Poor care killed woman denied abortion

Apr 19, 2013, 5:01 PM EDT
Praveen Halappanavar outside Galway County Hall, Ireland after the jury in his wife Savita Halappanavar's inquest returned a unanimous verdict of death by medical misadventure on April 19, 2013.
AP/Julien Behal, PA

DUBLIN (AP) — A miscarrying Indian woman who died from blood poisoning in an Irish hospital after being denied an abortion perished because staff bungled her diagnosis and didn't give her prompt treatment, a jury unanimously ruled Friday in a case that has divided Ireland.

The findings from a two-week coroner's inquest into the causes of Savita Halappanavar's Oct. 28 death at University Hospital Galway confirmed what her widower, Praveen, has maintained all along: Hospital staff refused to give his wife an abortion citing the country's Catholic social policies, waited three days until the 17-week-old fetus had died, then discovered she was in an advanced state of septicemia. She died three-and-a-half days later from organ failure.

At the conclusion of his fact-finding probe the Galway coroner, Dr. Ciaran MacLoughlin, praised Praveen Halappanavar for his courage in protesting publicly against his wife's medical treatment at the western Ireland hospital, where doctors had refused to perform a termination while the fetus retained a heartbeat. Halappanavar then shook the hands of the six-man, five-woman jury that ruled she died from "medical misadventure," meaning incompetence in her care.

Outside, he said legal action would continue to try to make particular staff responsible for her death. He said the hospital's inaction for several days of his wife's deteriorating health during a drawn-out, painful miscarriage meant she might as well have stayed at home.

"Medicine is all about improving patients' health and life. And look what they did. She was left there to die. It's horrendous, barbaric and inhuman the way Savita was treated in that hospital," said Praveen Halappanavar, speaking on the day that would have been the couple's fifth wedding anniversary.

"They could have intervened right from day one because they knew the fetus was inviable, so why wait?" he said, adding that the testimony had pinned down system-wide failures but no personal responsibility. "The midwife blames the consultant (doctor), the consultant blames the law. ... Somebody has to take ownership when a patient walks into the hospital."

The case highlighted a two-decade dilemma in Ireland's abortion law. A 1992 Supreme Court ruling declared that abortions deemed necessary to save a woman's life must be legal, but successive governments have refused to pass any law to support the ruling, fearful of voter backlash where Catholicism remains the dominant faith. That has left doctors fearful of facing prosecution for murder if they perform terminations in a country whose constitution contains a blanket ban on the practice.

The government of Prime Minister Enda Kenny has pledged it will pass a law, with related medical guidelines, by July that defines when life-saving abortions can be given. But Kenny's own party is split down the middle, with Catholic conservatives pledging to vote against the measure amid lobbying by church leaders.

MacLoughlin published eight recommendations for the hospital to improve how it records and shares patient information among staff, and monitors the risk of infections and blood poisoning in its patients.

His other recommendation was for Ireland's Medical Council to publish guidelines defining the exact circumstances when an abortion can be performed to save the life of the woman. These guidelines, long sought by doctors at Ireland's maternity hospitals, "would remove doubt and fear from the doctor and also reassure the public," he said.

MacLoughlin didn't rule on the question of whether an abortion one or two days before the fetus died would have saved Halappanavar's life. He found instead that staff failed to test her blood sufficiently for signs of poisoning; results which showed signs of that poisoning weren't consulted for hours or even days; and the hospital's notes on her file were incomplete, unclear and even had been unprofessionally amended in eight places days or weeks after her death. He said that should never happen again.

During the inquest, the key expert witness, Peter Boylan, former master of a major Dublin maternity hospital, said he was confident that an abortion one or two days before the fetus died would have saved Halappanavar's life.

He described her case as a deadly Catch-22, because Irish law meant doctors cannot perform a termination "unless the woman looks like she is going to die." By the time doctors finally reached that conclusion on the day her fetus died, he said, "it was already too late."