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Dec 09 2013

Don’t look behind the curtain

I’ve been arguing with someone on Atheist Ireland’s Facebook page, on a thread I started with a post about the ACLU/Means lawsuit against the bishops. My arguee has been claiming Savita Halappanavar’s death had nothing to do with abortion, and I’ve been saying it did too so. Her latest reply pointed out that “that was not a finding of the HIQA report or the Coroner’s report.” I hadn’t heard of the HIQA report, that I recall, so I looked it up. It came out on October 7th.

I skimmed the executive summary [pdf], and read the parts that addressed the medical treatment of SH. My arguee is right, assuming the summary accurately reflects the full report: it doesn’t spell out that the failure to induce delivery is the probable reason SH developed sepsis. It says the sepsis was badly managed, but not how or why it got started in the first place. It seems to me to be strikingly evasive in that way.

So I’m wondering if it will strike other people the same way. Of course I’ve just primed you to see it that way, so this isn’t a survey of how this report strikes people. It’s a question about the report, and what you think of it. I haven’t so far been able to find any reaction in Ireland that sees it that way. I’m wondering how much the illegality of abortion and the taboo on it in Ireland shaped the way the report was carried out and how it was written, and the way it was received.

For instance on page 5 there is this:

3.1 Care provided to Savita Halappanavar

The Authority identified, through a review of Savita Halappanavar’s healthcare

record, a number of missed opportunities which, had they been identified

and acted upon, may have potentially changed the outcome of her care. For

example, following the rupture of her membranes, four-hourly observations

including temperature, heart rate, respiration and blood pressure did not appear

to have been carried out at the required intervals. At the various stages when

these observations were carried out, the consultant obstetrician, non-consultant

hospital doctors (NCHDs) and midwives/nurses caring for Savita Halappanavar

did not appear to act in a timely way in response to the indications of her clinical

deterioration.

That first sentence is shocking to me, given that in the US (I understand via Jen Gunter) the standard of care for rupture of membranes at 17 weeks is expeditious termination. The report, weirdly, skips right past that to focus on badly done “expectant management.” Expectant management is one option, but it’s risky to the woman and the odds of saving the fetus are very low. It’s not relevant to this case because the Halappanavars requested termination. Repeatedly. They begged for it.

So to me it seems weird and creepy and irresponsible that this report consistently ignores that option. Yes, the hospital handled the sepsis incredibly badly, but if they had done the termination when the Halappanavars asked for it, the sepsis would probably not have occurred. (The Irish anti-abortion types insist that the sepsis was not caused by the PRM at all.) The bad handling of the sepsis ought to take a distant second place to the allowing it to happen in the first place.

Tell me what you think.

4 comments

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  1. 1
    Marcus Ranum

    It’s especially creepy if the report elides the fact that the patients were requesting a procedure – in fact, making a request that was medically correct and indicated. Obviously, including that in the report would require further explanation of why the patients’ requests were ignored, which is the real issue here.

  2. 2
    Argle Bargle

    The HIQA report goes out of its way not to mention pregnancy termination.

  3. 3
    Pierce R. Butler

    OT except for outrageousness: Somali woman who reported rape sentenced -

    Nineteen-year-old will be confined to home for six months and journalists who reported the story are to go to jail. … Neither of the men accused of the rape were arrested.

  4. 4
    Pen

    the odds of saving the fetus are very low

    With the waters broken, the odds of saving the fetus must indeed be very low. I don’t see an option other than an incubator and there’s really not a hope at that age. I’m sure we all hope for better things in the future, for the sake of parents who are losing much wanted children.

    For now, what struck me is that they failed to carry out the expectant management tests. Think about this for a minute. One of the things I expect of a test is that it will give information that might potentially change a course of action. In this case, they had no intention of changing their course of action. Ultimately, we have to imaging that if the tests showed her condition deteriorated enough, they intended, in that case, to start a termination. But they didn’t. The information from the tests didn’t change anything as far as they were concerned, so there was no point in doing the tests.

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