There were a number of deficiencies in the care of Savita Halappanavar who could have been still alive today had a request for a termination, to progress an inevitable miscarriage, been carried out one or two days after being admitted to hospital, an expert witness told an inquest yesterday.
When the coroner’s inquest into Savita’s death resumed at Galway County Council buildings yesterday consultant obstetrician gynaecologist and former master of the National Maternity Hospital in Holles Street, Dr Peter Boylan, gave his insights into the care that had been given from the time of admission on Sunday, October 21, to the time the 31-year-old Indian dentist succumbed to septic shock and died of multiple organ failure and cardiac arrest on Sunday, October 28.
In his conclusion Dr Boylan noted that under Irish law there had been no possibility of a termination being granted until October 24, but that by the time Savita met the requirements and the possibility of a termination was discussed it “was too late to save her life”. He told the inquest that once sepsis - which had not been diagnosed until 6.30am that day - had “taken hold it can be hard to deal with. It has a huge impact on organs and the progress can be very rapid”. Dr Boylan added that in the case of sepsis several things must be done and that “for every hour there is a six per cent increase of mortality”.
In his conclusion Dr Boylan said that Savita would have been alive today had the termination been carried out on Monday or Tuesday, however, he added that a termination at that time was not a “practicable proposition because of the law”. “From 4.15am and 6.30am on October 24 a termination had been justified but realistically it would not have been done until Dr Astbury came on her ward round,” said Dr Boylan, before explaining that Savita had become seriously ill in a short space of time and that intervention from 9.30am onwards on October 24 “would not have made any difference”.
Dr Boylan noted that there were a “number of deficiencies” in the care of Savita. Miscommunication between staff was highlighted, with Dr Boylan pointing out the poor quality of note taking on the morning of October 24 making it difficult to follow the sequence of events, and doctors being “left in the dark”. He also questioned why a further blood pressure test had not been carried out straight after the first taken at 10am showed it had dropped, and that there was no statement from the midwife.
At the beginning of his evidence Dr Boylan began by first noting the mortality rate for severe sepsis is between 20 and 40 per cent, but that this rate increases to 60 per cent for septic shock. However Dr Boylan said that the mortality rate is low, that early detection remains a challenge, that the progression through the stages of sepsis can be very rapid, and that many healthcare workers may never see a case so awareness would be low.
Outlining his review of the care given to Savita, Dr Boylan said when being admitted the white blood cell count was elevated, possibly due to infection, but “there was nothing to indicate her life was in danger at this point”. He noted that when a request for a termination was made Dr Katherine Astbury had explained the legal position in Ireland. On October 24, at 8.25am during morning rounds Dr Astbury noted Savita’s condition, that her pulse was 114, that there was still a foetal heartbeat, but also evidence of infection. Dr Boylan added that there was clear evidence of chorioamnionitis (an inflammation of the foetal membranes due to a bacterial infection ) at this stage, that there was risk to Savita’s life which was recorded by Dr Astbury who then discussed the possibility of a termination with colleagues.
During the course of the inquest hearing last week there had been conflicting evidence and as a result Coroner Ciaran MacLoughlin recalled two witnesses, midwife Anne Maria Burke and Dr Ikechukwu Uzockwu, in order to try to clarify matters. The inquest heard previously that Dr Uzockwu had not been told of Savita’s elevated pulse rate but that all vital signs were within normal range.
Ms Burke told the inquest yesterday that she had phoned Dr Uzockwu at 7.35pm on Tuesday, October 23, and she is “100 per cent sure” she told him that the pulse rate was elevated. She further explained that around 7.15pm a nurse had taken Savita’s pulse rate which was 114 beats per minute. Ms Burke asked for the pulse rate to be rechecked and when this came back as 110 she was still concerned and contacted Dr Uzockwu about it.
Dr Uzockwu maintained he was contacted at between 9pm and 11pm and told that although Savita was complaining of weakness her vital signs were within normal range. However he later admitted that he could not recall which midwife had made that call to him. He said that he did not carry out an examination when he arrived on the ward at 1am on Wednesday, October 24, because Savita was asleep but that when an examination did take place at 6am he diagnosed chorioamnionitis.
In cross examination, Eugene Gleeson, for Praveen Halappannavar, put it to Dr Uzockwu: “You attended Savita at 1am to review her, what prompted that? Did it not occur to you to look at the observation chart at her bedside?” to which Dr Uzockwu replied again that he was told the vitals signs, which includes temperature, blood pressure, pulse and respiratory rate, were within normal range. Mr Gleeson then put it to the witness that the observation chart shows that between 9pm on October 23 and 6.30am on October 24 only one of the four vitals signs, temperature, was checked.
After Dr Boylan’s evidence, Dr Frans Colesky who carried out the postmortem on the placenta, and Dr Michael Tan Chien Sheng were the next witnesses to give their findings at the inquest. It is understood that today Professor Grace Callagy who carried out the full post mortem will give evidence, and tomorrow coroner Ciaran MacLoughlin will charge the jury and it is hoped that a verdict will be reached the same day.