Savita report stresses failure to record symptoms
Cascade of failures at Galway hospital highlighted
Sir Sabaratnam Arulkatumaran , chairperson, at the publication of the Health Service Executive (HSE) clinical review report into the death of Savita Halappanavar on Thursday. Photograph: Eric Luke
The Coroner’s Inquest did likewise, but subsequent commentary diverted attention, suggesting that the law that was the primary problem.
Dr Arulkumaran does indeed say that that the law needs clarification, and no one disagrees with clarity. However, the kind of detail that complex medical situations require could never be the subject of legislation.
You could not write into law, for example, the exact moment at which a termination should be offered to a woman in Savita’s terrible situation. That remains a matter of clinical judgement, though Medical Council guidelines would be of immense help.
The HSE Inquiry summarises the causal factors as the team’s failure to adequately diagnose the danger that Savita was in, and crucially, she was therefore not offered treatment to which she was entitled. The hospital also did not adhere to sepsis clinical guidelines even when it was diagnosed.
The Report cites one damning statistic. ‘Those presenting [in the second trimester] with a live foetus and bulging membranes are associated with infection in 77% of cases. Therefore, the presence of infection should have been assumed and the progression to sepsis closely monitored for.’
It has received little comment how much this report contrasts with Dr Peter Boylan’s expert opinion at the Coroner’s Inquest and in subsequent media interviews.
Dr Boylan’s testimony to the coroner says that he thought it ‘unlikely that the failure to note the elevated white blood cell count on admission, or repeat it had any material impact on the eventual outcome.’
When this writer suggested in a radio interview to Dr Boylan that the failure to repeat the white blood cell test was ‘hugely significant’, he replied, “It wasn’t. No. You’re completely wrong.”
Dr Arulkumaran says regarding Savita: ‘The patient’s white blood cell count on admission may have been due to pregnancy but was too high to be normal and was suggestive of possible infection in the absence of any other obvious causes at this time. However, these blood test results taken on the 21st of October 2012 were never followed up.’
Dr Boylan expert testimony says that on ‘Monday October 22nd, Ms Halappanavar’s temperature was normal on five readings, her pulse ranged between 90 and 102…none of the readings gave cause for concern…’ He also notes three pulse rates of 100 or over on Tuesday October 23rd, which he says was ‘in retrospect, (emphasis mine) was probably evidence of developing chorioamnionitis.’
In the same radio interview, he says of Monday and Tuesday: ‘She had a normal pulse, she had a normal temperature, it was only in the very early hours of Wednesday…’