It is hard not to be cynical about the way in which the narrative about Savita Halappanavar has changed, given that abortion legislation has been safely passed. Now, a great deal of the commentary is focusing on failures within the hospital.
The report by the Health Information and Quality Authority (Hiqa) is repeating what we have heard from the coroner’s report onwards – symptoms were missed, communications breakdowns happened, and life-saving systems and protocols were either not in place or not implemented.
Yet before legislation was passed, with each successive report the commentary shifted attention back to the law, and away from the multiple failures described by people such as Dr Susan Knowles as far back as the coroner’s inquiry.
One of the Republic’s foremost experts in infections affecting pregnant women and newborn babies, she was very critical of the failure to follow up blood samples, or to have the proper regime of antibiotics in place.
It is also extraordinary that the tragic story of Tania McCabe has re-emerged into public discussion, although virtually no reference was made to it at the time of Savita’s death.
This is inexplicable, given the parallels – there was a failure to deal properly
with ruptured membranes, and a young mother died of sepsis. Her baby son,
Zach, also died.
At the time of Ms McCabe's death, it was recognised as a preventable tragedy, but there were no marches demanding changes in the abortion law.
Tragically, though, the recommendations made at the time, designed to
save women's lives and, where possible, the lives of their babies, were not implemented nationally.
In the Hiqa report on Savita’s case, it says that six out of 19 maternity units had no comment on the recommendations made after Ms McCabe’s death or had no evidence they were being implemented.
No wonder her family are “saddened and disappointed”. As a family, the McCabes have spearheaded fundraising for incubators. The least they might have expected would be that life-saving recommendations be implemented.
Nothing heals the hurt of losing your wife and child, but the knowledge that the tragic death might result in better outcomes for others might be some small comfort.
However, there are some people who still feel that the law was the primary problem. While the acknowledge other problems, they argue that these were not the key factors in Savita’s death.
Reinforcing the message
Dr Peter Boylan was interviewed about the Hiqa report on RTÉ's Morning Ireland this week. He did a sterling job reinforcing the message found in the report that the ratio of obstetricians to pregnant women is far too low, but said in relation to University Hospital Galway that "to turn the hospital upside down on the basis of a single catastrophe would be a mistake."
He also said that he was sure that the hospital had “learned their lesson” and that “staff have been subjected to the most awful vitriol.” He acknowledged the failings, but insisted that the “staff were inhibited in what they could do” [because of the law].
Oddly enough, he did not highlight this sentence from the report: “Ultimate accountability for the safe delivery of patient care lies with the named consultant in charge of that patient’s care. Crucially, the delivery of safe, high-quality patient care is not only the responsibility of a named individual, it is also the job of everyone who works in the multidisciplinary clinical team.”
The report highlights 13 “missed opportunities”, beginning with one Dr Boylan has dismissed on a number of occasions as of no clinical significance – the elevated white blood cell count on admission.
Curiously, Dr Boylan said on Morning Ireland that while the report highlights omissions, it does not suggest what should have been done instead.
This comment is odd, given that the report does say exactly what could have been done instead at these 13 missed opportunities, along with the clear statement that different management “may have potentially changed the outcome of her care”.
In other words, Savita's life might have been saved. However, Dr Boylan has consistently stated that primarily the law was at fault here because "the only thing that could have been done would've been to terminate the pregnancy," and "nothing else would have worked" (Tonight with Vincent Browne, April 22nd, 2013).
Yet the Hiqa report is clear – there was a "general lack of provision of basic, fundamental care, for example, not following up on blood tests as identified in the case of Savita Halappanavar; failure to recognise that Savita Halappanavar was at risk of clinical deterioration; failure to act or escalate concerns to an appropriately qualified clinician when Savita Halappanavar was showing the signs of clinical deterioration".
The obvious point is that, yet again, Prof John Bonnar’s view has been vindicated. He has consistently said that if Savita had received proper care, the baby could have been delivered by the Tuesday – and the law in no way impeded that.
Let us hope that a fraction of the energy that went into securing abortion legislation goes into ensuring that there are no more cases like Tania McCabe and Savita Halappanavar, and that the dishonourable Irish tradition of issuing reports but not actually doing anything does not go on.