Woman dies after termination denied

conaire1

Media reports of the death of an Indian woman, Savita Halappanavar, who was 17 weeks pregnant, at University Hospital Galway last month, are now 24 hours old. Why is there no thread on the subject on the Galway city board?

Predalien

Because it's a national issue and there are threads elsewhere?

chickencurry02

if it is such a big concern for you why dont you start one

conaire1

After five minutes searching, I found the national thread at http://www.boards.ie/vbulletin/showthread.php?t=2056806680
All shades of opinion there and some clear points being made in the midst of it all. My sympathies to her husband Praveen, who works in Boston Scientific, and her family in India.
Perhaps those who wish to express their views could do so on the national thread and this thread could be reserved for personal messages.

jc bamford

There is a big thread in The Ladies lounge

conaire1

I'm now an expert at finding national threads. The Ladies Lounge thread is at http://www.boards.ie/vbulletin/showthread.php?t=2056806875

GekkePrutser

I'm a bit surprised that there's no demonstration organised here in Galway, there are in Dublin and Cork but not here, where it happened. If there was a silent march or something I would certainly join it.

Edit: I just saw on the Irish Times website that a vigil is planned here for Saturday 5pm.

BhoscaCapall

The Catholic Church has held this country back more than any empire ever did, and I say that as a staunch Republican.

biko

It's a bit of an odd thread start there OP. Instead of starting a thread on the tragedy it's a thread on why there isn't a thread on the tragedy
I don't mind it being discussed here even though location is coincidental.

FB on Saturday's vigil, see you there.
http://www.facebook.com/events/111469712349997/

snubbleste

Galway is famous worldwide.

conaire1

Biko
I came to the Board last night to read local response to a local tragedy. When I saw no posts, I thought they may have been moved to the national tread(s). I'm baffled and disturbed that nobody had started a thread much earlier.
Thanks for the Saturday Vigil Facebook thread, I hope to be there.

ben.schlomo

conaire1 wrote: »

Biko
I came to the Board last night to read local response to a local tragedy. When I saw no posts, I thought they may have been moved to the national tread(s). I'm baffled and disturbed that nobody had started a thread much earlier.
Thanks for the Saturday Vigil Facebook thread, I hope to be there.

An experienced user of boards would know that threads were started elsewhere so that there wasnt necessarily any need to add to it here, that should ease your distress.

conaire1

I wanted to read a local response to a local tragedy.

biko

It is very sad it'd have to come to this (a local woman's death) before it's brought up how flawed the system is in this regard. Hopefully this terrible death will be the spark that opens up a debate and a change in the law so any further tragedies can be prevented.

Shakti

The mortal consequences of the appalling standards of care in UCHG.

antoobrien

biko wrote: »

Hopefully this terrible death will be the spark that opens up a debate and a change in the law so any further tragedies can be prevented.

Since terminations are already allowed if the mother's life is in danger, does the law really need to be changed to cover this case?

Septicemia is a dangerous condition, so it has to be asked is this a case of the medical staff failing to grasp the seriousness of the problem until it was too late?

biko

From what I heard on the radio most cases are pretty clear but in this one case circumstances were different and not covered under proper legislation (I don't recall exactly what was said but that's the jist of it).

My condolences to Mr Halappanavar and the family btw.

Shakti

Her husband, Praveen Halappanavar (34), an engineer at Boston Scientific in Galway, says she asked several times over a three-day period that the pregnancy be terminated. He says that, having been told she was miscarrying, and after one day in severe pain, Ms Halappanavar asked for a medical termination.

This was refused, he says, because the foetal heartbeat was still present and they were told, “this is a Catholic country”.

http://www.irishtimes.com/newspaper/frontpage/2012/1114/1224326575203.html

Sponge Bob

Termination is not permitted where the baby has NO chance of surviving. IN this case she had a fully dilated cervix and survivability was 0%. The same applies in cases of Anencephaly where the foetus may go full term and will die upon birth, no termination is permitted despite the 100% probability of death after delivery.

Clare Daly attempted to introduce a Bill to allow for termination in limited circumstances earlier this year. The Bill, if enacted, MIGHT have saved Savita even if only to get her out of hospital before she caught the superbug that killed her, E Coli EBSL.

This is the Bill. "The Medical Treatment (Termination Of Pregnancy In Case Of Risk To Life Of Pregnant Woman) Bill 2012"

http://www.oireachtas.ie/viewdoc.asp?DocID=20441&&CatID=59

Clare has some notes on it here . Read section 4 of the bill itself.

http://www.claredaly.ie/medical-treatment-termination-of-pregnancy-in-case-of-risk-to-life-of-pregnant-woman-bill-2012/

The following Galway West TDs voted AGAINST the Bill and are listed here.

http://debates.oireachtas.ie/dail/2012/04/19/00006.asp

Eamonn O Cuiv
Brian Walsh
Seán Kyne
Noel Grealish
Derek Nolan

Section 4

Provision of Medical Treatment
4.—(1) It shall be lawful for a medical practitioner to provide any
form of medical treatment to a woman, despite its consequences for
the life of the foetus, provided that—
(a) two medical practitioners have each formed an honestly
held and reasonable belief that there is a real and substantial
risk to the life of that woman, other than through
suicide or another condition ordinarily diagnosed and or
treated by a consultant psychiatrist or a clinical psychologist,
which can be averted only by the provision of that 25
medical treatment, or
(b) there is a real and substantial risk to the life of the woman
through suicide or another condition ordinarily diagnosed
and or treated by a consultant psychiatrist or a
clinical psychologist, as determined by— 30
(i) one medical practitioner and one consultant psychiatrist,
or
(ii) one medical practitioner and one clinical psychologist,
or
(iii) in the absence of an available consultant psychiatrist
or a clinical psychologist and to prevent undue delay
in the examination and or treatment of the woman,
two medical practitioners,
who have formed an honestly held and reasonable belief that there
is a real and substantial risk to the life of that woman which can be
averted only by the provision of that medical treatment.
(2) It shall be the entitlement of the woman—

(a) regarding the necessity of medical treatment under the
terms of this Act, to seek a further opinion from her
choice of such medical practitioner or practitioners, consultant
psychiatrist or clinical psychologist in such combi-
5 nation as is required by subsection 1 of this section—
(i) as have been nominated independently by her, or
(ii) to whom she has been referred by one or both of the
providers of the first opinion

Das Kitty

Sponge Bob wrote: »

Eamonn O Cuiv
Brian Walsh
Seán Kyne
Noel Grealish
Derek Nolan

It'll be interesting to see if any of them show up on Saturday.

antoobrien

BhoscaCapall wrote: »

The Catholic Church has held this country back more than any empire ever did, and I say that as a staunch Republican.

Actually I think you'll find that it was Queen Victoria's government that enacted the ban on abortions in 1861. A lot of our laws are carry overs or minor changes from British law.

Cleahaigh

Sponge Bob wrote: »

Termination is not permitted where the baby has NO chance of surviving. IN this case she had a fully dilated cervix and survivability was 0%. The same applies in cases of Anencephaly where the foetus may go full term and will die upon birth, no termination is permitted despite the 100% probability of death after delivery.

Clare Daly attempted to introduce a Bill to allow for termination in limited circumstances earlier this year. The Bill, if enacted, MIGHT have saved Savita even if only to get her out of hospital before she caught the superbug that killed her, E Coli EBSL.

This is the Bill. "The Medical Treatment (Termination Of Pregnancy In Case Of Risk To Life Of Pregnant Woman) Bill 2012"

http://www.oireachtas.ie/viewdoc.asp?DocID=20441&&CatID=59

Clare has some notes on it here . Read section 4 of the bill itself.

http://www.claredaly.ie/medical-treatment-termination-of-pregnancy-in-case-of-risk-to-life-of-pregnant-woman-bill-2012/

The following Galway West TDs voted AGAINST the Bill and are listed here.

http://debates.oireachtas.ie/dail/2012/04/19/00006.asp

Eamonn O Cuiv
Brian Walsh
Seán Kyne
Noel Grealish
Derek Nolan

Section 4

Provision of Medical Treatment
4.—(1) It shall be lawful for a medical practitioner to provide any
form of medical treatment to a woman, despite its consequences for
the life of the foetus, provided that—
(a) two medical practitioners have each formed an honestly
held and reasonable belief that there is a real and substantial
risk to the life of that woman, other than through
suicide or another condition ordinarily diagnosed and or
treated by a consultant psychiatrist or a clinical psychologist,
which can be averted only by the provision of that 25
medical treatment, or
(b) there is a real and substantial risk to the life of the woman
through suicide or another condition ordinarily diagnosed
and or treated by a consultant psychiatrist or a
clinical psychologist, as determined by— 30
(i) one medical practitioner and one consultant psychiatrist,
or
(ii) one medical practitioner and one clinical psychologist,
or
(iii) in the absence of an available consultant psychiatrist
or a clinical psychologist and to prevent undue delay
in the examination and or treatment of the woman,
two medical practitioners,
who have formed an honestly held and reasonable belief that there
is a real and substantial risk to the life of that woman which can be
averted only by the provision of that medical treatment.
(2) It shall be the entitlement of the woman—

(a) regarding the necessity of medical treatment under the
terms of this Act, to seek a further opinion from her
choice of such medical practitioner or practitioners, consultant
psychiatrist or clinical psychologist in such combi-
5 nation as is required by subsection 1 of this section—
(i) as have been nominated independently by her, or
(ii) to whom she has been referred by one or both of the
providers of the first opinion

Or maybe an early abortion could have ended up the same way, given the nature of the intervention. Abortions do have an elevated risk of septicemia as well.

Sponge Bob

Cleahaigh wrote: »

Or maybe an early abortion could have ended up the same way, given the nature of the intervention. Abortions do have an elevated risk of septicemia as well.

She may have picked up the worst of it lying around UCHG, a hospital full of resistant bugs such as E Coli ESBL, for 3 days..and with her cervix dilated during all that time. A very good summary is provided in this post here.

http://www.boards.ie/vbulletin/showpost.php?p=81766884&postcount=119

Lying around for 3 days in severe pain tends to depress immune systems.

The jury was out on Monday. The big problems started to manifest on Tuesday and by Wednesday the infection had become too advanced for treatment.

So the nub of the question is whether a wider variety of resolutions should have been available to the medical staff on Tuesday when they were aware of septicemia and are always fully aware of the implications of not treating it. By Tuesday she had certainly been weakened by pain and lack of sleep and by wednesday she was proven fatally weakened.

Then there is the question of whether she would have gotten the right treatment had there been an abortion and had tests shown the miscarriage was caused by E Coli ESBL which had at that point not entered the bloodstream but which may have showed in uterine matter.

It's a hard one. The only truth is that the system did not respond to her requests which were shown to have been reasonable all along. The system couldn't.

What is certain is that all our local TDs voted against a measure which would have fully entitled her to ask ANOTHER consultant to examine the issue for her. She was trapped on the list belonging to one consultant in there and the system does not allow another consultant to intervene as was proposed in that Bill of Clare Dalys. You are at the mercy of the consultant under whom you are admitted.

From that link, read all of it perhaps starting with the last line and then top down.

• She died of a septicaemic ESBL-producing E.Coli infection.
• She was admitted to hospital on a Sunday complaining of back pains and was told she was suffering a miscarriage. At this point, it doesn't appear she was in abnormally huge pain.
• On Monday, she asks for an induction to resolve the miscarriage and her request is refused due to the presence of a foetal heartbeat. At this point, i'd imagine the pain very slowly started to increase. At an estimation based on when she became symptomatic, i'd she was at least suffering from systemic inflammatory response syndrome + the early stages of sepsis.
• On Tuesday morning, she asked for another induction and was refused again. Symptoms of advanced septicaemia started to show that evening and the medical team responded by starting her on antibiotics.
• Wednesday lunchtime, the foetus died and the womb contents were removed. By evening, she is critical with weak vital signs and a high fever.
• By Saturday, her infection progressed to multiple organ failure and by the end of the day she had died.

Let's consider the scenario where they agreed to her request and aborted on Monday evening. She would have still been in a bit of pain which would have written off as normal and she would have been discharged with a prescription for painkillers. The abortion would have removed the source of the infection and some portion of the bacteria but if (as I suspect) the infection had already reached the bloodstream all it really would have done is prolong the incubation time. Instead of becoming symptomatic on Tuesday evening, she would have become symptomatic later on in the week. She'd return to the hospital again, they'd treat her with a standard antibiotic (Empirical prescribing is standard practice until they identify the species responsible for the infection) which probably wouldn't have any effect on the strain she was infected with and she'd die in the exact same way.

What medically sound reason is there to suggest that an abortion would definitely have stopped her death by septicaemia?

_Whimsical_

It's very difficult to get a full grasp of what happened without all the facts involved. I think the case was definitely mismanaged and medical staff were clearly not alert enough to her level of pain and distress or to the possibility of developing infection. Whether this tragedy occurred as a result of our abortion laws is harder to ascertain. From what I can see the Irish Medical Councils guidelines would have allowed for termination here and it would've been considered surgical management of a miscarriage rather than a termination in a case where there was zero chance of life for the baby. Apparently that is not uncommon in these situations and happens as a standard response to ectopic pregnancy which would involve a threat the mothers life and a nonviable but alive foetus.Also without signs of infection the management of this miscarriage was medically valid. So it could be a case where the fault lies with the medical teams lack of alertness more than it does with our laws. I'm going to wait for further facts in this case before I decide.

Something went horribly wrong here and it is a truly tragic case.I think X should be legislated for but not necessarily because of this case until more facts emerge.

Lon Dubh

There is a vigil for Savita on Saturday (tomorrow) in Eyre Square at 5pm if anyone is interested in attending.

Mrs OBumble

Lon Dubh wrote: »

There is a vigil for Savita on Saturday (tomorrow) in Eyre Square at 5pm if anyone is interested in attending.

I'm kinda picking that half Galway is going to be there.

shampoosuicide

_Whimsical_ wrote: »

It's very difficult to get a full grasp of what happened without all the facts involved. I think the case was definitely mismanaged and medical staff were clearly not alert enough to her level of pain and distress or to the possibility of developing infection. Whether this tragedy occurred as a result of our abortion laws is harder to ascertain. From what I can see the Irish Medical Councils guidelines would have allowed for termination here and it would've been considered surgical management of a miscarriage rather than a termination in a case where there was zero chance of life for the baby. Apparently that is not uncommon in these situations and happens as a standard response to ectopic pregnancy which would involve a threat the mothers life and a nonviable but alive foetus.Also without signs of infection the management of this miscarriage was medically valid. So it could be a case where the fault lies with the medical teams lack of alertness more than it does with our laws. I'm going to wait for further facts in this case before I decide.

Something went horribly wrong here and it is a truly tragic case.I think X should be legislated for but not necessarily because of this case until more facts emerge.

whatever about medical management, surely the point is that the woman asked for an abortion and was refused, which is clearly to do with abortion laws

Unrealistic

shampoosuicide wrote: »

whatever about medical management, surely the point is that the woman asked for an abortion and was refused, which is clearly to do with abortion laws

It's only the point if you're starting at it from the point of view that a woman should have the sole right to make a decision about having an abortion. But the reality is that abortion on demand hasn't a hope of happening in Ireland at any time the next few decades. The reality is that our Constitution bans abortion unless the life of the mother is threatened. So the point has to be clearly defining what are the threats to the life of the mother that warrant an abortion so that doctors can work within that definition rather than in a vacuum.

shampoosuicide

Unrealistic wrote: »

It's only the point if you're starting at it from the point of view that a woman should have the sole right to make a decision about having an abortion. But the reality is that abortion on demand hasn't a hope of happening in Ireland at any time the next few decades. The reality is that our Constitution bans abortion unless the life of the mother is threatened. So the point has to be clearly defining what are the threats to the life of the mother that warrant an abortion so that doctors can work within that definition rather than in a vacuum.

there's a difference between 'abortion on demand' and a woman asking for a foetus that has no chance of surviving to be removed from her womb though. Abortion on demand is a very loaded phrase but - as you imply - there's a middle ground we should be working towards, that gives women at least some control over situations like this, rather than leaving it to law or medical practice.

inisboffin

Unrealistic wrote: »

But the reality is that abortion on demand hasn't a hope of happening in Ireland at any time the next few decades.

It's not going to happen overnight, but I don't see it taking 30 years tbh.

Unrealistic

shampoosuicide wrote: »

there's a difference between 'abortion on demand' and a woman asking for a foetus that has no chance of surviving to be removed from her womb though. Abortion on demand is a very loaded phrase but - as you imply - there's a middle ground we should be working towards, that gives women at least some control over situations like this, rather than leaving it to law or medical practice.

Agreed, but that is something specifically prohibited in our Constitution so the reality is that it is not even on the table at the moment.