Tuesday at the inquest

Fergal Bowers reports for RTE.

A midwife who was working on the ward where Savita Halappanavar was being treated has given evidence at the inquest into her death.

Miriam Dunleavy told the Coroner’s Court in Galway that entries were put into Mrs Halappanavar’s medical notes by the hospital’s internal investigation.

Coroner Dr Ciaran McLoughlin raised questions as to the appropriateness of this.

Yes that does sound slightly inappropriate.

Dr Katherine Astbury also testified.

In a detailed chronological account of the treatment she provided, Dr Astbury said that she had requested an ultrasound on Monday 22 October after Mrs Halappanavar’s membranes ruptured.

On the following day when she asked for medication to assist a miscarriage, she said she told Mrs Halappanavar that the Irish legal position did not allow her to carry out a termination at that time, as there was no risk to her life or health.

If that’s true it’s an absolute outrage, because there was great risk to her life and health. Her cervix was found to be dilated on Sunday morning, and on Tuesday an obstetrician told her there was no risk to her life or health. That is frightening.

When her condition deteriorated the following day, Dr Astbury said she had formed the view that there might be no option but to consider a delivery, regardless of the foetal heartbeat.

They waited until she got much worse and then they started thinking there might be no option but to consider an abortion.

It’s disgusting.

Don’t go thinking it’s just Ireland though. I know I keep saying that, but it’s under the radar. It’s the US too. Here it’s against the law, but the law isn’t enforced. Catholic hospitals are allowed to make their own laws. This comment from yesterday on As no threat to Savita’s life illustrates that.

I can attest that termination is not a standard of care I received, even when requested, during a protracted miscarriage.  When my water broke on a Friday night  at 16weeks and I started bleeding heavily, I went to the ER.  No hope for the fetus.  I requested termination, and they said they couldn’t because it still had a heartbeat.  (30beats per minute.  C’mon!). They kept me overnight, sent me home in the morning with a dead fetus inside me with instruction to call my OB on Monday to schedule a D&E at some outpatient surgery center.  The next day, Sunday, I delivered a boy without warning.  Cut the cord, wrapped him in a cloth diaper and put him in a child’s shoebox.  Back to the ER where I eventually had a D&C to remove the very stubborn placenta.  Baby Boy was buried in a mass grave.

So, all that to say, I had 2.5 days of slow-motion second trimester miscarriage in which I requested a termination, was denied, was told they could not even perform the D&E after the fetus had died (I can’t remember why…) and some seriously traumatizing moments.  I did not get an infection, fortunately.  This was in Austin, where even the public hospital is run by the Catholics…

This should not be allowed. Not in Ireland, not in the US, not anywhere.




  1. dianne says

    Yes that does sound slightly inappropriate.

    If that happened in the US the lawyers for the patient would be extremely happy: Altering the medical record indicates understanding of mistreatment and an intent to cover it up. It is practically admitting that malpractice occurred (even when it didn’t-I remember a talk by a lawyer in medical school where he gave an example of a mildly bad outcome when the patient had been given perfectly acceptable treatment, but the hospital had to pay because the resident altered the record: no actual bad practice occurred, but the alteration suggested a guilty conscience and that was that.) The hospital needs to be shut down or at least reorganized and every top administrator even remotely involved fired. And the OB who failed to perform the abortion should never practice again.

  2. freemage says

    I can pitch in another “Catholic hospitals don’t do the miscarriage-termination thing” tale. My wife had a miscarriage about 10 weeks into her pregnancy. The Catholic hospital we wound up at (it was the closest, we were in a blind panic about her pain, so yeah) not only would not do anything that would speed up the process; they also refused to do aggressive pain-management because that might incidentally terminate the pregnancy (which they’d already acknowledged was doomed).

    I have a bit of an ongoing guilt about that night, frankly–I SHOULD have been the one to be clear-headed enough to insist on taking the extra time to locate and go to a non-Catholic hospital. I can guarantee it’s not a mistake I’d be likely to make again.

  3. dianne says

    Freemage: You should have been able to trust that whatever hospital you went to they would do the right thing for their patients, no matter what. You shouldn’t have had to even consider who owned the hospital. It should have been irrelevant.

    The Catholic church has no more business running a hospital than the Jehovah’s witnesses have running a blood bank.

  4. AsqJames says

    Miriam Dunleavy told the Coroner’s Court in Galway that entries were put into Mrs Halappanavar’s medical notes by the hospital’s internal investigation.

    Coroner Dr Ciaran McLoughlin raised questions as to the appropriateness of this.

    Yes that does sound slightly inappropriate.

    To me that is slightly ambiguous wording. It certainly sounds pretty inappropriate (if not illegal?) on initial reading, but (this may be easily dismissed and only due to me not being familiar with medical notes) is it possible the entries were marked as added later by the internal investigation due to evidence given to that investigation?

    It seems unlikely to me, not least because if that had happened why would they need her to testify to it.

    It just seems like such a dangerously self-incriminating thing for the hospital to do. It’s hard to believe intelligent, educated medical professionals would be that foolish, and more so that a team of them would do so without any individual having either moral/ethical or practical concerns. On the other, hand another group of medical professionals had already collectively killed a young woman (alright, deliberately allowed her to die through gross negligence) because jesus, so maybe I shouldn’t be surprised at all.

  5. Tim Harris says

    I wonder how people like Katherine Astbury live with themselves after this sort of occurrence. Perhaps their faith props them up.

  6. freemage says

    Diane: You’re right, of course. But that’s how the Catholics roll, at least in countries they don’t virtually rule. (We see it outside of health care, too–Catholic charities are getting a bit of a reputation for jumping on the ‘faith-based services’ bandwagon, taking government money to provide some needed function like homeless shelters and adoption services on the cheap, then threatening to disrupt those services when told that they are told they don’t get to discriminate against gays.) And of course, I have no doubt if I and my testicles walked in for any reason other than a vasectomy, I’d get decent care there. No interest, though, because I know what reprehensible human beings they are.

  7. Caledonia says

    It has been reported by two journalists who were in the courtroom that the alteration refers to one bracket.
    They are Maria Madden whose twitter handle is @dontmaddenme reporting for the Galway Independent and Nicola Anderson @tokonic for the Irish Independent.
    There is no suggestion that any of the medical staff involved in Savita’s care altered the notes.
    This case is bad enough without exaggeration.

  8. says

    @ 8 – can you point out what the exaggeration is? And by “has been reported” do you mean on Twitter? If it’s only on Twitter I think I’d rather go with the published report at RTE. If Madden and Anderson have reported this in their newspapers then you can provide links to the reports.

  9. Caledonia says

    From Maria Madden of Galway Independent on Twitter :Having just left the #savita inquest, the only reference I heard to any ‘tampering’ of notes was a bracket or scribble added by the internal investigation team. It was not inferred that any medical details were altered.
    Nicola Anderson, Irish Independent tweeted: it was a bracket scribbled on the notes afterwards when they were gathering together the notes together for the inquiry.
    Would go with the above but will link later today when there has been official clarification.

  10. Caledonia says

    Inquest told no retrospective interference to Savita Halappanavar’s medical notes
    Updated: 11:48, Wednesday, 10 April 2013

    ‘Declan Buckley SC for the hospital said a “squiggle” referred to during the course of yesterday’s proceedings was a bracket to provide an emphasis about four entries on the chart.
    Mr Buckley said it did not interfere with anything that had been written in the notes.
    He said it appeared somebody who was reviewing the chart simply took a pen and marked four entries.’
    Also reported on Newstalk today that it is thought it may have been someone in the ICU rechecking the chart as they battled to save her life.

    The important point of all this is that our abortion laws influenced medical treatment and delayed intervention.
    It is important that sensationalism/ disregard for facts doesn’t get in the way of this point.
    The remarks in a comment above regarding Dr. Astbury are not appropriate.

  11. dianne says

    The remarks in a comment above regarding Dr. Astbury are not appropriate.

    Which remarks do you find inappropriate? Dr. Astbury appears to have provided extremely substandard care and deviated from standard of care for treatment of second trimester inevitable abortion, chorioamnionitis, and sepsis a number of times. There is nothing inappropriate about pointing this out. We are not members of a jury deciding on a malpractice case. Nor are we expert witnesses being called for such a case. If we were then it would be inappropriate to make this judgement without complete review of the chart. But so far everything that has come out, including Dr. Astbury’s own words, suggests that her behavior was worse, not better, than it at first appears. For example, she states that she did not see this critically ill patient at all on October 22. This is extremely poor form and can-and in this case did-result in poor outcomes.

    It should be noted that your link remarks on a “‘flurry of retrospective notes’ up to 12 November.” This suggests that those writing the notes understood that they had made a grave error and were trying to justify themselves in retrospect. This would make a malpractice lawyer in the US very, very happy if s/he saw it in a chart.

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