Irish audit adds ethnic twist to Savita's death case

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New Delhi, June 25: Coming just weeks after a clinical review into the death of Savita Halappanavar identified serious failures at University Hospital Galway, Ireland's first national audit of severe medical complications during pregnancy has found that such complications are ‘disproportionately higher' among women from ethnic minorities.

The audit, published today, was conducted by the National Perinatal Epidemiology Centre (NPEC) and looked at the year 2011.

It covered 19 of the country's 20 maternity units, totaling over 67, 800 maternities - live births and stillbirths. This represents 93 percent of pregnancies reported in Ireland in 2011.

Savita Halappanavar died at Galway hospital last October from septicaemia after being admitted to the hospital 17 weeks into her pregnancy.

But the audit showed, in 2011, there was a total of four cases of septicaemia and all survived. The NPEC audit found, overall, one in 263 pregnant women will develop a severe maternal medical complication during pregnancy.

Unfortunately, the incident of severe maternal morbidity was disproportionately higher among ethnic minorities. Previous research has found that ethnic minorities are at an increased risk of maternal death, says the audit.

No ethnic factor, Savita was indeed denied care

But in Savita's case the Health Service Executive (HSE) clinical review early this month had concluded that there was "an apparent over-emphasis on the need not to intervene until the foetal heart stopped together with an under-emphasis on the need to focus appropriate attention on monitoring for and managing the risk of infection and sepsis in the mother".

"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," the review said.

The review team added that "similar incidents with a similar clinical context could happen again" unless there was "clarity as to the application of the law in a situation where it may be necessary for a doctor to consider, in the exercise of their clinical professional judgement, the termination of a pregnancy in the clinical welfare interest of their patient".

Among its recommendations, the review team stated: "There is an immediate and urgent requirement for a clear statement of the legal context in which clinical professional judgement can be exercised in the best medical welfare interests of patients."

Inquest called it medical misadventure

Even the April inquest into Savita's death recorded a verdict of medical misadventure.The eight-day hearing, held in Galway, concluded there had been failures in her health care at the hospital, but did not apportion individual blame.

The inquest found there had been poor communication between staff members, inadequate assessment and monitoring and a failure to follow up blood test results that would have indicated the presence of infection.

Following world-wide controversy over Savita's death, which reopened the debate about the Irish Republic's abortion law, the HSE had launched its clinical review of her health care last November.

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