Many medical issues remain to be clarified in the case of Savita Halappanavar

Evidence of consultant obstetrician, Dr Katherine Astbury, will be especially important

Praveen Halappanavar, the husband of the late Savita Halappanavar, with members of his legal team, arriving at her inquest in Galway. Photograph: Eric Luke/The Irish Times

Praveen Halappanavar, the husband of the late Savita Halappanavar, with members of his legal team, arriving at her inquest in Galway. Photograph: Eric Luke/The Irish Times

Tue, Apr 9, 2013, 06:00

The opening day of the inquest has cast additional light on some of the medical issues surrounding the care of Savita Halappanavar at University Hospital Galway last October.

Coroner Dr Ciaran McLoughlin said he had received some 53 statements from hospital personnel and that he would introduce four expert reports. Significantly he sought clarification on when guidelines on the management of sepsis had been introduced by the hospital.

In clarifying Praveen Halappanavar’s evidence on what he and his late wife meant by abortion, Dr McLoughlin confirmed that the witness meant expediting the process of miscarrying using a drug and not an instrumental intervention.

He asked Mr Halappanavar when his wife had begun shivering and teeth chattering on the Tuesday night of her hospital admission whether hospital staff used the medical term rigor to explain her symptoms. He replied they had not but had explained they were because of coldness in her hospital room. Rigors refer to the uncontrollable shivering that occur in someone whose temperature is elevated.

The indications from Mr Halappanavar’s evidence was that his wife was closely monitored by nursing staff in the hours after she became acutely unwell. However he maintained that no one had explained to them the risks to her health arising from the rupture of her membranes.

He described his wife as having laboured breathing, low blood pressure and a high temperature on Wednesday morning. These signs are consistent with the presence of blood poisoning (septicaemia). Later that day she was moved to the high dependency unit.

At about 11pm Ms Halappanavar was moved to the intensive care unit (ICU). There she came under the care of anaesthetic specialists and placed on a ventilator. On Thursday a doctor in ICU told him his wife had septicaemia and septic shock. By definition, this means she had sepsis with low blood pressure despite fluids having been administered.

On the Friday night he described his wife as having blue extremities with swollen hands and lips. This suggests she was receiving drugs to keep her blood pressure up concentrating blood flow in the vital organs with the result that extremities are shut down.

On the Saturday night, some hours before Savita died, her husband was told she had multiple organ failure. This means her kidneys, liver, lungs and heart were failing.

Many medical issues remain to be clarified by evidence from nurses, doctors and other hospital personnel. The evidence of consultant obstetrician, Dr Katherine Astbury, will be especially important, with indications from her counsel yesterday afternoon that she would challenge key elements of Praveen Halappanavar’s testimony. In particular she and other staff will want to address his contention yesterday that medical notes may have been altered retrospectively. If proven, this allegation would have serious professional repercussions for health professionals.