Savita Report Highlights Litany of Failures
Editor’s note. This analysis was provided courtesy of the Irish pro-life organization, LifeZine
Doctors caring for Savita Halappanavar, the 31-year-old Indian dentist who died at Galway University Hospital [in Ireland] last year, seriously failed to investigate, recognise and treat the infection which led to her death. This is according to a leaked draft of the report of an independent review of her case conducted by the HSE [Health Service Executive]. The major failing of the medical team caring for Savita at the hospital is that they underestimated the seriousness of her condition for too long—taking three days to follow up on crucial blood tests.
Abortion advocates shamelessly exploited Savita Halappanavar’s death, stirring up an international frenzy to further their cause. In so doing they recklessly damaged Ireland’s reputation as a world leader in maternal care. It is clear now from the leaked draft of Prof. Arurkumaran’s report that Mrs. Halapannavar’s tragic death was not caused, as abortion advocates have loudly proclaimed, by Ireland’s law on abortion. Instead, the report highlights the need to introduce clear guidelines concerning the diagnosis and treatment of septicaemia, and the need for adequate resources in our maternity hospitals. It is clear that nothing in Irish law or medical ethics would have prevented doctors from intervening to expedite delivery when it was clear that sepsis posed a real and substantial risk to Mrs. Halapannar’s life.On admission to hospital on Sunday, October 21, Savita, who was 17 weeks pregnant, was told a miscarriage was inevitable, with infection the likely cause. Savita’s death, a week later, however, was not inevitable. Though rare, septic miscarriage happens. When it is discovered, the pregnancy is induced and the woman is rushed to intensive care. But this did not happen in Savita’s case. It was not until Wednesday that medical staff conceded sepsis was “probable.”
It is unusual for staff to be able to ascertain the cause of any miscarriage at such an early stage, so the fact that “infection” was already thought likely on Sunday should surely have sounded alarm bells. Yet a doctor had decided that evening that it was “too late to stitch the cervix to prevent a miscarriage” and instead Savita and her husband, Praveen, were told to “await events.”
The next three days saw matters escalate. By Tuesday, the young woman, in growing agony, was begging for a termination of her pregnancy. Staff noted that her temperature had spiked on Wednesday morning and bacterial infection was identified that same day.
The report found a “lack of knowledge” among staff about quick-fire diagnosis of sepsis/blood poisoning. Her condition progressed from sepsis to septic shock which the draft report described as “like falling from a cliff.”
The report points to a litany of errors, of signs missed. It speaks of doctors too busy caring for other patients to deal with Savita; of a “difference in the recollection” of a phone conversation between a junior doctor and a registrar discussing her rising temperature; and of blood tests that were never followed up.
“The option of expediting delivery was requested by the patient and her husband and should have been considered whether or not requested by the patient,” the report says, because there had already been suggestions she had underlying infection. The “clinical situation indicated a significant and increased risk to the mother.” Doctors claimed, however, that they were unsure about their legal guidelines and felt their “hands were tied.”
The group said at that stage it was over 24 hours since the spontaneous rupture of her membranes. There was a need for antibiotic therapy and the “need for the removal of the source of infection, i.e. emptying the uterus should have been considered much earlier”.
This action would be in keeping with guidelines on the management of suspected sepsis in obstetric care.
The review group said the clinical evidence is that sepsis was present in Mrs. Halappanavar in the early hours of Wednesday, October 24. The patient went from sepsis to severe sepsis in two hours and had progressed to septic shock by 8.30am.
The mortality rate with severe sepsis can be as high as 60 per cent, even with treatment. Her progression to septic shock within four hours could have been avoided if doctors had intervened earlier to induce delivery.
The report says the absence of legislation in which abortions can be carried out was a “contributory factor.” But in a situation where Savita slipped further into danger while doctors apparently never realised, how could legislation possibly have saved her?
The Government is expected to examine the final report within 10 days, but Health Minister James Reilly refused to be drawn on the contents of the draft. “I haven’t seen it and I don’t have it,” he said. “I can’t make any comment until I have the report because clearly there could be legal issues arising out of this. I want to deal with the facts given to me in the report by Prof Arulkumaran, who is near completion. And as far as I know the final drafts are out for consultation.”
The draft report reveals:
* Blood tests were carried out on Savita on the day of her admission but not followed up. The tests showed an elevated white cell count—a signal for suspected blood poisoning.
* There was a lack of clarity on who was responsible for the follow-up. The senior specialist registrar in obstetrics ordered the tests, but the samples were taken under instruction by a junior doctor who also denied responsibility. A midwife said follow-up was not her job.
* The review team could find no examination of Savita’s pulse, blood pressure or temperature to test for early possibility of infection on her second day in hospital.
* There was no review of treatment options, and the pattern was to “await events.” Doctors monitored the foetal heartbeat in case “accelerated delivery” might be possible.
* There was over-emphasis on the need not to intervene until the foetal heartbeat stopped.
* On Tuesday her pulse rate at 9pm should have triggered a medical review, but the junior doctor was too busy caring for other patients. He did not attend her until 1am when he carried out a chart review. She was asleep and he did not wake her. “With the possibility of sepsis at this point, help from a senior medic should have been requested,” the review says. Although the junior doctor was busy with other patients, this could have been overcome by calling a senior doctor who was on call to see serious cases. A nurse found Savita cold and shivery at 4.20am and checked her two hours later.
The report, which was first revealed by the Evening Herald, details a difference in recollections of a phone call between a junior doctor and a registrar about Savita’s rising temperature that morning. The registrar did not recall being told of her heart rate and blood pressure, but the junior doctor said he gave the facts but was not told “anything extra.” It was not until Wednesday that a diagnosis of probable sepsis was made and more antibiotics were given.
A diagnosis of septic shock was made later that day and Savita suffered a miscarriage before being transferred to the high-dependency unit.
The following day she was transferred to intensive care and on Friday she was found to be failing. She died in the early hours of Sunday morning after suffering cardiac arrest.