An obsessive focus on abortion hasn't stopped women dying of sepsis in Irish hospitals

"Never let a good crisis go to waste," Winston Churchill is supposed to have said during World War II, though the advce is widely attributed to Saul Alinsky's 'Rule for Radicals' on the other side of the political spectrum, but either way it became shorthand for either learning from - or manipulating - a calamity.

This week in the Catholic Herald, Dubhaltach Ó Reachtnin wrote about the case of Savita Halappanavar, whose tragic death while miscarrying a baby became a lightning rod for a sustained campaign to legalise abortion in Ireland.

As  Ó Reachtnín wrote: 

When Halappanavar died it was widely reported that this was due to being denied an abortion to treat an unviable pregnancy, and that Ireland’s anti-abortion constitutional guarantees and the laws associated with it were the reasons for her death.

However, an inquest in 2013 found that Halappanavar died from “medical misadventure” and that her death was due to “fulminant septic shock from E. coli bacteremia”, compounded by a series of systems failures including not following sepsis treatment protocols. At the inquest, one doctor said that she died from the worst case of sepsis he had ever seen in 30 years.

The issue of sepsis management was largely ignored, however, while the “Catholic denial of abortion” narrative reverberated around the country—and the world—despite repeated investigations and inquests that pointed towards mismanagement of sepsis as the leading cause of Halappanavar’s death. The recommendations from the coroner following her death were many, and included three that related directly to sepsis management, each of which was to be applied nationally.

Sepsis was, at the time of Savita Halappanavar's death, listed as one of the most common causes of death in maternal healthcare according to the international medical  literature.

Another woman, Tania McCabe had died of sepsis after giving birth in Drogheda in 2007. A Hiqa report six years after her death found that most maternity units were not able to report on how they implemented the recommendations for the prevention of sepsis which were published after her death.

Ó Reachtaín points to a "letter to the Irish Times from 11 doctors which concluded: “It is important that all obstetrical units in Ireland reflect on the findings of the events in Galway and learn how to improve care for pregnant women. To reduce it to a polemical argument about abortion may lead to more – not fewer – deaths in the future.”

He then looks at another high-profile tragedy, that of Aoife Johnston who was just 16 when she lost her life on 19 December last year, after waiting 12 hours in rapidly deteriorating condition in a "severely overcrowded"  emergency department in University Hospital Limerick. The national guidelines on sepsis management had been breached in her care, the review found.

His point in regard to what care is being prioritised by successive Irish health ministers since the 8th amendment was repealed is, in my opinion, a valid one.

We were told, repeatedly, that legalising abortion was going to make Ireland a better, safer place for pregnant women. It is true that abortion provision seemed to become a top priority for government: we've never had Ministers tweeting endlessly about identifying and combatting sepsis.

We know that the National Maternity Strategy group was tasked with the vitally important job of developing standards and processes to make sure that cases like Savita’s did not occur again.

But in 2019, as soon as abortion became legal, came the shocking revelation that funding for the National Maternity Strategy had been halted, because, it seemed then Minister for Health Simon Harris needed the money to provide abortions.

According to Róisín Molloy, a patient representative on the National Maternity Strategy steering group, “the money that had been intended to go on the maternity strategy was effectively being spent on abortion services since January of this year”.

The Government took money away from a vitally important strategy to ensure women do not die in pregnancy and gave it to funding abortion. There is no clearer way of showing where their priorities lay.

For 2023, the "implementation of the national maternity strategy has been underfunded by almost €9 million this year, due to the absence of any new development funding", the Medical Independent reported last month.

The level of underfunding in 2023 represented “just under 20 per cent of the total estimated funding required to fully implement the strategy", it added.

In October, the Irish Independent reported that the current Minister for Health Stephen Donnelly was unsuccessful in obtaining additional funding for the maternity strategy for 2024.

He has been able, separately, to announce, however, that with abortion being a "main priority" for the Minister, he was able to recruit more senior staff "specifically tasked" to provide terminations.

Despite the "freeze on the recruitment of junior doctors, healthcare assistants, home helps and other frontline staff due to financial constraints” – and the obligation on the Minister is obliged to make savings of more than €600 million in health spending next year, there's always money for abortion is seems.

It's worth noting that in the four months after the abortion bill passed through the Dáil, two women died in Irish maternity hospitals, and the apparent causes – sepsis and a severe staff shortage – were the same factors which led to the death of Ms Halappanavar.

Marie Downey from Limerick, who had given birth to a little boy, died in Cork University Maternity Hospital (CUMH). She suffered a severe epileptic seizure, and was trying to raise the alarm when she collapsed on the floor of her room, trapping her baby underneath her. Baby Darragh also died two days later, and was buried cradled in his mother’s arms. Just three nurses were on duty on the ward that night, caring for 31 patients.

Like many other maternity hospitals, staff in CUMH had been complaining to the Minister for Health for years about the lack of resources, and the inquiries into the death of Savita Halappanavar found that staffing was an issue in the ability of maternity units to ensure women are safe.

In a separate tragedy around the same time, another mother, Karen McEvoy from Kildare, died on Christmas Day after giving birth to a baby girl in the Coombe maternity hospital. Ms McEvoy, who left behind three young children, died of sepsis.

We know that, despite assertions to the contrary during the referendum, Ireland was one of the safest places in the world to be pregnant and give birth. Legalising abortion doesn't seem to have reduced our maternal mortality any further, according to the figures from the Maternal Deaths Enquiry in Ireland.

It's notable, isn't it, that not a fraction of the time, money and energy that NGOs, campaigners, politicians, and the media poured into demanding abortion be legalised was spent on tackling sepsis.

However, sepsis continues to be a major cause of death across the Irish healthcare system. Almost 15,000 people contract sepsis in Ireland each year resulting in almost 3,000 deaths while an almost incredible 60% of all hospital deaths in Ireland are related to sepsis, the RCSI says, pointing out that it kills more people in Ireland than heart attack, lung, colon and breast cancer combined.

The review of Aoife Johnston's care found that she should have been administered a ‘sepsis bundle’ within an hour, but that this did not happen. By 10pm, the department was overrun, the review found.

Last week the Dublin District Coroner’s Court heard that Ahana Singh, 4, died at her home in Killester, Dublin after returning home from Temple Street hospital where, it was claimed, staff failed to react to a number of “red flags” that she young girl had sepsis. 

"It was the second case before coroner Clare Keane in the space of a week to hear evidence that there had been delays by staff at Temple Street in considering that a child, who subsequently died, had sepsis,"  the Examiner reported.

"Phoenix Graham-Hayden, 2, from Malahide, Co Dublin had died in the hospital on November 3, 2022, from Strep A infection just over 48 hours after being sent home from its emergency department," the report said.

The truth is that Ireland's healthcare system has been tipping into chaos for a long time, with experts repeatedly saying that staff shortages, overcrowding, and under-resourcing all combining in outcomes that endanger patients.

No-one seems to know what to do to right the system: but we do know what priorities the current Health Minister, like the man who went before him has.

Ensuring wider access to abortion is a "main priority" for Stephen Donnelly just as it was for Simon Harris. And the truth is that a Minister can only have so many priorities.