Abortion/ *Note* Thread Closing Shortly! ! !

Kiwi in IE

aloyisious wrote: »

Has the inquest been given the identity of the doctor whom the consultant alleges had Savita's Patient History Notes, thus preventing her from becoming aware of the changes in Savita's health?

I take note of the words used by the consultant in response to the question about the sensitivity etc of the "catholic country" reply to Savita, so much of a failure to show sensitivity to both Savita's widower and parents. I guess her legal rep advised her on what words to use in response so as to avoid a hint of legal admission of fault.

I really don't see why that comment was insensitive. She was stating a fact. The reason Ireland doesn't have abortion is because it is a Catholic country. If Savita had asked why there was a law preventing the termination of an unviable foetus, that was the answer. If this does not sit comfortably with people when said aloud, why is it allowed to go on in practice.

GCU Flexible Demeanour

aloyisious wrote: »

Has the inquest been given the identity of the doctor whom the consultant alleges had Savita's Patient History Notes, thus preventing her from becoming aware of the changes in Savita's health?

There's so much information coming out at last, that it's hard to keep track of. I don't know if these bits relate to the point you are seeking information on, but they might be of interest

http://www.breakingnews.ie/ireland/obstetrician-admits-system-failures-to-savita-inquest-590844.html

<...>Consultant obstetrician Dr Katherine Astbury told an inquest she was unaware of blood test abnormalities as they had not been passed on to her team from the weekend staff on-call.

She also confirmed Mrs Halappanavar’s clinical signs were not checked every four hours after her membranes ruptured in the early hours of Monday morning, which was a breach of hospital policy.

<...> Dr Astbury said that when she examined Mrs Halappanavar at 8.30am her vitals had dropped and she believed she had sepsis, not severe sepsis, and admitted her registrar Dr Anne Helps did not read the earlier entry reporting a foul smelling discharge from the patient’s vagina, a sign of chorioamnionitis.

The senior obstetrician insisted had she known this she would have started the steps for a termination then regardless of a heartbeat, instead of ordering tests to check for a urine infection and deciding to terminate at 1pm when severe sepsis was diagnosed.

“If someone has chorioamnionitis you only get the chorioamnionitis out by delivering the foetus,” she added.<...>

The doctors involved in the initial admission (which included an initial discharge home with a diagnosis of back pain) were interviewed already.

What's needed is a good journalist to pull it all together. Fintan O'Toole, in fairness to him, did a good job of that at the Beef Tribunal years ago where similarly there was a flood of detail that needed to be collated.

Kiwi in IE

The inaction, caused by legal observance of the rules of an adult fairytale, was insensitive. Not the fact that it was acknowledged verbally.

StudentDad

It is fascinating how this country is described as a Catholic country (It's not, it's a country that happens to have alot of Catholics living in it). If that is the case and it truly is a Catholic country - change the law. Compose the law in such a manner that people can decide for themselves. Those people who are Catholic will not avail of such legislation and those who do not follow the teaching of that church may freely choose themselves.

I have a feeling that such an idea will not get very far. The core issue here has nothing to do with belief and everything to do with control. I've always said that the true barometer of freedom in a society is what you are allowed to do when you are powerless, through illness or pregnancy etc., when you are at the mercy of agents of the State/Church. Are your wishes recognised?

SD

baalthor

UDP wrote: »

I have to call BS on the coroners' remark after the nurse admitted she said about the "catholic country".

All you have to do is look around nearly every hospital at the crosses and religious crap up on walls to know that this is a bs statement - not to mention probably most wards are named after a saint and their ethics committees are often religiously influenced.
https://twitter.com/FergalBowers/status/321993914246635522

Our local HSE hospital doesn't have any visible religious paraphernalia ... I'm not sure it's correct to say nearly every hospital, but I admit I haven't been in every hospital.

Obliq

baalthor wrote: »

Our local HSE hospital doesn't have any visible religious paraphernalia ... I'm not sure it's correct to say nearly every hospital, but I admit I haven't been in every hospital.

It's the INvisible religious paraphernalia you want to watch out for baalthor. Especially if you're a pregnant woman suffering from chorioamnionitis in an Irish hospital. Great blog post here folks - well reasoned.

http://drjengunter.wordpress.com/2013/04/09/savita-halappanavars-inquest-the-three-questions-that-must-be-answered/

"Just walking through the door with ruptured membranes at 17 weeks Ms. Halappanavar baseline risk of chorioamnionitis was 30-40%. Her presentation should not have posed a diagnostic dilemma, not even for an intern. She was a perfect set up.

In Canada and the United States, once chorioamnionitis is diagnosed the treatment is antibiotics and delivery. An “expeditious delivery…regardless of gestational age,” according to the guidelines of the American Congress of Obstetrics and Gynecology (ACOG). If the fetus is not viable there is no waiting for the fetal lungs to mature or waiting for the fetus to succumb. The recommendation is delivery. This is because chorioamnionitis kills women and if a fetus is on the cusp of viability it has a far greater chance of survival without an infection than with one. The infection helps no one, neither the mother nor the fetus."

and

"3. What is the treatment for chorioamnionitis?

If the answer is delivery then the delay must be explained. One obvious explanation is the swiss cheese effect, where several things are missed culminating in a very bad outcome. It shouldn’t happen, but it does. This problem can be fixed with better staffing, education, and specific protocols.

If the answer is, as the consultant obstetrician suggests, that Ms. Halappanavar was simply not sick enough to warrant delivery then it appears that the current “legal position” in Ireland is that a woman must be left brewing her infection until the stench is bad enough that Death himself gets a whiff and comes calling."

Penn

Obliq wrote: »

...then it appears that the current “legal position” in Ireland is that a woman must be left brewing her infection until the stench is bad enough that Death himself gets a whiff and comes calling."

Turtwig

Penn wrote: »

http://memecrunch.com/meme/6R60/apply-ointment-directly-to-the-burn/image.png

Hmm. .. that looks suspiciously like holy water to me Penn.:mad:

robindch

Jernal wrote: »

Hmm. .. that looks suspiciously like holy water to me Penn.

Could be -- I thought that could have been John Waters' wrist after he'd spent the evening looking through spunout.ie for things to be horrified at.

Morag

http://www.irishtimes.com/news/environment/government-urged-by-european-body-to-expedite-abortion-legislation-1.1356292

A report from the European Court of Human Rights (ECHR) Committee of Ministers published yesterday has called on the Government to implement legislation to deal with abortion.

In its sixth annual report, Supervision of the Execution of Judgments and Decisions of the ECHR , the committee of ministers urged the Government to “expedite” the implementation of the A, B and C judgment on abortion, delivered by the ECHR in 2010.

So they are being told to have X, A, B, C sorted out asap.

LittleBook

Kiwi in IE wrote: »

I find it quite absurd that the midwife is being somewhat vilified for making that comment.

I think the vilification stems from the comment being taken out of context, leaving room for the impression that it may have been said in a kind of "it's a catholic thing dearie so just suck it up".

I really sympathise with the midwife and can completely believe that she was genuinely trying to convey to the Halappanavars, as honestly as possible, why their (the staffs) hands were tied.

UDP wrote: »

I have to call BS on the coroners' remark after the nurse admitted she said about the "catholic country".

Coroner says 'Catholic' remark went around the world and people need to know Irish public hospitals do not have a religious line

Indeed. I've propagated similar remarks in my fair share of foreign countries to many foreign people while trying to explain the current abortion situation, why divorce was only an option in the late 90s and the history of the availability of contraception here!

Morag wrote: »

In terms of reproduction rights and healthcare for as long as the 8th amendment is in place we are catholic country.

And perhaps the coroner could explain why, if Irish public hospitals do not have a religious line, we need the following section in our Employment Equality Act:

A religious, educational or medical institution which is under the direction or control of a body established for religious purposes ... shall not be taken to discriminate against a person for ... if -

(a) it gives more favourable treatment, on the religion ground, to an employee or a prospective employee over that person where it is reasonable to do so in order to maintain the religious ethos of the institution, or

(b) it takes action which is reasonably necessary to prevent an employee or a prospective employee from undermining the religious ethos of the institution.

Lingua Franca

LittleBook wrote: »

I think the vilification stems from the comment being taken out of context, leaving room for the impression that it may have been said in a kind of "it's a catholic thing dearie so just suck it up".

I really sympathise with the midwife and can completely believe that she was genuinely trying to convey to the Halappanavars, as honestly as possible, why their (the staffs) hands were tied.

I do too, I feel really bad for her if she is being vilified.

Bannasidhe

Lingua Franca wrote: »

I do too, I feel really bad for her if she is being vilified.

Telling it like it is = sure fired way to be vilified in Ireland.

VinLieger

Bannasidhe wrote: »

Telling it like it is = sure fired way to be vilified in Ireland.

Especially when the vast majority of people doing the vilifying are using it to cover up their own shame of how unfortunately true the statement is

aloyisious

There is one sure-fire thing that is made obvious by Savita's death, The situation in maternal hospitals here in the Republic of Ireland would be a great deal worse, except for the majority opinion decision made by our Supreme Court (Finlay C.J., McCarthy, Egan and O'Flaherty J.J.) in 1992 that a woman had a right to an abortion under Article 40.3.3 if there was "a real and substantial risk" to her life. This right did not exist if there was a risk to her health but not her life; however it did exist if the risk was the possibility of suicide.

The following is from google and probably taken from the Dail debate record. The bill introduced by the Fianna Fáil minority government proposed to introduce the following clause into Article 40.3 of the Constitution (according to the article I found in google, it seem's that the reason for the amendment, and it's wording, was to prevent Supreme Court judicial decisions from becoming the law of the land).

3° The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.

FitzGerald and Fine Gael initially supported the wording, but, when in government, FitzGerald was advised by his Attorney-General, Peter Sutherland, that the wording as proposed was dangerously flawed.

Speaking against the original wording during the Dail debate Alan Shatter TD argued that:
The irony is that I have no doubt, not merely from the interpretation the Attorney General has given but from the other interpretations that can be validly taken from the amendment, that if it in its present form becomes part of our Constitution it will essentially secure a constitutional judgment in the not too distant future requiring the House to enact legislation to permit women to have abortions.[3]

Maybe now that the Republic's population is twenty-one years wiser, and it now can see clearly where we went wrong in 1992 and 2002, that it will follow the wisdom of the Supreme Court and have the courage to take it's health and future into it's own hands, send a clear unambiguous directive to the Dáil and Seanad "pull your fingers out, ladies and gentlemen, before other women and girls die".

aloyisious

Reading up on what has been revealed to the inquest by hospital witnesses. I am left sceptical as to their evidence. We have to take it at face value, and on that basis, anything they now say is the truth, the whole truth and nothing but the truth. This includes what was written into Savita's hospital medical treatment history and observations made of her condition during the time she was in the various hospital departments, both Post and Ante natal.

Details have been found to have been added to Savita's history file after the fact. with some notes seemingly having no relevance to what Savita's medical condition was during ALL the days she was alive under the hospital's care, as some of the notes were NOT entered onto her medical history file by those people who actually provided her medical treatment and care while she was alive there.

As it's a matter of trust between a hospital, it's medical staff and people who are going to put their lives, and the future lives of possible offspring, into the hands of the hospital's medical staff, I'd suggest GUH had failed abysmally here.

GCU Flexible Demeanour

aloyisious wrote: »

As it's a matter of trust between a hospital, it's medical staff and people who are going to put their lives, and the future lives of possible offspring, into the hands of the hospital's medical staff, I'd suggest GUH had failed abysmally here.

I don't particularly disagree, on the basis of what we've read. But, just to suggest an alternative view, I think we have to bear in mind that all of those medical staff would have been dealing with many patients over the period. It seems inexcusable if you see something like a doctor not reading a key entry on a chart, which could have alerted her to a need for urgent action. But if she's dealing with several people, each with a significant problem, I think its easier to understand how an individual mistake occurs.

However, there's a sense of there being no system, no operational system, guiding action. People will make mistakes. If the setup depends on informal contacts - the weekend shift remembering to pass on details of a blood test, rather than some systematic handover, whatever, then failure is inevitable.

aloyisious

GCU Flexible Demeanour wrote: »

I don't particularly disagree, on the basis of what we've read. But, just to suggest an alternative view, I think we have to bear in mind that all of those medical staff would have been dealing with many patients over the period. It seems inexcusable if you see something like a doctor not reading a key entry on a chart, which could have alerted her to a need for urgent action. But if she's dealing with several people, each with a significant problem, I think its easier to understand how an individual mistake occurs.

However, there's a sense of there being no system, no operational system, guiding action. People will make mistakes. If the setup depends on informal contacts - the weekend shift remembering to pass on details of a blood test, rather than some systematic handover, whatever, then failure is inevitable.

Yes, knowing that doctors are human, it's a certainty that they'll make mistakes. I read in one of the early online versions of today's papers that the consultant said that she had not read all of what was on Savita's file to update her knowledge on Savita's health details.

Another doctor attending at the same time, a junior to the consultant in her practice, said she was told in passing by the offgoing duty doctor of details of the changes in Savita's temperature overnight, but did not pass these onto her senior, the consultant.

Lingua Franca

(Read from bottom to top)


Fergal Bowers ‏@FergalBowers 12m
At 8.50am Weds Oct 24, lab reported 2nd key sepsis test 'not performed' Suggestions test should have been done on ward. #Savita
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Fergal Bowers ‏@FergalBowers 16m
Inquest told results of first blood test on #Savita were ready at 6.37pm Sun Oct 21 but not read until 5.25pm next day.
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Fergal Bowers ‏@FergalBowers 52m
Hospital says results 1st blood test ready 6.37pm Sun Oct 21. Not read until 5.24pm Mon. Can't identify who read it. #Savita
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Fergal Bowers ‏@FergalBowers 1h
Expert witness identifies shortcomings in Savita Halappanavar care at Galway Hospital as condition deteriorated. #Savita
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Fergal Bowers ‏@FergalBowers 1h
Dr Susan Knowles: Were 'subtle' indicators of sepsis before Weds Oct 24 but none to call for termination of pregnancy. #Savita
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Fergal Bowers ‏@FergalBowers 2h
Blood culture samples are in large glass bottles. Are hand delivered to microbiology and this can explain 'delay' to lab #Savita
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Fergal Bowers ‏@FergalBowers 2h
Dr Susan Knowles tells inquest, confusing as to which notes are retrospective and which are not in some cases. #Savita
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Fergal Bowers ‏@FergalBowers 2h
Antibiotic treatment given to #Savita between 7am and 1pm Oct 24 'ineffective' as E.Coli resistant to erythromycin.
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Fergal Bowers ‏@FergalBowers 2h
Broader spectrum antibiotic would have been better choice - some e.coli/sepsis strains resistant to certain antibiotics. #Savita
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Fergal Bowers ‏@FergalBowers 2h
Dr Susan Knowles tells inquest, #Savita died of multi-organ failure, secondary to septic shock.
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Fergal Bowers ‏@FergalBowers 2h
Dr Susan Knowles: Retrospective notes make progress of some events hard to ascertain #Savita
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Fergal Bowers ‏@FergalBowers 2h
Expert witness Dr Susan Knowles says a broader spectrum antibiotic should have been chosen #Savita
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Fergal Bowers ‏@FergalBowers 2h
Expert microbiologist Dr Susan Knowles says all #Savita vital signs should have been checked 4.15am Oct 24 when she was shivering
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Fergal Bowers ‏@FergalBowers 3h
Inquest to recall midwife and doctor over different recollections over what was said about vital signs. #Savita
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Fergal Bowers ‏@FergalBowers 3h
Praveen Halappanavar decides not to attend inquest today as it very stressful says his solicitor. He will return next week.


So many failures in her care.

Nodin

Its rather frustrating to know that entries were added, but not what they pertain to.

GCU Flexible Demeanour

Lingua Franca wrote: »

Fergal Bowers ‏@FergalBowers 2h
Dr Susan Knowles tells inquest, confusing as to which notes are retrospective and which are not in some cases. #Savita

Somehow, this doesn't seem surprising. But maybe I'm just experiencing confirmation bias.

aloyisious

GCU Flexible Demeanour wrote: »

Somehow, this doesn't seem surprising. But maybe I'm just experiencing confirmation bias.

It might be an angle of law that the Health Minister and the IMC could change to prevent additions, amendments or editing of Medical History files of a deceased patient, unless it's done under CCTV camera or phyical presence supervision: eg, a reading of the file before and after any amendments to prevent any perversion of the file's truthfullness. Any such changes should be dated and timed, with NO "hindsight" retrospective entries allowed, to prevent a mis-understanding of a file's true record.

One of the revelations today was the fact that after Savita died, the file was transferred to the care of the hospital morgue, as Savita's body was there, presumably so that any PM observations could be added to the file, and allow the person peforming the autopsy understand (by comparing physical evidence with the file entries) anything unusual noted during the PM. The consultant went to the Morgue, got the file there and then added entries to the file.

maco12

legalise it..plain and simple!

GCU Flexible Demeanour

maco12 wrote: »

legalise it..plain and simple!

I don't see how marijuana would help.

Morag

maco12 wrote: »

legalise it..plain and simple!

It's not that simple, there has to be policies, procedures and best practices drawn up. Legalizing limited abortion in line what that the majority of people agree with would only be the start, but it has to be part of mainstream health care rather then pushed into private clinics.

Mamie Cadden was bad enough, I would hate to see a repeat of her plying her trade or for it to be possible for a situation like the Gosnell clinic to happen here.

Kiwi in IE

Fergal Bowers ‏@FergalBowers 1h
Dr Susan Knowles: Were 'subtle' indicators of sepsis before Weds Oct 24 but none to call for termination of pregnancy. #Savita

For me this says it all. There were early indications of sepsis but not severe enough to 'call for termination'. All the failures in her care that happened after admission indicate medical misadventure. The results were tragic but these sorts of issues occur everywhere from time to time. However if Savita had been in Canada, France, England, Germany, Australia or any other first world country, the unviable pregnancy would have been terminated soon after admission and therefore it is highly likely she would still be alive. She was forced by law to endure a prolonged miscarriage because the unviable foetus had a heartbeat and this cannot be overlooked in the focus on any subsequent medical misadventure (which must be dealt with appropriately also). It is highly probable that the sepsis would not have developed had she not been left for several days with an open uterus. The fact of the matter is that she died because Catholic principles influence the law of this country. Midwife Ann Maria Burke's comment 'this is a Catholic country' is tragically true.

GCU Flexible Demeanour

Kiwi in IE wrote: »

For me this says it all.

However, more was said.

http://www.rte.ie/news/2013/0412/381029-halappanavar-inquest/

Dr Knowles <...> agreed that it was clear that the GUH protocols for dealing with sepsis infection had not been adhered to.

Dr Knowles said the antibiotics recommended as part of those guidelines had not been administered until around 1pm on Wednesday 24 October.

Dr Knowles is the consultant microbiologist at the National Maternity Hospital in Dublin.

The evidence is that the hospital's stated standard treatment protocols were not followed.

You have to invent a very strange version of reality to say the standard treatement protocols were not legally compliant. You are inventing what you want to see in the case, nothing more.

Kiwi in IE

GCU Flexible Demeanour wrote: »

However, more was said.The evidence is that the hospital's stated standard treatment protocols were not followed.

You have to invent a very strange version of reality to say the standard treatement protocols were not legally compliant. You are inventing what you want to see in the case, nothing more.

If there was not a law in place preventing uterine evacuation, causing her to spend several days with an open uterus miscarrying an unviable feotus, in all probability there would not have been an infection to require antibiotics. How do you not see this?

Anyway we are arguing about this in two different forums now!

Turtwig

I'd be curious to know if anyone has any comparison to the conduct of GUH to a hospital with strict Catholic Ethos in the U.S or else where. Then if possible, a comparison to a non religious hospital in a country with less stringent abortion laws would be nice. Ideally a comparison across a broad spectrum of hospitals would be preferred. But that may be asking too much.

Loafing Oaf

Jernal wrote: »

I'd be curious to know if anyone has any comparison to the conduct of GUH to a hospital with strict Catholic Ethos in the U.S or else where. Then if possible, a comparison to a non religious hospital in a country with less stringent abortion laws would be nice. Ideally a comparison across a broad spectrum of hospitals would be preferred. But that may be asking too much.

There appears to be a wall of silence around practice in this area in Irish hospitals. It seems to me that whenever obstetricians are asked by interviewers about the specifics of abortion practice, they steer the conversation deftly away. This is one of the things that suggests to me that standard maternity care in Ireland may involve practices that are at best dubiously legal.