Jackie Nanyonjo »« Left untreated, the outcome is maternal death

Wednesday at the inquest

Fergal Bowers reporting for RTE, again.

The consulting obstetrician said there were system failures.

Dr Katherine Astbury said Mrs Halappanavar’s clinical signs were not checked every four hours after her membranes ruptured, which was a breach of hospital policy.

She told the inquest that when Mrs Halappanavar requested a termination from her on the morning of 23 October, she outlined the legal position to her.

She said that Mrs Halappanavar had told her she was finding it very upsetting and difficult given that the ultimate outcome would be that her baby would not survive.

Dr Astbury told her “in this country it is not legal to terminate a pregnancy on the grounds of poor prognosis for a foetus”.

Pause to rant. That is disgusting. It’s sick. The issue in this case is infection and death and failure to treat, but even if it were “only” a matter of refusing to hasten the end of a doomed pregnancy, that is disgusting. As I understand it the fetus’s chance of survival was closer to zero than a very small percentage, and why should the mother be punished by being forced to wait for the fetus to die inside her? It is sick.

She said it was her view that Mrs Halappanavar was emotionally disturbed, but not physically unwell.

She told Mr Halappanavar’s barrister, Eugene Gleeson, that she felt at the time the prospect of viability for the foetus was poor as opposed to being non-existent.

The phrase “inevitable miscarriage” had been recorded in medical notes by a colleague of Dr Astbury on 22 October.

Dr Astbury told Mr Gleeson that “the law in Ireland does not permit termination even if there is no prospect of viability”.

She said this was her understanding based on the X case judgment and Medical Council guidelines.

She told Mr Gleeson it did not occur to her to consult her colleagues about the legal position.

That seems to indicate that Astbury has no idea that a dilated cervix and/or premature rupture of membranes is/are dangerous, while what I get from Jen Gunter is that that’s basic knowledge, in every textbook. Astbury isn’t a cardiologist after all, she’s an obstetrician. I’m wondering what is in Irish medical textbooks.

Dr Astbury said she did not see Mr Halappanavar or his wife on Monday 22 October after a scan detecting a foetal heartbeat was performed and that there was no formal request made to her for a termination on that day.

Great. Fantastic. They just shoved her in a corner to wait, then.

The Irish Times also reports.

Dr Katherine Astbury agreed with coroner Dr Ciaran McLoughlin there were systems failure at the hospital in relation to the monitoring of Ms Halappanavar and the processing of blood tests.

Asked about her decision to refuse Ms Halappanavar’s request for a termination, she said that under Irish law there had to be a “real and substantial risk” to the life of the patient before this could happen.

Which there was. And if there hadn’t been – why does Irish law want to force women to take risks?

I know why; it’s because priests; but it’s necessary to spell this crap out. Irish law sees fit to make gradations of risk and to force women to take what Irish law considers “unreal and insubstantial” risk to their lives.

At the time of the request, Ms Halappanavar was well and a termination was not permitted because of a diagnosis of poor foetal prognosis.

Dr McLoughlin urged the witness to get away from the “emotive term” of termination, which evoked the killing of the foetus. This was not the intention of the Halappanavars, he said. Dr Astbury said that if a patient was given medication to deliver at the time when there was a foetal heartbeat, her understanding was that this was a termination.

Dr McLoughlin quoted from Medical Council guidelines on obstetric complications, which state that it may be necessary to intervene to protect the life of the mother while making every effort to save the baby’s life.

Asked if she felt she had scope to intervene under these guidelines, the witness said she didn’t believe she could. Her understanding was that these guidelines applied to situation where a mother had been diagnosed with cancer or another life-threatening illness not related to her pregnancy. In that situation, intervention would be justified, Dr Astbury said. The issue was that there was no law to tell someone what was permitted or not. It was a question of law.

What an incredible dog’s breakfast.

 

 

Comments

  1. Wojo says

    “Dr Katherine Astbury said Mrs Halappanavar’s clinical signs were not checked every four hours after her membranes ruptured, which was a breach of hospital policy.”

    Great, now we know that Mrs Halappanavar’s death was directly caused by the negligence of the hospital. We can move on to the next issue. Would a termination of a nearly invioable fetus have saved her life? If yes then we need to re-examine the archaic laws/rules that would prevent us from saving peoples lives.

  2. miraxpath says

    If you watch the RTE video ( 1.23 min in ), you find out that the inestimable Dr Astbury, actually quantified the risk to the mother’s life that has to exist before she’d consider a termination. It is 51% or more! It is not even a 50%.

    She has to be a believer in magic. She was waiting for 2-3 days on a foetus that had a 12-14% viability (her view, the admitting doctor and Dr Gunter give the foetus 0%)

  3. noastronomer says

    “What an incredible dog’s breakfast.”

    Which is the whole point of this inquest. Muddy the waters sufficiently so as to avoid any one (besides Mrs Halappanavar) appearing to be at fault for this. Not the doctors, not the lawyers and most definitely not the government.

    Mike.

  4. dianne says

    I find this line from Dr. Astbury’s testimony rather telling: “She said it was her view that Mrs Halappanavar was emotionally disturbed, but not physically unwell.”

    I suspect that Dr. Astbury saw Ms. Halappanavar as a “hysterical foreigner” and ignored her complaints as “emotional disturbance” and therefore didn’t even consider the possibility that she was septic because it didn’t fit into Dr. Astbury’s frame of reference. I wonder if Ireland requires classes in cultural competence? They don’t seem to be working, if so.

  5. miraxpath says

    A midwife has admitted to the catholic country remark and so far she is one of the very few honest ones in this sorry mess. The coroner has expressed the view that this remark was harmful to Ireland’s international reputation as no hospital in Ireland is run according to religious precepts. Ha Ha! The delusion of these people. The entire country and its hospitals are hostage to reproductive health laws based on catholic doctrine and the rest of the world realises this well enough.

  6. rnilsson says

    I wonder. Has it ever been established whether Dr Katherine Astbury was, at any time during this prolonged and obviously extremely painful dying session, might have been even infinitesimally inebriated? Did she, to grab at straws here, for example attend Mass on Sinday? Could that, or perhaps something entirely different, have impaired her judgement at a crucial time?

    Never been to Ireland, so what do I know? I don’t even know if I ever want to go there, now. Takes drugs.

  7. Sercee says

    “The issue was that there was no law to tell someone what was permitted or not. It was a question of law.”

    Last I checked, one of the reasons doctors have the pay and prestige they do is because of the sheer amount of training they go through in order to be able to make difficult judgement calls that have direct and serious consequences on people’s lives. These judgement calls are often made in split second decisions. The law is not particularly involved in that moment but, at least in Canada where I live, it protects doctors from litigation when they’re trying to save someone’s life. The law doesn’t need to specifically outline every and all instances when a doctor may or may not do any particular procedure (such a manual would be impossible, and should never exist). The question was not of law, it was of her own ineptitude.

  8. miraxpath says

    “The question was not of law, it was of her own ineptitude.”

    While Dr Astbury and the other doctors involved in the care of Savita H do appear incompetent, the law in Ireland is such that pregnant women suffering miscarriages and other medical complications are NOT allowed terminations until and unless their lives are at substantial risk. That is completely unacceptable.

  9. PatrickG says

    I also feel sick.

    But I would like to thank you for covering this so thoroughly. Not exactly the most pleasant reading, but… yeah, thank you.

  10. notsont says

    This is insane, 30-40% chance…how is that not considered murder? If I did something that had a 1% chance of killing someone and it did, I would be up on charges of manslaughter at the very least. Hell if I did something that has a .0001% chance of killing someone I might be up on charges of manslaughter. The bar for being a “significant risk” is pretty low when your talking about someone dying.

  11. deepak shetty says

    It looks like they will try to portray this as a “system failure” by this hospital/ob and sweep the religious issue under the rug.

  12. AsqJames says

    If you watch the RTE video ( 1.23 min in ), you find out that the inestimable Dr Astbury, actually quantified the risk to the mother’s life that has to exist before she’d consider a termination. It is 51% or more! It is not even a 50%.

    Just think about the implications of that for a minute.

    How many women each year find themselves in Savita’s position part way through their pregnancy? Whatever that number is, Dr Astbury thinks half of them must be allowed to die.

  13. says

    So, other doctors clearly told Astbury about the danger and encouraged a termination but she valiantly held her ground. #bravehero

    dianne

    I suspect that Dr. Astbury saw Ms. Halappanavar as a “hysterical foreigner” and ignored her complaints as “emotional disturbance” and therefore didn’t even consider the possibility that she was septic because it didn’t fit into Dr. Astbury’s frame of reference

    The first time they went to the hospital they were dismissed. Everything allright. Hysterical pregnant bitch. Her being foreign might have played a role but I know too many women to whom this happened, including my cousin’s ex gf who, in her 9th month went to the hospital because she felt “wrong”, was not examined, did not get a CTG, was put to bed and told to sleep only to be woken up by the stillbirth of her baby.
    Hysterical bitches who don’t know shit about their bodies because they are only pregnant and not an OB/Gyn is sadly a common motive.

  14. says

    Oh, and “51% or more”?
    That woman knows so dangerously little about probability she shouldn’t be allowed to treat flubberworms.
    Having a “49% risk” doesn’t mean that you’re not in danger. It means that 49% of people with that condition die. So, obviously, “Dr” Astbury (sorry, I can’t call that woman a doctor. Doctors help people. They aren’t that grossly incompetent) is OK with 50% of the people in her care dying without them even trying to save their lives. Only when 51 out of 100 people with that condition would die she’s willing to move a finger…

  15. alai says

    I couldn’t quite believe my ears when I heard the “51%” comment, partly because it’s such an extraordinary statement in itself, and partly as it passed, at the time I heard it reported and since, with so little comment. Especially as compared to the “this is a Catholic country” business, which seems to have been given huge prominence, before and after anyone being quite sure even who’d said it, and subject to people spinning it this way and that. (Including some with the amazingly fanciful interpretation that whoever said it was “obviously” deeply anti-Catholic, on the basis that they were “apologising” for the lack of provision of a termination.)

    I suppose we should give Astbury some tiny degree of credit as a medical scientist and technician for not being satisfied to waffle about “real and significant” as if that had any actionable or useful meaning, as the lawyers seem content to do. But “tiny” indeed. I have no idea on what sort of basis she concludes that that’s what the threshold means, I have no idea if other doctors think the same, or they reckon it’s 5%, or 0.5%, or any other threshold. I don’t know if the medical council’s infamous “guidelines” that’re standing in for actual law in this area address it (not that I’m aware of, at least), or if this would be found to be consistent with the ruling in the X Case if tested legally, or the “equal right to life” clause in the constitution. On the face of it, one would think not, since this doctor seems to think that a 14% chance (at the most optimistic — that there was an real chance at all seems to be highly contested) of foetal survival) would trump a 49% chance of maternal death.

    As unreasonable as the legal constraints on the availability of terminations of pregancy in Ireland is, the lack of any actual clarity is what I find utterly bewildering.

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