‘Disgraceful’ that victim was last to hear of error
A BATTLE over who had the embarrassing responsibility of telling Limerick woman Vicky Phelan, 43, that her original smear test result had been wrong was ‘absolutely disgraceful’, the Dáil has heard.
Speaking under Dáil privilege, Donnchadh Ó Laoghaire, Sinn Féin TD for Cork South Central, said there had been a dispute as to who should be responsible for informing Ms Phelan of what had gone wrong.
A serious error in her case had come to light and on July 21, 2016, Ms Phelan’s doctor was informed.
‘But it was not until 27 September 2017 that Mrs Phelan was informed,’ Mr Ó Laoghaire said.
He said it was his understanding that the 14-month intervening period was ‘filled with correspondence between her doctor, Dr Kevin Hickey, and Professor Gráinne Flannelly, the clinical director of CervicalCheck.
‘It is disgraceful that she [Mrs Phelan] was the last to know, as was the delay before she was informed,’ said Mr Ó Laoghaire.
‘It appears that there was almost a battle between the doctors and CervicalCheck as to who had the obligation to tell her. That is wrong. It is disgraceful.’
However, there was more to the matter than knowledge at the time the worst was known, he said, pointing out that Professor John Shepherd, one of the medical experts called in Mrs Phelan’s court case, had given evidence on the original screening error.
‘He said he was struck by the obviousness of the abnormalities found on the slide which was reviewed. They should have been spotted speedily.’
The US laboratories involved had been used for ten years and yet concerns were first expressed about them by organisations such as the Well Woman Centre, which first raised a flag around 2007, Mr Ó Laoghaire said.
‘Of course, there will be mistakes. It is not possible to have a programme in which there are no mistakes. Nevertheless, it is worth asking whether we are going to engage in a review of the rate of misses from these laboratories,’ he said. ‘Such a review is vital to restore public confidence.
‘This is a very important programme and we all want it to be funded properly in order that as many people as possible might be screened.
‘Battle over who should tell her’
‘However, we need to know that the quality of checking in those laboratories is up to scratch and that there are not more things being missed in them than are missed anywhere else.’
He said he understood there is a contractual obligation to inform women within four weeks if a problem is identified with a smear test. ‘But if a problem was found in a subsequent review, a similar contractual obligation did not apply,’ he said.
‘Given the contractual obligation to inform women of problems identified in a smear test, why are women not told as soon as possible of problems… with a smear test in a subsequent review?’
According to Mrs Phelan’s solicitor Cian O’Carroll, if her cervical cancer had been detected in 2011, Mrs Phelan could have undergone treatment and stood a 90% chance of being cured instead of now having terminal cancer, the TD said. ‘It seems… the last person to know is the woman affected.’
Other women listening to Mrs Phelan’s story would rightly be worried, confused and frightened, Mr Ó Laoghaire said.
According to Mr O’Carroll, documents from Mrs Phelan’s case indicated that up to 14 other women diagnosed with cervical cancer had previously been told their smear tests were normal.
Yet anyone seeking reassurance will not have found it this morning if they listened to an interview with Dr Jerome Coffey of the National Cancer Control Programme.
Mr Ó Laoghaire said: ‘In response to straightforward questions, Dr Coffey obfuscated and avoided answering.’ He added that teh screenign chief was not able to state how many women had experienced what Mrs Phelan had or whether all of them had been informed. ‘He could not even indicate whether doctors were obliged to inform patients [about errors].’ Significant questions remain outstanding, he said.
Mr Ó Laoghaire asked how many patients this happened to.
The TD said anyone who had watched or listened to Mrs Phelan making a statement outside the Four Courts could not help but be moved by her ‘heartbreaking’ words. Judge Cross had described her as one of the most impressive witnesses he had ever encountered, and there was no doubt she was a remarkably brave and courageous woman, Mr Ó Laoghaire said.
Tánaiste Simon Coveney agreed. He said that in the midst of all the challenges Ms Phelan was facing, she had focused on the hope that something good may come from her situation.
‘I hope that is the case and we have an obligation to ensure it is. The key issue is the information flow. Once the State has a piece of information that is relevant to a woman in these circumstances, she should be entitled to have this information immediately,’ Mr Coveney declared. ‘It should not move between offices, physicians or anyone else without the patient having automatic access to it. The decision taken this morning was to change the approach and not before time.’
But Mr Coveney said it was important to use accurate language in the discussion. ‘This is not about misdiagnosis. A smear test is not a diagnosis but a screening mechanism that can spot early signs of change which need to be followed up in terms of potential cancer treatment.
‘In this case, we had what was effectively a false negative from the screening programme. Such false negatives occur because there is no perfect screening programme in place anywhere… The view of those involved in CervicalCheck is that the systems in place here are as good as… anywhere in the world and better than most… CervicalCheck is open to peer review, independent assessment and so on.’
‘Other women will be rightly worried’
WITHIN the course of just one week, we have now witnessed three separate cases where the health service has failed in its basic duties of openness and honesty.
Firstly, in the conclusions of the Medical Council inquiry into the tragic case of baby Mark Molloy, who died in 2012 in the Midland Regional Hospital in Portlaoise, we saw that the doctor in question altered his medical notes, after the fact.
That any doctor should do such a thing, something that within medical practice is utterly taboo due to the vital importance of the accuracy of such notes, is totally shocking.
Then, as if one such case of wrongdoing in Portlaoise wasn’t enough, it also came to light that in the very same hospital, another set of records were faked in the wake of the death of another baby. This time the mother’s arrival time at the facility was altered by an hour, so as to make it appear that the hospital was not as lax as it apparently had been.
Now, additionally, we have the scenario where, in 2014, the CervicalCheck service knew that a number of women – and we still have no idea how many – had had earlier cervical smear tests misread, meaning that early warning signs for cancer were missed, resulting in the women contracting the disease.
Yet, unbelievably, a decision was taken not to inform anyone of this – not the women themselves, not their doctors, not the general public.
There is only one word for such inaction and it is the word that Stephen Donnelly, Fianna Fáil spokesperson for health, used yesterday: cover-up.
This was a conscious decision not to make public something that was clearly in the public interest.
This was a choice that was made to cover up the truth and to deny to those affected what they and their families had every right to know.
It is impossible to justify such a failure to tell the public the truth. So much so that now we have the Irish Cancer Society suggesting (in a very diplomatic way) that we may well need legislation to require medics in such situations to tell the truth.
And while it seems preposterous that that is what may be required to make our health service accountable, there is no denying that the evidence suggests that that is, indeed, the way we may be heading.
For even in relation to the tragic case of Vicky Phelan, we have learned that there was an attempt to impose a gagging order in relation to the court proceedings.
Why on earth would that be productive for anyone?
Surely the most important thing is to shine a light on all of this and to learn from the mistakes that were made.
While the Irish Cancer Society is not definitive in its call for legislation, the suggestion is certainly food for thought.
With the details for this appalling medical debacle having to be dragged out of those in the know, perhaps, indeed, it is worth proceeding straight to law in order to enforce what the Irish Cancer Society calls a ‘duty of candour’.
What we must now establish in relation to this case is who, specifically, is responsible.
Who knew about the problem with the Texas laboratory? Who made the decision to cover it up? And at what level was that decision approved?
The person, or people, responsible must be exposed and held accountable.
In medicine as in life, mistakes happen. That’s the nature of being human.
But if honesty had been the priority in 2014, if a duty of candour had genuinely existed, then everyone would have been better served.
Hopefully now, however, those responsible will pay a heavy price.