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Savita inquest: Key moments from Galway Coroner's Court

TheJournal.ie takes a look back at the first five days of the inquest into the death of the 31-year-old dentist at Galway University Hospital.

Image: Photocall Ireland!

BEFORE PROCEEDINGS GOT underway on Monday, Praveen Halappanavar said this week’s inquest into the death of his wife Savita at Galway University Hospital was his last chance to discover the truth about how and why she died.

As the whole country focussed on Galway Coroner’s Court, numerous witnesses took the stand, including midwives, doctors, specialists, consultants and friends of the victim.

Nearly 70 statements from hospital staff and other sources have been gathered for the hearing into GUH’s first direct maternal death in 17 years.

Savita’s widower attended all but one day of proceedings, with his solicitor Gerard O’Donnell telling reporters yesterday that his client was finding the process very stressful.

The 31-year-old dentist, originally from India, died on 28 October 2012 from complications as a result of septicaemia. She had been admitted to the hospital on 21 October. She was 17 weeks pregnant but miscarrying.

The primary role of the inquest is to determine the facts of her death. A HSE draft report into her care and treatment has been given to Praveen Halappanavar but is yet to be made public. He told his solicitor that he was not happy with its contents as it did not explain why his wife died.

TheJournal.ie takes a look at some of the key moments from the past five days:

‘Catholic Thing’

Midwife Ann Maria Burke. (Image: Niall Carson/PA)

Praveen Halappanavar said Ann Maria Burke’s admission that she mentioned Ireland being a Catholic country to Savita as a part-explanation for why doctors could not expedite her miscarriage came “out of the blue” on Wednesday.

He thanked the midwife for her honesty, adding that it was of “some comfort” that the truth was coming out.

He also said he understood her point of view, in that she did not mean the remark in a nasty or hurtful way. While being questioned on Wednesday, Burke said the phrase had “come out the wrong way” and that she was sorry she said it.

“It does sound very bad now, but at the time I didn’t mean it that way.”

I was trying to be as broad and explanatory as I could. It was nothing to do with medical care at all.

Savita had also mentioned her Hindu faith to Burke.

The coroner Dr Ciarán McLoughlin said the remark had been picked up around the world but stated Irish public hospitals did not operate under religious dogma of any persuasion.

Termination requests

Dr Katherine Astbury. (Image: Niall Carson)

Much of Wednesday’s proceedings focused on when a termination was offered to the miscarrying patient.

Consultant Obstetrician Dr Katherine Astbury told the coroner’s court that Savita asked for a termination on the morning of 23 October when she was notified about the poor prognosis of her foetus.

The legal position was then outlined to her by the doctor. Currently, it is illegal to have an abortion in Ireland unless there is a risk to the mother’s life, something which had not been established yet, according to Astbury. The consultant also outlined that she was dealing in probabilities.

The following afternoon, Dr Astbury said her patient’s life was in danger as she had severe sepsis and she now felt she could carry out a termination. A subsequent scan, however, showed there was no foetal heartbeat. The patient was brought into surgery and the foetus delivered naturally.

Earlier, Praveen Halappanavar told the inquest that his wife had made three requests for a termination over two days. He said she first asked for the miscarriage to be expedited after a scan on Monday, 22 October.

Systems Failures

Galway University Hospital. (Image: Niall Carson)

Before a verdict has even been reached, Dr McLoughlin noted a number of systems failures at Galway University Hospital. He said hospital staff broke accepted protocols and best practice for monitoring the health of a woman miscarrying, especially regular checks for blood poisoning and ensuring all key staff saw the blood test results in a timely manner.

On Tuesday, he was told that blood tests taken the night she was admitted showed raised white blood cells – an indication of infection – but were not acted on until three days later. That point was reiterated by National Maternity Hospital consultant Dr Susan Knowles on Friday.

Dr Astbury also revealed that Savita’s clinical signs were not checked every four hours after her membranes ruptured, which should have happened.

Retrospective Entries

Dr Ciarán McLoughlin (Image: Niall Carson/PA)

In Thursday’s hearing, the court heard that eight retrospective entries were made into the patient’s 110-page medical file. The extra information was added to what were supposed to be contemporaneously taken notes. Some details were added as late as two weeks after her death.

The coroner said he had never seen so many backdated entries in one person’s medical records.

Declan Buckley, one of the lawyer’s for Galway University Hospital, said the entries were clearly labelled by date and there was “never any intention to mislead anyone”. He claimed the notes were added to ensure the most detailed record of care decisions could be presented and remedy any shortcomings in the notes about a serious tragedy.

Yesterday, consultant microbiologist Dr Susan Knowles told the inquest that there was poor documentation of Savita’s deteriorating condition. She said most of the medical notes from a crucial period of the onset of sepsis were made after the fact.

Final days

Midwife Miriam Dunleavy. (Image: Niall Carson)

Experienced midwife Miriam Dunleavy was one of the first to give evidence early in the week. She said she was frightened by how quickly her patient’s condition deteriorated.

“I have never seen a woman suffering a miscarriage get so sick so quickly and I have been on that ward seven years,” said the nurse.

The coroner also heard about Savita’s last days from family friend Mrudala Vasepalli on Tuesday. She recalled being present when Savita asked if anything could be done to save her baby.

She described her friend as being in great emotional distress when she discovered her baby would not survive.

“She was crying every time. She said: ‘Either way it hurts me. If the heartbeat is there, it hurts me. If it stops, it hurts me. What kind of mother am I, waiting for my baby to die’,” she told the packed courtroom.

Vasepalli also confirmed hearing the “Catholic thing” remark from the midwife.

The legal team for the Halappanavar’s read out a statement in court on Thursday to praise the emergency room staff for their “valiant efforts” to save Savita as she fell into a coma and her organs failed on 28 October last year.

The court heard from consultant anaesthetist Dr Paul Naughton who took over the pregnant woman’s care on 26 October when she had fallen into septic shock. He said it proved impossible to reverse the inflammatory reaction caused by the sepsis.

Stronger Antibiotics

Dr Susan Knowles. (Image: Niall Carson/PA)

Dr Susan Knowles, who is the consultant microbiologist at the National Maternity Hospital in Dublin, was critical of some aspects of Savita’s care during yesterday’s hearings. She told Praveen Halappanavar’s counsel that protocols for dealing with sepsis infection were not followed.

She said E.coli antibiotics were not give until about 1pm on Wednesday 24 October. From that point, the care was of a “high standard”, she said.

But prior to that time, the patient’s vital signs were not monitored and recorded as they should have been. According to Knowles, Savita’s vitals should have been recorded at 4.15am on 24 October when she complained of feeling cold and shivery. This did not happen.

Witnesses Recalled

Two witnesses are to be recalled to give evidence next week to discuss the time and content of a telephone call on the evening of 23 October.

According to RTÉ News, the coroner wants to clarify the issue as it would be unusual for a nurse to call a doctor to say a patient’s vital signs were normal.

Buckley said there were “irreconcilable differences” between the evidence given by Dr Uzockwu and Nurse Ann Maria Burke. During evidence, the doctor was positive in his belief that the conversation was about the patient having a bath and did not include any remark other than her vital signs being normal.

The inquest resumes on Wednesday. A verdict is expected late next week.

-Additional reporting by AP, AFP

Read: Praveen Halappanavar thanks midwife for honest answers at inquest

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