Laws, not doctors, to blame for Savita Halappanavar death, says expert witness

There is no other way to summarise yesterday's main testimony to the Savita Halappanavar inquest other than that, in the view of an expert witness, restrictive Irish abortion laws cost Ms Halappanavar her life.

Dr Peter Boylan’s statement that Ms Halappanavar would most likely be with us today if she’d been given a termination earlier may be just an opinion, but it is the opinion of one of the most eminent obstetricians in the State.

As the former master and current clinical director of the National Maternity Hospital, with extensive professional experience in the UK and US as well as Ireland, Dr Boylan clearly has vast experience.

But as a former member of the Government’s expert advisory group on abortion, he is also intensely familiar with the fault line where clinical practice meets the law in relation to terminations.

Last year, when news broke of Ms Halappanavar’s death, he stated that the issue of terminations hangs like “a sword of Damocles” over his profession.

It was clear yesterday, having reviewed the circumstances of the case in detail – his report runs to 18 pages – that his view hasn’t changed.

Risk to life
In effect, Dr Boylan is saying Ms Halappanavar lost her life because Irish law prevented Irish obstetricians from doing what counterparts in many other countries do – terminating a pregnancy to eliminate the risk to a woman's life.

In Ireland, there has to be a “real and substantial” risk to the mother’s life before the obstetricians can intervene and there are no guidelines on quantifying that risk to help them in their decisions.

In Ms Halappanavar’s case, this threshold was not fulfilled when she was admitted on Sunday, October 21st. More importantly, neither was it fulfilled on the following Monday and Tuesday, after her membranes had ruptured, she wanted a termination and, by Tuesday evening, there were signs of infection.

Even by Wednesday morning, when she had clearly developed sepsis, the continuing presence of a foetal heartbeat had an influence on medical decision-making in relation to a termination, according to Dr Boylan. He notes that Ms Halappanavar's consultant, Dr Katherine Astbury, felt it necessary to obtain a second opinion on terminating because of the legal situation.

Too late
By then it was too late, as the infection spread rapidly, too rapidly for doctors to counter. Sepsis turned to severe sepsis and then septic shock within a matter of hours, and her chances of survival diminished accordingly.

If Dr Boylan was scathing about the legal position, he was gentler in his assessment of the treatment Ms Halappanavar received from doctors at University Hospital Galway.

Crucially for Dr Astbury, he backed his fellow obstetrician’s calls on a termination right through the Monday to Wednesday period. Whereas termination “was not a practical legal proposition” on the Monday and Tuesday, he credits Dr Astbury with “clearly recognising” the real and substantial risk to her patient’s life that had developed by the Wednesday.

The initial management of Ms Halappanavar in the hospital on the day of admission was “entirely appropriate”, he said. As for senior house office Dr Ikechukwu Uzockwu’s failure to take her vital signs at a crucial time early on Wednesday morning, Dr Boylan said it was “perfectly reasonable” for a doctor to decide not to awaken a sleeping patient.

After six days of intense scrutiny of Ms Halappanavar’s case, this inquest will certainly give the Government plenty to think about.