Consultant 'refused abortion plea'

opinion guy

animum wrote: »

And I believe that she is hiding behind the law to cover her own mistakes.

Its my opinion I know, but as a Catholic Irish person, I can not believe that a medical professional, stood back and let a woman die before thier eyes, because of the Catholic Religion and the laws of our country. There are laws to protect women in instances like this. And terminations are carried out all the time.

I'm glad you can finally acknowledge your own biases.

And I think you should note - nobody stood back and watched her die -they did what they were allowed to do. Yes somethings weren't done perfectly right - which may or may not have been important.

Indeed, the consultant herself has stated the law got in her way:
http://www.irishtimes.com/news/savita-halappanavar-consultant-tells-inquest-she-refused-termination-over-legal-position-1.1355359

Do you cherry pick the news you read to suit your own viewpoint or had you just missed this article ?

I mean this issue of the law is the only reason we have even heard of this case. Or have you forgotten the 'its a Catholic country' comment Praveen brought to light in the first place.


As an aside lets do a thought experiment:
Let me ask you this. Imagine Savita had survived and we had never heard this story. Suppose everything else happened as it did but she pulled through in the ICU and went home after a week or something. She would have still endured a horrible painful traumatic experience possible medical consequences and still lost her baby. She would have still asked for a termination and been refused and nature let take its course. She would have still brewed an avoidable silent infection and become seriously ill and ended up in ICU. What right do you or anyone else have to tell a woman that she must endure such a horrendous experience instead of having an early termination as was her choice ? The baby was going to die either way. Who are you or me or the state to dictate to a woman that she must suffer through all that when it could be foreshortened and made safer by an earlier termination ?

The most serious consequences of this case were avoidable if the mother's choice was respected. The baby was doomed either way. There is simply no getting around that. This was needless. This choice was taken away from her by the unclear legal situation as stated by her Doctor.

Grayson

Neyite wrote: »

Because the media don't have a political agenda at all...

There were 4 different sources there. Where do you get your news? Alive!?

john.han

opinion guy wrote: »

I'm glad you can finally acknowledge your own biases.

And I think you should note - nobody stood back and watched her die -they did what they were allowed to do. Yes somethings weren't done perfectly right - which may or may not have been important.

Indeed, the consultant herself has stated the law got in her way:
http://www.irishtimes.com/news/savita-halappanavar-consultant-tells-inquest-she-refused-termination-over-legal-position-1.1355359

Do you cherry pick the news you read to suit your own viewpoint or had you just missed this article ?

I mean this issue of the law is the only reason we have even heard of this case. Or have you forgotten the 'its a Catholic country' comment Praveen brought to light in the first place.

I agree with a lot of what you say, but the reality is they did not do what they were allowed to do, they failed to diagnose and treat/monitor properly, which meant they did not see a risk to the mother's life. If they had seen the risk, which they should have done, then the law did not pervent them from procuring the miscarriage. The law did not tie their hands as tightly as they suggest, the failures in her care played a far bigger part in my opinion.

Neyite

Grayson wrote: »

There were 4 different sources there. Where do you get your news? Alive!?

I'm pro choice. Why on earth would I read that rag?

Overseas media love to portray Ireland as this little religious backwater - it makes better reading. RTE are a state organisation, nuff said. The Indo leans a bit towards Catholic bias, no? The Herald is right-wing.

It is in the interests of our Government to have this inquest arrive at the conclusion that this was NOT anything to do with legislation, or lack thereof. It suits them to have it written off as medical malpractice, down to the individual doctor, and not have the HSE at fault. Of course RTE as a state broadcaster are going to slant it to look more favourably to suit the political agenda.

so I'll rephrase my post, with added sarcasm rolleyes to make it clearer:
"because the media dont have any political leanings at all, do they? :rolleyes:"

Loafing Oaf

opinion guy wrote: »

This choice was taken away from her by the unclear legal situation as stated by her Doctor.

I don't think the legal situation is even unclear, or at least I don't believe the lack of clarity that there is impacted this case. I believe Dr Astbury's interpretation of Article 40.3.3 and the X Case judgement is correct, insofar as that can be ascertained for such a gnomic piece of legislation. And hence I don't believe any 'clarifying' X case legislation, if it is to remain true to 40.3.3 and X, would have made any difference in this case...

GCU Flexible Demeanour

Kiwi in IE wrote: »

opinion guy wrote: »

You are all missing the point.

But I am making the same point as you!

Fancy that.

jjn2

Kiwi in IE wrote: »

I think you are missing the point completely.

If Ms Halappanavar had recieved the appropriate treatment as per any other First world country, where law is not influenced by religious principles, there would in all probability, have been no sepsis. Therefore the Sepsis policy of GUH and whether or not it was followed, would have been irrelevant.

It seems Ms Halappanavar could have been saved twice; firstly if she had recieved appropriate treatment for the miscarrying of an unviable feotus, this the law prohibited, and secondly if the medical team had dealt appropriately with the sepis that resulted from the law preventing best practice in the treatment of her primary condition.

Has your claim in the second paragraph actually been established?

I may be misreading or misapplying this, but according to http://apps.who.int/rhl/reviews/CD003518.pdf,

Expectant management led to a higher risk of incomplete miscarriage, need for surgical emptying of the uterus, and bleeding. Noneof these were serious. In contrast, surgical evacuation was associated with a significantly higher risk of infection. Given the lack of clear superiority of either approach, the woman’s preference should play a dominant role in decision making. Medical management has added choices for women and their clinicians, but these were not reviewed here.

If anything, according to the above, surgical evacuation would be worse in terms of the risk of infection? Now from what I understand, once chorioamnionitis is diagnosed, delivery is the correct treatment, but prior to this, according to the above, it is not necessarily the case.

Nodin

Just to jog some memories.....

The Health Service Executive report on the death last year at Galway University Hospital of Savita Halappanavar has found there was an overemphasis by hospital staff on the welfare of Ms Halappanavar’s unviable foetus and an underemphasis on her deteriorating health.

The final draft report says: “The investigating team considers there was an apparent overemphasis on the need not to intervene until the foetal heart stopped, together with an underemphasis on the need to focus an appropriate attention on monitoring for and managing the risk of infection and sepsis in the mother.”

http://www.irishtimes.com/news/health/savita-halappanavar-death-report-finds-foetus-not-mother-was-main-focus-1.1345890

drkpower

jjn2 wrote: »

If anything, according to the above, surgical evacuation would be worse in terms of the risk of infection? Now from what I understand, once chorioamnionitis is diagnosed, delivery is the correct treatment, but prior to this, according to the above, it is not necessarily the case.

'The woman's preference should play a dominant role in decision making'..........

jjn2

drkpower wrote: »

'The woman's preference should play a dominant role in decision making'..........

The claim I quoted was that "in all probability", there would have been no sepsis if expectant management hadn't been chosen.

There are two separate issues, (1) would her chances of survival have been greater had she been treated differently, and (2) should she have been given the option of being treated differently. My point was in relation to the first issue.

Are you a doctor? If so, you might be able to explain whether surgical or medical evacuations provide a better prognosis than expectant management?

I Heart Internet

We'll have to wait for the outcome of the inquest but it appears that more and more evidence is emerging of woeful mismanagment of Savita's case and inadequate technical practices at the hospital. That's what it seems like.

That Savita's case was hijacked earlier on by those with a political agenda to advance is a shame.

As it turned out the "Catholic country" phrase so loved by headline writers was a massive red-herring and there appeared to be no doubt whatsoever in the consultant's mind regarding the legal position.

Bad practice, not legal confusion, seems to have been behind this tragedy.

Loafing Oaf

I Heart Internet wrote: »

and there appeared to be no doubt whatsoever in the consultant's mind regarding the legal position.
.

You're right about this, she was quite certain, rightly IMO, that she was not legally entitled to terminate the pregnancy on the Monday or Tuesday, as would be standard practice in other countries, because there was no evidence of a substantial threat to Savita's life at that point. Are you happy that medical care for miscarrying women in Irish hospitals is below international standards in this way (as a direct result of Article 40.3.3/the X case)?

jjn2

Loafing Oaf wrote: »

You're right about this, she was quite certain, rightly IMO, that she was not legally entitled to terminate the pregnancy on the Monday or Tuesday, as would be standard practice in other countries, because there was no evidence of a substantial threat to Savita's life at that point. Are you happy that medical care for miscarrying women in Irish hospitals is below international standards in this way (as a direct result of Article 40.3.3/the X case)?

By below international standards, do you mean below international standards in terms of choice offered, or in terms of outcomes? If the latter, is there actually evidence, or has it been established that a worse outcome could have been predicted with expectant treatment, given what the doctors knew?

Loafing Oaf

jjn2 wrote: »

By below international standards, do you mean below international standards in terms of choice offered, or in terms of outcomes? If the latter, is there actually evidence, or has it been established that a worse outcome could have been predicted with expectant treatment, given what the doctors knew?

In terms of the choice. This is probably lazy and complacent, but if a medical thing is done one way in Ireland and another in most developed countries, I tend to think it's more likely they're the ones doing it right...

homerjay2005

Kiwi in IE wrote: »

I think you are missing the point completely.

If Ms Halappanavar had recieved the appropriate treatment as per any other First world country, where law is not influenced by religious principles, there would in all probability, have been no sepsis. Therefore the Sepsis policy of GUH and whether or not it was followed, would have been irrelevant.

It seems Ms Halappanavar could have been saved twice; firstly if she had recieved appropriate treatment for the miscarrying of an unviable feotus, this the law prohibited, and secondly if the medical team had dealt appropriately with the sepis that resulted from the law preventing best practice in the treatment of her primary condition.

so what infection did she have when she was admitted to the hospital? she came in for a reason and likewise, the baby died due to something.

it is very straightforward here, they didnt think her life was at risk, what ever infection she had, is what ultimately escalated her condition which led to the sepsis infection.

a termination is not a cure for sepsis either i may add.

I Heart Internet wrote: »

Bad practice, not legal confusion, seems to have been behind this tragedy.

this sums up the entire case IMO.

I Heart Internet

Loafing Oaf wrote: »

Are you happy that medical care for miscarrying women in Irish hospitals is below international standards in this way (as a direct result of Article 40.3.3/the X case)?

Medical care for miscarrying women and pregnant women in general is not below international standards in this or any other sense. There is no evidence that the consultant or medical staff required the option of earlier delivery of the baby in this case to save the life of the mother. The consultant has made it clear that she did not believe delivery was necessary any earlier than when she decided to intervene (as it happens, Savita delivered the child naturally while being prepped for this intervention).

What appears to have been drastically at fault here was the identification and treatment of severe infection.

Those who, from the very begining of this case, literally day-one once it broke in the media, sought to use the tragedy to further their own political aims - in particular to influence the ongoing debate on dealing with the X-case (a very important decision it its own right)- should hang their heads in shame.

Loafing Oaf

I Heart Internet wrote: »

The consultant has made it clear that she did not believe delivery was necessary any earlier than when she decided to intervene.

Have you a citation for this?

I Heart Internet

Loafing Oaf wrote: »

Have you a citation for this?

Dr Astbury said she was not aware of the results of blood tests conducted four days after Ms Halappanavar was admitted, where her condition was deteriorating. If she had been aware of the result, she would have seen her soon. At the time, she didn’t have the blood result and was working only on clinical signs. There was no evidence to suggest she had severe sepsis.
“If we had the blood results back sooner we may have considered intervening sooner,” she said.

from http://www.irishtimes.com/news/health/savita-halappanavar-s-consultant-acknowledges-hospital-systems-failures-1.1355804

A scan at 2pm found the foetus had died and Ms Halappanavar later delivered. Dr Astbury told the inquest she would have prepared to terminate Ms Halappanavar’s pregnancy five hours earlier than she did had she read Ms Halappanavar’s notes – which showed Dr Ikechuckwu Uzockwu’s serious concern at 6.30am on Wednesday October 24th – on her ward round at 8.20am.

from http://www.irishtimes.com/news/health/law-delayed-savita-termination-consultant-1.1356451

Dr Astbury was, apparently, willing and legally free to intervene if she had evidence that the danger to Savita was serious enough. Through system failures and human errors, it would seem, Dr Astbury did not have the evidence in front of her in order to make that decision.

Loafing Oaf

I Heart Internet wrote: »

from http://www.irishtimes.com/news/health/savita-halappanavar-s-consultant-acknowledges-hospital-systems-failures-1.1355804



from http://www.irishtimes.com/news/health/law-delayed-savita-termination-consultant-1.1356451

Dr Astbury was, apparently, willing and legally free to intervene if she had evidence that the danger to Savita was serious enough. .

Nobody's disputing that. However, she explicitly does not say she would not have intervened earlier if she had been legally free to do so, whether to accede to Savita's request for a termination or on her own medical judgment, or some combination of the two.

Atlantis50

Nodin wrote: »

...it has been deemed a contributory factor by the report into the matter, if you care to recall.

Selective leaks from a provisional draft of the report do not give a definitive answer and should not be relied upon. How about waiting for the full final report to emerge?

At the inquest on the other hand, many new facts have emerged which point to medical errors and "systems failures" as the major contributory factor to Savita's tragic death.

Shint0

[

homerjay2005 wrote: »

it is very straightforward here, they didnt think her life was at risk, what ever infection she had, is what ultimately escalated her condition which led to the sepsis infection.

Likewise, Savita's husband repeatedly said in media interviews that they made the initial request because he said once they realised the baby would not survive they just wanted to get it over with so they could go home. So even they, themselves, at that stage must not have considered Savita to be seriously ill if they felt she could be discharged after the procedure and go home. It seems it was explained to them after the initial request that this is not a sufficient basis in Ireland to carry out a legal termination. One of the midwives giving evidence during the week did say that Savita had been one of the more healthy patients on the ward and then never saw someone to deteriorate so fast. Her condition did appear to escalate quickly but equally if her blood results had been acted upon on time the underlying infection could have been treated sooner. As to what her chances of survival would have been with earlier intervention to treat the type of infection is what I believe the inquest must try to answer.

Nodin

Atlantis50 wrote: »

Selective leaks from a provisional draft of the report do not give a definitive answer and should not be relied upon. How about waiting for the full final report to emerge?

.....

...that wasn't the provisional draft.

The final draft report says: “The investigating team considers there was an apparent overemphasis on the need not to intervene until the foetal heart stopped, together with an underemphasis on the need to focus an appropriate attention on monitoring for and managing the risk of infection and sepsis in the mother.”

http://www.irishtimes.com/news/health/savita-halappanavar-death-report-finds-foetus-not-mother-was-main-focus-1.1345890

Atlantis50

Nodin wrote: »

...that wasn't the provisional draft.


http://www.irishtimes.com/news/health/savita-halappanavar-death-report-finds-foetus-not-mother-was-main-focus-1.1345890

My use of the word "provisional" was unnecessary because "draft" by definition means that the report is provisional / preliminary:

draft

[draft, drahft] Show IPA
noun 1. a drawing, sketch, or design.

2. a first or preliminary form of any writing, subject to revision, copying, etc.


[...]

http://dictionary.reference.com/browse/draft

Happy now?

Flier

GCU Flexible Demeanour wrote: »

Look, you don't even need to go there. Now, unless you are suggesting both that the GUH protocols for dealing with sepsis are unlawful and that the the consultant microbiologist at the National Maternity Hospital doesn't know that there's a conflict between the law and appropriate action, your point seems to fall. I've tried to explain twice why your statement isn't dealing with the point. I'm afraid I can't put it any clearer - I can't see any reason for confusion.

How on earth did you infer that I might have taught the protocols at UCHG were not legal. I presented the 'timeline' :

http://www.irishtimes.com/news/healt...days-1.1357554

Above is a useful 'timeline' of the salient events as heard at the inquest.

There was a clinical diagnosis of chorioamnionitis by the SHO at 6.30am.
The consultant diagnosed sepsis (but not severe sepsis) and probable chorioamnionitis on her rounds at 8.25am.
I wonder what was the delay in evacuating the uterus at this point, if it wasn't waiting for there to be a perceived 'substansial risk' to life. If the law allowed termination for less than a 'substantial risk', would there have been a delay at this point.
I accept that there were mistakes made (I would be surprised if errors were not found to be made in any random sample of clinical cases), but the situation in law was the main reason for delay in instigating proper treatment.




..and asked you the question:


.....Given the clinical evidence which I've presented, which is what was known at the time by the treating medical team, what do you think would have been the appropriate course of treatment, and did the law interfere with the appropriate course being taken?




Which you seem to be more than happy to ignore!



If we accept that mistakes were made, and even if we go so far as to say that perhaps the situation might not have ever got to be critical if the appropriate measures were taken earlier (although I doubt that to be the case unless a termination was part of those measures), that still leaves us with woman who is in need of intervention. Given what the medical team knew, they still felt they were restrained by law, as 'substantial risk' in their clinical judgement had not been reached. The consultant knew that there was sepsis, she knew what the appropriate treatment was, but felt that in her judgement, she was not free to act. So while the skills and facilities were there to offer the best treatment at that time, and evacuation of the uterus, it wasn't done. Despite the errors that had happened before, at that stage in events, it was the law that was the impediment. It was due to this law that the next 'layer of protection' to trap errors was not available. Unfortunately it seems, that was the last layer and the holes in the 'swiss cheese' were duly aligned. http://en.wikipedia.org/wiki/Swiss_cheese_model

Atlantis50 wrote: »

The media are gradually come around to accepting and reporting the fact that medical errors played "the pivotal role" in Savita's tragic death

The media's opinion is irrelevant - the coroner gets to decide on this one. In fact, some of the media coverage just exposes how badly versed in medical matters their correspondents are. The are journalists after all.

GCU Flexible Demeanour

Flier wrote: »

How on earth did you infer that I might have taught the protocols at UCHG were not legal.

I've simply pointed out that it's a consequence of your dogmatic position. You are completely ignoring the expert assessment given by the consultant from Holles Street, simply because it doesn't sit well with the political point you want to support.

Flier

GCU Flexible Demeanour wrote: »

I've simply pointed out that it's a consequence of your dogmatic position. You are completely ignoring the expert assessment given by the consultant from Holles Street, simply because it doesn't sit well with the political point you want to support.

No,not at all. I accept that there were mistakes. I accept the statement from the microbiologist. But despite the errors, there was still a chance to safe this woman's life, and that chance couldn't be taken because of a legal situation.
It seems it is you who is ignoring the obvious.

GCU Flexible Demeanour

Flier wrote: »

No,not at all. I accept that there were mistakes. I accept the statement from the microbiologist. But despite the errors, there was still a chance to safe this woman's life, and that chance couldn't be taken because of a legal situation.
It seems it is you who is ignoring the obvious.

No, you've still not understood that you are seeing the possibility of happenstance as a solution.

This is not a defence of the present constitutional position on abortion; it's just to point out that it's not the pivotal issue at stake here. Some people yearn for it to be the pivotal issue, and have expressed that yearning as if it were fact for weeks past, before any actual facts were revealed.

Flier

GCU Flexible Demeanour wrote: »

No, you've still not understood that you are seeing the possibility of happenstance as a solution.

This is not a defence of the present constitutional position on abortion; it's just to point out that it's not the pivotal issue at stake here. Some people yearn for it to be the pivotal issue, and have expressed that yearning as if it were fact for weeks past, before any actual facts were revealed.

Once again, a lot of waffle, no substance. I rest my case.

Grayson

Shint0 wrote: »

[
Likewise, Savita's husband repeatedly said in media interviews that they made the initial request because he said once they realised the baby would not survive they just wanted to get it over with so they could go home. So even they, themselves, at that stage must not have considered Savita to be seriously ill if they felt she could be discharged after the procedure and go home. It seems it was explained to them after the initial request that this is not a sufficient basis in Ireland to carry out a legal termination. One of the midwives giving evidence during the week did say that Savita had been one of the more healthy patients on the ward and then never saw someone to deteriorate so fast. Her condition did appear to escalate quickly but equally if her blood results had been acted upon on time the underlying infection could have been treated sooner. As to what her chances of survival would have been with earlier intervention to treat the type of infection is what I believe the inquest must try to answer.

The simple fact is that the foetus was not going to survive. But a termination was refused because they didn't think her life was in danger (I'm going with the fact that she died to show that she was in actual danger). That's two things wrong.

If they had proceeded with a termination anyway, she probably would have survived. The law, heavily influenced by catholic teachings, was to blame for that.

It was incompetence that caused the misdiagnoses. I seriously hope someone loses their license and goes to jail for it.

Shint0

Grayson wrote: »

It was incompetence that caused the misdiagnoses.

I do agree with this but the law as it currently stands could also have protected her. It just wasn't applied in a timely fashion due to mismanagement.