Crucial information including repeated requests for a termination were not recorded in Savita Halappanavar’s medical records, her husband’s solicitor claimed yesterday.
Gerard O’Donnell, representing Praveen Halappanavar, said the notes covering her care on Monday, October 22nd, when it is alleged she made her first request for a termination, were “particularly scant”.
“It’s almost as if a whole day is missing from the notes,” he said last night. He said while there were records kept of her having cups of tea or of her husband asking for extra blankets for her, there was none on the requested termination.
Ms Halappanavar died at the hospital on October 28th, having presented with severe backpain a week earlier. She had been 17-weeks pregnant and had been found to be miscarrying. Mr Halappanavar says she asked repeatedly, between Monday 21st and Wednesday 23rd, that the pregnancy be terminated. This was refused, he says, as a foetal heartbeat was present and he claims they were told: “This is a Catholic country.”
She contracted E-coli and septicaemia and died four days after the foetus.
“There is no reference in the notes to the fact a termination was requested,” said Mr O’Donnell. “It is extremely fortunate that there were other people in the room when one of the requests was made, on the Tuesday morning, to witness the request and the reference to Ireland being a Catholic country.”
Mr Halappanavar has said the first request was made on Monday 22nd and that the consultant said she would have to check if this was permissible.
Mr Halappanavar has told The Irish Times the consultant returned on Tuesday morning.
He said she told them a termination was not possible as long as the foetal heartbeat remained, and made the “Catholic country” reference.
Also in the room, he has said, were a family friend, two junior doctors and a midwife.
Mr O’Donnell said he wrote to Galway University Hospital on November 2nd asking for copies of Ms Halappanavar’s medical notes and received them on November 16th.
Minister for Health James Reilly was asked about the claims of gaps in the health records in Sligo last night. He said: “Obviously this is of concern and this is a substantive matter for the investigation”.
HSE director general designate Tony O’Brien said information that Mr Halappanavar had that would “speak to any inconsistencies between what’s in the record and his personal knowledge would be of great value to the review team”.
A HSE spokeswoman said: “The investigation team has commenced its work and, as such, it would not be appropriate at this juncture to attempt to address matters which come within its remit. The investigation now under way will be important in terms of determining the completeness of information regarding the care provided to Ms Halappanavar.”
Meanwhile, advocacy group Patient Focus said its representative on the HSE inquiry team would walk away from any investigation which was not about getting to the bottom of what happened.
The death of Savita Halappanavar must be the subject of an independent public inquiry, according to a Galway-based surgeon who is a close friend of the 31-year-old woman and her husband Praveen.
The Government is not ruling out an independent inquiry into the tragic death of Ms Halappanavar, who presented on October 21st with back pain at Galway University Hospital where she was found to be miscarrying at 17 weeks. She died of septicaemia on October 28th.
Her husband, an engineer at Boston Scientific in Galway, had described how she asked several times over a three-day period that the pregnancy be terminated, given that she was in pain and was miscarrying. He said the request was refused by medical staff who said they could not do anything because there was still a foetal heartbeat. He said they were told that this was the law and that “this is a Catholic country”.
He said she spent more than three days “in agony” until the foetal heartbeat stopped. The dead foetus was removed, but Ms Halappanavar’s condition deteriorated and she died.
The HSE said last night an independent external expert in obstetrics and gynaecology would be appointed to strengthen the incident management team it has asked to investigate the circumstances of Ms Halappanavar’s death.
Next of kin
The terms of reference for this review and the members of the team were currently being finalised, a spokeswoman said. The team would liaise with Mr Halappanavar as next of kin.
“The process of incident review seeks to ascertain the facts relating to the incident, draw conclusions and make recommendations in relation to any steps that may need to be taken to prevent a similar incident occurring again.” She extended the HSE’s deepest sympathies to the family and friends of Ms Halappanavar. Both the hospital and the HSE said they would not be commenting on the circumstances of the case.
Taoiseach Enda Kenny did not rule out an independent inquiry when it was suggested by Fianna Fáil leader Micheál Martin. He said it was appropriate for Dr Reilly to first receive the reports of the hospital and the HSE.
The case, which attracted worldwide media attention yesterday, has increased pressure on the Government to legislate for the implications of the X case 20 years ago.
Dr Prasad, who visited Ms Halappanavar in hospital before she died, said: “Any inquiry should be public. That is the way it should be, it should not be conducted by the HSE or the hospital. It should be independent.I hope that might save the life of another women. This should never happen to another woman. Religion and medicine should never mix.”
Mr Halappanavar yesterday repeated his belief that his wife would not have died if she had been given the termination that the couple repeatedly asked for in the hospital. Asked whether he thought things could have turned out differently if a termination had been carried out, he said: “Yes of course.”
Speaking to The Irish Times from Belgaum in southwestern India, his wife’s home region, he said Ireland’s reputation for being a “good place to have a baby” was among the factors in their decision to start a family here. “All our friends had great stories to tell about the babies they had in Ireland. So we decided we’d go there. We had heard Ireland was a good place to have a baby. Most of our friends there had babies there and they’re all fine and so we decided: have a baby in Ireland.”
A postmortem has been carried out on Ms Halappanavar and the coroner has been notified. The couple came to Ireland in 2008. She had a dental post in Westport, Co Mayo.
Several hundred people gathered at Leinster House last night to demonstrate in favour of abortion legislation, while candle-lit vigils were held in Cork, Limerick and London. Further protests are planned in Dublin, Limerick, Belfast and Galway in coming days.
Minister for Health Dr James Reilly said it would be an extremely serious matter if there had been any hesitation in relation to Ms Halappanavar because of moral or religious beliefs. However, he said he had no evidence of the application of a Catholic bias in relation to treatment and he warned against prejudging the circumstances surrounding the death.
Dr Reilly said it was a terrible tragedy for the family involved. For the staff involved, it was an emotionally traumatic time and they were entitled to due process.
Speaking in the Dáil, he said he had asked his officials to consider the report of the expert group on abortion, which had been submitted to his department on Tuesday.
Independent Senator Ronan Mullen described the case as deeply tragic but said it should not be “used as a wedge by abortion campaigners”
He added: “Its regrettable that some people are seeking to use this tragedy as an argument for legislating for the Supreme Court decision in the X case”.
Two years ago, the European Court of Human Rights ruled that Ireland had failed to provide for abortion in circumstances where the mother’s life is at risk. The decision means Ireland has to legislate but Dr Reilly is facing resistance from within Fine Gael to any liberalisation of the laws on abortion.
Two investigations are under way into the death of a woman who was 17 weeks pregnant, at University Hospital Galway last month.
Savita Halappanavar (31), a dentist, presented with back pain at the hospital on October 21st, was found to be miscarrying, and died of septicaemia a week later.
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”.
She spent a further 2½ days “in agony” until the foetal heartbeat stopped.
The dead foetus was removed and Savita was taken to the high dependency unit and then the intensive care unit, where she died of septicaemia on the 28th.
An autopsy carried out by Dr Grace Callagy two days later found she died of septicaemia “documented ante-mortem” and E.coli ESBL.
A hospital spokesman confirmed the Health Service Executive had begun an investigation while the hospital had also instigated an internal investigation. He said the hospital extended its sympathy to the family and friends of Ms Halappanavar but could not discuss the details of any individual case.
Speaking from Belgaum in the Karnataka region of southwest India, Mr Halappanavar said an internal examination was performed when she first presented.
“The doctor told us the cervix was fully dilated, amniotic fluid was leaking and unfortunately the baby wouldn’t survive.” The doctor, he says, said it should be over in a few hours. There followed three days, he says, of the foetal heartbeat being checked several times a day.
“Savita was really in agony. She was very upset, but she accepted she was losing the baby. When the consultant came on the ward rounds on Monday morning Savita asked if they could not save the baby could they induce to end the pregnancy. The consultant said, ‘As long as there is a foetal heartbeat we can’t do anything’.
“Again on Tuesday morning, the ward rounds and the same discussion. The consultant said it was the law, that this is a Catholic country. Savita [a Hindu] said: ‘I am neither Irish nor Catholic’ but they said there was nothing they could do.
“That evening she developed shakes and shivering and she was vomiting. She went to use the toilet and she collapsed. There were big alarms and a doctor took bloods and started her on antibiotics.
“The next morning I said she was so sick and asked again that they just end it, but they said they couldn’t.”
At lunchtime the foetal heart had stopped and Ms Halappanavar was brought to theatre to have the womb contents removed. “When she came out she was talking okay but she was very sick. That’s the last time I spoke to her.”
At 11 pm he got a call from the hospital. “They said they were shifting her to intensive care. Her heart and pulse were low, her temperature was high. She was sedated and critical but stable. She stayed stable on Friday but by 7pm on Saturday they said her heart, kidneys and liver weren’t functioning. She was critically ill. That night, we lost her.”
Mr Halappanavar took his wife’s body home on Thursday, November 1st, where she was cremated and laid to rest on November 3rd.
The hospital spokesman said that in general sudden hospital deaths were reported to the coroner. In the case of maternal deaths, a risk review of the case was carried out.
External experts were involved in this review and the family consulted on the terms of reference. They were also interviewed by the review team and given a copy of the report.