25/11/12

Irish Independent

By Maeve Sheehan

Sunday November 25 2012

Bereft and grieving, Praveen battles on

Widower has not wavered in his account as he continues to look for a public inquiry

GIVEN the shambles of the official response into the death of his wife, few would blame Praveen Halappanavar for doubting the system. Savita died on October 28 at University Hospital Galway and, at almost every turn since, something has turned up to feed Praveen's suspicion that the health services cannot be trusted.

There have been complaints of incomplete medical notes; an internal hospital review that was bumped up to a national investigation before settling on calling itself a clinical review. Consultants appointed to it were booted off after its independence was questioned; and there have been cack-handed megaphone appeals from no less than the Taoiseach to a grieving husband.

The scandal is how an otherwise healthy and fit 31-year-old woman died. She was 17 weeks pregnant; the baby was dying inside her; she pleaded for a termination but, according to her husband's account, was told Ireland is a Catholic country. She delivered her dead foetus and died of blood poisoning days later. Her husband believes that she would still be alive had the foetus been terminated. Two investigations are now underway – both of which fall far short of Praveen's call for a public sworn inquiry, at which witnesses could be cross-examined.

The HSE is conducting a clinical review, which it says it is compelled to conduct under best practice guidelines. The health watchdog, Hiqa, has launched a statutory investigation – in part because the HSE asked it to conduct an inquiry, but also because it seems the watchdog has concerns of its own. It will investigate the safety and quality of care given to critically ill patients – not just the care that was given to Savita, or other pregnant women.

Praveen and his solicitor Gerald O'Donnell are still holding out for a public inquiry, following a hastily arranged meeting on Friday with the Minister for Health James Reilly, who happened to be in Galway at a health event. While government sources are not ruling one out, Dr Reilly has said he is confident that the existing inquiries will establish the truth of what happened to Savita.

There are two sides to this story and the hospital's account has yet to emerge. Some sources say that the hospital staff will challenge Praveen's account that he was told by a hospital consultant that "this is a Catholic country" so his wife's baby could not be terminated.

Whatever the truth of what happened to Savita, the tragedy of it has been compounded by the fact it now seems that the State and its agencies struggled to deal with the fall-out from her death.

Praveen has not wavered in his account of what happened, most recently in an interview with RTE's Miriam O'Callaghan on Prime Time last week.

How on October 21, she went to University Hospital Galway complaining of severe back pain to be told by a doctor that she was miscarrying: "He basically said the baby would not survive, it's cervical dilation, the cervix is open," he said. The doctors told them they could do nothing because the foetus was still alive. According to Praveen, Savita said: "'No. Can't take it, please terminate'. She requested. Basically, the (doctor) said he will check and come back because Savita was so insisting." He continued: "We were waiting for the doctor to come back to us on the termination. We were waiting and the doctor came for the morning rounds around 10.30 along with the two other junior doctors. There was the midwife, the nurse, you know and also we had a close friend of ours with us, visiting us in the room. . . The doctor said unfortunately the foetus is still alive and it's a Catholic country and we won't be able to terminate. That's what the doctor said. Savita was insisting that she's not a Catholic and she's not Irish either so why impose the law on her?"

Savita's health worsened on Tuesday night. On Wednesday, she delivered the dead baby in the operating theatre. By Thursday afternoon Praveen was told that "further tests picked septicaemia, septic shock". He said the doctor told him "she is critically stable" and was "on antibiotics". "On Friday they started telling me that she was critically ill. She is very, very ill." She died early on Sunday morning, 28 October. Asked if he believed she would still be alive, if she had had a termination, he replied: "Of course, yes."

A spokesman for Galway University Hospital has pointed out that it responded immediately to Savita's death, notifying the coroner, who notified the gardai, conducting a risk assessment, notifying the maternal deaths register and preparing a clinical review of her death. It also dispatched a letter of condolence to Praveen on October 31, which apparently included mention of an internal review of his wife's death. But Praveen has insisted that he went public with his story because "nothing was being done". He appointed a solicitor, Gerard O'Donnell, before he returned to India with his wife's remains. Her distraught family in Belgaum – her parents had just returned from visiting their daughter in Ireland days before her death – were disbelieving. He could tell them nothing as he had heard nothing. Although in fairness to the hospital, it apparently had no contact details for him in India.

But in his absence, Praveen's Indian friends in Galway took action on his behalf. They contacted a pro-choice group in the city, met one of its representatives, and discussed how to break this major story: Praveen could go for a public onslaught or insist on anonymity. Praveen chose to go public.By the time the news of Savita's death broke on November 14, Galway University Hospital's internal review of Savita's death still had not begun, and her medical file had still not been released to her husband's solicitor.

With the hospital under international media scrutiny, this was not good enough. Her death, as told by her husband, was laden with suggestion of religious dogma still lurking in a secular health system in a country polarised over abortion.The HSE stepped in. On November 15, the day after the story broke, it announced that the hospital's local review was being bumped up to one that would be "overseen" by the HSE's National Incident Management Team – with the assistance of an independent external expert. On November 16, Savita's medical records were released to Praveen's solicitor, O'Donnell. He found no mention in the notes of Savita's multiple requests for a termination, even though at one point, according to Praveen's account, a doctor went off to check with another whether one was possible. As Praveen later said, the notes included requests for tea and toast and a blanket, but not for a termination.

Michael Boylan, a lawyer experienced in cases of a medical nature, regarded this as surprising: "It is surprising that there is no mention of it whatsoever. You would have expected there to be some note of it."Those were not the only issues relating to the hospital's record-keeping. Retrospective notes were added to Savita's file. It's common for staff going off duty to fill in medical records at a later stage. But according to O'Donnell, some notes were added after Praveen had requested the file. "There are entries after I requested the notes. My request went in on November 2. I would say that someone sat down and began to look at this file after my request went in," said O'Donnell. "In fact, I'd say someone sat down and looked at this file after the poor lady died. Certainly after my request went in, I'd say they had to look at it a bit closer."

Over last weekend, the HSE found an expert to appoint to the national incident management team's overseeing of the review of Savita's death. But the Government and the health authorities were mistaken if they thought that the announcement of this inquiry would bring lockdown on the scandal. Last Saturday, Praveen's solicitor spoke to the HSE director, Dr Philip Crowley, to discuss the draft terms of reference of this inquiry. O'Donnell claimed he told Dr Crowley that Praveen wasn't happy with the HSE conducting the inquiry: "I said to him, 'I'm flagging this now for you and I will write to you on Monday setting out my thoughts in writing'. I did that and sent off the letter. Then on Monday afternoon I heard they had gone ahead and established it anyway. That's why we have no faith in the HSE."

At a press conference last Monday, the HSE's "review" was bumped up to an "investigation", headed by Professor Sabaratnam Arulkumaran, a renowned expert on obstetrics and gynaecology from London – who himself was accused of being a liberal on abortion. Surprisingly, the three consultants who worked for Galway University Hospital were originally selected by the hospital to do the initial local "review" of Savita's death. According to the HSE this weekend, the three Galway consultants were simply "subsumed" into the bigger inquiry, yet no one had spotted the potential conflict of interest in having three consultants help investigate the very hospital they work for.

By Thursday, Tony O'Brien, the head of the HSE, was calling the "investigation" a "clinical review", acknowledged its limitations and called in the health watchdog, Hiqa, to add independence by launching a statutory inquiry. Regardless of Praveen's concerns, it would be criminally negligent for the HSE's inquiry not to proceed.

But the controversy and confusion over the setting up of an inquiry into Savita's death became an ugly side show in an appalling human tragedy. Threats from Praveen's solicitor of High Court injunctions to stop the inquiry by refusing it access to Savita's medical records, talk of complaints to the Data Protection Commissioner about breaches of confidentiality, of complaints to the Ombudsman, have as yet come to nothing.

This weekend, O'Donnell had suggested that a commission of investigation – if it included cross examination and was in public – might just do. Praveen meanwhile cuts a lonely figure, bereft, grieving and the only representative of their families in Ireland to battle for answers over her death.

"The family are very much behind him, they are on to him several times a day. And they want a public inquiry. So he is doing his best for them as well, both for his own parents and for Savita's parents," said O'Donnell.