Death of Savita Halappanavar

On 21 October 2012, Halappanavar, then 17 weeks pregnant, was examined at University Hospital Galway after complaining of back pain, but was soon discharged without a diagnosis. She returned to the hospital later that day, this time complaining of lower pressure, a sensation she described as feeling "something coming down", and a subsequent examination found that the gestational sac was protruding from her cervix. She was admitted to hospital, as it was determined that miscarriage was unavoidable, and several hours later, just after midnight on 22 October, her water broke but did not expel the fetus.{{cite web|last=External Independent Committee|title=Investigation of Incident 50278 from time of patient's self referral to hospital on the 21st of October 2012 to the patient's death on the 28th of October, 2012.|url=https://www.hse.ie/eng/services/news/nimtreport50278.pdf|publisher=HSE|date=June 2013}}{{rp|22–26}}{{rp|29}}{{cite press release|title=HSE publishes Report of the Investigation into the death of Ms. Savita Halappanavar |work=HSE |url=https://www.hse.ie/eng/services/news/media/pressrel/newsarchive/2013archive/jun13/savitareport.html |language=en|date=13 June 2013|archive-url=https://web.archive.org/web/20151023202004/https://www.hse.ie/eng/services/news/media/pressrel/newsarchive/2013archive/jun13/savitareport.html |archive-date=23 October 2015 }} The following day, on 23 October, Halappanavar discussed abortion with her consulting physician but her request was promptly refused, as Irish law at that time forbade abortion if a foetal heartbeat was still present, with her midwife furthermore stating that "Ireland is a Catholic country".{{rp|33}}{{cite news|publisher=RTÉ News|title=Midwife confirms she told Savita Halappanavar Ireland a 'Catholic country'|url=https://www.rte.ie/news/health/2013/0410/380613-savita-halappanavar-inquest/ |first=Fergal |last=Bowers |date=11 April 2013}} Halappanavar developed sepsis and, despite doctors' efforts to treat her, had a cardiac arrest at 1:09 AM on 28 October, and died, aged 31.{{rp|53}}{{rp|44–46}}

After her death, a coroner's inquest was held, finding that she died of medical misadventure.{{cite news |access-date=4 May 2022 |url=https://www.thejournal.ie/savita-inquest-the-coroners-9-recommendations-876864-Apr2013/|title=Savita inquest: The coroner's nine recommendations endorsed by the jury |last=O'Carroll |first=Sinead |date=19 April 2013 |newspaper=TheJournal.ie}} The Health Service Executive (HSE) and Health Information and Quality Authority (HIQA) conducted an investigation. Both criticized the team for not diagnosing the sepsis soon enough and for not using already-standard screening tools for detecting and managing maternal sepsis; for poor keeping of medical records, poor communication at shift changes, and failure to notify staff with needed expertise. The administration of the hospital was also criticized for the poor system in which the team failed. They made recommendations about training and policies for the hospital locally along with a number of national recommendations, including the creation of a laboratory system to coordinate a national response to emerging microbial threats.{{cite web|url=https://www.hiqa.ie/sites/default/files/2017-01/Patient-Safety-Investigation-UHG.pdf|title=Investigation into the safety, quality and standards of services provided by the Health Service Executive to patients, including pregnant women, at risk of clinical deterioration, including those provided in University Hospital Galway, and as reflected in the care and treatment provided to Savita Halappanavar|date=7 October 2013|publisher=Health Information and Quality Authority}}{{cite press release |url=https://www.hiqa.ie/hiqa-news-updates/patient-safety-investigation-report-published-health-information-and-quality |access-date=5 May 2022 |publisher=HIQA|date=9 October 2013|title=Press release: Patient Safety Investigation Report published by Health Information and Quality Authority (Savita Halappanavar)}} The HSE also recommended changes to the legal situation and training of doctors about the law.

The law in force at the time stated that the act of abortion, where continuing the pregnancy posed no immediate physiological threat to the woman's life, was a criminal offence punishable by life imprisonment. Following a ruling of the Supreme Court of Ireland in 1992 (the X Case), terminations are allowed where "a pregnant woman's life is at risk because of pregnancy, including the risk of suicide".{{cite news |url=https://www.independent.ie/irish-news/most-tds-will-back-legislation-on-x-case-28902859.html |access-date=5 May 2022 |title=Most TDs will back legislation on X Case|date=18 November 2012 |newspaper=Irish Independent }} However at the time of Halappanavar's death, there was legal uncertainty regarding the precise circumstances when this exception was allowed, as the matter had not been enacted in legislation.

On 3 November 2012, friends and family of the Halappanavars contacted local abortion rights groups (Galway Pro-Choice) to find out what they could do, with dozens meeting in person on the 6th. Galway Pro-Choice put them in contact with The Irish Times journalist Kitty Holland{{cite news|url=http://www.irishexaminer.com/viewpoints/columnists/victoria-white/savitas-death-is-not-about-abortion-it-is-about-medical-negligence-247993.html|first=Victoria|last=White|title=Savita's death is not about abortion, it is about medical negligence |date=31 October 2013}}{{cite news|url=https://www.irishtimes.com/news/social-affairs/global-observers-horrified-and-bewildered-by-savita-case-1.2568298 |title=Global observers horrified and bewildered by Savita case |access-date=5 May 2022 |first=Kitty |last=Holland |newspaper=The Irish Times |date=11 March 2016 }} on 7 November.{{cite web|url=http://galwayprochoice.org/2012/12/galway-pro-choice-were-approached-by-savitas-friends/|publisher=Galway Pro-Choice|title=Galway Pro Choice Were Approached by Savita's Friends|date=2012-11-21|access-date=2015-02-11|archive-url=https://web.archive.org/web/20150211201358/http://galwayprochoice.org/2012/12/galway-pro-choice-were-approached-by-savitas-friends/|archive-date=11 February 2015|url-status=dead}}{{cite book |last=Holland|first=Kitty|title=Savita: The Tragedy that Shook a Nation|publisher=Transworld Ireland|page=70|isbn=978-1848271838|year=2013}} Abortion rights groups then organised on the Irish Choice Network (ICN) email group before the story broke.{{cite news |url=http://www.independent.ie/irish-news/prochoice-activists-got-tipoff-on-tragic-death-28902755.html |title=Pro-choice activists got tip-off on tragic death |newspaper=Irish Independent }}

Halappanavar's death became public knowledge on 13 November 2012 when the TV programme Tonight with Vincent Browne showed front-page stories that The Irish Times and the Irish Independent had planned for the next day.{{cite news|url=https://www.irishtimes.com/newspaper/ireland/2012/1117/1224326702387.html|title=Savita story resonates around the world|date=17 November 2012|access-date=17 November 2012|last=Mullally|first=Una|newspaper=The Irish Times|archive-date=17 November 2012|archive-url=https://web.archive.org/web/20121117094548/http://www.irishtimes.com/newspaper/ireland/2012/1117/1224326702387.html|url-status=dead}} This resulted in the news being disseminated on Twitter, including tweets by journalists Caitlin Moran and India Knight, and coverage by publications such as BBC News, the British edition of The Huffington Post, The Guardian, The Daily Telegraph, the Daily Mirror, and The Independent newspapers.

On 14 November, more than 2,000 people gathered in her memory to protest against Ireland's abortion laws outside the Dáil in Dublin.{{cite news|url=https://www.thejournal.ie/savita-demonstration-leinster-house-674695-Nov2012/ |access-date=5 May 2022 |title='Over 2,000' attend sit-down protest for Halappanavar at Leinster House|publisher=TheJournal.ie| date=14 November 2012}} In addition, candle-light vigils were held in Cork{{cite news|url=https://www.bbc.co.uk/news/uk-northern-ireland-20321741 |access-date=4 May 2022 |title=Woman dies after abortion request 'refused' at Galway hospital|work=BBC News|date=14 November 2012}} and Belfast the following day.{{cite news|url=https://www.irishexaminer.com/news/arid-30574384.html|title=Belfast vigil held in memory of Savita|work=Irish Examiner|date=15 November 2012}} The evening before the news story broke, the government's expert committee on abortion had handed in its report on the A, B and C v Ireland judgement to the Department of Health.{{cite news|url=http://www.breakingnews.ie/ireland/taoiseach-expert-group-delivered-abortion-report-last-night-574183.html|title=Taoiseach: Expert group delivered abortion report last night|date=14 November 2012|access-date=9 June 2016|publisher=Breaking News.ie}} Halappanavar's death led to protests in Galway, particularly from the local Indian community.{{cite news|url=https://www.theguardian.com/world/2012/nov/16/ireland-abortion-savita-halappanavar-indian-envoy|title=Savita Halappanavar 'would still be alive if she had been treated in India'|work=The Guardian|date=16 November 2012|location=London|first=Henry|last=McDonald}} The Daily Mirror reported that the University Hospital was the subject of several investigations.{{cite news |access-date=5 May 2022 |url=https://www.mirror.co.uk/news/uk-news/savita-halappanavar-husband-claims-pregnant-1435830|title=Savita Halappanavar: Husband claims pregnant wife would still be alive if doctors hadn't 'refused' her an abortion|date=14 November 2012|last=Rudd|first=Andy|newspaper=Daily Mirror}} Halappanavar had been one of the organisers of the annual Galway Diwali festival, which was cancelled in response to her death.{{cite news |url=https://www.cbsnews.com/news/husband-ireland-hospital-denied-savita-halappanavar-life-saving-abortion-because-it-is-a-catholic-country/ |title=Husband: Ireland hospital denied Savita Halappanavar life saving abortion because it is a 'Catholic country' |agency=Associated Press |access-date=4 May 2022 |work=CBS News|date=14 November 2012}}

There were calls upon the Taoiseach to start an external enquiry. There were also calls for a change in the law, as the legislation in effect at the time was an Act of the British Parliament of 1861{{snd}}when Ireland was part of the United Kingdom{{snd}}which declared that it was unlawful to "procure a miscarriage". On 16 November, the Irish Health Service Executive established an independent inquiry into the circumstances surrounding Halappanavar's death.{{cite news |url=https://www.irishtimes.com/newspaper/breaking/2012/1116/breaking2.html |title=HSE still finalising details of Savita Halappanavar inquiry |newspaper=The Irish Times |date=16 November 2012 |access-date=17 November 2012 |archive-date=17 November 2012 |archive-url=https://web.archive.org/web/20121117090828/http://www.irishtimes.com/newspaper/breaking/2012/1116/breaking2.html |url-status=dead }}

On Saturday 17 November, the Garda Síochána (Ireland's national police) estimated that between ten and twelve thousand protesters marched from Parnell Square to Merrion Square to demand a change in the law, with other rallies across Ireland and many other countries.{{cite news|url=https://www.irishtimes.com/newspaper/breaking/2012/1117/breaking4.html|title=Thousands attend Savita vigils around the country|newspaper=The Irish Times|date=17 November 2012|access-date=17 November 2012|archive-date=17 November 2012|archive-url=https://web.archive.org/web/20121117151221/http://www.irishtimes.com/newspaper/breaking/2012/1117/breaking4.html|url-status=dead}} The Gardaí announced that they were assisting the coroner in the investigation.{{cite news |url=https://www.irishtimes.com/newspaper/breaking/2012/1117/breaking4.html |title=Gardaí assisting coroner in Savita Halappanavar case |date=17 November 2012 |access-date=17 November 2012 |newspaper=The Irish Times |archive-date=17 November 2012 |archive-url=https://web.archive.org/web/20121117151221/http://www.irishtimes.com/newspaper/breaking/2012/1117/breaking4.html |url-status=dead }} Medical terminations had previously been performed at the University Hospital when complications arose in pregnancy, as it is permitted by Irish law to save the life of the woman.

On Monday 19 November, the Roman Catholic bishops of Ireland met in response to Halappanavar's death and released a statement that the Catholic Church believes in the "equal and inalienable right to life of a mother and her unborn child" and that the Church has never taught that the life of an unborn child takes precedence over the mother.{{cite news|url=https://www.rte.ie/news/2012/1119/346307-x-case-legislation-abortion/ |access-date=5 May 2022 |title=Treatment that risks foetus can be 'ethically permissible' – Catholic bishops|publisher=RTÉ News | date=19 November 2012}}

The staff of University Hospital as well as members of Ireland's Health Services Executive (HSE) Regional Health Forum stated that there is no "Catholic ethos" affecting treatment.{{cite news|url=https://www.irishtimes.com/newspaper/ireland/2012/1116/1224326668071.html|title=Catholic ethos suggestion dismissed|last=Humphreys|first=Joe|date=16 November 2012|newspaper=The Irish Times|access-date=20 November 2012|archive-date=16 November 2012|archive-url=https://web.archive.org/web/20121116214216/http://www.irishtimes.com/newspaper/ireland/2012/1116/1224326668071.html|url-status=dead}}

Dr Sam Coulter-Smith, a prominent obstetrics and gynaecology physician, said that current standards of care were legally unclear, saying, "We really do need legislation in this area, otherwise we're going to be at risk of doctors working outside the law, and that's not appropriate."{{cite news|url=http://www.rte.ie/news/av/2012/1116/media-3436430.html|title=We absolutely need legislation – Rotunda Master Dr Sam Coulter-Smith|publisher=Raidió Teilifís Éireann|date=15 November 2012|url-status=dead|archive-url=https://web.archive.org/web/20121128092407/http://www.rte.ie/news/av/2012/1116/media-3436430.html|archive-date=28 November 2012}}{{cite news|url=https://www.irishexaminer.com/news/arid-30574300.html |title= Rotunda head: No confusion|work=Irish Examiner|date=15 November 2012}} Dr Rhona Mahony, Master of the National Maternity Hospital, said: "It is very disappointing that, 20 years after the 'X-Case', we don't have legislation" and that women "need to know that they are going to get the appropriate health care that they need" while doctors "need to know that they are also protected in their ability to do their job".{{cite news|url=https://www.irishexaminer.com/news/arid-30574284.html |title=Maternity hospital chief: Women and doctors need protection|date=15 November 2012|work=Irish Examiner|access-date=20 November 2012}} Peter Boylan, of the Irish Institute of Obstetricians and Gynecologists, said: "The current situation is like a sword of Damocles hanging over us. If we do something with a good intention, but it turns out to be illegal, the consequences are extremely serious for medical practitioners."{{cite news|url=https://www.nytimes.com/2012/11/23/world/europe/inquiry-sought-in-death-in-ireland-after-abortion-was-denied.html|title=Inquiry Sought in Death in Ireland After Abortion Was Denied|first=Douglas|last=Dalby|newspaper=The New York Times|date=22 November 2012}}

Microbiologist James Clair stated in a letter to the IrishExaminer that the "main problem is being missed" in the case, suggesting that the real issue may be that the sepsis was caused by extended-spectrum beta-lactamase positive gram negative bacteria (ESBL), which "are now spreading rapidly within the Irish population" and are resistant to many known antibiotic treatments.{{cite news|url=http://www.irishexaminer.com/opinion/savitas-death-may-have-been-due-to-resistant-bacteria-strain-214431.html|title=Savita's death may have been due to resistant bacteria strain|first=J. |last=Clair|work=Irish Examiner|type=letter|date=20 November 2012|access-date=29 June 2022}}

A week after the story broke, Taoiseach Enda Kenny stated, "I don't think we should say anything about this until we are in possession of all the facts."{{cite web|url=http://www.itv.com/news/update/2012-11-14/enda-kenny-wants-all-the-facts-before-savita-action/|title=Enda Kenny wants 'all the facts' before Savita action |date=17 November 2012|work=ITV News|access-date=18 November 2012}}

Minister for Health James Reilly said that the public must not pre-judge the situation and that he was awaiting the results of the investigations, adding he had no evidence of a "Catholic ethos" at the University Hospital that prevented Halappanavar's life from being saved by a medical termination.{{cite news|url=http://www.irishexaminer.com/breakingnews/ireland/reilly-no-evidence-catholic-ethos-prevented-savitas-life-from-being-saved-574238.html |title=Reilly: No evidence Catholic ethos prevented Savita's life from being saved |newspaper=Irish Examiner |date=14 November 2012 |access-date=2012-11-23}} He also stated that an inquiry into Halappanavar's death must stand up to international scrutiny.{{cite news|url=http://www.independent.ie/national-news/video-probe-must-stand-up-to-international-scrutiny-reilly-3294919.html|title=Video: Probe must stand up to international scrutiny - Reilly|newspaper=Irish Independent |date=15 November 2012|access-date=17 November 2012}} On 18 December, after a panel of experts submitted its report to the parliament recommending that "the government legislate the issue in order to clarify what the current laws actually do and do not permit", Reilly stated, "We will clarify in legislation and regulation what is available by way of treatment to a woman when a pregnancy gives rise to a threat to a woman's life."{{cite magazine |date=19 December 2012 |title=Ireland's Historic Abortion Shift and the Tragedy That Shadowed It |url=https://world.time.com/2012/12/19/irelands-historic-abortion-shift-and-the-tragedy-that-shadowed-it/ |access-date=2012-12-20 |magazine=Time}}

Brian Walsh, a Fine Gael TD for Galway West, said that Galway University Hospital had carried out terminations in recent years in accordance with the judgement in the X Case and the guidelines of the Irish Medical Council. He said that the University Hospital was not run or managed by any (Catholic) religious orders and did not have a "Catholic ethos".{{cite news|url=https://www.irishtimes.com/newspaper/frontpage/2012/1116/1224326668914.html |archive-url=https://archive.today/20130127061746/http://www.irishtimes.com/newspaper/frontpage/2012/1116/1224326668914.html |url-status=dead |archive-date=27 January 2013 |title=Too soon to commit on abortion legislation, says Reilly |first1=Paul |last1=Cullen |first2=Kitty |last2=Holland |first3=Harry |last3=McGee |newspaper=The Irish Times |date=16 November 2012 |access-date=2012-11-23}}

Fianna Fáil leader Micheál Martin said that Halappanavar's death was tragic and harrowing. Martin said that Ireland had always prioritised a low death rate during pregnancy, but that this was "cold comfort" to Halappanavar and her surviving family. He called for an independent inquiry with experts from outside the country to establish the full circumstances. On 17 November he said that "legislating for the X Case would not have stopped [the death of Savita Halappanavar]".{{cite web|url=http://www.herald.ie/news/law-on-x-case-would-not-have-saved-savita-says-martin-3294869.html|title=Law on X Case would not have saved Savita, says Martin|work=Herald.ie|date=15 November 2012|access-date=17 November 2012|last=Murphy|first=Cormac}}

File:Dublin Savita Halappanavar Rally 56.jpg

Abortion rights campaigners highlighted at the time that the lack of legislation clarifying the limited circumstances in which abortion is legal in Ireland contributed to Halappanavar's death.{{cite news|url=http://www.independent.ie/national-news/termination-would-have-saved-savita-heartbroken-husband-3294638.html?start=3 |title='Termination would have saved Savita' – heartbroken husband |newspaper=Irish Independent |date=15 November 2012 |access-date=2012-11-23}} Several rallies and vigils were organised nationwide, calling for the Irish government to legislate in relation to abortion on the basis of the X Case case. Campaigners argued that legislation remained outstanding at the time of Halappanavar's death despite the European Court of Human Rights having instructed the state to clarify its laws on abortion after finding in A, B and C v Ireland (2010) that Ireland had violated the Convention by failing to provide an accessible and effective procedure by which a woman can have established whether she qualifies for a legal abortion under current Irish law.

Irish Choice Network allegedly emailed members, calling for an emergency meeting to discuss how to proceed with this "major news story".{{cite news |last=Reilly |first=Jerome |url=http://www.independent.ie/national-news/prochoice-activists-got-tipoff-on-tragic-death-3296844.html |title=Pro-choice activists got tip-off on tragic death |newspaper=Irish Independent |date=18 November 2012 |access-date=2012-11-23}}

In response to critics accusing abortion rights activists of exploiting Halappanavar's death, Kate Smurthwaite responded in a column in The Huffington Post titled "Yes, Savita Halappanavar's Death IS a Political Issue" in which she stated, "If I am ever a victim of an unjust legal discrepancy that infringes my human rights and leads to my untimely and unnecessary agonising death I want every man, woman and child on the streets immediately demanding that it never, ever be allowed to happen again."{{cite news|url=http://www.huffingtonpost.co.uk/kate-smurthwaite/savita-halappanavar-abortion_b_2135674.html|title=Yes, Savita Halappanavar's Death IS a Political Issue|last=Kate Smurthwaite|date=15 November 2012|work=HuffPost|access-date=19 November 2012}}

{{Abortion in the Catholic Church}}

The Life Institute in Ireland accused "abortion campaigners" of exploiting Halappanavar's death to further the abortion rights agenda.{{cite news |url=https://www.irishtimes.com/newspaper/ireland/2012/1115/1224326607685.html |title=Lobby group accused of exploiting death |newspaper=The Irish Times |date=15 November 2012 |access-date=17 November 2012 |first=Ciara |last=Kenny |archive-date=16 November 2012 |archive-url=https://web.archive.org/web/20121116013700/http://www.irishtimes.com/newspaper/ireland/2012/1115/1224326607685.html |url-status=dead }}

Michael Kelly of The Catholic World Report rejected claims that Ireland's abortion laws led to Halappanavar's death, writing that "medical experts and bioethicists have been quick to express their view that Ireland's ban on abortion had nothing to do with Mrs. Halappanavar's death. They insist that guidelines from the Irish Medical Council are perfectly clear that pregnant women must be given all necessary medical treatment."{{cite news |url=https://www.catholicworldreport.com/2012/11/16/after-tragedy-irish-abortion-laws-come-under-fire/ |first=Michael |last=Kelly |title=After Tragedy, Irish Abortion Laws Come Under Fire |date=15 November 2012 |work=The Catholic World Report |access-date=19 November 2012}} Father Shenan J. Boquet, president of Human Life International, said that there was no evidence to indicate that "a Catholic ethos" prevented responsible treatment of the mother, and called news reports that that was the case "demonizing the Church's position on abortion". He described the debate resulting from the event as "activism masquerading as compassion and moral outrage".{{cite web|url=http://www.catholic.org/international/international_story.php?id=48524|title=Human Life International Statement on the Death of Savita Halappanavar in Ireland|last=Boquet|first=Shenan J.|date=15 November 2012|work=Catholic Online|access-date=16 November 2012|url-status=dead|archive-url=https://web.archive.org/web/20140102192739/http://www.catholic.org/international/international_story.php?id=48524|archive-date=2 January 2014}}

There were protests outside the Irish embassies in London, Berlin{{cite news|url=https://www.irishtimes.com/newspaper/breaking/2012/1121/breaking13.html|title=Up to 70 people also protested outside the Irish embassy in Berlin tonight|date=21 November 2012|newspaper=The Irish Times|access-date=29 November 2012|archive-date=22 November 2012|archive-url=https://web.archive.org/web/20121122114718/http://www.irishtimes.com/newspaper/breaking/2012/1121/breaking13.html|url-status=dead}}{{cite news |url=http://www.youreonlymassive.com/berlin-vigil/|title=Vigil for Savita and Protest at Ireland's Abortion ban, Irish Embassy, Berlin|date=21 November 2012|work=Midi Grrrl|access-date=29 November 2012}} and Brussels.{{cite news|url=http://www.broadsheet.ie/2012/11/22/last-night-in-brussels-2/|title=Last night in Brussels|date=22 November 2012|work=Broadsheet.ie|access-date=12 February 2013}}

In India, Minister for External Affairs Salman Khurshid recalled the Indian ambassador to Ireland, Debashish Chakravarti, for deliberations over the issue.{{cite news|url=http://ibnlive.in.com/news/indian-woman-death-mea-summons-irish-ambassador-after-row-over-antiabortion-laws/305886-3.html|archive-url=https://web.archive.org/web/20121118002952/http://ibnlive.in.com/news/indian-woman-death-mea-summons-irish-ambassador-after-row-over-antiabortion-laws/305886-3.html|url-status=dead|archive-date=18 November 2012|title=Savita death case: MEA summons Irish envoy after row over abortion|work=IBN Live|publisher=CNN-IBN, IBN Live|date=16 November 2012}} Chakravarti later met Eamon Gilmore, Ireland's Tánaiste and foreign minister, and promised to keep Halappanavar's husband up to date with the government's response.{{cite news |url=http://timesofindia.indiatimes.com/india/Salman-Khurshid-closely-following-developments-in-Savita-Halappanavar-death-case/articleshow/17270798.cms|title=Salman Khurshid closely following developments in Savita Halappanavar death case|date=18 November 2012|work=The Times of India|access-date=19 November 2012}} Rajeev Chandrasekhar, an independent member of the Rajya Sabha (the upper house of the Parliament of India) said, "The death of Savita Halappanavar should be pursued by family and Govt. of India as a case of human rights violation and murder. Instead of simply protesting, cases should be filed against the Govt. of Ireland and its leadership at the International Court of justice and United Nations Commission for Human Rights (UNHCR). This should move beyond protesting to where people are brought to account!"{{cite news |url=http://rajeev.in/News/human_rights_violation/Times_of_India.html |title=State take up her cause: CM Shettar Says Humanity Should Precede Legality |newspaper=The Times of India |date=17 November 2012 |access-date=2012-11-23 |archive-date=29 January 2016 |archive-url=https://web.archive.org/web/20160129021259/http://rajeev.in/News/human_rights_violation/Times_of_India.html |url-status=dead }}

In an editorial on 17 November 2012, The Times of India said, "There appears to be a tendency to view this issue in terms of India versus Ireland or the Catholic faith against other religions. To fall prey to such tendencies would be a serious mistake and a great disservice to the memory of Savita. ... Adding a nationalist or communal tone to the debate detracts from the merit of argument rather than enhancing it."{{cite news|url=https://timesofindia.indiatimes.com/nri/other-news/Savitas-kin-being-consulted/articleshow/17249834.cms|archive-url=https://web.archive.org/web/20130413023832/http://articles.timesofindia.indiatimes.com/2012-11-17/other-news/35171888_1_halappanavar-northern-ireland-savita-case|url-status=live|archive-date=13 April 2013|title=Savita's kin being consulted |date=17 November 2012|work=The Times of India|access-date=19 November 2012}}

Amnesty International stated that Halappanavar's death "illustrates [the] gap in Irish law" and asked the government of Ireland to change the law on abortion "in line with international human rights laws".{{cite news|url=http://timesofindia.indiatimes.com/world/uk/Irish-govt-must-clarify-on-abortion-issue-Amnesty/articleshow/17253462.cms|title=Irish Government must clarify on abortion issue: Amnesty|newspaper=The Times of India|date=17 November 2012| access-date=17 November 2012|last=Press Trust of India}} The executive director of Amnesty International in Ireland, Colm O'Gorman, said that "successive Irish Governments have failed in their duty to provide necessary clarity on how this right is protected and vindicated, leaving women in Ireland in a very vulnerable position."

On 19 November 2012, the HSE named Professor Sir Sabaratnam Arulkumaran to head a seven-member panel looking into the case. Arulkumaran was the head of obstetrics and gynaecology at St George's Hospital Medical School and president-elect of the International Federation of Gynaecology and Obstetrics. The panel sought to uncover all the facts and "to identify any safety issues arising in this case".{{cite news|url=https://www.irishtimes.com/newspaper/breaking/2012/1119/breaking1.html|title=HSE unveils membership of Halappanavar inquiry team|date=19 November 2012|newspaper=The Irish Times|pages=direct quote is from the video, at approx 1 min|access-date=20 November 2012|archive-date=20 November 2012|archive-url=https://web.archive.org/web/20121120033149/http://www.irishtimes.com/newspaper/breaking/2012/1119/breaking1.html|url-status=dead}}

On 20 November 2012, three members of the panel were asked to step down when Savita Halappanavar's husband, Praveen Halappanavar, indicated that he would not cooperate with the panel due to their connections as consultants to University Hospital. Arulkumaran requested a meeting with Mr. Halappanavar.{{cite news|url=https://www.irishtimes.com/newspaper/breaking/2012/1121/breaking13.html|title=HSE announces Savita inquiry team replacements|date=21 November 2012|newspaper=The Irish Times|access-date=22 November 2012|archive-date=21 November 2012|archive-url=https://web.archive.org/web/20121121172923/https://www.irishtimes.com/newspaper/breaking/2012/1121/breaking13.html|url-status=dead}} On 21 November, the Irish Independent reported that Arulkumaran was being accused of promoting a "pro-abortion" approach in papers that he had published.{{cite news|url=http://www.independent.ie/national-news/probe-into-savita-shambles-goes-from-bad-to-worse-3301343.html|title=Probe into Savita shambles goes from bad to worse|first1=Eilish |last1=O'Regan |first2=Greg |last2=Harkin|date=21 November 2012|work=Irish Independent|access-date=21 November 2012}}

The Arulkumaran report was published on 13 June 2013. It identified three "Key Causal Factors" for the death: inadequate assessment and monitoring; failure to offer all management options to a patient; and non-adherence to clinical guidelines related to the prompt and effective management of sepsis. It made six recommendations for improvements in patient care in such situations. Most recommendations called for improvements in healthcare guidelines, training and practices, and one recommendation called for legislative changes if necessary to allow for expediting delivery for clinical purposes. Additionally, it made three recommendations to address incidental factors.{{rp|13–18}}

The report indicates the first key causal factor was inadequate assessment and monitoring which would have allowed medical staff to recognise and respond to indicators that the infection was causing a deterioration in Halappanavar's condition. Additionally, staff failed to devise a plan of care recognising that (1) the infection was the most likely cause of the patient's miscarriage, and (2) with increase in time following admission, and the rupture of the patient's membranes, the risk of infection and sepsis increases.

The second factor was the hospital's failure to offer all management options to the patient. The panel points out that the patient was "experiencing inevitable miscarriage of an early second trimester pregnancy where the risk to the mother increased with time from the time that membranes were ruptured."{{rp|13}}

The panel found that hospital staff failed to adhere to clinical guidelines on severe sepsis and septic shock, calling for timely and effective management after first diagnosis.{{rp|13}}

In reviewing the care given to Halappanavar in light of clinical guidelines, the panel wrote:

{{blockquote|Rupture of membranes may be caused by infection and vomiting indicates that the patient was unwell increasing the possibility of infection becoming systemic to causing sepsis. At interview, clinicians indicated that their management decisions were guided by the Royal College of Obstetricians and Gynaecologists Green-top guidelines ... . The patient was commenced on erythromycin at 22.00hrs on the 22nd of October. ... Erythromycin has also been shown to delay delivery which is beneficial in the management of preterm pre-labour rupture of the membranes but not in cases of inevitable miscarriage. ... .

The appropriate management of spontaneous rupture of the membranes in cases of inevitable miscarriage where infection is a possible underlying cause is somewhat different to the appropriate management of Preterm Pre-labour Rupture of the Membranes where the incidence of infection at presentation is lower and the survival of the fetus is more likely.

There are no accepted clear local, national or international guidelines on the management of inevitable early second trimester miscarriage (i.e. less than 24 weeks) including the management of miscarriage where there is prolonged rupture of the membranes. The reason for the absence of such guidelines may be that clinical practice in other jurisdictions would have led to an early termination of pregnancy in equivalent clinical circumstances. It is recommended that such guidelines be developed for such patients as a matter of urgency and they should be explicit in the guidance given as to when one should offer termination based on symptoms and signs of infection implying increasing health risk to the mother which may even threaten her life.

We recognise that such guidelines must be consistent with applicable law and that the guidance so urged may require legal change.

1. Prompt introduction of a Maternity Early Warning Scoring Systems Chart for patients with pregnancy complications in gynaecology wards. This should be followed by a compliance audit. The chart should indicate a monitoring coupled with an escalating nursing, medical and multidisciplinary response.{{rp|15}}
2. Introduction of mandatory induction and education on early recognition, monitoring and management of infection and sepsis. This includes severe sepsis and septic shock.
3. Development and implementation of national guidelines relating to infection and pregnancy, in addition to multidisciplinary educational programmes to improve care in such cases. In particular, there needs to be audited compliance with guidelines on management of infection, sepsis, and suspected sepsis in cases of inevitable miscarriage of an early second trimester pregnancy. This includes when there is a prolonged rupture of membranes, and increasing time from this point increases the risk to the mother.
4. Two sub-recommendations:
5. Compliance with guidelines on the management of early second trimester inevitable miscarriage. This should recognise possible rapid patient deterioration, possibly within a few hours, from sepsis to severe sepsis to septic shock. It should also recognise the high mortality rate, of up to 60 percent, associated with this. These guidelines should include the same emphases as those for infection and pregnancy listed in recommendation 3.{{rp|16}} The panel recommended such guidelines should include guidelines relating to expediting delivery for clinical reasons, including "medical and surgical termination" based on the expertise available and legal feasibility.{{rp|17}}
6. Clear statement of the legal context in which clinical professional judgement can be exercised in the best medical welfare interests of patients. The Oireachtas should consider the law including any necessary constitutional change and related administrative, legal and clinical guidelines in relation to the management of inevitable miscarriage in the early second trimester of a pregnancy.
7. The panel recommended improved communication practices between all relevant staff, and improvements in handover of acutely ill patients. Additionally, definitive tools for clearly communicating information relating to the deterioration of a woman's condition, consultation and/or handover to a higher level of care, according to 'Improving patient handover – RCOG Good Practice No 12' (Dec 2010).{{rp|17}}
8. Compliance of guidelines on the consultants' responsibilities, according to the Royal College of Obstetricians and Gynaecologists, "Responsibility of the consultant on call" (RCOG Good Practice No. 8 - March 2009). These indicate the need to involve senior medical staff due to difficulty coping with case load, or to consult on suspected serious cases. Midwives and nurses should be able to obtain help from senior nurse midwifery managers or the director of nursing on duty, and need to be able to contact the consultant if needed.{{rp|17}}

In 2017, Arulkumaran commented that a significant contributing factor to Halappanavar's death was Ireland's restrictive abortion laws.{{cite news|title=Author of Savita Halappanavar report says 8th Amendment contributed to her death|url=https://www.breakingnews.ie/ireland/author-of-savita-halappanavar-report-says-8th-amendment-contributed-to-her-death-810432.html|newspaper=BreakingNews.ie|date=24 April 2018}}

The Health Information and Quality Authority (HIQA) published a report into the incident on 9 October 2013. It found "following the rupture of her membranes, four-hourly observations including temperature, heart rate, respiration and blood pressure did not appear to have been carried out at the required intervals", noting "that though UHG [University Hospital Galway] had a guideline in place for the management of suspected sepsis and sepsis in obstetric care, the clinical governance arrangements were "not robust enough to ensure adherence to this guideline".{{cite news|url=https://www.thejournal.ie/savita-patient-report-1121411-Oct2013/ |title=Damning Savita report details litany of hospital care failures |newspaper=TheJournal.ie |date=9 October 2013}}{{cite news |url=https://www.thejournal.ie/savita-halappanavar-missed-opportunities-timeline-1121510-Oct2013/ |title=This shocking graph shows 13 'missed opportunities' in treatment of Savita |last=Daly |first=Susan |date=9 October 2013 |newspaper=TheJournal.ie |access-date=9 October 2013}}

{{see also|Protection of Life During Pregnancy Act 2013|Thirty-sixth Amendment of the Constitution of Ireland}}

Partly in response to the protest movement after the death of Savita Halappanavar,{{cite news |url=https://www.dnaindia.com/world/report-savita-halappanavar-effect-irish-president-signs-first-abortion-bill-into-law-1867644 |title=Savita Halappanavar effect |date=30 July 2013 |work=DNA India |access-date=30 July 2013}}{{cite news |url=https://www.thehindu.com/news/international/world//article60434865.ece |title=Ireland performs first legal abortion |date=23 August 2013 |work=The Hindu |access-date=30 July 2013 |location=Chennai, India }} the Irish government introduced the Protection of Life During Pregnancy Act 2013. Having passed both Houses of the Oireachtas in July 2013, it was signed into law on 30 July by Michael D. Higgins, the President of Ireland.{{cite news|url=https://www.independent.ie/irish-news/president-higgins-signs-abortion-bill-into-law-29459937.html |title=President Higgins signs abortion bill into law|date=30 July 2013|work=Irish Independent|access-date=30 July 2013}}

On 20 September 2013, Praveen Halappanavar's solicitor served legal proceedings against Galway University Hospital and separately against Doctor Katherine Astbury. The proceedings claim that Halappanavar's constitutional right to life had been breached and allege 30 issues of medical negligence.{{cite news|last=Crawford|first=Caroline|title=Savita's husband to sue her doctor for negligence|url=https://www.independent.ie/irish-news/savitas-husband-to-sue-her-doctor-for-negligence-29596560.html |access-date=26 September 2013|newspaper=Irish Independent|date=22 September 2013}}{{cite news|last=Holland|first=Kitty|title=Halappanavar begins action against hospital, doctor|url=https://www.irishtimes.com/news/ireland/irish-news/halappanavar-begins-action-against-hospital-doctor-1.1536230|access-date=26 September 2013|newspaper=The Irish Times|date=21 September 2013}}

By May 2014, Praveen Halappanavar had emigrated from Ireland to the United States.{{cite news |first=Brian |last=McDonald |access-date=5 May 2022 |url=https://www.independent.ie/irish-news/tragic-savitas-husband-quits-ireland-for-the-us-30237521.html |title=Tragic Savita's husband quits Ireland for the US|date=2 May 2014|newspaper=Irish Independent}} On 10 March 2016, Praveen Halappanavar settled the case with the HSE, after the HSE agreed to a confidential, six-figure cash settlement.{{cite news|url=https://www.irishtimes.com/news/crime-and-law/savita-halappanavar-husband-s-action-for-damages-settled-1.2567771|title=Savita Halappanavar: Husband's action for damages settled|date=10 March 2016|first=Mary|last=Carolan|newspaper=The Irish Times|access-date=13 March 2016}}{{cite news |url=https://www.independent.ie/irish-news/courts/savita-halappanavar-case-settled-for-six-figures-34534933.html |title=Savita Halappanavar case settled for six figures |first=Maeve |last=Sheehan |date=13 March 2016 |access-date=13 March 2016 |newspaper=Irish Independent}}{{cite news|url=http://www.rte.ie/news/2016/0309/773765-savita-halappanavar/|title=Settlement reportedly made over Halappanavar case|date=9 March 2016|publisher=Raidió Teilifís Éireann}}

Abortion law continued to be an issue of heated political debate. In 2016-17 the Irish government convened a Citizens' Assembly to advise about the Eighth Amendment.

A speech by John Waters at the 2017 Renua conference resulted in Kitty Holland suing him for libel, and in 2024 being awarded €35,000 damages plus costs.{{cite news |title=Waters ordered to pay full legal costs in Holland case |url=https://www.rte.ie/news/courts/2024/0711/1459346-john-waters/ |access-date=11 July 2024 |work=RTÉ News |date=11 July 2024 |language=en}} Waters had said that to claim the refusal of an abortion had caused Halappanavar's death was "a lie that resulted in the journalist who started the lie getting multiple awards from her colleagues".{{cite news |last1=Keena |first1=Colm |title=Kitty Holland wins defamation case against John Waters and is awarded €35,000 in damages |url=https://www.irishtimes.com/crime-law/courts/2024/07/03/kitty-holland-wins-defamation-case-against-john-waters-and-is-awarded-35000-in-damages/ |access-date=11 July 2024 |newspaper=The Irish Times |language=en}} Waters argued in court that 'he was not saying Ms Holland lied but that she was the "initiator of a process" that "at some indeterminate point along its trajectory became a lie"',{{cite news |last1=Carolan |first1=Mary |title=Kitty Holland tells judge that John Waters's letter was 'quite the assault on me and The Irish Times' |url=https://www.irishtimes.com/crime-law/courts/2024/04/25/kitty-holland-tells-judge-that-john-waterss-letter-was-quite-the-assault-on-me-and-the-irish-times/ |access-date=11 July 2024 |newspaper=The Irish Times |date=25 April 2024 |language=en}} and that she had been "badly served" by her editors.{{cite news |last1=Keena |first1=Colm |title=John Waters claims he faces 'ruination' should he lose defamation action taken by Kitty Holland |url=https://www.irishtimes.com/crime-law/courts/2024/04/30/john-waters-claims-he-faces-ruination-should-he-lose-defamation-action-taken-by-kitty-holland/ |access-date=11 July 2024 |newspaper=The Irish Times |date=30 April 2024 |language=en}} The judge ruled Waters' words were "a serious attack on [Holland's] professional integrity".

On 20 May 2018, the parents of Halappanavar called for a Yes vote in Ireland's referendum on the repeal of the Eighth Amendment, with her father saying, "I hope the people of Ireland will vote yes for abortion, for the ladies of Ireland and the people of Ireland. My daughter, she lost her life because of this abortion law, because of the diagnosis, and she could not have an abortion. She died."{{cite news|url=https://www.irishtimes.com/news/social-affairs/savita-s-father-calls-for-repeal-as-campaigns-target-undecided-1.3501906|title=Savita's father calls for repeal as campaigns target undecided|last=Holland|first=Kitty|newspaper=The Irish Times|date=20 May 2018|access-date=21 May 2018}} On 25 May 2018, the people of Ireland voted Yes to repeal the Eighth Amendment by a margin of 2 to 1.

On 30 September 2018, an open letter by Emma Watson to Halappanavar was published in Porter magazine.{{cite news|url=https://www.independent.co.uk/life-style/women/emma-watson-savita-halappanavar-abortion-ireland-death-miscarriage-letter-porter-magazine-a8563131.html|title=Emma Watson Pens Powerful Letter To Savita Halappanavar, Who Died After Being Denied An Abortion in Ireland |last=Barr|first=Sabrina|date=30 September 2018|access-date=1 October 2018}}

• Sheila Hodgers
• PP v. HSE
• Indians in Ireland

{{Reflist}}

• [http://www.rte.ie/news/search/?query=savita%20halappanavar Savita Halappanavar] collected video, news and commentary at RTÉ.ie
• [http://www.ndtv.com/topic/savita-halappanavar Savita Halappanavar] collected video, news and commentary at NDTV
• [http://timesofindia.indiatimes.com/topic/Savita-Halappanavar Savita Halappanavar] collected news and commentary at The Times of India

{{Abortion in the Republic of Ireland}}

{{Authority control}}

{{DEFAULTSORT:Halappanavar, Death of Savita}}

Death of Savita Halappanavar

Death of Savita Halappanavar

Death of Savita Halappanavar

Category:Deaths by person in the Republic of Ireland

Category:Women deaths

Death of Savita Halappanavar

Death of Savita Halappanavar

Category:Political scandals in the Republic of Ireland

Category:India–Ireland relations

Category:Social problems in medicine

Category:October 2012 in Ireland