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Dublin: 14 °C Tuesday 21 May, 2013

Confirmed: HIQA to investigate the death of Savita Halappanavar

The investigation will assess “safety, quality and standards of services” provided at the Galway where hospital where Savita died last month following a miscarriage.

Image: Julien Behal/PA Wire/Press Association Images

THE HEALTH INFORMATION and Quality Authority (HIQA) has announced that it is to investigate the death of Savita Halappanavar.

In a statement this afternoon the independent health watchdog says that it will assess the “safety, quality and standards of services” provided by the Health Service Executive at University Hospital Galway as reflected in the care and treatment of Savita, who died following a miscarriage last month at the hospital.

The family of the 31-year-old dentist claim that she was denied an abortion despite repeated requests to doctors at the hospital from both her and her husband. She died as a result of blood poisoning contracted in the days after she miscarried.

The death has drawn worldwide attention in light of Ireland’s strict abortion laws which fresh debate about whether or not there is a need to legislate for the Supreme Court X case 20 years ago.

The HSE is currently investigating the death but this investigation has been mired in controversy with Savita’s husband Praveen Halappanavar refusing to cooperate with it and instead calling for a public inquiry into her death.

It is not yet clear whether he will cooperate with the HIQA inquiry.

In a statement today, the health watchdog said that on foot of a request from the HSE, which was considered by its board this morning, it will now “investigate the safety, quality and standards of services provided by the HSE at University Hospital Galway (UHG) to critically ill patients, including critically ill pregnant women as reflected in the care and treatment provided to Savita Halappanavar”.

The statement continued:

The investigation will assess whether the services provided complied with the National Standards for Safer Better Healthcare and national and international evidence of what is known to achieve best outcomes.

The Authority requested, and received, information from University Hospital Galway and the HSE to ascertain the facts about the tragic case of Savita Halappanavar.

Following consideration of this information, the Board of the Authority has made the decision to instigate this investigation.

The terms of reference and membership of the investigation team will be published when finalised.

As with any investigation undertaken by the Authority, and in the interest of a fair and thorough investigation, the Authority does not envisage making any further public comment until the investigation has concluded. The investigation report, and its recommendations, will be published following the completion of the investigation.

Read: Opposition calls for Taoiseach to meet with Savita’s husband

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Comments (76 Comments)

  • @rory. To elaborate. Ireland has signed up to European convention of human rights, we are obliged to honour this. I for one am glad that we live in a democracy where people can take a stand to have their rights met.

    Reply
    • Irene , what utter rubbish ! I agree totally that we must legislate. What we are talking about in this article is basically , the attitude of Praveen to whatever inquiry. Not the broader issue of ECHR. Talk to the subject

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    • @rory. I suggest you should re read my posts. I am speaking of the rights of Mr Halappanavar to request a public inquiry. If mr Halappanavar takes this to the European court of human rights, because his rights are not being met, Ireland will be obliged to abide by the ECHR ruling as we have signed up to the European convention. The ‘attitude’ you speak of is mr Halappanavar seeking justice for his dead wife and he feels a public inquiry is the best way to get that since, as i have explained earlier, it will involve, among other issues, cross examination under oath.
      According to his solicitor this morning and irish council for civil liberties he is well within his rights and would have just cause for taking this case to the ECHR in accordance with article 2 of the European convention for human rights.
      I was responding to your initial comment of ‘ the issue does not have to revolve around his demands’. I was merely pointing out that the man is asserting his rights.
      But given your ‘attitude’ I suspect you probably believe that the Irish council for civil liberties are talking ‘utter rubbish’ too.

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    • Irene . this whole sad episode cannot be inquired into at the dictates of Praveen. Just think what a precedent this would set. Does it mean that every death in every hospital would be subject to the demands of the next of kin ? Clearly , the man is distraught at this awful event , but a nation cannot respond just as he wishes. Yes , there ought to be an independent inquiry in this case. An inquest would be one way of doing it , where there is a right to cross-examination. But ,by talking of the ECHR at this stage is way off kilter. Deal with it by inquest first and this will show whether something else is needed. If so , proceed and do it.

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    • @ Rory.
      An inquest is exactly what the man is asking for!
      According to Praveen halappanavar’s solicitor, he will only go to the ECHR if a public inquiry does not happen. You yourself stated ‘ yes there ought to be an independent inquiry in this case’. An independent inquest would be one way of doing it, where there is right to cross examination’. Yet you are quite critical of mr halappanavar’s demands to request just that. He does have rights, it would seem, according to iccl
      There is the independent coroners inquest of course but this will not cover all aspects of events leading up to savita’s death. There are some concerns over HIQA investigation ie will it suffice, expressed by some e.g iccl today. Though independent, they outlined several problems with such an investigation. So where does that leave him, when he does not trust any hse investigation, understandably, because it would not be independent.

      Re your comment about what kind of precedent would it set. I would hope, in a democracy that in the events of an erroneous death in a hospital, the next of kin would be entitled to ‘demand’ a fully independent inquiry that would satisfy their need to find out what happened. Perhaps this case might set a new precedent on how state and hse should handle such cases so that it doesnt end up getting to the stage where the next of kin is demanding a public inquiry to get justice. I and im sure many service users would welcome that.

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  • This is still not what Praveen Halappanavar has requested ( according to his solicitor this morning on pat kenny radio show) a fully independent inquiry which satisfies the following criteria: cross examination of witnesses ( under oath), full disclosure, transparency in the public domain, compellability. Therefore he wishes a public inquiry as these criteria would not be met by a hse or hiqa inquiry.
    There are some who have commented that Praveen Halappanavar should accept the Hiqa inquiry and/ or he should not be entitled to public inquiry. However his solicitor has stated Praveen Halappanavar is entitled under article 2 of the European convention for human rights. The Irish council for civil liberties ( independent human rights watchdog) have reiterated this on lunch time radio today. Mr Halappanavar is considering taking this to the European court of human rights if a public inquiry does not happen. I commend his courage.

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    • The issue does not have to revolve around his demands [not requests].

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    • @ Rory. The issue does relate to the RIGHTS of Praveen Halappanavar.

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    • Irene, actually it doesn’t, at least not totally.

      The most serious and immediate issue now relates to the safety of future pregnant women and ensuring that this doesn’t happen again. In this context, a HIQA enquiry is entirely appropriate. A public enquiry would take too long and be too legalized to get to the root of this issue.

      The HIQA enquiry also has no bearing on whether or not a public enquiry can take place.

      Reply
    • @irene, surely it is about the rights of Savita Havappanavar?

      People seem to be forgetting her rights whilst jumping on various bandwagons

      Reply
    • @bob.
      Firstly, I did not suggest that a HIQA investigation is not appropriate. What I said it would not meet Praveen Halappanavar’s requests.I am speaking about an investigation into savita’s death. The wider issues relating to making safe hospitals for pregnant women, which although are necessary ( and will hopefully improve the care that pregnant women receive in general) and i dont dispute they need to be done, are secondary to the Halappanavar case.
      Secondly the issues relating to the manner/ nature of the investigation, are central to Praveen Halappanavar’s rights. This is in accordance with his solicitor and the irish council for civil liberties. The issue is about Praveen Halappanavar wanting an investigation to bring to light what happened to his wife. We have all seen the prime time programme where he clearly does not have any faith in a hse investigation. He wants a public inquiry, he is not getting one and therefore is considering asserting his rights under article 2 of the European convention for human rights because currently, according to his solicitor, he is not getting these rights met.

      Minister Reilly, the week this case broke stated there would be an investigation that would have to hold up to international scrutiny. International scrutiny by means of the European courts might well demand a public inquiry if they deem Mr Halappanavar’s rights are not being met.

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    • @ vocal outrage. You are right this is about savita’s rights, that is why her husband wants this case to be thoroughly investigated in a manner that he sees will get to the truth. Not ‘jumping on a bandwagon’ here? Surely that is why he is doing all of this in the first place because he feels her rights were not met and now she is dead.

      Reply
    • I’m sorry Irene but I consider the rights of living pregnant women to be paramount in this case. That no-one else should die needlessly ought to be everyone’s primary objective. Praveen Halappanavar’s rights are unfortunately secondary to this – not the other way around as you suggest.

      As I said, the public enquiry that Praveen Halappanavar wants can still happen; however, such an enquiry would take a while to set up and would also likely mean that all parties get legalled up. I have very little confidence that such an enquiry would lead to a speedy conclusion and identify any changes that need to be actioned immediately.

      Reply
    • @bob.
      . For Mr Halappanavar, why his wife died is his primary concern and getting the issue investigated thoroughly and independently via a public inquiry ( hence my reference to general safety aspects re maternity services of galway hospital being secondary to his case – not to negate such important issues as you seem to suggest i am doing- rather to put the perspective from his side of the fence and why he wants a public inquiry).
      I reiterate that my post in no way suggested a HIQA investigation should not go ahead. However, a HIQA investigation should not negate the rights of mr Halappanavar as per the European convention of human rights.
      Indeed, President Higgins came out with a statement that any investigation has to take into account the family’s concerns as well as the state

      Reply
  • Good!!

    Reply
  • tom 23/11/12 #

    we are meeting and excelling at our obligations and shouldn’t confuse rights with demands.

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    • @tom. According to the Irish Council for Civil liberties Praveen Halappanavar is acting within his rights. Or, are you suggesting that the experts from the Irish independent watchdog for human rights are confused?

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    • @ Tom. I would also like to add that in terms of meeting and excelling at our obligations, I really hope you don’t mean this in a general sense. Because we are failing on many levels to meet the rights of many people including women who request a termination if they are already miscarrying the baby and/ or their life is endangered.

      Reply
    • tom 23/11/12 #

      we have meet and excelled in our obligation so far. there is no requirement to do more. two independent inquiries is more than sufficient at this time.

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    • tom 23/11/12 #

      now you have brought the pro abortion campaign into this and I can see why you feel that we should go futher.

      it’s not about justice, malpractice or laws being unclear that could or might prevent a similar tragic death but a push for pro choice.

      that will have to wait for a referendum at another time

      Reply
    • @ Tom. You speak with authority that the hse and hiqa investigation are sufficient. It could well be the European court for human rights, not you, who will decide whether the hse/ hiqa investigation is sufficient.

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  • Given that the outcome of these inquiries may be the catalyst for long delayed legislation affecting the life or death of mothers & partners is itself a valid reason that a full public inquiry be conducted.

    Furthermore, it is quite likely if the couple involved had not been Indian & Hindu with less ‘understanding’ of our States deviant ways this case might never have been revealed to the public in the manner it was. It is quite likely, given the support & sympathy for this unfortunate family, that similar tragic cases involving the current abortion laws will emerge leaving the Government/State in a liable situation where lives may have been lost and the health of women permanently affected, other than where they took themselves to the UK for a abortion needed on the grounds of a threat to their health.

    Reply
  • Four enquiries now i believe. Internal hospital one, HSE, hiqa and the coroner. It’s a shame the husband won’t cooperate but I think there’s enough investigating being done already. At this stage he’s only obstructing the truth. Hopefully he’ll come around.

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  • Why was the comment about the now missing notes deleted?
    More stuff going missing it seems!

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    • Are they actually pages of notes missing or did they just not write stuff down?

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    • Hi Sean, not sure – I would doubt that physical pages are missing – more that requests were not documented. (Reports are coming out that initial requests for termination were not documented, however later requests were – not unusual, I would say an overplay by the media).

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    • Can’t really see how that’s important then. Terminations aren’t granted by request so why would it be noted in the chart?

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    • Terminations are considered by request – if a woman requests one and lists a legally valid reason, I would hope there would be a record of it being considered.

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    • There is no legally valid reason to request a termination. i thought this had been covered already. The law was never overturned, even after the Supreme court decision. A doctor can perform a termination during a medical intervention in order to save the life of a woman.

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  • Do we need two ‘inquiries’ to wash away the culpability of Irish governments over their inaction on legislating on the X-CASE?

    Reply
    • Possibly not, seeing as how you seem to have made up your mind without access to all the facts. If the HSE didn’t have an inquiry, people would be rightly complaining. HIQA are probably best placed to do an independent inquiry, they have a good history of not holding back.

      Reply
    • @ Donncha It’s not going to investigate why successive governments refused to legislate on the Supreme Court’s decision in the X Case, which held that a woman had a right to an abortion under Article 40.3.3 if there was a real and substantial risk to her life.

      Reply
    • Andrew, regardless of the cowardice of generations of Irish politicians, there still needs to be investigation to establish if Savita was refused a termination on solid legal grounds.

      Many people are suggesting that there it was negligence within the current (unsatisfactory) legal arrangement.

      Reply
    • Kerry
      Do you have the qualifications and relevant experience to be able to qualify the terms of reference of this HIQA enquiry because most of your contributions on these pages seem to be straightforward political denunciation of Government actions with attendant Sinn Fein messaging. Perhaps you would advise us as to how you’re so qualified.

      Reply
    • Andrew (and the thousands like you), if you’ve already made your mind up about what happened, why have an enquiry at all?

      Reply
  • Well I don’t trust the HSE as I have experience with them they even told lies on oath I then went to HIQA and the truth came out thanks to HIQA so I think it’s a start for the honest truth to be told

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  • Family is talk about going to the International Courts of justice. All thay wanted was a Full Public inquiry under Oath. Why Not?

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  • Looking like something is wrong already. No wonder this is looking like a white wash or cover up already. http://www.independent.ie/national-news/reilly-denies-savita-probe-a-shambles-as-notes-on-requests-for-a-termination-missing-3303063.html

    Reply
    • Gamma 23/11/12 #

      oh an internet link, because if it’s online it’s gotta be true!!!!

      Reply
    • Katie Does, what if Praveen’s recollection is incorrect? Is that not for an inquiry to determine? You are prejudging this. Let an inquiry determine if such a request is made. It seems that you are seeking an inquiry into something that you have already decided. An inquiry will determine that. Not you. What would you say to the hypothetical situation if everyone in GUH said such a request was not made?

      Reply
  • Sadly, the HIQA investigation misses the mark, legally speaking. If you review sections 8 & 9 of the Health Act 2007, it is apparent that HIQA has not been designed to investigate medico-legal issues as they arise in individual cases. It is trying to fit a square peg into a round hole.

    Praveen’s rights have not been properly addressed or rendered capable of vindication. Please read the ICCL letter of today’s date.

    There is obvious xenophobia in some of the remarks against Praveen. He deserves the full panoply of rights and it is the least that this State can do, having so badly let him down. All of the demand made through his solicitor have been reasonable, proportionate and the minimum he should be seeking.

    There is an imperative need for a Commission of Investigation or a Public Tribunal of Inquiry. Because of unity of time, place, personnel, short elapse of time, limited records and defined nature of issues, such formal statutory based inquisitions or inquiries can be fast tracked and wrapped up with the minimum of time and expense. A much more wide ranging Inquiry, the McCracken Tribunal of Inquiry was wrapped up within 6 weeks.

    I endorse all of the cogent and spot on points made by Irene Kavanagh.

    Reply
  • @ Rory . Sivata’s husband said she asked for this request over and over again . A fact not disputed by the hospital. They just conveniently forgot to put it in her notes !!!!!
    She should not have even had to ask . It should be the norm once the experienced medical staff deemed that the the patient was miscarrying and the foetus was not going to live in any circumstances !!! Everything that is possible should be done for any women in similar situations to make this terrible trauma a little more bearable and lessen the long term impact of emotional scars !!!!! It is not a simple matter for any woman to suffer a miscarraige

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  • I find it very disturbing that minor requests like requests for cups of tea were added into Sivata’s notes but the repeated requests for a termination was omitted. ! It makes the hospital look bad !
    And since when is ok to leave a pregnant woman , already miscarrying her baby, who had no chance of survival , lie in a hospital bed and do nothing to spare her more pain and mental anguish ! In all the arguments the main facts of this case have been overlooked. That is
    that she was already miscarrying the child, that would not and could not survive ! She did not request the termination on a whim ! No hospital in the world should allow this blatant lack if treatment for one of its patients !
    If it happened to a member of my family I would move every stone in my way to get answers!

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    • From my understanding it was not her requests that were noted, it was the staffs action. So it wouldn’t say “patient requested glass of water”, it would say “patient given glass of water”. And the hard fact is that giving her an abortion would have been illegal, no matter how many requests she made.

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    • Mary , how is it that you know such a request was made ?

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    • @Rory We know because her husband, who was with her, said so.

      But I wondered when that question would be asked. I knew from the start that eventually there would be people who would be able to look at this bereaved man, see his all to raw and real grief, and still accuse him of lying. Have you come up with any reason that satisfies you as to why Mr Halappanavar would have lied about such a request being made?

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  • Can Praveen have any faith in the system with missing files etc????

    Reply
    • Go away with your conspiracy theories…. I live and work in Galway and have friends who work in NUIG and to say they have been completely knocked for six by all of this is an understatement… What bugs me the most is there is some sort of general assumption on here and in the media in general that the staff in NUIG are incompetent or worse again incapable of being fair and honest….This discussion has been so one sided and i for one will wait till thye full facts emerge!!! Did the consultant in charge deny a termination for example?? Its all gossip and completely inappropriate as far as i am concerned… Shame on all of you on here…!!!

      Reply
    • @ Declan maybe you trust the Government. Nice world to live in. But some people live in the Real world of politics and now what goes on. http://www.independent.ie/national-news/reilly-denies-savita-probe-a-shambles-as-notes-on-requests-for-a-termination-missing-3303063.html

      Reply
    • Fair play Declan, I have nothing to do with NUIG but agree that it’s completely one sided. No one knows the facts and appears that on a few occasions the public appear to be government bashing for the sake of it and going completely off topic. I think the two inquiries are enough and this is what every other person in our country gets in relation to a death. Also, notes were not made re a termination because if its not case X then what was being asked is against the law of our land and wouldn’t be documented. Maternal deaths are so rare in or country because we have an extremely high standard of care to people. Let the details emerge and vicious rumours stop until all the facts are known!!

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    • Sure just go ahead there Michael and quote a internet link!!!! Give me strength!!!! I have no reason no to trust the people who work in NUIG because in my experience these people are of the highest integrity and have a fantastic work ethic…Its nothing to do with Goverment tbh…Enda K was not there that night, neither was Dr O’Reilly or amyone else for that matter….
      I am sick to the teeth of this conspiracy theory bull that floats around this site….
      I stick to my original point…Those of you passing comment without knowing the true facts of the case are a complete disgrace!!!!!!!!!!!!!!!!! Thats includes journalists and j.ie

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    • They won’t have a problem with a full public inquiry then will they?

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    • @Declan With the best will in the world you can’t say authoritativly of any group of hundreds of people that “these people are of the highest integrity and have a fantastic work ethic”. You’ll have a fairly random cross section of humanity in there, some will deserve that description, others will definitely not, many will just be of average integrity with an average work ethic. Which is fine, that’s just how people are.

      Nor can any they be granted immunity from having their actions questioned and examined closely by virtue of where they work or how highly they are thought of by people in the locality or anywhere else. That’s sadly the kind of exemption from scrutiny that led to horrendous abuses in hospitals and other ‘caring’ institutions in that past.

      You are right, there is a huge difference between the response to this case and ‘ every other person in our country gets in relation to a death’. But there has to be. We’ll all die and most of us will die in hospital. However the circumstances of this case, the fact that it exposes a serious lego-medical issue and the international public controversy that has now ensued (and whatever you think of that, it can’t be undone) renders this case very different from the norm, and that’s why it needs to be treated differently.

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    • Does that become the norm then and every person that has lost a wife/girlfriend/mother/aunt/niece under the same circumstances get a public investigation? I have the deepest sympathy for this case but we don’t know the full facts and therefore cannot assume against any worker or decision made in NUIG until what actually happened is known!

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    • @rachel That’s kind of circular logic. We can’t have an independent investigation cos we don’t know the full facts?

      And yes, if anyone is lost under the same circumstances they should have full and complete investigation. Because the seriousness of the issue does not change depending on the person involved.

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  • Praveen has not yet decide if he will participated in this inquiry either.

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  • Oh boy 23/11/12 #

    Costing the tax payer extra cash

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  • @Sean Beag ! She did not request an abortion ! An abortion is a termination of a viable foetus ! Her body was already miscarrying a foetus that could not live ! This foetus could not nor would not have lived ! A fact not disputed by the all the medical staff involved . You obviously have no concept of the physical or the
    emotional trauma a woman goes through when miscarrying a child ! A doctor takes an oath to do his/her best for the patients health and leaving a woman , whose waters had broken , which all medical facts tell us leave her open to infection , lying in a hospital bed and do nothing about it is not in the best interests of any patient . This is nothing to do with religion , been pro or anti abortion! It’s to do with best medical practice and looking after the interests of your patient !!!!!

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  • about the eu court of human rights, can I ask if there is any prerequisite before the case is brought there? I mean there’s zero investigation so far being done. would it be normal for say, a lower court to be completely bypassed and brought to a supreme court in most countries?

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  • Unless the request was not made , I agree with you.

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  • HSE is government funded as is HIQA…..go:figure……

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