Midwife manager 'regrets' using 'Catholic country' remark to Savita Halappanavar
Consultant obstetrician tells inquest in Galway she felt constrained by Irish law from acceding to woman’s request for termination
Midwife Anne Marie Burke arrives to give evidence at the inquest into the death of Savita Halappanavar in Galway today. Photograph: Eric Luke/The Irish Times
Ms Halappanavar died in Galway University Hospital of septicaemia due to E.Coli on October 28th, 2012, a week after being admitted.
At the inquest into Ms Halappanavar’s death in Galway today, Ann Maria Burke said that she now regrets the remark but explained that it wasn’t meant to be hurtful.
“It was not said in the context to offend her. I’m sorry how it came across. It does sound very bad now but at the time I didn’t mean it that way,” she said.
“It was the law of the land and there was two referendums where the Catholic church was pressing the buttons.” She said it was more to give information and to throw light on Irish culture.
Coroner Dr Ciaran McLoughlin said the words “went around the world”.
Irish public hospitals do not follow any religious tenets or dogma, he pointed out.
Ms Burke said Ms Halappanavar knew a termination was against the law. She, Ms Burke, felt her back was against he wall and had to say something. “I shouldn’t have said it but it came out the wrong way.” It was a chat and had nothing to do with the provision of care, she told the inquest today.
Earlier, a consultant obstetrician today insisted she had not used the term in her discussion with Ms Halappanavar about why she could not terminate her pregnancy.
Dr Katherine Astbury also told the inquest she felt constrained by Irish law from acceding to her request for a termination of the 17-week foetus she was miscarrying.
Dr Astbury told Eugene Gleeson, SC for the dead woman’s husband Praveen Halappanavar, that she recalled on the morning of Tuesday, October 23rd, being asked by Ms Halappanavar for a termination of her pregnancy. She said Ms Halappanavar, while emotionally distressed, was not physically unwell.
"I recall telling her about the legal situation. She basically said she was finding it very upsetting and difficult having to sit with the baby in her. She didn't want to have to wait."
Dr Astbury said she said to Ms Halappanavar: "In this country it is not legal to terminate a pregnancy on grounds of poor prognosis for the foetus."
When pressed for clarification by Mr Gleeson, she said: "The law in Ireland does not permit termination even if there is no prospect of viability [for the foetus]. That would be my understanding of the legal position based on the legal judgement in the X-case and the Medical Council guidelines."
Mr Gleeson said he had to put it to her that she had said to Mr and Mrs Halappanavar: "Unfortunately I can't carry out a termination. This is a Catholic country."
Dr Astbury replied: "No, I didn't say that. I made no mention of religion."
Asked would she agree that it would be "insensitive, uncivilised and wrong" to have said Ireland was a "Catholic country", she agreed. "It's certainly not something I would say," she said.
Dr Astbury said it was her understanding "in this country it is not legal to terminate a pregnancy on the grounds of poor prognosis for the foetus" and that unless there was a "real and substantive risk to the life of the mother", abortion was illegal in all circumstances.
Mr Gleeson asked her if Ms Halappanavar had been in another jurisdiction, such as England, would she have been offered a termination. Dr Astbury said it was her understanding that if she had been in a country where abortion was legal, she would have been offered that option.
“Are you a lawyer?” asked Mr Gleeson.
Mr Gleeson asked the witness if she discussed with an obstetric colleague whether to offer or perform a termination when Ms Halappanavar's health was deteriorating. Dr Astbury replied that there had been no need to as there had been no "evidence of a real and substantial" risk to Ms Halappanavar on Tuesday, October 23rd.
Coroner Dr Ciaran McLoughlin intervened and said a doctor's decision as to when to terminate a pregnancy was a "clinical" as opposed to a legal one.
The decision to terminate Ms Halappanavar's pregnancy was taken at 1.20pm on October 24th after her condition had deteriorated to such an extent that Dr Astbury judged her life was at risk. However, a scan at 3pm found the foetus had died and Ms Halappanavar later delivered it in theatre.
Dr Astbury earlier told the inquest that she would have prepared to terminate Ms Halappanavar's pregnancy five hours than she did had she read Ms Halappanavar's notes on her ward round on the morning of October 24th.
The notes indicated her life was by then at risk.
However, she did not look at the notes on her rounds and the decision to terminate was not made for another five hours, during which time Ms Halappanavar's health was deteriorating rapidly.
Dr Astbury agreed in evidence, given Ms Halappanavar's shivering early on the Wednesday morning, as reported yesterday by midwife Miriam Dunleavy, it was likely Ms Halappanavar's infection "was arising" at 4.30am. The inquest yesterday heard from Dr Ikechuckwu Uzockwu, that at 6.30am on Wednesday, Ms Halappanavar had a temperature of 39.6 degrees, an elevated pulse of 160bpm and a foul smelling discharge from her vagina. Dr Astbury agreed the foul-smelling discharge was "significant".
However, as another doctor had Ms Halappanavar's notes, she was not aware of this on her ward round at 8.20am.
"Is that acceptable?" Mr Gleeson asked her.
"I should have been aware of it," she said. At that point there was a "potential risk to life".
If she had known about it at 8.20 am, she said: "I would have done what I did at 13.20. I would have started it [preparing to terminate]."
Earlier,Dr Astbury said the loss of the foetus had not been "inevitable" when she saw Ms Halappanavar, on Monday 22nd in the hospital. Her membranes had ruptured at 12.30am that morning. She said she told Ms Halappanavar there "was a very small prospect the foetus might reach viability", despite the fact she had been told earlier that a miscarriage was "inevitable".
She told Mr Gleeson that once the membranes had ruptured there was a 30 to 40 per cent likelihood of Ms Halappanavar contracting an infection.
"That is serious from a patient's point of view? It's a significant risk to her health?" he asked.
"If you consider 30 to 40 per cent significant, yes," Dr Astbury replied. She agreed the longer a woman with ruptured membranes remains undelivered, the greater the risk of infection.
Mr Gleeson again asked her about hospital policy on checking the vital signs of a woman with ruptured membranes every four hours. This was policy, she confirmed, agreeing that good hospital record keeping was "important".
Ms Halappanavar's notes show vital signs were recorded and noted just five times on both Monday 22nd and Tuesday 23rd, rather than six.
"That is a policy failure then?" asked Mr Gleeson.
"Yes," she replied.
She said she hadn't checked how many times records had been noted in Ms Halappanvar's notes while she had been her patient. The vitals were recorded and noted every four hours in Ms Halappanavar's case, she said it was but "overnight there were longer gaps", referring in particular to the night of Tuesday, October 23rd, when Ms Halappanavar deteriorated rapidly.
"This was a system failure then?" asked the coroner.
"Yes," the witness replied.
Dr McLoughlin asked her about the wide variation in Ms Halappanavar's white cell count, of 16.9 on her admission on Sunday 21st and 1.6 when next checked on Wednesday 24th. A normal upper-limit white cell count in a second trimester woman, said Dr Astbury, was 14.8.
Asked to comment on the fact she had not been told by the doctor who was on-call on the Sunday but who was not a member of her medical team, of the elevated white cell count on admission, Dr Astbury said: "If I had known that I would have re-checked it [earlier than on Wednesday 24th]."
"Is that a systems failure?" asked Dr McLoughlin.
"I suppose the team should check its own results,” the witness replied.