Law delayed Savita termination - consultant

Consultant says key medical information was not given to her on time, delaying intervention

Tony Canavan, chief operating officer, Galway and Roscommon Hospital Group, and consultant obstetrician Dr Katherine Astbury arriving at the inquest into the death of Savita Halappanavar in Galway. Photograph: Eric Luke

Tony Canavan, chief operating officer, Galway and Roscommon Hospital Group, and consultant obstetrician Dr Katherine Astbury arriving at the inquest into the death of Savita Halappanavar in Galway. Photograph: Eric Luke

 

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Dr Katherine Astbury told Eugene Gleeson, SC for Praveen Halappanavar, she recalled on the morning of Tuesday, October 23rd, being asked by Ms Halappanavar for a termination.

“I recall telling her about the legal situation.” 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.”

Mr Gleeson put it to her that she had in fact said: “Unfortunately I can’t carry out a termination. This is a Catholic country.”

“No I didn’t say that. I made no mention of religion,” replied Dr Astbury.

Dr Astbury said it was her understanding Irish law did “not permit termination even if there is no prospect of viability [for the foetus]” and that unless there was “a real and substantive risk to the life of the mother”, abortion was illegal.

The decision to terminate Ms Halappanavar’s pregnancy was taken at 1.20pm on Wednesday 24th as her condition had deteriorated to such an extent that Dr Astbury judged her life was now at risk.

A scan at 2pm found the foetus had died and Ms Halappanavar later delivered. Dr Astbury told the inquest she would have prepared to terminate Ms Halappanavar’s pregnancy five hours earlier than she did had she read Ms Halappanavar’s notes – which showed Dr Ikechuckwu Uzockwu’s serious concern at 6.30am on Wednesday October 24th – on her ward round at 8.20am.


Notes
She said she had not looked at the notes as her registrar, Dr Ann Helps, had them. The decision to terminate was not made until 1.20 pm, during which time Ms Halappanavar’s health deteriorated rapidly. Dr Uzockwu told the inquest on Tuesday he had been concerned about a foul-smelling discharge from the vagina at 6.30am as an indicator of sepsis.

Dr Astbury agreed the discharge was “significant” but she hadn’t known about it at 8.20am. “Is that acceptable?” Mr Gleeson asked her.

“I should have been aware of it,” she replied. If she had known about it, she said: “I would have done what I did at 13.20. I would have started it [preparing to terminate].”

Dr Astbury agreed with coroner Dr Ciaran MacLoughlin there were systems failures at the hospital in relation to Ms Halappanavar’s treatment. Dr Astbury said she was not aware of the results of blood tests conducted four days after Ms Halappanavar was admitted, when her condition was deteriorating.

If she had been aware of the result, she would have seen her sooner. At the time, she didn’t have the blood result and was working only on clinical signs.

There was no evidence to suggest she had severe sepsis. “If we had the blood results back sooner we may have considered intervening sooner,” she said.

Later, Dr Astbury told her barrister, Eileen Barrington SC, she could not accede to the request for a termination because “on the balance of probabilities” there was not a real and substantial risk to Ms Halappanavar’s life at the time.

Four days after admission, when Ms Halappanavar’s condition had deteriorated, she decided that a termination was necessary regardless of the foetal heartbeat.


Line of questions
Mr Gleeson protested that this line of questions by Ms Barrington was an attempt to justify the decision not to go down the termination route on the basis that this would have taken time.

Dr MacLoughlin said he had never seen so many retrospective notes on the medical notes as in this case. Some of the entries were made up to two weeks after the events occurred and would have been based purely on memory, he said. He said he had to draw a conclusion from this and it seemed to be a systems failure. The inquest continues.