Questions raised over three-hour delay in analysing Savita's blood
Questions have been raised at the inquest of Savita Halappanavar about a three hour delay in analysising blood samples.
A sample was taken from Ms Halappanavar at 7am on Wednesday, October 24. However, it was not sent to the lab until 10.12am that morning.
The sample then took seven hours to culture, as is the norm. Consultant microbiologist Dr Deirbhile Keady was questioned as to the delay in receiving the sample and agreed with counsel for the family, Mr Eugene Gleeson that time was of the essence in a case like this.
However, she insisted that Ms Halappanavar was on the correct antibiotics from lunchtime that day. The results finally became available at between 8.30pm and 9pm that night and the course of antibiotics remained the same.
She was unable to throw any light as to the reason for the delay but conceded under questioning from the coroner that the delay would be a concern.
Earlier, the final moments of Ms Halappanavar's life were revealed on the fourth day of the inquest into the death of the 31-year-old dentist.
Jacinta Gately, staff nurse in the Intensive Care Unit at University Hospital Galway, gave evidence of being with Ms Halappanavar through her final hours on the night of Saturday October 27 and morning of Sunday October 28.
Ms Gately told the inquest that as Savita's condition had deteriorated overnight she spoke on several occasions to Savita’s husband Praveen who was in a nearby waiting room with friends.
Savita was given blood and platelets, was ventilated and placed on dialysis. However, her condition continued to deteriorate resulting in multi organ failure and subsequently suffered a cardiac arrest.
Ms Gately immediately told Praveen and asked him if he wanted to be present for the resuscitation efforts, which he answered he did.
"I explained that this would be very difficult for him," she said, adding that a friend accompanied him for support.
However, despite their best efforts to revive Savita she passed away with the time of death recorded as 1.09am on the morning of Sunday October 28, 2012.
This morning theatre staff nurse, Noreen Hannegan, gave evidence of Ms Halappanavar spontaneously delivering the foetus of her baby daughter when she was brought to theatre to have a central line inserted on Wednesday, October 24.
Ms Hannegan told how neither she nor her colleagues had expected this but told how after the line was inserted they have given the couple time to grieve.
Speaking of the condition in theatre she said: "She was weak and distressed but fully aware of what was happening".
Later when she was handing over care of Savita, Ms Hannegan said; "I held her hand and wished her well and she thanked me."
Also this morning, Praveen Halappanavar said he forgave midwife Ann Maria Burke for telling his wife she could not have a termination because she was in a "Catholic country".
However, Mr Halappanavar stood by his claims that consultant obstetrician Katherine Astbury had made similar comments, despite her rejecting his claims completely.
Mr Halappanavar spoke briefly on his way into the fourth day of the inquest hearing.
He was asked if he forgave Ms Burke for her comments to which he replied: "Yes, I do".
He added that he appreciated Ms Burke's evidence to the inquest and her admission that she made the comments.
Mr Halappanavar said "it was very difficult" to listen to all the evidence but added: "It just give some comfort that the truth is coming out as well."
When the inquest got under way today, a doctor said he had not been told of plans to induce the foetus when he was asked to bring Savita to theatre to insert an IV line into her neck.
Dr Aidan Magee, a Senior House Officer at the hospital, brought Ms Halappanavar to theatre on Wednesday afternoon so that the line could be inserted. He understand this was to ease the process of giving her multiple medications.
The inquest had previously heard evidence from Dr Katherine Astbury, who claimed that the foetus was to be induced at that stage.
When asked by Eugene Gleeson, counsel for Praveen Halappanavar, whether there had been any discussion to induce labour, Dr Magee replied: "I didn't have any discussion with anybody about that."
He also told the inquest that he could not be certain that anybody from obstetrics was in the theatre when he began the procedure but confirmed they were there at some stage during the procedure.
"I can't say if when we arrived in theatre an obstetrics person was present but certainly over the course of that time they were present," he said.
The inquest heard that over the course of the day and night Savita's condition continued to deteriorate. She had contracted pneumonia forcing medics to intubate her at 3am on Thursday morning.
Dr Mahesh Palanisamy told the inquest that the patient was unable to talk properly, she had difficulty breathing and her lactate levers were high, which was a mark of the level of sepsis.
When asked whether Ms Halappanavar was in septic shock at that stage, he confirmed: "She was".
She was transferred to ICU in the early hours of Thursday morning.
Earlier, consultant anaesthetist Dr John Bates gave evidence of having treated Savita when she was moved to the High Dependency Unit.
Mr Gleeson began his cross-examination of Dr John Bates by passing on Praveen’s sincere thanks for all the attempts by the ICU staff to save Savita.
"He will to his dying day be grateful for the valiant efforts you and your colleagues made" to save his wife, said Mr Gleeson.
Giving some of the symptoms that accompany severe sepsis, Dr Bates said there were specific guidelines that should be followed within six hour period to deal with the onset of the infection.
Dr Bates gave evidence that it was very difficult to put in place systems to treat sepsis. He said the best results he had ever seen was 52pc from the Mayo Clinic.
"The intensive care community is very focused on it but it is very difficult," he said.
"It is difficult to get a system in place that captures all patients and gets them optimal treatment within the specified guidelines," he added.
Dr Kevin Clarkson gave evidence of attempts to find the cause of the infection which he said appeared "highly likely" to be an obstetric issue from the information provided.
"My only concern was just to make sure that perhaps had they missed something else like appendicitis or a urinary tract infection but there was nothing else," he said.
Dr Brian Kinirons said Ms Halappanavar had a number of symptoms that would be indicative of sepsis including low blood pressure, high temperature, low white blood count and bleeding tendencies. He told the inquest he was confident the sepsis was pregnancy related.
Dr Kinirons said Ms Halappanavar had severe sepsis, "the worst end of the spectrum, septic shock".
He first saw Savita at 6pm on Wednesday, October 24. At the time her prognosis was very poor.
It also emerged this morning that the delegation for Mr Halappanavar's family would delay meeting with the chairman of the HSE clinical review until after the inquest in order to have the benefit of all the evidence heard at the inquest hearing.
Yesterday, midwife Ann Maria Burke apologised for having made the remarks to Ms Halappanavar and a friend, Mrudula Vasealli, on Tuesday, October 23, while they were talking about the reason behind the refusal to give her a termination after situation in Ireland.
She said she had since regretted the remarks but stressed she had never meant them in "a hurtful context".
When asked by coroner Dr Ciaran McLaughlin if she had been the person to make the remarks last October, Ms Burke had replied: "Yes, to be honest. I've been upset about this and I'm very upset. I did mention a Catholic country, I didn't mention it in a hurtful context."
The inquest into the death of Savita Halappanavar resumed at Galway courthouse today where it is due to hear evidence from four ICU doctors.
Savita Halappanavar (31) died on October 28 last at Galway University Hospital. She was 17 weeks’ pregnant when she was admitted to the hospital a week earlier suffering a miscarriage.