Prudente testimony delayed on State Advocate’s last-minute objection

Andrea Prudente ‘given the runaround’ by Mater Dei over her medical file, says gynaecologist whose help was sought by pregnant American visitor and her partner in Malta

Jay Weeldreyer and Andrea Prudente at Mater Dei Hospital
Jay Weeldreyer and Andrea Prudente at Mater Dei Hospital

A last-minute objection by the State Advocate has derailed plans for a court to hear testimony by Andrea Prudente today, in her ongoing constitutional case against the State.

Prudente was due to testify via video link as the case filed over doctors’ refusal to terminate her unviable pregnancy at Mater Dei Hospital during her stay in Malta, continued before Madam Justice Miriam Hayman.

However, just before her testimony was about to begin, lawyer Fiorella Fenech Vella for the Office of the State Advocate objected, first to Prudente; and when this was overruled, to her partner Jay Weeldreyer, testifying remotely. The lawyer argued that several articles of the Code of Organisation and Civil Procedure required a request for the testimony of a witness who resides abroad to be made through an application to the court. 

The judge pointed out that a recently introduced article in the Code of Organisation and Civil Procedure explicitly permitted the practise, suggesting the objection should have been raised earlier and that now the court would need to decree on the issue.

Lawyer Lara Dimitriyevic, representing Prudente, said it was not right to delay her testimony.

Dimitriyevic objected to the State Advocate’s argument, but was overruled by the judge. The court however upheld Dimitriyevic’s request that Prudente testify behind closed doors, a request to which the State Advocate did not object.

The case was adjourned to April.

Prudente ‘given the runaround by Mater Dei over her medical file – Professor

Professor Isabel Stabile concluded her deposition to the court earlier this morning. “The bottom line of several studies over several years is that the risk to the foetus [in cases such as Prudente’s] is much less than the risk to the mother,” said the gynaecologist.

The Federation of International Gynaecologists and Obstetricians (FIGO) provides guidelines to practitioners, added Stabile, exhibiting a letter from the FIGO president, which she claimed, stated exactly what she had just said.

Shown Prudente’s medical file in court, Prof. Stabile read that the mother had no fever or high pulse rate, but was bleeding vaginally and had period-like cramps. She noted that the foetal heart rate was slow, “not a good sign” she said and anhydramnios, which she explained meant that there was no amniotic fluid in the amniotic sac.

At Mater Dei, Prudente was told that the prognosis for the foetus was poor but that her pregnancy was still viable and that she should stay in hospital under observation, due in part to the risk of infection.

The witness was categorical in her reply when asked what the outcome of the pregnancy would have been. “It was doomed to fail. Almost no amniotic fluid and the likelihood of it regenerating was very small, [together with] the amniotic fluid was still leaking out. The outcome was obvious,” Stabile said.

“So the prognosis seemed very poor,” observed Madam Justice Miriam Hayman. “What procedure would have been adopted at Mater Dei Hospital?” 

“International guidelines would have directed the consultants to give her a very good idea of what the prognosis was and allow her to make the decision,” Stabile replied. She repeated that “international guidelines tell us to consult with the patient,” when the judge clarified that she meant “within our legal framework.”

Within the legal framework and common practice at Mater Dei Hospital, the way forward would be to inform the patient, repeated the judge, before asking “would the patient need to reach such a state before the doctors would have to intervene?”

“The answer is no. There is absolutely no reason to wait when a foetal prognosis is close to zero,” insisted the witness.

In reply to a question asked in cross-examination by the State Advocate, Prof. Stabile said she lectured at the Faculty of Dental Surgery at the University of Malta and not at the Faculty of Medicine. “The Faculty of Medicine were unhappy with the fact that I’m a ‘doctor for choice’,” referring to her activism for the pro-choice cause. “Basically, I was ostracised and therefore I decided to leave,” explained the witness.

Stabile was asked by the State Advocate whether there had been any “irregular practises” on her part. “If there were, I wasn’t made aware of them,” she replied.

She had worked in the US and the UK before returning to Malta to start a private practice based at St Luke’s Hospital, several years ago. “I never worked at Mater Dei.” 

The State Advocate lawyer confronted the witness with an academic paper previously quoted from in court by Prof. Yves Muscat Baron, an obstetrician and gynaecologist who chairs the Maternity and Gynaecology Department at Mater Dei Hospital.

“If you actually look at the numbers in the paper, in that first group of 24 patients, there were five deaths and 19 survived the discharge. Those were from 19 to 23 weeks, so no foetus at 17 or 18 weeks, survived,” Stabile said.

“The abstract to the report is misleading, because it says the survival rate post-discharge… is 79.2%,” Stabile added. “But if you look at the actual paper, the tables show that there were no survivors in that period of gestation. The abstract is misleading and it should have been picked up. The person who reviewed this paper should have caught it in the review process. However the actual data in the study is still in the paper itself.

Stabile also said she had been first contacted by Jay Weeldreyer, Prudente’s partner, through FPAS (Family Planning Advisory Support), and that she had not examined his partner. “The call that I received from Jay was concerning the medical records. They had made the decision to try and transfer out of Malta because, I presume, of the poor prognosis given to them by doctors at Mater Dei Hospital. He had already approached customer care at Mater Dei for her records but there were apparently some difficulties.”

Stabile said she did not remember telling the patient that her life was in danger. “I don’t remember making that statement, but the prognosis was poor.”

“I made a phone call to Mr Alberto Vella… prompted by Jay’s request for help in accessing the medical records. Basically he was being given the runaround by customer service and I wondered whether the consultant could help.”

The case continues in April.