Timeline: final days of Savita Halappanavar until report publication

An account of the days before her death and the period until HSE clinical review published

Savita Halappanavar: died at Galway University Hospital in October 2013.
Savita Halappanavar: died at Galway University Hospital in October 2013.

Sunday October 21st:

AM: Savita Halappanavar – 17 weeks pregnant – experiences back pain at her home and attends Galway University Hospital. Doctors would later admit she was suffering contractions prior to miscarriage.

PM: After being sent home that morning, she returns to hospital in the afternoon complaining of a dragging sensation. Doctors find her membranes are bulging and there is a foetal heartbeat. Blood tests are ordered. The registrar tells her the loss of her pregnancy is inevitable. Her consultant, Dr Katherine Astbury, will later tell her the prognosis is poor but not non-existent.

Monday October 22nd:

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12:30am: Mrs Halappanavar's waters break. Vital signs are normal. Dr Astbury reviews her during her morning round. The plan is to "await events". She is put on antibiotics that evening to protect against infection.

Tuesday October 23nd:

AM: Mrs Halappanavar asks Dr Astbury for a termination but this is refused because the foetal heartbeat is present and her life is not at risk. Midwife manager Ann Maria Burke attempts to explain to Mrs Halappanavar why a termination is not possible in this State and uses the term "because Ireland is a Catholic country".

Wednesday October 24th:

AM: Mrs Halappanavar sleeps during the early hours but her condition is not checked every four hours, as required by hospital policy.

6.30am: It is now 54 hours since Mrs Halappanavar's membranes ruptured. Her temperature is raised and her heart beat is twice what it was on admission. Dr Ikechkwu Uzockwu notes a foul smelling discharge from her vagina, and diagnoses probable chorioamnionitis, an inflammation of the foetal membranes due to infection. He orders tests and puts her on a stronger antibiotic.

8.25am: Dr Astbury visits Mrs Halappanavar. She does not read the notes herself and is not told by her team about the reference to the foul-smelling discharge. She diagnoses sepsis, as opposed to severe sepsis, because Mrs Halappanavar's blood pressure is not low. She later tells the inquest that the information about the foul-smelling discharge is significant and had she known, she would have terminated sooner.

1pm: Dr Astbury is told Mrs Halappanavar's condition has deteriorated. She decides, after consulting a senior colleague, to carry out a termination. However, a scan reveals the foetal heartbeat has stopped.

3.15pm: Mrs Halappanavar is moved to theatre. During insertion of a central line, she spontaneously delivers a deceased baby girl. She is then transferred to the high dependency unit. Later that night she is moved to intensive care suffering from septic shock.

Friday, October 26th:

Mrs Halappanavar’s condition deteriorates. Blood tests reveal septicaemia due to E.coli ESBL, which is highly resistant to the first antibiotic on which she was placed. She becomes critically ill.

Sunday, October 28th:

Mrs Halappanavar suffers cardiac arrest. Attempts at resuscitation are unsuccessful and she is pronounced dead.

Thursday, November 1st:

Praveen Halappanavar takes his wife's body home where she is cremated and laid to rest on November 3rd.

Wednesday ,November 14th:

The story of Savita Halappanavar's death is broken by Irish Times journalist Kitty Holland and makes headlines worldwide. Vigils in her memory and protests at the perceived role of Irish law in her death are held over the following days. There are calls for a public inquiry into her death and for the Government to bring forward legislation to give statutory effect to the decision of the Supreme Court in the X case.

Thursday, November 15th:

Tánaiste Eamon Gilmore calls for "legal clarity" on the issue of abortion – while Minister for Health James Reilly resists pressure to commit to the introduction of legislation before he has considered the report of his expert group on abortion.

Monday, November 19th:

The Health Service Executive (HSE) unveils details of its inquiry into the death of Savita Halappanavar after the draft terms of the inquiry are sent to Praveen Halappanavar.

Tuesday, November 20th:

Ireland’s Catholic bishops say the church “has never taught that the life of a child in the womb should be preferred to that of a mother”. In a statement, the standing committee of the Irish Catholic Bishops Conference say Mrs Halappanavar’s death – along with that of her unborn child – was “a devastating personal tragedy for her husband and family”.

Wednesday, November 21st:

Following objections from Mr Halappanavar, three consultants from Galway University Hospital are replaced on the inquiry team. Mr Halappanavar however refuses to co-operate with the HSE inquiry – calling instead for a full public inquiry. President Michael D Higgins intervenes in the row over the inquiry, saying it must meet the needs of her family as well as those of the State.

Tuesday, November 27th:

The report of the expert group on abortion is brought before Cabinet and published. It outlines a series of options for the Government on the issue of abortion.

Friday, November 30th:

The Health Information and Quality Authority publishes the terms of reference for its investigation into Mrs Halappanavar’s death.

Tuesday, December 18th:

The Cabinet announces that a combination of legislation and regulations will be required to comply with the Supreme Court decision on abortion in the X case.

Wednesday, February 13th:

Savita Halappanavar’s husband is said to be “very upset” by the leaking of a draft report of the HSE inquiry into his wife’s death.

Friday, March 29th:

The draft report of the HSE inquiry into the death of Mrs Halappanavar is handed to her husband’s solicitor in Galway. He later claims the report vindicates his account of events at the hospital.

Monday, April 1st:

Praveen Halappanavar says he is not satisfied with the conclusions of the draft HSE report into her death because of “shortcomings”.

Wednesday, April 3rd:

The HSE apologises to Praveen for the care it gave to his wife and the events at Galway University Hospital that contributed to her death.

Monday, April 8th:

The inquest into Savita Halappanavar’s death opens in Galway. Praveen spends 90 minutes reading his statement, detailing how he met and married Savita, and the events leading to her death.

Wednesday, April 10th:

Mrs Halappanavar’s consultant obstetrician Dr Katherine Astbury tells the inquest there were a number of systems failures at Galway University Hospital in her treatment.

Wednesday, April 17th:

Praveen Halappanavar does not attend his wife's inquest after a week of "stressful" hearings. Dr Peter Boylan, clinical director of the National Maternity Hospital, says if Ms Halappanavar had been given a termination one or two days after she was admitted, she would "on the balance of probabilities", still be alive.

Friday, April 19th:

The jury in the inquest returns a unanimous verdict of death by medical misadventure. Praveen Halappanavar says the way his wife was treated in hospital was “horrendous, barbaric and inhumane”. Dr James Reilly says he will consider the verdict and draw lessons from it.

Tuesday, April 30th:

The Government publishes the draft heads of the proposed Protection of Life during Pregnancy Bill 2013. The bill allows for abortion in the case of a threat to the life of a pregnant woman, including the threat of suicide.

Friday ,May 17th:

The Oireachtas committee on health begins hearings on the Government's draft abortion legislation. Dr James Reilly is among 50 medical experts who will address the cross-party committee. The Masters of two Dublin maternity hospitals differ on the suicide provisions in the legislation.

Tuesday, May 21st:

A medical ethics expert tells the Oireachtas health committee that legislators should “at the very least” consider reducing the maximum penalty of 14 years in prison for women who have illegal terminations. The Government later says it will examine the issue.

Sunday, May 26th:

As the societal debate on the abortion legislation rages and lobby groups engage in strongly emotive tactics, it emerges that the chairman of the Standards in Public Office Commission Mr Justice Matthew Smith has written to Minister for the Environment Phil Hogan seeking greater powers to sanction groups that fail to co-operate with its inquiries.

Monday, May 27th:

A newsletter being circulated by the Catholic Communications Office says it is “untrue” to state “that there is no change to the law on abortion in Ireland” being planned by the Government.

Wednesday, May 29th:

The HSE begins implementing a number of system changes recommended at the Savita Halappanavar inquest. The introduction of an early warning system and educating staff about septic shock are now under way.

Thursday, May 30th:

Fianna Fáil leader Micheal Martin announces he is to allow a free vote on the abortion legislation in the Dáil and Seanad. Taoiseach Enda Kenny meanwhile continues to insist that the whip will apply to all Government TDs.

Wednesday, June 12th:

Taoiseach Enda Kenny continues to resist pressure from church leaders, telling the Dail he is a Taoiseach who happens to be Catholic – but he is not a Catholic Taoiseach.

Today

After agreement by Cabinet, the Protection of Life during Pregnancy Bill is published shortly after midnight. It contains a number of changes from the original draft heads published in April. The final HSE clinical review report into Mrs Halappanavar’s death is also published.

Colin Gleeson

Colin Gleeson

Colin Gleeson is an Irish Times reporter