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On Daily Kos I have commented that an explanation is still possible which does not involve:
There have been allegations of Roman Catholic dogma determining the medical treatments  available to non-Catholics in Irish hospitals; allegations of racism; and allegations of a patriarchal medical system and culture that would rather have a woman suffer in acute pain rather than give her appropriate treatment and relief.

and that the medical team treating Savita may have taken the view that an abortion in this particular case would not reduce her risks of infection or that an abortion carried at least as many risks as benefits.  That raises two issues:

  1. Were the medical team correct in their assessment based on the available evidence -  e.g. no evidence of infection at that time, and the very low incidence of septicemia following miscarriage in Ireland? Doctors aren't infallible, mistakes happen,  and even very low risks materialize in a very few cases.  So the question here is a straightforward medical practice one - was she properly diagnosed, monitored and treated based on the available evidence, did the medical team make a good faith mistake, were they negligent in some way, or was this a case of medical malpractice requiring, at the very least, a disciplinary response if not a criminal prosecution. It is just about possible that this is one of the rare occasions where a patient dies even though proper medical protocols were adhered to. Unlikely, but still possible, in my view, depending on what the inquiry finds.

  2. But why then was she apparently told she couldn't have an abortion because "this is a Catholic country" and not that the team's medical judgement that an abortion carried as many risks as benefits? It is possible that she WAS told that an abortion carried as many risks as benefits and that the team was therefor not going to carry one out. It is possible that she then she decided that she wanted an abortion anyway, and that she was THEN told that abortion of demand is not possible because "this is a Catholic country".

My point is that we have only heard her husband's allegations, but have heard no testimony for the medical team themselves. We haven't even seen the medical records. So it is to prejudge the issue to make firm assertions at this stage.  The medical team, too, are entitled to a presumption of innocence until the facts are fully investigated. My concern is that a rush to judgement which turns out to be wrong could be damaging to the pro-choice movement. Hell, any rush to judgment in the absence of all the evidence being heard is damaging to the credibility of any community which claims to be reality based and which claims to respect due process.

Some here have accused me here of being a concern troll.  I am most certainly concerned that all the evidence is heard before judgement is made.  I consider the reputation of Daily Kos being at greater risk because of some of the prejudicial, ill-informed and intemperate commentary here.

Index of Frank's Diaries

by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Thu Nov 22nd, 2012 at 08:05:12 AM EST
[ Parent ]
I fear that the Kossacks on average does not care about the effects on the Irish abortion debate, but only the effects on the US abortion debate. And while in Ireland the eventual outcome of the inquiry will be important, Savita will be forgotten in a week or two in the US so they better get the most outrage out of it while it lasts.

A vote for PES is a vote for EPP! A vote for EPP is a vote for PES! Support the coalition, vote EPP-PES!
by A swedish kind of death on Thu Nov 22nd, 2012 at 08:30:54 AM EST
[ Parent ]
Unpleasantly similar to a creationism or second amendment debate ...


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sapere aude
by Number 6 on Thu Nov 22nd, 2012 at 10:49:13 AM EST
[ Parent ]
You are right about the screeching crowd over there, and I appreciate your raising arguments in advance, before the foetus firsters do so. Your argument hinges on the risk of an infection by the abortion, though. Even if I concede for argument's sake that this might be true for an operation, there is still prostaglandine. Where is the heightened infection risk for that? Your scenario is really far-fetched and makes me wonder if you aren't wrong too when you say this is not the best moment for a campaign to alter the law.
by Katrin on Thu Nov 22nd, 2012 at 08:41:04 AM EST
[ Parent ]
I said in the diary that:

European Tribune - Would an abortion have saved Savita Halappanavar?

It might also have been possible to accelerate the process by inducing an earlier delivery.

I don't know if this was considered, and if so why that option was rejected. Presumably her medical records will shed some light on this. Given that miscarriage is basically premature childbirth triggered if there is some malfunction - I'm not sure if it is known precisely why or how - but which is a naturally occurring end to many pregnancies, perhaps the medical team felt - at the time - there was no need to accelerate the process, or that it was proceeding normally and naturally and with no excessive risk to the mother.

I share your view that this is a somewhat far fetched scenario given that, reportedly, her membrane had ruptured, and that this posed a significant risk of infection. I do know that many successful child-births can take a long time and that induction is often used to accelerate the process, so the suspicion has to be that this was not done here because it was known the foetus was unviable and so that an induction at that time could be construed as an abortion.

However the Catholic Church has often used the somewhat Jesuitical distinction between a treatment intended directly to abort a foetus, and a treatment required by the mother and which has the "side-effect" of aborting the foetus, and so it seems to me the medical team where not "theologically" precluded from pursuing this option. However the failure of the Irish Parliament to legislate to provide greater clarity as to what is and is not legally allowed under the current Constitution may have contributed to uncertainty and procrastination on their part.  

Presumably the inquiry team will question them precisely on this point.

Index of Frank's Diaries

by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Thu Nov 22nd, 2012 at 09:15:53 AM EST
[ Parent ]
I share your view that this is a somewhat far fetched scenario given that, reportedly, her membrane had ruptured, and that this posed a significant risk of infection. I do know that many successful child-births can take a long time and that induction is often used to accelerate the process, so the suspicion has to be that this was not done here because it was known the foetus was unviable and so that an induction at that time could be construed as an abortion.
Well, I know wikipedia is not an authoritative source and all that, but...
Premature rupture of membranes (PROM) is a condition that occurs in pregnancy when there is rupture of the membranes (rupture of the amniotic sac and chorion) more than an hour before the onset of labor. PROM is prolonged when it occurs more than 18 hours before labor. PROM is preterm (PPROM) when it occurs before 37 weeks gestation. Risk factors for PROM can be a bacterial infection, smoking, or anatomic defect in the structure of the amniotic sac, uterus, or cervix. In some cases, the rupture can spontaneously heal, but in most cases of PROM, labor begins within 48 hours. When this occurs, it is necessary that the mother receives treatment to avoid possible infection in the newborn.

...

Maternal _risk factors for a premature rupture of membranes include chorioamnionitis or sepsis. ...

...

... Current obstetrical management includes an induction of labor at approximately 12 hours if it has not already begun though many physicians believe it to be safe to induce labor immediately, and consideration of Group B Streptococcal prophylaxis at 18 hours.

...

Infection

  • Maternal: If chorioamnionitis [inflammation of the amniotic sac] is present at the time of PPROM, antibiotic therapy is usually given to avoid sepsis, and delivery is indicated. If chorioamnionitis is not present, prompt antibiotic therapy can significantly delay delivery, giving the fetus crucial additional time to mature. In preterm premature rupture of membranes (PPROM), antibiotic therapy should be given to decrease the risk of sepsis. Ampicillin or erythromycin should be administered for 7 days
  • Fetal: If the GBS status of the mother is not known, Penicillin or other antibiotics may be administered for prophylaxis against vertical transmission of Group B streptococcal infection.


I distribute. You re-distribute. He gives your hard-earned money to lazy scroungers. -- JakeS
by Migeru (migeru at eurotrib dot com) on Thu Nov 22nd, 2012 at 09:47:39 AM EST
[ Parent ]
Frank Schnittger:
we ... have heard no testimony for the medical team themselves. We haven't even seen the medical records.

How then can we even ask (but you do) this question:

Frank Schnittger:

Were the medical team correct in their assessment based on the available evidence

What assessment? What evidence?

Frank Schnittger:

no evidence of infection at that time

At what time? This took place over several days. Evidence of infection should have been constantly watched for during that time.

Frank Schnittger:

the very low incidence of septicemia following miscarriage in Ireland

What kind of miscarriage? This one wasn't over quickly, three days went by in which the risk of sepsis was constantly rising. This case called for careful monitoring and attentive reassessment more than once a day. It evidently didn't get it -- I see no reason to doubt the husband's testimony that it was only when his wife collapsed on the third evening that it was realized she needed antibiotics.

Of your three sets of allegations, religious bias and racism will be hard to determine, it will be one person's word against another's. But "a patriarchal medical system and culture that would rather have a woman suffer in acute pain rather than give her appropriate treatment and relief" seems to me clearly established.

by afew (afew(a in a circle)eurotrib_dot_com) on Thu Nov 22nd, 2012 at 09:15:59 AM EST
[ Parent ]
afew:
Frank Schnittger:
we ... have heard no testimony for the medical team themselves. We haven't even seen the medical records.

How then can we even ask (but you do) this question:

Frank Schnittger:

Were the medical team correct in their assessment based on the available evidence

What assessment? What evidence?

Frank Schnittger:

no evidence of infection at that time

At what time? This took place over several days. Evidence of infection should have been constantly watched for during that time.

I am not referring to the public evidence available to us now, but to the evidence available to the medical team at the time, and which will now, presumably, be minutely examined by the inquiry team.

What I am saying is that we are not currently in a position to draw definitive conclusions from the publicly available evidence, but that is precisely what the inquiry team should be doing based on a minute investigation of the currently private medical records and interviews with all the parties involved.

Index of Frank's Diaries

by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Thu Nov 22nd, 2012 at 09:27:03 AM EST
[ Parent ]
Then I suppose there's no point in discussing this further, it's up to the "inquiry team" (that we may trust with pretty much as much trust as we usually bestow on inquiry teams).
by afew (afew(a in a circle)eurotrib_dot_com) on Thu Nov 22nd, 2012 at 09:41:34 AM EST
[ Parent ]
The Hospital has apparently released Savita's medical records to her husband, so they may well end up in the public domain shortly. His lawyer's first reaction is to note they make no reference to Savita's requests for an abortion. So their completeness and accuracy is immediately open to question.

The Chairman of the inquiry team is a senior professional with a very high international reputation. Given that he has advocated for wider availability of abortion in countries where it is currently very restricted seems to indicate he is at least not a "pro-life" nut job like those medics who recently passed the Dublin Declaration.

The other members of the inquiry team are all Irish medical professionals/administrators/advocates who probably have no great desire to throw their colleagues in Galway under a bus. However the reputation of the profession is at stake, so I doubt they would cover up clear medical malpractice. They may, however, be tempted to pass responsibility onto the politicians who have failed to provide a clear legal framework so that professionals know where they stand and what treatment options are available to them under what circumstances.

I suspect their remit is only to examine the circumstances of Savita's death. They will probably not make specific recommendations for legislative, much less Constitutional changes. So there will be lots of wriggle room and  controversy as to what legal changes are required even if the Inquiry finds legislative changes are required.

Indeed the original Inquiry - in addition to having it's three Galway Hospital based members removed - now seems to be downgraded to the status of a "Clinical Review" and with Health Information and Quality Authority being asked to initiate a Statutory Inquiry. Perhaps this will satisfy Savita's husband demand for an independent public inquiry.

HSE asks Hiqa to carry out Savita Halappanavar inquiry - The Irish Times - Thu, Nov 22, 2012

The Health Service Executive has asked the State's health watchdog Hiqa to initiate a statutory inquiry into the death of Savita Halappanavar.

Separately, Praveen Halappanavar's solicitor Gerard O'Donnell has said there is no record in Ms Halappanavar's medical file of her requests for a termination while she was being treated in University Hospital Galway.

The director general designate of the HSE Tony O'Brien said even if Ms Halappanavar's family decided not to co-operate with the executive's inquiry, the review "must be brought to a conclusion".

"There was 'no way' the inquiry could be stopped as it would be "criminally negligent" not to proceed, he said.

Mr Halappanavar's decision not to participate in the inquiry "does not absolve the HSE of an obligation to ensure that the inquiry proceeds" he said. The HSE inquiry would provide it with a clinical information that may be of "immediate value" in the hospital,he said.

In order to give "further reassurance" to her family and the public, Mr O'Brien said he told the Hiqa chief executive  he will request that Hiqa initiate its own statutory inquiry. This could take place before the HSE inquiry concluded, he said.

It was not "either or" as to a public review and the HSE clinical inquiry, he told RTÉ Radio's News at One.  There will also be a coroner's process under way shortly which has "many attributes of a public inquiry," he said.

Mr O'Donnell said he had studied the medical records given to the family closely and had written to the HSE about them on Monday.

Mr O'Donnell's main concern was that there was no request documented in the Savita Halappanavar's medical records that she or her husband had repeatedly sought a termination.

"There's absolutely no entry by the medical team of this in the medical records," he told RTÉ.

In response Mr O'Brien said any information that Mr Halappanavar had that would "speak to any inconsistencies between what's in the record and his personal knowledge would be of great value to the review team".

He also that the HSE was not as "aware as it should have been of the wider context that was emerging" and was focused on the "clinical aspects" in its inquiry.

Asked about the inclusion of three Galway clinicians in the original review team, he said Minister for Health Dr James Reilly was not aware of the total composition before it was announced because that was a matter for the HSE.

Once the HSE heard the concerns of the family it took steps to have the Galway clinicians stand down, he said.

Earlier today, Minister for Social Protection Joan Burton welcomed President Michael D Higgins's intervention in the controversy over the inquiry into the death of Savita Halappanavar.

Ms Burton said she had read and heard the comments made by the President and believed they were considerate, thoughtful, reflectful and humane, she added.

President Michael D Higgins yesterday intervened in the continuing row over the inquiry into the death of Ms Halappanavar, saying it must meet the needs of her family as well as those of the State.



Index of Frank's Diaries
by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Thu Nov 22nd, 2012 at 10:15:06 AM EST
[ Parent ]
Frank Schnittger:
They may, however, be tempted to pass responsibility onto the politicians who have failed to provide a clear legal framework so that professionals know where they stand and what treatment options are available to them under what circumstances.

Yes, and that produces pressure for legislation. I assume that one needn't alter that constitution of yours in order to define "substantial risk to the life of the mother".

by Katrin on Thu Nov 22nd, 2012 at 10:32:18 AM EST
[ Parent ]
No - the purpose of legislation is to define the constitution in more detail. A new can be challenged as "unconstitutional", and then the Supreme court had the final word on whether it is or not.

Index of Frank's Diaries
by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Thu Nov 22nd, 2012 at 10:44:41 AM EST
[ Parent ]
"A tragic case but also unique and unlikely to occur again. No change necessary."


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sapere aude
by Number 6 on Thu Nov 22nd, 2012 at 11:20:55 AM EST
[ Parent ]

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