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.
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)
(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.