

    Apart from the glaringly obvious mentioned above, the report reads like an average summary of any English hospital fuckups, and adding to that, if she was indeed killed by a multi-resistant E.coli, that’s unfortunately a bug we see increasingly often in patients from the subcontinent, even here in Australia, mainly thought to be due to the fact that you can buy antibiotics like lollies and over the counter in places like India.

  4. says

    Snap, David – I was just posting a bit of that transcript in a new post.

    And rorschach clearly the issue is the law, not particular doctors.

    Although…also clearly, Praveen Halappanavar does blame the hospital and staff, for at least failing to tell them to go elsewhere. I’ve been wondering if they could have fled to Northern Ireland by car or hired ambulance.

  5. Amy Clare says

    Dr Astbury was hampered by the law – that’s a cop out. If she knew what she was doing as a doctor, she knew that Savita was at ‘real’ risk of dying. She chose to do nothing about it because she either a) agrees with the law or b) was too scared for her job.

    If you have a decent bone in your body you save the person’s life, worry about the consequences later. I can’t imagine any court in the land would have seriously imprisoned Dr Astbury for terminating a doomed fetus. She knew what she was doing, she agreed with it.

    Has she ever once expressed anger at Irish law for forcing her into inaction? Seems from the reports I’ve read that it’s the opposite, she has tried to cover her arse. She is every bit as fucked up as the law.

  6. says

    It’s weird, isn’t it. The law seems to be deeply internalized, so that many people don’t rage at it or struggle with it. I’m having a hard time picturing how things went at UHG – a hard time picturing the interactions between the Halappanavars and the staff. The whole situation is profoundly weird.

  7. Amy Clare says

    I have a hard time imagining it too, given that things would go so differently in England. Although there was a debate recently on UK television about Northern Ireland’s abortion laws, and you would be surprised at how many Irish people are ‘proud to be different’. Including women of childbearing age, who passionately defended the lack of access to abortion in NI even though there’d be nothing to stop them experiencing the same kind of tragic death as Savita.

    It’s not a massive stretch of the imagination to consider that Dr Astbury may feel similarly.

  8. says

    So, not only didn’t they treat their patient, they also kept her in the dark about the actual state of her condition? In what practical way is that different from murder?

  9. says

    Negligent homicide, at the very least, but I really think it goes beyond that. When you’re actively keeping a person in the dark about a life-threatening medical condition, despite the fact that you’re a doctor, her doctor, and know full well the possible results, that goes beyond mere negligence and into something else.

  10. ema says

    And yes, the law resticts women from getting the care they need and deserve.

    Irish law provides for fines and jail time for Ob/Gyns if they are competent when treating pregnant patients? I thought it was only here and some places in South America that had to deal with this barbarism.

    In any case, Dr Astbury needs to lose her license and never be allowed near a patient ever again.

    A competent physician 1) is familiar with the treatment of common conditions like miscarriage and infection, and 2) knows that if she’s unable to provide proper care (irrelevant why not) it’s her professional responsibility to transfer the patient to insure proper treatment.

  11. says

    Barrister Eileen Barrington said there was “no basis in fact or law” to call for the accountability of her client, Dr Katherine Astbury, the consultant responsible for Savita’s care while in hospital.

    What a crock of shit.

    As a doctor, it was her responsibility, her duty, to save her fucking patient.

    There is EVERY fucking “basis in fact or law” to call for the accountability of “doctor” Astbury. She murdered a woman!

  12. karmacat says

    I guess her doctors thought she would run off to Northern Ireland if they told her their plans, laws and her condition. so they imposed their religion on her just because she lived in Ire. I also wonder if her doctors could have gotten away with lying about hearing a fetal heartbeat. There are small things doctors can do to get around the system. I just can’t fathom just sitting around watching a patient suffer and die. You would have to have a heart of stone

  13. says

    Presumably you’re also unaware that Irish abortion law is a shambles

    No, I’m quite aware of it, thanks. As Ophelia mentions above, people(and doctors) there seem to have internalized the law to a certain degree, and lost the best interest of their patients out of their sight in the process.

    Aside from the cockups described in the report(like residents not communicating change in vital signs etc.), I can not see how someone could seriously argue that the overseeing and responsible Ob/Gyn would not be in any way shape or form liable for what happened. Fetal survival after PROM at that gestational age is zero as far as I know, and if I know it, then that Consultant Ob/Gyn knows it too. Best practice is not to wait until infection sets in, not anywhere in the world.

  14. says

    Not to godwin, but I think a doctor being complicit with an immoral and rotten law is more that just a little similar to a citizen being complicit with an inhuman political system. If you are a doctor and oppose these abortion laws, then you see that your patients get the care they need, either by sending them elsewhere, or by creatively interpreting the existing legal framework.

    From what I read, Dr Astbury is guilty of being complicit with the rotten Catholic morality at wotk at UHG.

  15. says

    I think the debate is being wrongly framed; I’ve heard doctors interviewed about the procedure that Savita needed who didn’t say ‘termination’, they said ‘delivery’. The most convincing of the doctors that I heard said that all the medical textbooks will tell you that the only effective treatment is immediate delivery, regardless of the status of the baby/fetus/can’t-remember-which-word-he-used. The baby is in the process of dying; it will not make the baby’s situation better to leave it in utero. The mother may be in the process of dying; it will not make her situation better to leave her with a failing pregnancy while the risk of infection becomes astronomical. You deliver the baby, according to this doctor, and then you try to treat both baby and mother as best you can.

    It’s only when you turn “delivery” into “termination” that you fall foul of the (cruel, misogynistic) law.

    Of course, we wouldn’t even have to talk about the wording if the medical staff applied their rule — “there’s a heartbeat” — to the MOTHER as well as to the potential child.

  16. says

    Hmm, saying “delivery” when it’s a pre-viable fetus smacks of deception to me.

    The doctors I’ve read on this say the standard of care is prompt delivery or termination, but not immediate. Same day but not necessarily same hour.

  17. dianne says

    I think this is a situation where everyone (on this thread) is right:

    Rorschach is right that Dr. Astbury has been acting in an unethical manner since the day she accepted employment in an institution and country where she can not, by law, do the right thing for her patients. She knew that her patient had a high chance of dying and she deliberately did not do the one thing that could have saved her. Heck, she didn’t even do the things that could have possibly helped keep her patient alive until she could do the right thing, i.e. ICU care and antibiotics for whatever FSMawful resistant bacteria she had and then abortion at the very first moment it was legal. Or before: take a stethoscope, listen for fetal heart tones and DON’T FIND THEM! Find a sympathetic colleague to do same if you need verification. It’s not that hard if you want to save your patient and not let her die for ideology’s sake.

    OTOH, David, Amy, et al are correct that simply deregistering Dr. Astbury won’t solve the problem. Because not every OB is Dr. Tiller. Not everyone is willing to risk life, limb, and career for their patients. The law has to change or there will be more women dying because they were treated by indifferent and mediocre OBs.

    Dr. Astbury deserves to be fired and deregistered, but that won’t be enough. Laws have to change. And attitudes. Why does the entire world not recoil from people willing to enslave women and violate their most basic right to bodily integrity? When will we stop treating fetuses are worth more than adult women?

  18. jmb says

    During the initial protests last fall, I read a number of articles by Irish women who had been in the same situation, and were told by *ethical* medical pracitioners that, although they couldn’t specifically (ie legally) say so, “if you were my daughter, I’d go to England yesterday,” etc. Just as doctors at Catholic hospitals in the US do things like say, “I hear no heartbeat,” and go ahead. So claiming that everyone’s hands were tied, and therefore they’re ethically exonerated, is simply not true.

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