Consultant 'refused abortion plea'

drkpower

GCU Flexible Demeanour wrote: »

There's a difference between those two statements, but the emerging picture suggests that (similar to the reported outcome of the HSE inquiry) the law wasn't the pivotal issue. The pivotal issue was the condition was undiagnosed (or, at least, that would seem to be what's coming out the testimony.)

I don't see why you see one as the pivotal issue over the other.

Were it not for abortion laws, evacuation of the uterus (one of the treatments for her condition) would definitely have occurred earlier.


We're it not for the delay in the consultant being aware of certain infective indicators, antibiotic treatment (the other treatment for her condition) may have occurred earlier.


Again, I think you can see the difference and it doesn't appear to demonstrate that the delay in making the consultant aware of the infective indicators was the pivotal issue at all.

GCU Flexible Demeanour

positron wrote: »

The figure of 56000 might look big, but when they say India they are talking about over 1.2 billion people, so it might be really tiny in percentage terms.

Ah, come on.

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html

India has something of the order of 200 maternal deaths per 100,000 live births. That's about twenty times the rate you'd expect in Europe.

positron wrote: »

Dr Astbury also said she felt constrained by the Irish law to giving an abortion as soon as she knew the fetus was not viable. I am sure everyone would agree there is no point prolonging the agony and risking death in such a case, and it is shocking really that in this day and age a knowledgeable medical team with armed with the right skillset, knowledge, medical equipment and test results, can't proactively act to help someone, due to some conditions setup by a society under the influence of a religious order with no knowledge of the medical procedures, threats or benefits just because they feel they are the guardians of some sort of moral value and feels the need to inflict that upon everyone else irrespective of their own personal belief or the lack of.

She agreed that, in other jurisdictions, an abortion would be offered where a fetus was not viable, and I do agree that there's no point in prolonging a pregnancy in such circumstances (unless there's some genuine medical reason that would make a natural miscarriage safer.)

Nevertheless, the facts suggest that the issue in this case was a failure to identify what the actual problem was. The emerging facts suggest that a different outcome might well have been achieved, if all the individual bits of information had been gathered and assessed.

Changing the law won't address wrong diagnosis. We have to be very clear-headed about this case. There could be very good reasons for changing the Constitutional position with respect to abortion. But that's not, primarily, what this case is telling us.

Almaviva

positron wrote: »

Dr Astbury also said she felt constrained by the Irish law to giving an abortion as soon as she knew the fetus was not viable. I am sure everyone would agree there is no point prolonging the agony and risking death in such a case, and it is shocking really that in this day and age a knowledgeable medical team with armed with the right skillset, knowledge, medical equipment and test results, can't proactively act to help someone, due to some conditions setup by a society under the influence of a religious order with no knowledge of the medical procedures, threats or benefits just because they feel they are the guardians of some sort of moral value and feels the need to inflict that upon everyone else irrespective of their own personal belief or the lack of.

That's democracy for you.

GCU Flexible Demeanour

drkpower wrote: »

I don't see why you see one as the pivotal issue over the other.

Were it not for abortion laws, evacuation of the uterus (one of the treatments for her condition) would definitely have occurred earlier.

But it would only be happenstance if that avoided the outcome; bear in mind, again, that the emerging issue seems to be a lack of organisation around the management of the case.

Can you see what I'm driving at? It doesn't matter what the law is, if cases are misdiagnosed. It doesn't matter if evacuation of the uterus is lawful, if you get sent home with a diagnosis of back pain.

A lot of people have invested a lot of political argument into this case being about the legal position, in advance of the facts being known. I think that's clouding judgments.

drkpower

GCU Flexible Demeanour wrote: »

But it would only be happenstance if that avoided the outcome; bear in mind, again, that the emerging issue seems to be a lack of organisation around the management of the case.

Can you see what I'm driving at? It doesn't matter what the law is, if cases are misdiagnosed. It doesn't matter if evacuation of the uterus is lawful, if you get sent home with a diagnosis of back pain.

A lot of people have invested a lot of political argument into this case being about the legal position, in advance of the facts being known. I think that's clouding judgments.

Had there been no legal obstacle, an evacuation of the uterus would have occurred well before any issues of misdiagnoses became relevant and well before systemic sepsis would have developed.

If there is a pivotal issue, there you have it.

animum

mle

GCU Flexible Demeanour wrote: »

But it would only be happenstance if that avoided the outcome; bear in mind, again, that the emerging issue seems to be a lack of organisation around the management of the case.

Can you see what I'm driving at? It doesn't matter what the law is, if cases are misdiagnosed. It doesn't matter if evacuation of the uterus is lawful, if you get sent home with a diagnosis of back pain.

A lot of people have invested a lot of political argument into this case being about the legal position, in advance of the facts being known. I think that's clouding judgments.

I completel agree, I have 2 friends that had to endure proceedures that ended with legal teminations. I have spoken with a surgeon who claims that every hospitalin the country carry out legal terminations every week. He claims that this is nothing but complete neglegence on the hospitals behalf, but it woiuld be very difficult to prove. He compared the Surgeons proffessional body (dont know the name) to the Mafia....no-one will 'rat' on anyone. my father in law sufferd a 'botched' surgery and was advised to travel to the uk for an assessment, as willnever get the full story here. Its terrible.

Flier

http://www.irishtimes.com/news/health/timeline-savita-halappanavar-s-last-days-1.1357554

Above is a useful 'timeline' of the salient events as heard at the inquest.

There was a clinical diagnosis of chorioamnionitis by the SHO at 6.30am.
The consultant diagnosed sepsis (but not severe sepsis) and probable chorioamnionitis on her rounds at 8.25am.
I wonder what was the delay in evacuating the uterus at this point, if it wasn't waiting for there to be a perceived 'substansial risk' to life. If the law allowed termination for less than a 'substantial risk', would there have been a delay at this point.
I accept that there were mistakes made (I would be surprised if errors were not found to be made in any random sample of clinical cases), but the situation in law was the main reason for delay in instigating proper treatment.

April O Neill

In the defense of the person who said "This is a Catholic country", they may just have been trying to explain why their hands were tied. Carrying out an abortion could have had them struck off or prosecuted, they couldn't perform it even if they wanted to. Of course they could have handled it better.

GCU Flexible Demeanour

drkpower wrote: »

Had there been no legal obstacle, an evacuation of the uterus would have occurred well before any issues of misdiagnoses became relevant and well before systemic sepsis would have developed.

If there is a pivotal issue, there you have it.

You've missed the point. It that was the solution, it would only be through happenstance. The issue is about stuff going un-noticed, or at least all known facts not being brought together. If that's the situation, it means that any complications arising from any action might not be picked up. I'm only repeating the point already made here, as you haven't engaged with it.

Flier wrote: »

I accept that there were mistakes made (I would be surprised if errors were not found to be made in any random sample of clinical cases), but the situation in law was the main reason for delay in instigating proper treatment.

That's not sustainable on the basis of the evidence presented. It's just showing a desire to extract from the case whatever is useful from a political perspective, while ignoring the significant points actually emerging.

Flier

GCU Flexible Demeanour wrote: »

That's not sustainable on the basis of the evidence presented. It's just showing a desire to extract from the case whatever is useful from a political perspective, while ignoring the significant points actually emerging.

I disagree. Given the clinical evidence which I've presented, which is what was known at the time by the treating medical team, what do you think would have been the appropriate course of treatment, and did the law interfere with the appropriate course being taken?

Shint0

Flier wrote: »

http://www.irishtimes.com/news/health/timeline-savita-halappanavar-s-last-days-1.1357554

Above is a useful 'timeline' of the salient events as heard at the inquest.

There was a clinical diagnosis of chorioamnionitis by the SHO at 6.30am.
The consultant diagnosed sepsis (but not severe sepsis) and probable chorioamnionitis on her rounds at 8.25am.
I wonder what was the delay in evacuating the uterus at this point, if it wasn't waiting for there to be a perceived 'substansial risk' to life. If the law allowed termination for less than a 'substantial risk', would there have been a delay at this point.
I accept that there were mistakes made (I would be surprised if errors were not found to be made in any random sample of clinical cases), but the situation in law was the main reason for delay in instigating proper treatment.

Then would the grey area not rest with the doctor's own clinical judgement?

Electric Sheep

HondaSami wrote: »

This is the only time i am in favour of it, save the mother always imo.

I'm for it in rape/incest cases also, just to be clear but never on demand.

Considering the length of time it takes for a rape case to get to court, let alone to secure a conviction, don't you think you are being disingenuous? How would one prove rape in the very short window of opportunity to terminate a pregnancy?

drkpower

GCU Flexible Demeanour wrote: »

You've missed the point. It that was the solution, it would only be through happenstance. The issue is about stuff going un-noticed, or at least all known facts not being brought together. If that's the situation, it means that any complications arising from any action might not be picked up. I'm only repeating the point already made here, as you haven't engaged with it.

I'm not sure what you mean by happenstance.

If there was no legal obstacle, the uterus would have been evacuated on the patients presentation. It is that simple. The issues regarding the possible delayed diagnosis of sepsis are highly unlikely to have ever arisen.

Loafing Oaf

animum wrote: »

mle

I completel agree, I have 2 friends that had to endure proceedures that ended with legal teminations. I have spoken with a surgeon who claims that every hospitalin the country carry out legal terminations every week. He claims that this is nothing but complete neglegence on the hospitals behalf, but it woiuld be very difficult to prove..

This doesn't ring true to me. If the UCHG staff were generally lazy and incompetent, wouldn't the easiest thing to do have been to terminate the pregnancy right away, if only for the sake of a quiet life. Everything I've read about the case strongly suggests to me that Dr Astbury genuinely believed she was striving to comply with the law.

Loafing Oaf

drkpower wrote: »

I'm not sure what you mean by happenstance.

If there was no legal obstacle, the uterus would have been evacuated on the patients presentation. It is that simple. The issues regarding the possible delayed diagnosis of sepsis are highly unlikely to have ever arisen.

Indeed, GCU talks about issues around diagnosis being the most salient thing about the case, but in this alternative scenario the only diagnosis involved would be that of the miscarriage itself, which presumably even a competent GP or nurse could do...

Kiwi in IE

GCU Flexible Demeanour wrote: »

Ah, come on.

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html

India has something of the order of 200 maternal deaths per 100,000 live births. That's about twenty times the rate you'd expect in Europe.She agreed that, in other jurisdictions, an abortion would be offered where a fetus was not viable, and I do agree that there's no point in prolonging a pregnancy in such circumstances (unless there's some genuine medical reason that would make a natural miscarriage safer.)

Nevertheless, the facts suggest that the issue in this case was a failure to identify what the actual problem was. The emerging facts suggest that a different outcome might well have been achieved, if all the individual bits of information had been gathered and assessed.

Changing the law won't address wrong diagnosis. We have to be very clear-headed about this case. There could be very good reasons for changing the Constitutional position with respect to abortion. But that's not, primarily, what this case is telling us.

I completely disagree. If the pregnancy had been terminated as soon as it was identified as unviable, it is probable that there would have been no condition to misdiagnose. Sepsis develops in miscarriage due to the uterus being open and bacteria free to enter. We do not know at what point the bacteria that caused the sepsis entered, but the longer the miscarriage goes on the higher the probability of infection. The fact she was left in this condition for several days, because of the influence of Catholicism in Irish law, cannot be overlooked due to focus on subsequent medical errors. To do so would be a further injustice to Ms Halappanavar and an injustice to all women living in Ireland.

GCU Flexible Demeanour

Flier wrote: »

I disagree. Given the clinical evidence which I've presented, which is what was known at the time by the treating medical team, what do you think would have been the appropriate course of treatment, and did the law interfere with the appropriate course being taken?

Look, you don't even need to go there.

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.

Now, unless you are suggesting both that the GUH protocols for dealing with sepsis are unlawful and that the the consultant microbiologist at the National Maternity Hospital doesn't know that there's a conflict between the law and appropriate action, your point seems to fall.

drkpower wrote: »

I'm not sure what you mean by happenstance.

If there was no legal obstacle, the uterus would have been evacuated on the patients presentation. It is that simple. The issues regarding the possible delayed diagnosis of sepsis are highly unlikely to have ever arisen.

I've tried to explain twice why your statement isn't dealing with the point. I'm afraid I can't put it any clearer - I can't see any reason for confusion.

I'm not saying the point is irrefutable - maybe someone has something to say that would make me re-assess it. But, unfortunately, you're just not addressing it.

GCU Flexible Demeanour

Kiwi in IE wrote: »

I completely disagree. If the pregnancy had been terminated as soon as it was identified as unviable, it is probable that there would have been no condition to misdiagnose.

Ditto as for drkpower.

Kiwi in IE

GCU Flexible Demeanour wrote: »

Ditto as for drkpower.

I think you are missing the point completely.

If Ms Halappanavar had recieved the appropriate treatment as per any other First world country, where law is not influenced by religious principles, there would in all probability, have been no sepsis. Therefore the Sepsis policy of GUH and whether or not it was followed, would have been irrelevant.

It seems Ms Halappanavar could have been saved twice; firstly if she had recieved appropriate treatment for the miscarrying of an unviable feotus, this the law prohibited, and secondly if the medical team had dealt appropriately with the sepis that resulted from the law preventing best practice in the treatment of her primary condition.

GCU Flexible Demeanour

Kiwi in IE wrote: »

I think you are missing the point completely.

If Ms Halappanavar had recieved the appropriate treatment as per any other First world country, where law is not influenced by religious principles, there would in all probability, have been no sepsis. Therefore the Sepsis policy of GUH and whether or not it was followed, would have been irrelevant.

No, I've understood and responded to this point. The issue is that yourself and drkpower haven't grasped that this would just be happenstance, if the situation is one of misdiagnosis. I repeat

GCU Flexible Demeanour wrote: »

It doesn't matter what the law is, if cases are misdiagnosed. It doesn't matter if evacuation of the uterus is lawful, if you get sent home with a diagnosis of back pain.

A lot of people have invested a lot of political argument into this case being about the legal position, in advance of the facts being known. I think that's clouding judgments.

opinion guy

You are all missing the point.

Savita, the woman who endured horrible pain and ultimately death, requested a termination as soon as she was told the child was not viable. The religiously biased laws denied her this. Her wishes were ignored and she endured horrendous suffering and a likely avoidable death when there was no possibility the child would survive. Then she died. The end. No semantics or clever debate points - this is what happened.

You all need to grow up and take a cold hard look at what your superstitious beliefs resulted in.

Kiwi in IE

It does matter if uterine evacuation is lawful however when miscarrying over several days because it is unlawful results in sepsis. And that, in combination with medical error treating the sepsis, ultimately results in death.

Kiwi in IE

opinion guy wrote: »

You are all missing the point.

But I am making the same point as you!

Atlantis50

GCU Flexible Demeanour wrote: »

Ah, come on.

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html

India has something of the order of 200 maternal deaths per 100,000 live births. That's about twenty times the rate you'd expect in Europe.She agreed that, in other jurisdictions, an abortion would be offered where a fetus was not viable, and I do agree that there's no point in prolonging a pregnancy in such circumstances (unless there's some genuine medical reason that would make a natural miscarriage safer.)

Nevertheless, the facts suggest that the issue in this case was a failure to identify what the actual problem was. The emerging facts suggest that a different outcome might well have been achieved, if all the individual bits of information had been gathered and assessed.

Changing the law won't address wrong diagnosis. We have to be very clear-headed about this case. There could be very good reasons for changing the Constitutional position with respect to abortion. But that's not, primarily, what this case is telling us.

Spot on.

Some on this thread are still desperately clinging to the idea that Ireland's abortion laws caused her death despite the catalogue of medical errors outlined in evidence at the inquest.

Kiwi in IE

Atlantis50 wrote: »

Spot on.

Some on this thread are still desperately clinging to the idea that Ireland's abortion laws caused her death despite the catalogue of medical errors outlined in evidence at the inquest.

Interesting. I think the opposite. It appears to me that some are in complete denial of the pivotal role that the law played because they don't want it blamed.

Atlantis50

Kiwi in IE wrote: »

Interesting. I think the opposite. It appears to me that some are in complete denial of the pivotal role that the law played because they don't want it blamed.

You're the one in denial Kiwi.

The media are gradually come around to accepting and reporting the fact that medical errors played "the pivotal role" in Savita's tragic death:

Three-hour test delay 'could have made all the difference' - Herald.ie

Shortcomings in Halappanavar care identified - RTÉ News

Missed chances by staff raise yet more questions - Independent.ie

Savita Halappanavar inquest: 'Shortcomings in treatment'- BBC News



Savita should have been given stronger antibiotics, inquest told- Irish Times

Nodin

Atlantis50 wrote: »

Spot on.

Some on this thread are still desperately clinging to the idea that Ireland's abortion laws caused her death despite the catalogue of medical errors outlined in evidence at the inquest.

...it has been deemed a contributory factor by the report into the matter, if you care to recall.

Neyite

Atlantis50 wrote: »

You're the one in denial Kiwi.

The media are gradually come around to accepting and reporting the fact that medical errors played "the pivotal role" in Savita's tragic death:

Three-hour test delay 'could have made all the difference' - Herald.ie

Shortcomings in Halappanavar care identified - RTÉ News

Missed chances by staff raise yet more questions - Independent.ie

Savita Halappanavar inquest: 'Shortcomings in treatment'- BBC News



Savita should have been given stronger antibiotics, inquest told- Irish Times

Because the media don't have a political agenda at all...

Loafing Oaf

Atlantis50 wrote: »

Spot on.

Some on this thread are still desperately clinging to the idea that Ireland's abortion laws caused her death despite the catalogue of medical errors outlined in evidence at the inquest.

You're playing semantic games. The 'cause' of Savita's death was sepsis, the question is whether and how it could have been prevented. Would she have survived if the relevant medical procedures had been conducted properly? Yes, probably. Would she also be alive if the consultant had been legally permitted to carry out delivery/termination in the early stages of the miscarriage, as is standard pratice in most other countries? Almost certainly, and this approach can be applied in almost all cases of miscarriage, irrespective of specific details of infection etc.

animum

Loafing Oaf wrote: »

This doesn't ring true to me. If the UCHG staff were generally lazy and incompetent, wouldn't the easiest thing to do have been to terminate the pregnancy right away, if only for the sake of a quiet life. Everything I've read about the case strongly suggests to me that Dr Astbury genuinely believed she was striving to comply with the law.

And I believe that she is hiding behind the law to cover her own mistakes.

Its my opinion I know, but as a Catholic Irish person, I can not believe that a medical professional, stood back and let a woman die before thier eyes, because of the Catholic Religion and the laws of our country. There are laws to protect women in instances like this. And terminations are carried out all the time.

opinion guy

animum wrote: »

And I believe that she is hiding behind the law to cover her own mistakes.

Its my opinion I know, but as a Catholic Irish person, I can not believe that a medical professional, stood back and let a woman die before thier eyes, because of the Catholic Religion and the laws of our country. There are laws to protect women in instances like this. And terminations are carried out all the time.

I'm glad you can finally acknowledge your own biases.

And I think you should note - nobody stood back and watched her die -they did what they were allowed to do. Yes somethings weren't done perfectly right - which may or may not have been important.

Indeed, the consultant herself has stated the law got in her way:
http://www.irishtimes.com/news/savita-halappanavar-consultant-tells-inquest-she-refused-termination-over-legal-position-1.1355359

Do you cherry pick the news you read to suit your own viewpoint or had you just missed this article ?

I mean this issue of the law is the only reason we have even heard of this case. Or have you forgotten the 'its a Catholic country' comment Praveen brought to light in the first place.


As an aside lets do a thought experiment:
Let me ask you this. Imagine Savita had survived and we had never heard this story. Suppose everything else happened as it did but she pulled through in the ICU and went home after a week or something. She would have still endured a horrible painful traumatic experience possible medical consequences and still lost her baby. She would have still asked for a termination and been refused and nature let take its course. She would have still brewed an avoidable silent infection and become seriously ill and ended up in ICU. What right do you or anyone else have to tell a woman that she must endure such a horrendous experience instead of having an early termination as was her choice ? The baby was going to die either way. Who are you or me or the state to dictate to a woman that she must suffer through all that when it could be foreshortened and made safer by an earlier termination ?

The most serious consequences of this case were avoidable if the mother's choice was respected. The baby was doomed either way. There is simply no getting around that. This was needless. This choice was taken away from her by the unclear legal situation as stated by her Doctor.

Grayson

Neyite wrote: »

Because the media don't have a political agenda at all...

There were 4 different sources there. Where do you get your news? Alive!?

john.han

opinion guy wrote: »

I'm glad you can finally acknowledge your own biases.

And I think you should note - nobody stood back and watched her die -they did what they were allowed to do. Yes somethings weren't done perfectly right - which may or may not have been important.

Indeed, the consultant herself has stated the law got in her way:
http://www.irishtimes.com/news/savita-halappanavar-consultant-tells-inquest-she-refused-termination-over-legal-position-1.1355359

Do you cherry pick the news you read to suit your own viewpoint or had you just missed this article ?

I mean this issue of the law is the only reason we have even heard of this case. Or have you forgotten the 'its a Catholic country' comment Praveen brought to light in the first place.

I agree with a lot of what you say, but the reality is they did not do what they were allowed to do, they failed to diagnose and treat/monitor properly, which meant they did not see a risk to the mother's life. If they had seen the risk, which they should have done, then the law did not pervent them from procuring the miscarriage. The law did not tie their hands as tightly as they suggest, the failures in her care played a far bigger part in my opinion.

Neyite

Grayson wrote: »

There were 4 different sources there. Where do you get your news? Alive!?

I'm pro choice. Why on earth would I read that rag?

Overseas media love to portray Ireland as this little religious backwater - it makes better reading. RTE are a state organisation, nuff said. The Indo leans a bit towards Catholic bias, no? The Herald is right-wing.

It is in the interests of our Government to have this inquest arrive at the conclusion that this was NOT anything to do with legislation, or lack thereof. It suits them to have it written off as medical malpractice, down to the individual doctor, and not have the HSE at fault. Of course RTE as a state broadcaster are going to slant it to look more favourably to suit the political agenda.

so I'll rephrase my post, with added sarcasm rolleyes to make it clearer:
"because the media dont have any political leanings at all, do they? :rolleyes:"

Loafing Oaf

opinion guy wrote: »

This choice was taken away from her by the unclear legal situation as stated by her Doctor.

I don't think the legal situation is even unclear, or at least I don't believe the lack of clarity that there is impacted this case. I believe Dr Astbury's interpretation of Article 40.3.3 and the X Case judgement is correct, insofar as that can be ascertained for such a gnomic piece of legislation. And hence I don't believe any 'clarifying' X case legislation, if it is to remain true to 40.3.3 and X, would have made any difference in this case...

GCU Flexible Demeanour

Kiwi in IE wrote: »

opinion guy wrote: »

You are all missing the point.

But I am making the same point as you!

Fancy that.

jjn2

Kiwi in IE wrote: »

I think you are missing the point completely.

If Ms Halappanavar had recieved the appropriate treatment as per any other First world country, where law is not influenced by religious principles, there would in all probability, have been no sepsis. Therefore the Sepsis policy of GUH and whether or not it was followed, would have been irrelevant.

It seems Ms Halappanavar could have been saved twice; firstly if she had recieved appropriate treatment for the miscarrying of an unviable feotus, this the law prohibited, and secondly if the medical team had dealt appropriately with the sepis that resulted from the law preventing best practice in the treatment of her primary condition.

Has your claim in the second paragraph actually been established?

I may be misreading or misapplying this, but according to http://apps.who.int/rhl/reviews/CD003518.pdf,

Expectant management led to a higher risk of incomplete miscarriage, need for surgical emptying of the uterus, and bleeding. Noneof these were serious. In contrast, surgical evacuation was associated with a significantly higher risk of infection. Given the lack of clear superiority of either approach, the woman’s preference should play a dominant role in decision making. Medical management has added choices for women and their clinicians, but these were not reviewed here.

If anything, according to the above, surgical evacuation would be worse in terms of the risk of infection? Now from what I understand, once chorioamnionitis is diagnosed, delivery is the correct treatment, but prior to this, according to the above, it is not necessarily the case.

Nodin

Just to jog some memories.....

The Health Service Executive report on the death last year at Galway University Hospital of Savita Halappanavar has found there was an overemphasis by hospital staff on the welfare of Ms Halappanavar’s unviable foetus and an underemphasis on her deteriorating health.

The final draft report says: “The investigating team considers there was an apparent overemphasis on the need not to intervene until the foetal heart stopped, together with an underemphasis on the need to focus an appropriate attention on monitoring for and managing the risk of infection and sepsis in the mother.”

http://www.irishtimes.com/news/health/savita-halappanavar-death-report-finds-foetus-not-mother-was-main-focus-1.1345890

drkpower

jjn2 wrote: »

If anything, according to the above, surgical evacuation would be worse in terms of the risk of infection? Now from what I understand, once chorioamnionitis is diagnosed, delivery is the correct treatment, but prior to this, according to the above, it is not necessarily the case.

'The woman's preference should play a dominant role in decision making'..........

jjn2

drkpower wrote: »

'The woman's preference should play a dominant role in decision making'..........

The claim I quoted was that "in all probability", there would have been no sepsis if expectant management hadn't been chosen.

There are two separate issues, (1) would her chances of survival have been greater had she been treated differently, and (2) should she have been given the option of being treated differently. My point was in relation to the first issue.

Are you a doctor? If so, you might be able to explain whether surgical or medical evacuations provide a better prognosis than expectant management?

I Heart Internet

We'll have to wait for the outcome of the inquest but it appears that more and more evidence is emerging of woeful mismanagment of Savita's case and inadequate technical practices at the hospital. That's what it seems like.

That Savita's case was hijacked earlier on by those with a political agenda to advance is a shame.

As it turned out the "Catholic country" phrase so loved by headline writers was a massive red-herring and there appeared to be no doubt whatsoever in the consultant's mind regarding the legal position.

Bad practice, not legal confusion, seems to have been behind this tragedy.

Loafing Oaf

I Heart Internet wrote: »

and there appeared to be no doubt whatsoever in the consultant's mind regarding the legal position.
.

You're right about this, she was quite certain, rightly IMO, that she was not legally entitled to terminate the pregnancy on the Monday or Tuesday, as would be standard practice in other countries, because there was no evidence of a substantial threat to Savita's life at that point. Are you happy that medical care for miscarrying women in Irish hospitals is below international standards in this way (as a direct result of Article 40.3.3/the X case)?

jjn2

Loafing Oaf wrote: »

You're right about this, she was quite certain, rightly IMO, that she was not legally entitled to terminate the pregnancy on the Monday or Tuesday, as would be standard practice in other countries, because there was no evidence of a substantial threat to Savita's life at that point. Are you happy that medical care for miscarrying women in Irish hospitals is below international standards in this way (as a direct result of Article 40.3.3/the X case)?

By below international standards, do you mean below international standards in terms of choice offered, or in terms of outcomes? If the latter, is there actually evidence, or has it been established that a worse outcome could have been predicted with expectant treatment, given what the doctors knew?

Loafing Oaf

jjn2 wrote: »

By below international standards, do you mean below international standards in terms of choice offered, or in terms of outcomes? If the latter, is there actually evidence, or has it been established that a worse outcome could have been predicted with expectant treatment, given what the doctors knew?

In terms of the choice. This is probably lazy and complacent, but if a medical thing is done one way in Ireland and another in most developed countries, I tend to think it's more likely they're the ones doing it right...

homerjay2005

Kiwi in IE wrote: »

I think you are missing the point completely.

If Ms Halappanavar had recieved the appropriate treatment as per any other First world country, where law is not influenced by religious principles, there would in all probability, have been no sepsis. Therefore the Sepsis policy of GUH and whether or not it was followed, would have been irrelevant.

It seems Ms Halappanavar could have been saved twice; firstly if she had recieved appropriate treatment for the miscarrying of an unviable feotus, this the law prohibited, and secondly if the medical team had dealt appropriately with the sepis that resulted from the law preventing best practice in the treatment of her primary condition.

so what infection did she have when she was admitted to the hospital? she came in for a reason and likewise, the baby died due to something.

it is very straightforward here, they didnt think her life was at risk, what ever infection she had, is what ultimately escalated her condition which led to the sepsis infection.

a termination is not a cure for sepsis either i may add.

I Heart Internet wrote: »

Bad practice, not legal confusion, seems to have been behind this tragedy.

this sums up the entire case IMO.

I Heart Internet

Loafing Oaf wrote: »

Are you happy that medical care for miscarrying women in Irish hospitals is below international standards in this way (as a direct result of Article 40.3.3/the X case)?

Medical care for miscarrying women and pregnant women in general is not below international standards in this or any other sense. There is no evidence that the consultant or medical staff required the option of earlier delivery of the baby in this case to save the life of the mother. The consultant has made it clear that she did not believe delivery was necessary any earlier than when she decided to intervene (as it happens, Savita delivered the child naturally while being prepped for this intervention).

What appears to have been drastically at fault here was the identification and treatment of severe infection.

Those who, from the very begining of this case, literally day-one once it broke in the media, sought to use the tragedy to further their own political aims - in particular to influence the ongoing debate on dealing with the X-case (a very important decision it its own right)- should hang their heads in shame.

Loafing Oaf

I Heart Internet wrote: »

The consultant has made it clear that she did not believe delivery was necessary any earlier than when she decided to intervene.

Have you a citation for this?

I Heart Internet

Loafing Oaf wrote: »

Have you a citation for this?

Dr Astbury said she was not aware of the results of blood tests conducted four days after Ms Halappanavar was admitted, where her condition was deteriorating. If she had been aware of the result, she would have seen her soon. 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.

from http://www.irishtimes.com/news/health/savita-halappanavar-s-consultant-acknowledges-hospital-systems-failures-1.1355804

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.

from http://www.irishtimes.com/news/health/law-delayed-savita-termination-consultant-1.1356451

Dr Astbury was, apparently, willing and legally free to intervene if she had evidence that the danger to Savita was serious enough. Through system failures and human errors, it would seem, Dr Astbury did not have the evidence in front of her in order to make that decision.

Loafing Oaf

I Heart Internet wrote: »

from http://www.irishtimes.com/news/health/savita-halappanavar-s-consultant-acknowledges-hospital-systems-failures-1.1355804



from http://www.irishtimes.com/news/health/law-delayed-savita-termination-consultant-1.1356451

Dr Astbury was, apparently, willing and legally free to intervene if she had evidence that the danger to Savita was serious enough. .

Nobody's disputing that. However, she explicitly does not say she would not have intervened earlier if she had been legally free to do so, whether to accede to Savita's request for a termination or on her own medical judgment, or some combination of the two.

Atlantis50

Nodin wrote: »

...it has been deemed a contributory factor by the report into the matter, if you care to recall.

Selective leaks from a provisional draft of the report do not give a definitive answer and should not be relied upon. How about waiting for the full final report to emerge?

At the inquest on the other hand, many new facts have emerged which point to medical errors and "systems failures" as the major contributory factor to Savita's tragic death.