Thursday, June 13, 2013

Footnote to Tragic Story of Savita Halappanavar: Irish Health Service Executive Publishes Report on Story

A brief footnote to the tragic story of Savita Halappanavar and her death from septicemia in the 17th week of pregnancy in a Galway hospital last October, about which I blogged here and here: following Halappanavar's death, the Irish Health Service Executive conducted a review of what happened in her case. HSE has just made available its report, which finds multiple failures by the hospital's medical personnel to assess properly and to monitor carefully Halappanavar's situation.

The Irish Times has just published the complete report online, with commentary by Carl O'Brien. O'Brien notes that the failures the HSE report finds include the following:

- A failure to adhere to clinical guidelines for prompt and effective management of sepsis when it was diagnosed 
- Not offering all management options to the patient as she experienced inevitably miscarriage, even though the risk she faced increased from the time her membranes ruptured 
- Inadequate assessment and monitoring that would have allowed the clinical team to recognise and respond to the signs that her condition was deteriorating.

The report also "found an apparent over-emphasis on the need not to intervene until the foetal heartbeat stopped and not enough emphasis on the need to focus on monitoring and managing the risk of infection." And it states plainly, 

The interpretation of the law related to lawful termination in Ireland, and particularly the lack of clear clinical guidelines and training, is considered to have been a material contributory factor in this regard.

Among the recommendations the HSE report makes, in light of what it learned as it probed the Halappanavar case:

- The Oireachtas should urgently consider amending the law - including any necessary Constitutional change - to help provide clinicians with a clear legal context for the management of "inevitable miscarriage"
- The HSE should develop and implement national guidelines on infection and pregnancy, along with education programmes to improve the quality of care in pregnancies complicated by infection 
- Clear and precise national clinical guidelines to meaningfully assist clinical professionals who have to use their professional judgement in cases which may involve a rapid deterioration or emergency.

Should what happened to Savita Halappanavar (and her husband, who lost her) concern folks outside Ireland, where the Catholic church continues to wield extraordinary influence in almost any sector of government and society imaginable? As Valerie Tarico, Sara Lin Wilde, Katie McDonough, Kirk Johnson, Danny Westneat and others have recently proposed, the current extension of Catholic healthcare in one state alone, Washington, raises troubling questions about the growing pattern of merging state-run and state-funded medical services with Catholic ones in various places in the U.S.

In these mergers, guidelines for women's healthcare formulated and defended by the Catholic hierarchy are routinely extended to merged healthcare systems that benefit from taxpayer funding. As I've noted in a previous posting, a proposed merger between the Catholic hospital in my home city of Little Rock and the taxpayer-supported hospital of the state medical university is eliciting serious questions among many citizens for precisely the reasons outlined in the preceding articles about the state of Washington, and in the Irish report: will women enjoy the full range of healthcare options permitted by federal and state law, if stipulations of the Catholic bishops govern the kinds of healthcare available to them? How can state funds support merged hospitals whose range of healthcare options is restricted by the faith-based stances of a particular religious body?

These questions won't go away, even as Catholic healthcare systems extend their influence through mergers which demands that hospital systems created from the mergers dance to the tune of the Vatican and bishops. Nor should they go away, as the case of Salita Halappanavar suggests.

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