Crucial questions hospital must answer
ANALYSIS:Central question surrounds Praveen Halappanavar’s allegation
“Why did Savita Halappanavar die?” is the central and obvious question that any inquiry into her death has to answer.
This was the first maternal death in 17 years at Galway University Hospital, but the nature and disputed circumstances of this one death has effectively consigned this excellent record to history.
The answer to the question will be found through a thorough examination of the standard of treatment she received, the clinical decisions that were made and the speed with which these were executed.
Ms Halappanavar’s own medical records and her husband Praveen’s account may provide further clues as to why her pregnancy went so tragically wrong.
The next crucial question which must be answered, because it cuts to the core of so much of the debate, is whether a termination of Ms Halappanavar’s pregnancy would have made any difference to the outcome. In simpler terms, would she be alive today if the termination which her husband says they both sought had been performed?
The treatment of Ms Halappanavar, from beginning to end, will form the spine of any inquiry. There are many questions to be answered here: How soon was the seriousness of her condition recognised? Why was the decision made not to abort the pregnancy? What factors underlay this decision – purely medical considerations, legal fears or moral viewpoints?
An inquiry will tell us at what point infection became an issue in her treatment. Was there any indication of an infection when she first presented at the hospital? How was her infection dealt with when it was identified? Were antibiotics prescribed soon enough? Were they the right antibiotics? Was this the right approach to treating a massively invasive infection?
The processes and staffing levels at the hospital will also come under close scrutiny in any proper investigation into this death. The hospital has suffered from long waiting times in recent years but its performance has improved greatly this year under a new manager. It is now part of the Galway Roscommon hospital group, a trailblazer for other hospital groups planned for the rest of the country.
Ms Halappanavar was admitted at a weekend and died seven days later during a bank holiday weekend. The number of patients on trolleys is one measure of how busy a hospital is. There is no publicly available count for this on the Sunday Ms Halappanavar was admitted but on the following day 11 patients were on trolleys at the hospital.
So were staffing levels on the weekend of her admission sufficient to ensure a speedy diagnosis of her condition? Were consultant staff available to make the necessary decisions or did these have to wait until clinical rounds on Monday?
Mr Halappanavar has said his wife’s medical notes make no mention of their request for a termination. It is, therefore, unclear whether the hospital will say it received such a request, and whether it entertained one. But assuming it did, how was the request handled? And who was involved in the decision-making process – the clinical team or, in addition, an outside body such as an ethics committee?
Issues of “who said what to whom” form part of any inquiry and the central question surrounds Mr Halappanavar’s allegation that he was told, when they asked for a termination, that this could not be performed “because Ireland is a Catholic country”. Does the hospital accept this remark, which has since gone around the world, was made? If so, who made it? And what was meant by it?
Depending on the form of inquiry, other issues will be examined. The HSE’s clinical review will focus solely on the treatment of Ms Halappanavar while she was in the hospital, but a broader inquiry would also look at the subsequent handling of her death. Was there a delay in ordering an inquiry into her death, for example?
A letter of condolence was sent to Mr Halappanavar after his wife died but very little else seems to have been done to provide him with comfort and answers. Some of this may be down to communications difficulties after he went home to India but it is undoubtedly true that if some small efforts had been made at this stage, the hospital, the health service and Ireland probably wouldn’t be in the mess it is in now.