MUCH LIKE THE X Case 20 years before it, the death of Savita Halappanavar has influenced cohorts – on both sides of an argument – to rally on an issue.
The inquest into the death of the 31-year-old pregnant dentist heard from a number of witnesses who said that, if it was legally permissible, an earlier abortion could mean that the patient would still be alive today.
But it also heard of systemic failures and deficiencies in the management of her care which led to the inquest returning a verdict of medical misadventure. Once proceedings finished, there were numerous calls for action from various parties.
The Abortion Rights Campaign claimed that the eighth amendment to the Constitution – which protects the right to life of the unborn – played a “huge part” in Savita’s death and said it needs to be repealed “immediately”. This was echoed by Praveen Halappanavar’s lawyer Gerard O’Donnell who described an “extremely worrying” situation for women in Ireland who must wait until they are “gravely ill”.
He urged the Medical Council to “urgently review” the coroner’s first recommendation about its abortion guidelines and asked the government to look at the case to decide if legislation is necessary to ensure it will not happen again.
While charging the jury and giving his nine recommendations, Dr McLoughlin addressed the controversial issue, making it clear that “It is not for [this] court to advise the Oireachtas but they may take cognisance of these proceedings.”
He described the Medical Council’s guidelines on abortion as “very brief” and in his first recommendation to the jury, he told them they could advise the council to lay out when exactly a termination can be carried out if there is a risk to the life of the mother in similar circumstances to this case.
He said doctors who practise medicine in good faith should not have to labour under the threat of sanctions as severe as prison or being erased from the medical register, which puts them on a “path of ignominy and shame”.
Responding to the verdict yesterday, the Medical Council issued a statement to say it will give detailed consideration to the recommendations of the coroner.
Health Minister James Reilly also reacted to the verdict, promising that there would be lessons taken from Mrs Halappanavar’s death.
“Everything we learn from this inquest, from the clinical review and from the HIQA examination of this tragedy will feed into guidelines, protocols and checklists in maternity and other hospitals to keep patients safe,” he said.
Indeed, many of Dr McLoughlin’s recommendations, which were strongly endorsed by the jury, will be applied to national hospitals as soon as possible. The measures include new protocols for the management of sepsis, proper procedures for correct and efficient blood testing and effective communication between staff at the change-of-duty time.
The coroner also advised that doctors and nurses should take separate notes and keep different documents for each patient. He also asked for a modified early warning score chart to be adopted by all hospitals in the state as soon as practicable.
Following the inquest, Praveen Halappanavar recalled being “kept in the dark” by the medical team at Galway University Hospital. Dr McLoughlin recommended that there should always be early and effective communications with patients and/or their relatives to ensure that a treatment plan is readily explained and understood.
Finally, and in direct reference to one of the key characteristics of the inquest, the coroner said no additions should ever be made to the medical records of a deceased whose death is the subject of a coroner’s inquiry. “Additions may inhibit the inquiry and prohibit the making of recommendations which may prevent further fatalities,” he added.
These recommendations, accepted by the jury, relate to all hospitals in Ireland.
The aim of an inquest is to find out all the facts about how and why a death occurred. Its findings do not point to culpability or exoneration. Inquests hope to prevent further deaths from occurring for the same reasons, not find someone accountable for the one being examined.
It will now be left to legislators to decide if there are lessons to be learned for the law from the death of Savita Halappanavar on 28 October.
There may also be another trip to the European Courts for Ireland’s human rights to come under scrutiny once more, as the Halappanavar family have hinted they will take the fight for the truth to Strasbourg if required.
Savita Halappanavar died on 28 October 2012 at Galway University Hospital. She was 17 weeks pregnant. The cause of death was recorded as severe sepsis, E.coli in the bloodstream and a miscarriage at 17 weeks.