An Irish teenager died in University Hospital Limerick due to delays in recognising and treating sepsis, <em>The Sunday Independent</em> <a href="https://www.independent.ie/irish-news/health/revealed-schoolgirl-aoife-johnston-who-died-from-meningitis-waited-in-aande-for-12-hours-as-sepsis-went-untreated/a345024656.html"><mark style="background-color:rgba(0, 0, 0, 0)" class="has-inline-color has-vivid-cyan-blue-color">reported</mark></a> on 10 December after a review into her treatment and care following reports she spent a significant time on a hospital trolley.
Aoife Johnston was 16 when she died on 19 December last year. The Health Service Executive in Ireland has issued an apology for “serious failings in the care” provided to her. An internal review into the circumstances of her death was provided to her family, revealing that she waited 12 hours in UHL’s severely overcrowded emergency department and was not treated for sepsis until it was too late, and despite her family flagging her deteriorating condition. The review found that delays in her treatment breached national guidelines on sepsis management.
The situation might sound very familiar to those in Ireland, and abroad, who followed the debate around Ireland’s abortion referendum in 2018. The tragic case of 31-year-old Indian dentist Savita Halappanavar, who in 2012 died in Galway while pregnant, became a totem for the removal of the 8th amendment—which protected the rights of the unborn and in effect banned abortion—from the Irish Constitution and the introduction of one of the most liberal abortion regimes in the world.
Halappanavar died at University Hospital Galway hospital on 28 October 2012 having presented a week earlier with severe back pain. She was found to be miscarrying and the miscarriage continued for three more days during which time she developed severe sepsis. She was apparently told that she couldn’t have a termination or early induction because Ireland was “a Catholic country”.
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 <a href="https://www.hse.ie/eng/services/news/nimtreport50278.pdf" target="_blank" rel="noreferrer noopener"><mark style="background-color:rgba(0, 0, 0, 0)" class="has-inline-color has-vivid-cyan-blue-color">inquest</mark></a> 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 <a href="http://www.irishtimes.com/news/health/expert-tells-inquest-savita-had-worst-case-of-sepsis-he-had-seen-in-30-years-1.1364882" target="_blank" rel="noreferrer noopener"><mark style="background-color:rgba(0, 0, 0, 0)" class="has-inline-color has-vivid-cyan-blue-color">she died from the worst case of sepsis</mark></a> 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.
Yet the substantive findings from the inquest received little or no support or interest. The focus was solely on abortion under the guise of saving women’s lives, and in spite of the counter argument that there was nothing in law preventing early delivery to save a mother’s life). A <a href="https://www.irishtimes.com/opinion/letters/savita-halappanavar-inquest-1.1378062" target="_blank" rel="noreferrer noopener"><mark style="background-color:rgba(0, 0, 0, 0)" class="has-inline-color has-vivid-cyan-blue-color">letter</mark></a> to the <em>Irish Times</em> from 11 doctors 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.”
While not wishing to repeat the approach taken by abortion activists of making a political football out of a tragedy, it is arguable that had greater emphasis been placed on the fundamental issues highlighted through the inquest, then sepsis protocol management may have been a greater concern and priority for the government, for women’s rights activists and for the HSE, and ultimately resulted in proper protocol management for Aoife Johnston in UHL. Her death arose due to failure to follow sepsis management protocols compounded by systematic overcrowding in hospitals, the latter being another factor that has been ignored in the clamour for abortion.
Successive <a href="https://gript.ie/with-a-health-service-in-chaos-why-is-donnellys-priority-abortion/" target="_blank" rel="noreferrer noopener">health ministers</a> in Ireland have been fixated with abortion: whether by removing constitutional and legislative obstacles to abortion in the first place, by promoting abortion as a public good, by paying doctors from the public purse more to provide abortion care than pregnancy management care, by continuing to lobby for removal of additional barriers such as the 3-day “cooling off” period and the 12 week limit for “no-cause” abortion, as well as by an incessant push to ensure all maternity hospitals provide abortion.
It appears there is little publicity to be gained or appeal for <a href="https://www.theguardian.com/world/gallery/2018/may/26/ireland-says-yes-to-abortion-reform-in-pictures" target="_blank" rel="noreferrer noopener"><mark style="background-color:rgba(0, 0, 0, 0)" class="has-inline-color has-vivid-cyan-blue-color">wild celebrations</mark></a> when it comes to implementing the nuts and bolts of sepsis management. Getting the basics right in Irish healthcare doesn’t get you plaudits in today’s febrile world of activism. Hospitals in Ireland continue to be overcrowded, waiting lists grow ever longer, and more people remain on trolleys when waiting for hospital beds and emergency care.
Just how little has been learned or changed is illustrated by the failure to follow sepsis management protocols again being a significant causal factor in the death of another female in Ireland, this time a girl, a whole 10 years after Savita Halappanavar died, while attended by the subsequent political and media pile-on and publicity of her death.
Despite the mismanagement and errors around Johnston's death, there is no sign of any self-reflection from women’s rights activists that an ideologically motivated appropriation of a tragedy in 2012 may have contributed to another tragedy in 2022 by providing political cover to successive governments who have not managed (or attempted) to implement the basics of healthcare management in Ireland.
Minor protests followed Johnstone’s death, but there was no public outcry—nothing close to what happened after Halappanavar’s death. The celebrity hand-wringing, the concerts in the dark, the countrywide candlelit vigils that spontaneously appeared in a coordinated fashion—all that was <a href="https://gript.ie/where-is-the-national-outcry-over-aoife-johnstons-death-at-a-limerick-hospital/"><mark style="background-color:rgba(0, 0, 0, 0)" class="has-inline-color has-vivid-cyan-blue-color">entirely absent</mark></a> for Johnstone.
Will there now be six years of campaigning to ensure that what happened to her never happens again? It seems highly unlikely.
Some tragedies are simply less useful than others.
Photo:<em> Those in support of the 'Yes' vote celebrate as the result of the Irish referendum on the 8th amendment concerning the country's abortion laws is declared—66.4 per cent to 33.6 per cent in favour of 'Yes'—at Dublin Castle, Dublin, Ireland, 26 May 2018. (Photo by Charles McQuillan/Getty Images.)</em>
