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HIQA HAS REVEALED details of a 12-member team to investigate the circumstances surrounding the death of Savita Halappanavar in Galway two months ago.
The Indian woman, 31, died of septicaemia at University College Hospital in Galway two months ago, days after being denied an abortion when she learned she was miscarrying.
The team will be led by Dr Paul Fogarty, a consultant obstetrician and gynaecologist from the Ulster Hospital in Belfast, who specialises in ultrasound and foetal medicine and in medical education.
Dr Fogarty has previously chaired the UK’s National Patient Safety committee, and helped to oversee the production of the Northern Ireland Maternity Strategy.
Three of the other members of the team have also been drawn from the UK; they include Dr Nuala Lucas, a consultant anaesthetist based in Middlesex; Denise Boulter, a midwife consultant in Northern Ireland; and Dr Bharat Patel, a consultant medical microbiologist from the UK’s Health Protection Agency.
The team will also include Dr Robert Cunney, a consultant microbiologist from Temple Street Children’s Hospital who is also the coordinator of the Irish Paediatric Surveillance Unit, and a lay member, Loretta Evans, a patient safety activist.
The identity of a seventh external member has not yet been revealed, as the final member is still in the process of being appointed.
The seven-member unit will be managed by five staff from HIQA, including its director of regulation Phelim Quinn, each of whom will also form part of the investigation team.
The group are to be tasked with reviewing the safety, quality and standards of services provided at University Hospital Galway to its patients at risk of clinical deterioration, and in particular to Savita Halappanavar in the time leading up to her death.
The unit will have the right to enter and inspect premises, records and documents, and to conduct interviews and seek explanations from concerned individuals. It also has the power to commission the expert advice of external parties.
The terms of reference for the inquiry team, which were published last month, do not define a deadline by which the team must issue a report.
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there is no need for a inquiry,under Irish law a medical professional cam preform an abortion where the result of not doing so will kill the mother..it was incompetent for them not to preform an abortion and let the mother die..
So without any inquiry or investigation taking place; you’re quite happy to label an entire medical team as incompetent? ffs
No.
Termination can only be provided where there is an immediate risk to the life of the mother, where treatment is emergency termination.
Treatment for miscarriage is early termination, NOT emergency termination. By emergency termination septicaemia has taken over and there is really nothing that can be done to reverse this.
You’d be thanked if you would kindly leave out the cry of incompetence until reports are compiled.
I suppose your right its better to have a team of 12 at a cost of millions tell you the exact same thing..
just bring it straight into court find out why they ignored the law or didn seek more clarification then anyone guilty prosecuted
It’s a bit premature to label anybody as negligent, because obody knows the actual facts of this case. There hasn’t been a coroners verdict on the cause or circumstances that may have led up to this death and no details have emerged from the internal review which is standard. How can HIQA conduct an inquiry in the absence of the facts from the internal inquiry and coroners verdict?
Sorry James but I do not understand the difference . Can you explain.? Surely if the woman’s waters had broken, such in the case of Savita, the like hood of infection was greater to her?
It is my understanding that Savita was already miscarrying her baby and she and any woman in the same position, where clearly the foetus could not survive outside the womb should, in my opinion be offered a termination ASAP. It’s traumatic enough for any woman to suffer a miscarriage but to make her suffer in a hospital bed for days is in my own opinion inhuman . And my point have nothing to do with religious aspects.Is this the common occurrence for a woman miscarrying?
At the same time I am not laying any blame at the hospitals door because I do not know all the facts.
Hi Mary. The law in relation to termination states that there must be a “Real and immediate risk to the life of the mother” before a termination can be sought.
When Savita presented at GUH she was bleeding, leaking amniotic fluid and in pain. This characterises a miscarriage to a fault, however, the risk is only to the health of Savita, not her life and therefore termination cannot be obtained, as it would have been an “elective” procedure, not an emergency procedure.
As time goes on, the procedure becomes a semi-elective one, and eventually an emergency one. Termination can only be carried out when the procedure is emergent, not elective.
Yes, you are correct, a miscarrying woman does have a heightened chance of being infected, yes it is inhumane, it is cruel, it is frustrating, it is wrong to hold a miscarrying foetus to higher regard than the woman carrying it.
@James …. Thank you for explaining. Who the hell makes up laws like this which I assume are the same all over the country.? It plainly shows little or no concern for the physical health of the mother let alone for her mental state which must be devastating. How can anyone place the life of an unviable foetus on par with the life of a mother , who may have other children at home who depend on her. How do hospitals make judgement calls like that ? The mind boggles.!
@ James “the risk is only to the health of savita and not to her life”
obviously not true as the girl died.
@mary I agree
Mary, it’s a law that doesn’t protect the people who use the service, or those who work in it – it is designed to keep various interest groups appeased, which is utterly disgraceful.
Vinnie, I’m not arguing with you because your initial comment shows me there’s no point.
Thank you James . It is kind of scary as I always had the utmost confidence in the hospital any time I was unfortunate enough to be admitted. I never thought various interest groups could impact the treatment I was given.
I notice a few people talk about what the law says, but part of the problem is that there is no law stating when an abortion can be performed.
There’s the Constitution, which says the mother has an equal right to life but there’s no law in place setting out how to apply that right in practical, day to day, terms; there’s the X Case judgement, which isn’t relevant in every case; and there are Medical Council guidelines, which don’t have the force of law behind them. On the other hand, there’s the 1861 Offences against the Person Act, which includes a prohibition on abortions.
In any case, HIQA’s enquiry won’t be to determine if there was criminal wrong doing. It’s to establish if best practices were followed, to identify errors in systems and processes and to make recommendations on improvements. But if anyone thinks they’re going to be chummy with the HSE, you only need to read their previous enquiry reports to see that they definitely won’t be.
Still have the utmost confidence in your team – they are very highly trained, it does have to be stated this case is unusual. (That’s not to say we don’t have to presume it won’t happen again though).
The idea of healthcare providers acting on the basis of beliefs is laughable – healthcare has to be universal as not everybody believes in the same thing, as we are now seeing.
A healthcare professional should be able to practice to the limitations of knowledge, not the limitation of belief, and health care systems should be secular, as anything else is a discrimination against those who don’t possess the same beliefs as us.
Can someone answer this question.
If someonedies after going into hospital with say a toe injury and subsequently it is revealed there is possible medical negligence factor in the death, how is this case investigated.?
Why is it that we are scrambling to set up inquiry panels and investigative teams in the Savita case, surely we should have an automatic investigation system/process in such situations.
Good luck with that, Rory. I’ve been asking the same question for weeks.
The HSE has a National Incident Panel, which investigates all such incidents.
If it is found that a medical practicioner has mal-practiced, a case will be taken through the Irish Medical Council.
If it is found that a nursing practicioner has mal-practiced, a case will be taken through An Bord Altranais.
The reason there are other investigations in this case is to ensure the highest of care, especially as it could be an incident that affects the safety of every woman in the country, not just women who attend GUH.
Well there’s no public debate about the ethics of toe-removal, and toe removal isn’t a procedure which one entire gender will be likely to be involved in at some stage of their lives, and two lives aren’t at stake where the outcome of a toe-removal operation is concerned. If it’s not safe to give birth in this country because womens’ lives are being put at risk by doctors who are prevented from acting because of our dated and uninformed practises, I’d like to know so that I can go elsewhere to do so when I have children. Lawmakers will need to know the exact circumstances so that they can draw up befitting legislation which doesn’t allow on-demand abortions but protects the life of the mother too.
I just can’t believe how ignorant the hospital staff were and hope they are seriously considering the heinous results of their negligence. Instead of saving the mother’s life they decided to let both die. How is that pragmatic in any way?
Toe injury death – inquest; following inquest there would probably be an internal hospital inquiry; or an HSE inquiry. I doubt this would be public or that it would make the media. Again, the family of the deceased may well have to start legal proceedings to find out the whole truth of why their relative died.
The problem with unexpected / controversial deaths which occur whilst the person is under medical care (I am being careful not to use the word negligence here) is that the inquiry is too often seen by those outside the medical profession as a cover-up – the doctors looking after their own. This has happened in most, if not all, professions (try to get a solicitor to sue another solicitor for you). Part of the blame for this lies with the insurance which will not allow apologies becasue apologies = admission of guilt.
In many medical situations there may be more than one course of action which the doctor may take. Sometimes, unfortunately for the rest of us, he / she may choose the wrong one. Is this negligence? I would say not, but if the family go to another doctor and s/he says “Well I would have done something different which may have meant your relative would not have died” the family may think they have a case which they can pursue.
All unexpected deaths under medical care should be investigated in the way plane crashes are – what went wrong, why and what should we do to prevent this happening again. Not, as at present, who got it wrong, who can we blame, who can we sue.
As for why this case has had so much media attention – you know the answer to that full well, Rory. Ireland is a really evil place where women cannot at a whim, decide to abort any baby they may have conceived regardless of any circumstances surrounding the pregnancy.
@ Orly
‘If it’s not safe to give birth in this country because womens’ lives are being put at risk by doctors who are prevented from acting because of our dated and uninformed practises, I’d like to know so that I can go elsewhere to do so when I have children’
This particular statement undelines why any sort of reasoned debate is impossible on this topic. Ireland is in the top 6 safest places in the world to have children and you owe it to your future children to become more informed
Actually Josh, the “Ireland is one of the safest places to have a baby” is more testament to poor Irish record keeping than our maternal safety.
Turns out we weren’t using the same criteria for our assertion that the rest of the world uses.. When these criteria are applied, Ireland comes far lower on that list, in around the average.. Perhaps you are the one who needs to be properly informed, after all, it’s been all over the news the past few weeks..
Why do people keep saying that women’s lives are in danger because of no abortion available here when even the dogs in the street know that the mother’s life is always given priority in circumstances where her life is in danger in Irish hospitals. It is a recognised fact and acknowledged right across the board that Irish hospitals have the lowest number of deaths of mothers having babies, so why do people keep lying and giving misinformation regarding this. And why do some people keep referring to the death recently of Savita, when the investigation has not been completed and they don’t know the full story?
You don’t know what happened in this case because the investigation is not completed yet. Please deal in facts, not propaganda.
Agree 100 per cent
Would that be the same news that had a “muddled” story according to the person who broke the story about the unfortunate mother who died in GUH?
@ Shanti,
Let’s see these reports that you refer to and then let’s compare them with the UN and other Reputable bodies reports
Hi Josh; Shanti is correct in what she says – Ireland’s method of recording differs to that of the main bodies of stat recording – the UN and WHO.
Where a pregnant mother dies in a setting other clinical it is not recorded as being Maternity Related in Ireland however is under the UN and WHO recording protocols.
Add to that, the fact that not all deaths are counted as maternal deaths on death certificates, this being due to the inconsistent passing of information from the Coroners office.
A conservative estimate were we to count deaths as above places the MMR at twice what it is being reported as (it is hovering around 6pa at present), this could be easily as high as 12-15.
@ James Connolly, some really clear, informative and enlightening posts. It is so helpful to read explanations from someone who is expert in real and actual practice and not driven by some ideological or dogmatic position.
Many thanks indeed.
I am in awe of the burden of responsibility on all clinicians and the level of expertise which exists in Ireland has a lot to be proud of in relation to standards of maternal care and, if the law is at fault, as I suspect it is, that is such a tragic shame.
Let us keep our minds open to the possibility that it was bad law which caused Savita’s death. If it was bad law, the situation of the medical team was horrific, not as horrific as for Savita Halappanavar and her husband Praveen Halappanavar, but an experience no one should ever have to endure.
One thing is crucially important. Let not the medical team be scapegoated if it was bad law which is to blame. I am led to believe that the medical team and the lead consultant are devastated by what happened. They deserve fairness and fair process.
I detest when the pro life advocates raise the possibility of medical negligence as a means of distracting from the constraints of law.
Hi Peter, thank you for your posts. They’ve been very helpful, and provided a good basis of the legal situation better than I could ever provide.
Any info you need, holler. I’ll endeavour to answer, I troll the forums here to provide accurate info to those genuinely looking!
Debates like these need to be accurate not emotive.
I agree James! U have to wait for the outcome but the majority when got wind of savitas story didn’t wait for the outcome
And that is the best argument against a public enquiry. It’s important that all evidence is heard and considered before a conclusion is reached. In a public enquiry each days incomplete will be analysed and it’s possible for incorrect conclusions to be arrived at early. And these have a habit of becoming ‘fact’.
Also in Ireland if its found they the doctors were negligent towords the mother they are in trouble
You’re right; they will be.
But before we start blaming doctors and nurses and midwives can we see the initial indication please? Thanks.
So more than 50% of the 7 person “Team” will be from the UK where abortion on demand is a common and everyday occurrence.
Well then they would probably know more about these procedures. You comprise an ‘expert’ panel of people who actually have experience in the field in question. And this inquiry is not about whether abortion is right or wrong, It’s about determining the exact cause of this tragic death.
Not in Northern Ireland, looks like two of the UK-based team are from there.
The HIQA Investigation is a general investigation into standards and procedures. From a legal perspective it is ill suited and legally inappropriate to an inquiry into Savita Halappavar’s tragic death. This is not a criticism go the objectivity and transparency of the inquiry by HIQA, merely that HIQA was not statutorily established for this type of inquiry.
The Terms of Reference are rather stretched in a attempt to get over the lack of statutory power to investigate a specific case. That said, I really hope that the investigation will reveal the full facts and circumstances.
Based on the accounts as reported thus far, I see no indication that there was any medical negligence and it is important that the clinicians are given a fair hearing. As a retired lawyer, I remain of the provisional view that it was bad law, not bad medicine which was at fault.
I believe that the law should never interfere in the boundaries or limits of appropriate medical therapeutic treatment.
I know very little of medicine and I would be very interested in a nursing or medical practitioner’s view as to the dividing line between a woman’s health and a woman’s life. My impression, I may be wrong, is that life and health are like a continuum as as health is compromised eventually life expectancy and life itself may be placed in peril.
Laws are such a blunt, poorly nuanced, and inappropriate way of addressing complex medical situations which are dynamic and fast changing.
I dislike the idea of laws reflecting a particular religious dogma.
It seems to me that lawyers make really bad doctors and Archbishops make atrociously bad lawyers, which is saying something.
Hi Peter, I should have differentiated between the risk to life and the risk to health, apologies!
A risk to health is a risk to the general wellness of a being. The end point is illness. For example if you are exposed to someone with the flu, you have a risk to your health – resulting in flu.
A risk to life is self explanatory – the end point is death. To continue the analogy above, if you don’t treat the flu, it evolves to something more serious like pneumonia, which is a risk to the life of the patient. This is just an example, obviously. (Flu doesn’t always lead to pneumonia, just an illustration!)
Thank you for your posts Peter, informative as always! Keep them coming!
Any other questions or info required – holler! Very important that facts are known instead of emotive arguments from either side!
Rgds, J
What happens when women die from infections from abortion? The reply I received from a pro-abort was ‘well that just happens.’ http://www.dailymail.co.uk/news/article-2206202/Teen-mum-abortion-wasnt-ready-second-baby-died-contracting-superbug-procedure.html
What happens when women die? So-called “pro-life” groups simply don’t give a damn!
There is a risk factor with everything, whether it’s taking blood, or gaining IV access, or attaching a ventilator, or taking an appendix out, or the removal of an ingrown toe nail or whatever – everything has a risk factor. There is nothing 100% safe, and as long as humans are involved in the administration of health care, that’s the way it’s always going to be.
This woman died of StrepB, an infection which she had a 1:800 chance of contracting, and a 1:10,000 chance of being fatal to her. That is the same basic risk factor for every patient, not just those of termination services – this woman could easily have been obtaining an appendectomy, or a course of Chemotherapy, or it’s quite possible she might have been just lying in her hospital bed – that is not termination specific, it applies to every patient of every service.
If youth defence and other ‘pro-life’ activists care about babies’ lives why haven’t they started a campaign against religious circumcision? Babies have died from infections passed during the ritual, so New York have even brought a law in so parents have to sign a disclaimer stating they know the ritual could be fatal. How come that isn’t addressed? Is it because the ‘pro-life’ side only care about religion and not the welfare of life?
‘Pro abort’ – you’re nailing your colours to the mast with this Youth Defence term. Incidentally I had a long discussion with members of said organisation a few weeks ago when I was accused of being a ‘pro abort’ because I questioned their methods.
Lets have a reasoned debate on this, where the real issues are properly debated, rather than a name calling match which it seems to be descending into already.
An estimated 68,000 women die from illegal or backstreet abortions too, which is what happens when abortion is made illegal.
Joe, you’re absolutely right! I’m blocked from their page for asking honest, open questions, such as asking how they got their statistics for claiming they have saved “100,000 babies”. The result of asking this question was being told that since I cannot disprove it, they can say what they like.
I got blocked from the youth defence page for asking them to provide evidence of a statement they made as without the necessary evidence they may have been committing libel.
They’re still spamming my news feed with ads and sponsored posts, despite me clicking the x and saying its against my interests.. I respect their right to have an opinion, but they really force it on you don’t they?
Hi Shanti Om – make a complaint to Comreg about text spam from a well known gym. I got free gym membership for a year from the offender.
I’m not sure what a similar punishment for Youth Defence would be – anyone got any ideas?!!!
That should have read ‘I did about text spam from……..’
150,000 terminations have been carried out on Irish women abroad since 1980, does that mean they’re deluded and think that only 50,000 were carried out or deluded and think that if termination were in Ireland that 250,000 women would’ve used the service?
have your say