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THE HEALTH INFORMATION and Quality Authority has announced details of its investigation into the safety, quality and standards of services provided by the HSE to patients, including pregnant women, at risk of clinical deterioration.
The inquiry will look specifically at the care and treatment provided to Savita Halappanavar, as an example of case managment.
Savita died on 28 October in University Hospital Galway after contracting blooding poisoning. An earlier miscarriage had lasted two-and-a-half days and, according to her husband, she was denied a termination because a foetal heartbeat was still detected by medical staff.
The Halappanavar case will not be the only element of care reviewed by the authority as it will look at the treatment available to all pregnant women at UHG.
The probe will review the diagnosis and management of patients with sepsis at the hospital and an assessment will be made against the National Standards for Safer Better Healthcare, as well as relevant evidence of what is known to achieve best outcomes – both nationally and internationally.
It will also examine the arrangements the HSE has in place to ensure that clinically deteriorating pregnant women receive care that is compliant with national standards.
The scope of the inquiry will be limited to what the Authority believes to be relevant services and material.
HIQA said that if, in the course of its investigation, it becomes apparent that there are “reasonable grounds to believe that there are further or other serious risks to the health of any person receiving similar services”, the team may recommend to the Authority and/or the Minister for Health, that these terms be “extended to include further investigation or that a new investigation should be undertaken as appropriate”.
A report of the team’s findings will be prepared and published once the investigation is complete. HIQA will also make local and national recommendations as to the standards of services provided by the HSE “to the extent that it considers appropriate”.
The Board said the report will be published after it is approved “for the benefit of the health and welfare of the public”.
For the investigation, the chosen team will have the right to inspect premises, records and documents. It also has the right to conduct interviews and ask for explanations in relation to any pertinent documents.
Meanwhile, the HSE has told RTÉ News that its clinical review into the death of the 31-year-old dentist is “well advanced”. An interim report is due to be given to the Minister for Health before Christmas.
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Let’s hope they can find simple honest answers for the family. And apply new structures in place to avoid anything similar happening to anybody else in the future.
Sadly and unfortunately HIQA cannot deliver these results. I agree that we need to stop such a tragedy happening ever again. That will require the repeal of Article 40.3.3 of the Constitution and Sections 58 and 59 of the Offences against the Person Act, 1861.
Preventing necessary and potentially life saving medical intervention by clinicians is an obscenity.
The real Edna Kenny did tell us what he would do. We did not listen. Many were blinded by his ability to fool them into hearing something other than the words he used to hide his real intent: “opposed to the legalisation of abortion”
I sincerely hope this satisfies the family.
A lot of people will be asking the same question Rory……With the 2 investigations going ahead, hopefully the results will be to the satisfaction of Mr. Halappanavar and his family..
Rory, I certainly hope that the family would not be misguided enough or gullible enough to accept the HIQA inquiry.
Patrick, these inquiries may have limited use but they are I grossly inadequate to meet Praveen’s legal entitlements and perfectly reasonable wish to find out and expose what happened to his beloved wife.
When I refer to exposure, I emphasise that I am not referring to any suggestion of clinical negligence, for which there is no indication.
Oh dear, what an unmitigated legal mess. I have just finished reviewing the Terms of Reference on the HIQA website. Originally, when I read the original proposal, I thought that this was an attempt to hammer a square peg into a round hole. Now I can see that it is a stretched effort to make a silk ourse out of a sow’s ear.
The HIQA inquiry is not a direct and focused inquiry into Savita’s death. It is a general inquiry into standards and indirectly as reflected in Savita’s care.
Section 9 of the Heath Act specifies and limits the functions of HIQA investigations. It can examining standards and observance in relation to health and welfare and try to avoid harm to health and welfare of living patients. I can think of very few forms of more inappropriate, unsuited and legally misdirected forms of inquiry.
The Senior Counsel who drafted the Terms of Reference but cannot avoid the problem that HIQA simply does not possess the legal authority to investigate Savita’s death. I am glad that Praveen’s experienced and highly competent solicitor rightly advised his client to reject and not to cooperate with this sham of an inquiry, this stunt, this shabby and cynical ploy.
Incidentally but very importantly, I have carefully sifted through the facts as reported by Kitty Holland and the particular timeline. I have spoken to a friend who is a retired obstetrician. He examined what is known, subject to the proviso that he has not seen the records and he and I agree that there is not the slightest evidence to suggest medical negligence or anything other than appropriate standards of medical care and treatment.
For now and it is a provisional view, it does seem highly probable that Savita’s death was due to the fact , the reality, that the clinicians hands were tied by bad law. That bad law prevented potentially life saving medical treatment.
HIQA was never designed for this type of inquiry and the clinicians would be well advised to take legal advice if they have not already done so.
What an unmitigated legal farce, following a desperately tragic human tragedy.
This is Ireland for you.
Get your red thumbs busy. Support authority and do your best to deprive Praveen of his legitimate and deserved entitlement to an appropriate inquiry. Criticise his solicitor, as so many have done, because if you do you prove your ignorance.
Peter you are much appreciated voice of reason on these boards.
I was dubious as to whether HIQA could actually look at Savita’s death directly, I still am. HIQA can (as far as I know) only provide guidance on standards – they can’t really look at individual cases as this is covered by the national incident body (whose name I can never remember).
You might be a better person to say if that’s accurate Peter.
@peter
I will echo annabel’s comment. Thank you for your much needed expertise in this matter. HIQA have a proven track record within the confines of their remit, which is not investigating the specifics of a case such as what happened in Galway.
Annabel, James and Irene, you are too generous in what you say and I really appreciate that moral support.
I am learning a lot about the medical dimension, which I knew very little about before the 20th November 2012 but have now garnered invaluable information from James.
As a retired lawyer, I’m frustrated by the way in which obscenely excessive legal fees and a less than scrupulous profession acted in the greedy times of the Celtic Tiger. Understandably, legal process, legal rights and fair process are now greeted with cynicism, doubt and even hostility. Then, when legal rights are so important and so critical, people attack Praveen’s motives, they invoke situations in other countries and they do everything possible to prevent a transparent and impartial inquiry. A few TDs have reported a wave of written and phone complaints urging them not to cave into Praveen’s “demands”. I am told that the Law Society has had to explain that it cannot respond to misconduct allegations about Praveen’s solicitor’s role.
It is as if a large segment of Irish society wants to dismiss Praveen’s legitimate objections. They want to tell him to accept what he is given and as a few posts actually said “to shut up”.
Others want to assume that the clinicians are to blame and they make these groundless accusations without any evidence whatsoever. One poster accused the medical team of criminal neglect and called for manslaughter charges. Frightening and reprehensible. Everything I have read, and has not been in any way contradicted, points so clearly in the direction of a legal impediment to a performance of a timely induction because of the presence of a foetal heart beat. I can’t quite imagine what it would be like to be a clinician in such a nightmarish situation but it could only have been traumatic and heart rending, the best and instinctive desire to intervene and the law manacling such intervention. This was all because zealots foisted a horrible Constitutional Amendment on us in 1983.
In 1995, I was at a social function at which two Supreme Court judges were present, both Roman Catholic. To the utter astonishment of others present, they expressed private horror about Article 40.3.3 and said that it would cause needless death. They despaired of politicians of any party confronting this. They believed that no government would have the almost suicidal courage to introduce a referendum to repeal Article 40.3.3. Of course Article 40.3.3 should never have been introduced in the first place and now there is political fear even to discuss its possible repeal.
The Expert Report specifically stated that it was not permitted to recommend any change to the Constitutional status quo. HIQA cannot address it, despite what the Irish Hospital Patients Association says, the NIMT in the HSE cannot address this and a Coroner’s Inquest is so limited that it can only give a very bare verdict, say death by misadventure. Whether intentionally or unintentionally, every process and procedure, even the closed doors NIMT, is closed off from referring to the precise and damaging impact of Article 40.3.3. This suits the two Government parties. They don’t want to have to confront the mischief of Article 40.3.3 and endure the horrible times of 1983. I remember those times and they were truly nasty times. I saw a van load of Youth Defence League activists jump out of a white van in Molesworth Street carrying Hurley sticks and threaten anti Referendum activists. I was shocked.
Many TDs still remember the terrible pressure they and their families had to endure. It was unreal. Many pro-life activists lay aside reason and genuine debate. Some kind of atavistic obsession kicks in, an obsession with the interests of the foetus above all else. The original pro-life wordings gave absolute supremacy to the foetus.
It seems to me that the foetus symbolises a rallying flag for a strange, elemental, irrational and obsessive movement, dogmatic, extreme and the essence of intolerance. There is strange talk of “abortion mills”‘, thenskybdark with the black smoke of human incineration and a weird notion that pregnant women are held back by law alone from resorting to mass scale abortion.
I infer from all of this that protection of the foetus is a cipher for something else, a reference back to absolutism, the comfort of a notion of absolute right and a lever for a very authoritarian society. It is not quite a Taliban like movement but it shares some of the notions of certainty, a priori reasoning, the ease of bending the facts to serve the desired conclusion already formed and a dogmatic militancy that seems medieval today.
There are some who have an emotional desire to protect the foetus, a genuine and well meaning emotion and pure of motive. But these genuine people are wound up by and directed by a more sinister and malign group who have an ulterior motive to dismantle what is perceived to be an excessive liberal and multicultural society.
Do we see the pro-life movement worry about famine, child poverty or the socio-economic and abuse factors which compel women to travel to the UK and the Netherlands reluctantly, sadly and even with desperate reluctance to avail of abortion. It would be more credible if the Pro-life movement, Life Institute, Iona Institute et al showed determined efforts to address the causes of the need for abortion other than for and in addition to therapeutic abortions.
No woman should ever die for the sake of a foetus.
Please forgive the almost confessional nature of this post. It is perhaps too revealing. But I can’t escape the sense of absolute horror for all those who were tortured by the tragic events of those terrible days in October. It is heinous and unforgivable that all those people, Savita, Praveen, friends and clinicians has to endure all of this.
Peter that is the best and most lucid overview of where we find ourselves that I have read. Thank you. It deserves to be fleshed out and published as an article – otherwise as a comment it will disappear below the fold all too soon and be lost and little read.
I too remember those horrible days in 1983 – those who were not around then can have no concept of how ugly it was. It was frightening the kind of intimidation and opprobrium that was visited on anyone who tried to put their head above the parapet and speak out against them. A close friend of mine lost her job over it – she refused when told by her boss to put a pro-life sticker in the back window of her company car and was immediately fired. She emigrated and has never returned so disillusioned was she with the situation here. That sort of thing was not unusual.
I remember too how the ‘pro-life’ lobbyists had to be dragged kicking and screaming to the position where the life of the mother had even equal status to that of the mother – they opposed it, loud, long and strenuously, determined to keep the wording they wanted which gave the foetus superior rights.
I cried the night the results came through, I was so stunned. I was young and naive enough to hope people would see sense at the last moment and oppose it. That night marked the end of any hope I had of being a truly equal citizen of this country.
Peter, you really should speak publicly for the pro choice movement and the repeal of the 8th amendment, you do have credibility and put the facts across very succinctly, this country needs people like you to help drag it out of the dark ages.
@katie and Kelly I could not agree more.
@ Peter. Your insight and continual commentary into both savita’s case and the issues surrounding abortion legislation are far superior in delivery, content and knowledge to any commentary I have read on journal.ie.
Even more importantly your expert opinions are far more comprehensive and knowledgable than much of the ‘expert’ opinions I have heard/read in media and press. No offence to the journal.ie but your insights are far too important to be lost as a mere ‘comment’ on an article in the Journal.
@ Peter
Thank you for having taken the time to share your thoughts. Pity that you are retired: you seem to be a truly just and enlightened man.
Is there a time frame for the report? Many of these investigations tend to ramble on and then get quietly put into the public domain on a busy news day.
Not in the terms of reference Brian, but I can assure you we won’t miss this one.
Thankfully the accurance of a situation where doctors need to sacrifice the baby to save the mother only happens once every twenty five years and this tragic death may not have been one of these.
A “sacrifice”? Now that’s insensitive.
What sacrifice? Which by the way is as crass as it gets. There was never going to be a baby in this case. Savita miscarried. And then she died.
Great posts Peter between yourself and James Connolly you’ve provided a very informative legal and medical view.
Well Tom, that view is not exactly clear headed or helpful. It does not assist the analysis. Babies are never sacrificed by clinicians. You say it happens that it happens once every 25 years. So, we are in the clear for the next 25 years and only 4 pregnant women need to have their babies sacrificed in a century. Then you say that this tragic death may not have been one of these. Do you refer to Savita or her foetus? Can you identify anything in your comment above which assists in anyway?
I can’t.
I have never heard of baby sacrifice in Ireland except in prehistoric times in which child sacrifice took place.
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