Savita: More Than Just about Abortion.


Like everyone else in the country I was appalled at the death of Savita Halappanaver 6 months ago. I've not said much about it or joined in any debates, as only one very sad and tragic side of the story was in the public domain. I really wanted to hear the hospital and HSE's account of the tragic events that resulted in the death of this young woman, who was hospitalised due to back pain while pregnant last October.

I have to be completely honest and say that I was never totally convinced that her death was solely related to the initial  refusal to give her the abortion that she and her husband had understandably requested.

I always suspected that other issues had a part to play.

As the HSE report has been released and the inquest is now been heard we are finally hearing the medical side of the story. And what a truly tragic tale it is.

I've not read extensively on this issue, it is far too upsetting for that, but I have read some of the Irish Independent's coverage and some reliable twitter links. So far it seems that a series of appalling systems failures (poor communications between staff and test/result procedural errors) were a huge factor in this young woman's death. It also seems that Mrs Halappanaver's rapid deterioration surprised everyone and was quite unusual. Which only serves to highlight the importance of constant monitoring and communications and to adhering to accepted medical practices.

 This is about more than just our Irish abortion law.

Even if you set the abortion law aside for just one second you would have to wonder if more timely pathological testing/results, communications and monitoring (per agreed medical practice) would have saved her life?

No woman should die in a developed country such as ours in this day and age due to a pregnancy related illness. If the abortion law in Ireland played any role in this poor woman's death then change or clarify it so that Doctor's can act as fast as possible in the future to avoid this ever happening again. Ever.

But please, for the sake of all Irish hospital patients, do not let this case be solely about our Abortion law. 

We must also ensure that  proper medical practices and communications are adhered to in all our hospitals, or we could be facing similar outcomes for other patients.

If it hasn't already happened.

During my elderly mother's long spells in hospitals over the past year with (multiple) stroke related issues I have often been worried about the timeliness of investigative scans, pathology, results, monitoring and weekend lab/scan access and cover. I have great respect for our Doctors and nurses and appreciate all the wonderful care and respect they have shown us. But it never stopped me worrying or feeling that I had to constantly monitor them, monitoring her.

Doctors/Consultants make all sorts of life-saving decisions every day. They may be presented with very difficult cases (with possible legal implications) as in the tragic Savita case, but they also make difficult decisions in elderly cases too. They base their decisions on their considerable medical experiences, accepted practices and most likely outcomes.

Feeding a seemingly failing elderly person is one such life-affecting decision, just as it is with a mother/baby one. There is a very fine line dividing continued feeding (via an NG tube or the more invasive Peg) as being nourishment or force-feeding - prolonging a life that is perceived to be failing. If you agree to choose not to feed them then you are choosing to willingly and complicatedly (that is how it feels) to let them die. This is after consulting with the medical team and being advised that 'it is better for the patient that way, they wouldn't want to live like that' they tell you. They will of course have asked beforehand if that's what you think the patient would want. But, who really knows?

Such a clinical decision was made on my mother's behalf last November and she was sent from an acute hospital back to the nursing home, on palliative care with advice not to feed and 3 weeks to live. Sent 'home' to die.

I do understand the decision that was made, really I do. I get that an acute hospital is not for minding the patient, she is definitely better off being minded in the nursing home. However, they could have minded her a bit longer, just to be sure, as there were other possible contributing factors to her presentation that they didn't accept. It was a clinical decision, sensitively given. And they were wrong.

I would love nothing better than to now, 5 months later, wheel the patient back to that hospital and show them how she is now, how she now relishes a variety of specially prepared foods. How she has a life. Well, it may be a half-life but it's her half-life.... and it turns out she didn't want to die. Or so the lady has since informed me. I will be forever grateful to the nursing home who went with the patient and not solely on her presentation.

In general our Doctors and nurses do an amazing job in increasingly difficult circumstances, but they are not infallible. It is right that we ask questions of them as constantly as we wish. It is something I do regularly and has always been welcomed by any medical doctor I have contacted. In my experience they like that you care enough to do it and they do want to do the best for their patients. Whatever else happened in the Savita case I get a sense of that among the medical personnel involved there too.

I admire Savita's husband Praveen for his incredible strength and generosity of spirit at this extremely difficult time and his persistence in getting definitive answers in his wife's case.

If we don't let ourselves get bogged down in just one aspect of this case alone then a great service may be done for health care in our hospitals.

We seriously need to examine the reasons behind the apparent systems failure in this case and check it across all hospitals.

If it has anything to do with over-stretched resources/staff  then that needs to be dealt with and the staff properly supported and resourced. If it's human error than that needs swift resolution also. The worrying thing to me is that this system failure occurred mid-week as opposed to weekend, but weekend cover and lab/scan access and reporting  in our hospitals needs a serious overhaul too.

If cutbacks are ultimately the cause we should then send a copy of the final report to the IMF, the Troika and any of our European partners who forced us down the now considered false road of austerity and make them pay.

They need a strong reminder that Ireland Inc., is not merely an economy - we are a society.

And they, through enforced cuts and austerity, are killing us (society and economy).

While we stand meekly by and let them.

Forget about loan extensions and 'ploughing millions into our banks' . 

Burn the remaining bondholders and instead plough the money directly into our Economy (jobs, people's spending pockets) and our Society (Health, Education and Special Needs requirements)

Now.

xx

(a rather irate)




NOTE 1: Since posting this yesterday I came across this article in thejournal.ie regarding 'Serious concern over staff shortages in Emergency Departments. I wonder where else there are shortages?

NOTE 2: 17/4/2013: Dr Peter Boylan stated at the inquest today that a termination on the Monday would have saved her life, but would have been illegal due to our Abortion Law. As I've said above we need to change our law so that doctors can act sooner and give mothers a right to life too. I absolutely re-iterate that we also need to deal with the reasons (staff shortages/austerity measures?) behind the massive systems failures. Could her life still have been saved if they'd monitored the sepsis sooner, given the correct antibiotics?

NOTE 3: 19/04/2013: VERDICT: The verdict in the inquest into the death of Savita Halapanaver was given today. A report and analysis of today's verdict can be read in this thejournal.ie link . Here's a short synopsis of the verdict:

'The inquest today found that there was medical misadventure relating to the management of her treatment. The jury’s verdict was unanimous. It alsostrongly endorsed the coroner’s nine recommendations, including a recommendation to the Medical Council to “lay out exactly when a doctor can intervene to save the life of the mother in similar circumstances, which will remove doubt and fear from the doctor and also reassure the public”.'

This is a tragically sad day, it is also Savita and Praveen's 5th wedding anniversary. There are still questions to be asked. Praveen is a very, very brave man and as I say above he has done a great service for patient care in Irish hospitals by virtue of the Coroner's 9 recommendations. Now to ensure they are adhered to.

My heart goes out to him as does the hearts of the Irish nation.

Sleep well Savita and baby Prasa.










16 comments:

  1. "...she was sent from an acute hospital back to the nursing home, on palliative care with advice not to feed and 3 weeks to live. Sent 'home' to die." Oh, I can't tell you how appalling this is. I am so glad she's proved them wrong, and as you said, half life or not, it's hers to choose.

    Savita's case is a tragic, tragic one no matter how you look at it.

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  2. @Shelly: It does sound appalling put like that, doesn't it? There was a big discussion about it before hand and we reluctantly agreed to it (didn't matter if we didn't as they would have transferred her anyway.)The 'palliative care' bit is important though...that included comfort care: basic 1000ltr IV fluid, sponge dipped in water/juice/yogurt if she requested food etc. The big thing was the strokes left her with a seriously impaired effective swallow. So they weren't monsters, I understand why they made the decision they did, but they did play God, just a little.

    Savita's case is so terribly tragic, I get a sense of a needless death.

    Thanks for your comment :-)

    xx Jazzy

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  3. I know nothing of the facts about poor Savita's tragic death but your post is spot on. Most doctors and nurses are doing the best they can in extremely difficult and pressured circumstances. Having said that - I'm glad your Mum proved them wrong.

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  4. @Midlife Singlemum: I still await the official outcome of this inquest but so far it doesn't auger well.

    Thanks for your comment :-)

    xx Jazzy

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  5. Oh, Jazzy. Not good, not good at all. I haven't seen much about Savita's case, due to being very slack at turning on the telly... so so sad for the family. I am really glad that your mum is doing well, although I am sure that it must be very hard for you both. xx

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  6. so heartbreaking
    You bring up such great points
    Sooo glad that your mum is doing well

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  7. Perhaps one of the lessons is that it needs to be okay to admit to mistakes: it was interesting to see the reaction to the midwife's revelation that she made the "Catholic country' comment. She was called brave and praised - she just told the truth, which is an example for so many others in public life. But isn't it also sad that telling the truth is called 'brave'? We need more people - preferably everyone - to be truthful, to help prevent problems like these you've written about happening again xx

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    1. You are right and it doesn't happen enough because in the public service "Brave" is seen as "Foolish" (I'm quoting Sir Humphrey in Yes Minister)
      Every time that psychopath Micheal Neary performed a Caesarian hysterectomy on a perfectly healthy woman, there was a surgical nurse beside him. If there was more bravery and recognition of bravery in speaking out as a * good * thing then maybe he could have been stopped before he ruined so many lives.

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  8. @Bright Side of Life: Thanks. She IS doing well, considering, but not always easy!

    @Floortime Lite Mama: Thank you. It is very heartbreaking indeed. This story was very big in your home country for the abortion and 'Catholic country' remark that Blue Sky mentions.

    @Looking for Blue Sky: Excellent point and I totally agree. BUT....we MUST get to the bottom of WHY the mistakes were made. I purposely didn't mention the 'Catholic country' remark. I know it was very important to Praveen to get the truth about that one but debating that remark and the abortion issue is masking the real problems here and we MUST highlight them. Really, we must.

    Thank you both for your comments and for the comments and support on twitter and facebook.

    One twitter friend with medical background has stated that staffing and medical management are issues in our hospitals in general. There was also a link to a piece in thejournal.ie referring to serious problems in staffing our ER Depts. I will tag that to the end of this blog post later.

    xx Jazzy

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  9. I don't like anyone presuming what another person wants, and telling YOU that as they know better than you. Keep advocating.

    As for Savita? I have experienced first hand the clusterf**k of a hospital ward where no one is communicating properly several times. It's a management failure and it doesn't matter how well meaning and caring everyone is if there is incompetent management and no clear line of authority. In my case it wasn't life threatening but it was seriously stressful for me and my daughter who was the patient in both cases. 7 nurses clustered around the nursing station but not one can go and get a wheelchair for a semi sedated child? A child doing a metabolic screen needs to eat before her next blood test, but nobody knows how to make toast and bring it to the patient before it goes stone cold?
    A firm request to have an autistic child seen first in the schedule as she's been fasting since mid-night and the hospital demands that she attend at 7am, - is interpreted as "leave her hungry, dehydrated and anxious until 2pm when we get through the list of 6 other kids"
    I really lose respect for hospital staff in these situations and I wonder if the deliberate lack of authority and good management is designed to devolve responsibility when things go wrong.

    Ironically, given the comments made by the mid-wife and consultant in this case; I think hospitals were better when in the control of nuns. A clear management structure exists in Holy Orders and everyone knows what their job is. If the lab isnt returning a test result, go and give them a bollocking because YOUR patient needs it.
    Removing that structure without replacing it with strong, qualified management leads to a "systems failure" where everyone says "oh dear" but nobody says "I fucked up, it was my fault"

    Excellent post Val. Worth sharing a lot. Xx

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  10. @Lisadom Grace App: I honestly believe that the Michael Neary scenario would have happened in a Private hospital also. Its a Doctor/nurse power thing as opposed to a public service thing?

    I definitely have a problem with anyone playing God, but behind it was the patient's interests. Then again,they didn't take into account her incredible fighting spirit, or the background knowledge we have of her presentations. The nursing home did though ;-)

    Situations like you describe with your daughter make me very, very mad. I totally agree with everything you say here. I too have seen some scary stuff in our recent hospital experience. I don't include here as ultimately our experience was good and this is more about Savita and trying to change the public debate over the real causes.

    Yes, the nuns did indeed run a tight ship and a clear management structure and plan, properly resourced, is required.

    Like it or not pay and conditions are a crucial part of this. Croke Park 2 will DO NOTHING to solve any staffing difficulties for the future. Absolutely nothing....

    Thank you for your very valued comment. It means a lot to me when people like you and Blue Sky like what I write.

    xx Jazzy

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  11. I've been finding it extremely painful to read about Savita too. The loneliness and fear she must have suffered absolutely haunt me.
    There's no lack of compassion among nurses and doctors (for the most part) but it's an organisational disaster, not helped by the fact that the vast majority of single, mobile nurses emigrate. Staff numbers is a very real problem.
    I've sat in on many of those conversations with a patient and family about the decision to continue treatment (about a million years ago when I worked in hospitals, but also as a daughter when my Dad was terminally ill). Mostly, it is as heart-breaking for the staff as the patients, but very often the crux is "are we prolonging the patient's life or prolonging their death?". These decisions, in my experience, have always been made from a place of genuine compassion and sound clinical judgement. But that's just my experience.
    But Savita's case is just too frightening. My feeling is that her case would have been swept under the carpet had her husband and herself not been educated, assertive people and had the hot-potato issue of abortion not raised it's head. I honestly fear that many other similar, but less contested, events have happened over the years.
    And you're absolutely right that patients who don't have advocates and loving family to care for them are sometimes neglected. I have often witnessed those shouting loudest getting cared for sooner, while the meek little granny in the corner (with no-one to mind her) being ignored. It is absolutely heart-breaking, and an often deeply demoralizing environment to work in.
    The politics behind Croke Park 2 etc bore me at this stage. They want public servants to work night-shifts, bank holidays, weekend etc plus longer hours and less holidays for less salary. It cost my husband 10,000 euro to do his Masters Degree in nursing and 15 years of hard grafting to get to the position he's in. He loves his job and loves making the lives of people better every day. But he doesn't love being scape-goated for the sins of bankers. Trust me when I say that if you think there's a staff crisis now, you ain't seen nothin' yet.
    And innocent people like Savita get caught in the cross fire.
    Wonderful post Jazzy, about a subject I've been finding very difficult to look at XXX

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  12. @Jean: Thank you so much for your brilliant and informed comment. I wholeheartedly agree with everything you say here. Everything. I needed a nurse/medical person to confirm what I already know but am not qualified to say. I was also being careful in the language I used in this post. I know staff shortages are at the bottom of this but want a report to confirm it. In black and white, to shove in the Troika's faces. I also fear that this has happened before.

    Thank you for your input on treatment of the elderly. That question "are we prolonging the patient's life or prolonging their death?" was definitely said to us a number of times and I get it, I do. I wrote about our experience in more detail in the link I provided. I felt that the Doctors in the smaller hospital gave her more time to respond on her first stroke (which was followed by seizures & a smaller stroke) than the acute hospital did on her 2nd dense stroke (also followed by seizures) She had a history of not responding within the acceptable time limit and of being an incredible fighter. Absolutely incredible.She also has another condition which was potentially influencing her presentation. She shouldn't still be with us, but she is.

    Savita's story is such a tragic one, I can only imagine how upset the staff are and frustrated too I'm sure. Not being able to do your job properly is dreadful.

    As for Croke Park 2? Don't get me started! It is the subject of my next post (in general terms.) It is wrong what they are doing to frontline staff....and to all non-frontline staff (some of whom give the neccesaary clerical back up.) They will NEVER solve medical personnel staff shortages and prevent emigration of staff THEY have trained with brutal pay cuts. Never.

    Thanks again Jean.

    xx Jazzy

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  13. I remember hearing about that case as well, so awful. And your post is really informative and unbiased. Most importantly, I'm so glad to hear that your mother is doing better, and I hope that continues. xo

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  14. Just so very sad. Brilliantly written and informative post jazzy. I too am so glad your mum proved them wrong...

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  15. @Tanya Savko: It is very much a global news story. That's another reason I'm afraid that the systems failures might get bruhed under the carpet. Thanks - she is one incredible lady!

    @BavarianSojourn: Thanks so much. I can't watch Savita's husband on the news without tearing up. That poor man, he is very, very brave. I'm glad my mam proved them wrong too!

    Thank you both for your comments :-)

    xx Jazzy

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Your comment is very much appreciated! x

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