In between writing and research about plastic bottles, industrial clean-up and challenges involved in financing commercial transport, has been the tragedy of Savita Halappanavar. At the request of Mark Lambert I wrote a column that he kindly hosted on his blog, which gets a lot more hits than mine! He was then challenged about it and one person, apparently, went so far as to strongly suggest that he should take it down. I can understand one side of the debate getting seriously huffy - after all, if Mrs Halappanavar did not die from the effects of Catholic teaching and being denied an abortion, then the wind in their sails is reduced the slightest zephyr.
When I began to investigate I thought I would uncover confirmation of medical malpractice or incompetence. (Yes, I went in with some prejudgements already in place. Mea culpa. ) Instead, I discovered an unavoidable tragedy and a matter for concern far away from the current hysterical arguments. Nothing to do with abortion and everything to do with unresponsive medical infections.
Just in case things change, i am going to publish here again the original column hosted by Mark. The Weeping Gargoyle took issue with it and I put my rebuttal below, along with a link to the Gargoyle's post.
(Gosh. One tries to spread a little light in place of heat and it don't work!)
Who stands to gain from tragedy?
If you can’t find evidence of a conspiracy then you aren't looking hard enough…
There is a need to stop this side of David Icke (WELL this side of David Icke) but, sometimes, conspiracy theories turn out to hold water.
The death of Savita Halappanavar is a tragedy that became a catastrophe for her family – that much is crystal clear and pretty much everyone can agree on it. But then things get murkier and murkier. There are agendas at work and the hint of something rather nasty at large.
Mrs Halappanavar died of an antibiotic-resistant infection, specifically e.coli ESBL. She did not die from an abortion, from being denied an abortion, from Catholic teaching or from a confused legal system in Ireland.
WHAT IS IT?
ESBL stands for Extended Spectrum Beta-Lactamase positive gram negative bacteria. It is resistant to most strains of antibiotics. One of my informants told me: “… the antibiotics given were to no avail…two things can happen if it doesn't respond to treatment. Either the body's immune system deals with it in the normal way and wins or the bug defeats the immune system and the patient develops an overwhelming septicaemia, leading to septic shock. The kidneys start to fail and the blood pressure starts to fall.” They then go on and die – the mortality rate is massive.
The great concern – or what should be the concern – is that e.Coli ESBL and other antibiotic-resistant infections are now at large in the community. Previously, such things were limited to identifiably higher-risk areas: hospitals themselves; food processing (slaughterhouses in particular); and farms, where slurry is often used as a fertilizer. But Mrs Halappanavar was a dentist.
Instead of being concerned that untreatable infections are in the community as a whole and spreading, the debate has been hijacked by special-interest groups. But it is worse than that.
It is proving to be very difficult to get the truth of the fatal infection into the mainstream news media; they are only interested in the abortion angle – if they remain interested at all. As for the medics I have spoken to – they are all concerned for their careers. Getting information has been like pulling teeth. I cannot mention names or attribute their comments even to ‘a doctor/nurse/paramedic at x/y/z hospital/surgery/healthcare trust’. I can’t even mention the area they live and practice; they are frightened of being traced and found out. That could have been put down to the fear that they were passing on hearsay and gossip – but the same story has come from multiple sources. It passes the usual tests of corroboration.
FEAR MAKES FOOLS OF US ALL
I am getting a message pretty loud and clear that speaking out about this, that going public with the 'wrong' message may very well impact upon an individual's career. "Most people are afraid to comment..." one of my informants has said. Some of my informants are coming towards the end of their careers and are slightly more inclined to speak out but even then there is a great deal of caution. There appears to be real, tangible fear.
Is it a conspiracy? Well, in my experience, you don’t often find doctors and nurses so frightened for their jobs. Patient confidentiality is always respected, of course, but there is so much out in the open now that confidentiality is not an issue. It is odd – very odd – that the ‘pro-choice’ group whose press release triggered off this furore seems to have known about the incident for some days, had access to medical information that was not at the time in the public domain and was, therefore, supposedly confidential. It had the chance to tee up its members and supporters that a major story was about to break.
FOLLOW THE MONEY....
It happened shortly after a Marie Stopes facility opened in Northern Ireland, and soon after an RTE broadcast of an undercover investigation that revealed pregnancy advisory services are behaving in an illegal and dangerous manner. One of my informants has pointed out that the consultant in charge of the deceased lady is actually English and mentioned casually that it was unusual to see people coming in from the UK - that the traffic is usually the other way. "...it may be because she has an agenda", they said. They may be appallingly right. As someone said, there is a lot of money to be made from abortions, as the UK and US experience demonstrates.
The tragedy of Mrs Halappanavar and the ensuing fuss has arrived very conveniently to overwhelm the negative programme - who now remembers it at all - in a tide of prejudice, misinformation and lynch-mob hysteria.
I had to ask some rather distasteful questions to get to the truth and got some fleas in my ear for suggesting the possibility of racism or gender-selective illegally-procured abortion! And then the gates began to crack open, the information started to flow but the fear of my informants has become almost tangible. The enquiry looked like the sort of stitch-up from the old days; it was almost laughable. Now the widowed husband has got a lawyer and is involved in setting the terms of reference of the enquiry – which hasn’t even started yet. If his wishes are not abided by, then he will not allow his deceased wife’s records to be released. I hesitate before making this observation but, of course, if no-one is responsible, if it was a tragic death that was unpreventable, then some interests will be frustrated. There are interests in finding someone or something to blame. Which means that there will be horsetrading going on to make sure it lands in the ‘right’ place. As I said, if you can’t find evidence of a conspiracy then you aren’t looking hard enough.
GET THE MESSAGE OUT
A Doctor Clair, from Cork, has had the courage to speak out publicly, in the form of a letter to the Irish examiner that was published on Tuesday 20 November. He is almost alone at the moment but one hopes his letter will get wider publicity. Readers of this blog should disseminate it as widely as they can.
This was originally published on Mark Lambert's blog, here: http://marklambert.blogspot.co.uk/2012/11/who-stands-to-gain-from-tragedy.html
My response to The Thirsty Gargoyle's criticism (http://thethirstygargoyle.blogspot.co.uk/2012/11/patience-is-virtue.html) was submitted in two pieces. Here it is in all its glory:
We do not know each other, I can confirm. Why, you do not even know how to spell my name correctly (It's Ruari. Short for the Argyll Gaelic name but that's what I do to make things easier for the English...)
I was not aware of Dr Clair's letter in the Examiner until Mark Lambert drew my attention to it on Wednesday morning, after I had semi-prepared the information that ultimately appeared on his blog as a guest post. He will be able to confirm that I had been trying to confirm the particular strain of antibiotic-resistant bacterium for some days. I had not told anyone what I had been advised it was, in order to avoid even being seen to be bringing undue influence to bear.
I was told it was an antibiotic-resistant infection last Friday and got the name of e.coli ESBL on Saturday. I spent nearly four days (off and on - I have a living to earn as well!) seeking to confirm that this was indeed the infection that killed the unfortunate Mrs Hallapanavar and, specifically, that it was not O104:H4, the strain in the 2011 German outbreak that killed 24 people and infected more than 2400. I wanted to confirm that particularly because O104:H4 deploys a particularly effective 'poison pill' defence: it dies quite readily under attack from antibiotics but, as it dies, cells burst and release intense toxins that overwhelm the body's defence mechanisms. As the standard treatment for a pregnant woman presenting with pains symptomatic of bacterial infection is antibiotics, if it had been O104:H4, the cure would have killed her, very quickly.
Had that been the case then, with years of experience, I would understand the fears that could be found to be leading to a cover-up. But it was not O104:H4, it was an EBSL.
In the course of my investigation I asked some pretty impertinent questions, including enquiries about possible racism and, maybe, cultural influences, including the possibility of procurement of an illegal abortion for the purposes of gender selection. (The racism enquiries were in both directions, btw). I got some pretty strong fleas in my ear for doing so. Like it or not, the suggestion that racism had something to do with the case was rebutted in the strongest possible terms.
I conducted enquiries as exhaustive as they could be, Greg. I did not go off the deep end - I held back from publishing for days in order to confirm what I had been told. I did not (he said, gently) go off down the road that this was about medical incompetence.
Oh, bugger gently. Greg, you talked about medical incompetence in your blog of 14 November. I quote: "... it seems to me that at least on the basis of the facts as reported, this was a straightforward and stomach-churning case of shocking -- possibly even criminal -- medical malpractice with a tragic outcome."
You leaped to medical malpractice; I didn't. I spent days trying to find out what actually happened.
Does that make me a better person than you? I don’t know you so I cannot say. All I can say is that I think I have displayed at least as much level-headedness as you accuse Mark Lambert of possessing. In the middle of this firestorm, I went looking for reliable testimony.
I found it, and I also found fear and trepidation. I will not apologise for saying that, because it is the truth. People are concerned. I asked a few days ago why the Irish government had not raised the possibility of incurable infection, a possibility of which I was already aware. I have not had a satisfactory explanation. I have had shrugs and shiftiness, sidelong glances and slippery looks, but no satisfactory explanation.
When I said, If you can't find evidence of a conspiracy then you aren't looking hard enough, it was intended to raise a smile - but a knowing smile, to be a joke 'on the square', if you like. The old idea that once is happenstance, twice is coincidence and thrice is conspiracy may not always be true but it's worth bearing in mind when headline-consuming firestorms erupt. There may very well be no connection at all between Marie Stopes opening a clinic in Northern Ireland; RTE broadcasting an undercover investigation revealing illegal and dangerous practices in advisory services in Ireland; and the fact that a lobby group appears to have had advance notice of this case, as well as access to confidential patient records. In fact, there probably isn't - it's all just coincidence. Forget I mentioned it.
I agree with you that "... pro-choicers shouldn't be jumping to the conclusion that Savita died because she was denied a termination of pregnancy or because of any supposed uncertainty in Irish law,"
And I certainly agree that "...neither should pro-lifers be asserting that she definitely didn't die for those reasons..." That's why I spent days researching and investigating - past the point where I could have sold the story to mainstream media, btw. (I make my living as a journalist so not selling stories or leads causes me physical as well as financial pain).
However, we draw apart when you talk of "...grabbing at the claim that she died because of some subcontinental superbug." "Subcontinental" implies that this strain of e.coli is restricted to, or originated in this case from, India. That is incorrect and there is no proof of it. A concern among the Irish medics I spoke to is that, far from being restricted to the Subcontinent, this bug has become established in the general public in Ireland. And it isn't a 'superbug' - just an example of evolution at work. There will be many more and we should all be concerned about that reality.
Actually, 'that reality' is my real concern. An informant said to me that they believed it was not a coincidence that the UK's Chief Medical Officer had chosen to release a major paper on antibiotic-resistant infections last week. Did you miss it? Catch up at http://www.dh.gov.uk/health/2012/11/eaad-cmo/
If resistance to antibiotics spreads further into the bacterial field, we will be back to the 1930s. Infections we think of as minor will, once again, be killers. All this stuff about whether the law in Ireland needs to be revised is so much eyewash.
Greg, you got to a truth in your post on 18 November, headlined "Paper Doesn't refuse Ink, as my Dad says". A crucial truth was buried in the middle of Kitty Holland's article, to whit: "Whether the fact that Savita had been refused a termination was a factor in her death has yet to be established."
That is a classic 'not me guv' defence: search the article and you will find no absolute accusation that the lack of an abortion killed Mrs Hallapanava; indeed, you can find this note of caution where no-one will look for it - except you, to your credit.
You think Kitty Holland has no agenda?
Yes, I am pro-life but I was initially going into this story looking for confirmation of my expectation that it was about medical malpractice and misunderstanding of Catholic teaching, as well as Irish medical ethics. And that a dreadful coincidence of those two had led to this woman's catastrophic death.
That is not what I found. I stand by what I said on Mark's blog.