Anger at response by HSE screening chief

His interview ‘just left us with further questions’

‘Did not provide full clarity’

A RADIO interview with the head of the HSE’s screening services has prompted an angry reaction – as he failed to answer key questions on the cervical test scandal.

Dr Jerome Coffey acknowledged the ‘very difficult situation’ cancer sufferer Vicky Phelan has been through, but failed to clarify how many patients had wrongly been given the all-clear, and whether there is an obligation to tell patients affected of the error.

He told RTÉ’s Morning Ireland yesterday any obligation on whether to inform patients of any mistakes in the system rests with the GP.

‘That is between the physician and the patient,’ he said. ‘I don’t know what the statistics are in how many physicians have spoken to how many patients, but the information is made available to the physician to discuss that with the patient.’

Asked how many patients had their results audited at the same time as Ms Phelan, Dr Coffey answered: ‘I don’t have those figures here today.’

Commenting on the interview, Sinn Féin leader Mary Lou McDonald said there are ‘now more questions than answers’. She said: ‘I think any woman listening to the HSE this morning would be asking themselves, “I wonder was my smear OK?”’ Ms McDonald added that it is ‘unacceptable that, where a mistake is made, that information is withheld from the person’s GP or physician, or then withheld from the woman herself’.

She said it must be discovered if there are other women in the same position as Ms Phelan, who is fighting terminal cancer after she was wrongly given the all-clear in a 2011 test.

The Sinn Féin leader called on the Government to establish the facts of the case, and said: ‘It is not acceptable to send somebody from the HSE on to the national airwaves, and when asked simple questions like, “How many cases are there?”, to say, “Well, I don’t have that information”.’

Tánaiste Simon Coveney said he had heard the interview, and that it ‘raised some questions and did not provide full clarity in terms of the HSE’s response’. However, he said the clinical director of CervicalCheck, Gráinne Flannelly, had spoken on radio subsequently ‘and provided much more clarity’ on the issues. Mr Coveney thanked both individuals ‘for their efforts to bring clarity.’

DID you notice the missing word? When Dr Jerome Coffey, director of the National Cancer Control Programme, was interviewed on Morning Ireland yesterday about the appalling series of blunders – or calculatedly worse – that has left Vicky Phelan terminally ill, here is how he began: ‘I’d like to acknowledge the very difficult situation Ms Phelan has been through. I have every sympathy for that.’

And the missing word? In seven-and-ahalf minutes on air, during which he blustered, and fudged direct questions from Gavin Jennings, Dr Coffey never once said ‘sorry’.

Sorry. It’s a small word, easy to pronounce, but clearly very difficult to say even when he should have been screaming it. There is no way to sugarcoat this – Vicky Phelan is dying, and she is dying because an initial smear test was misread. To add to her pain, she was not told this until 2017, a full year after her consultant learned of the mistake, and three years after it was discovered by CervicalCheck as a result of her cancer diagnosis.

For that, Dr Coffey was obliged to do a number of things yesterday. First, he should have said sorry to Mrs Phelan, her husband and their two children for the ordeal they must now face with grim determination and all the love they can muster in the time they have left together.

He also needed to acknowledge that there are other women out there facing the same predicament, and apologise to them too. He needed to apologise to every women who has undergone a smear test with CervicalCheck, the national screening programme, and reassure them that their results were accurate – because they’ve been exhaustively audited. He needed to apologise to every mother and grandmother, every woman, single and childless, for the fear they now all must feel as they wonder if their apparently negative tests might also have been misread, and if they too will find themselves in the same position as Vicky Phelan.

The errors occurred in a laboratory in Texas, but Dr Coffey should have acknowledged that this happened on the HSE’s watch. Instead, the apparent tone – and tone is vital in these situations – was that of a bureaucrat, with no real feeling for the human victims of these mistakes.

That might sound harsh, but when the director of the national programme could not conclusively say that all of the women affected had been informed, one would have to be fearful about oversight and communication. Underlying this is not only the fact that the tests were misread, though that is horrific, but also many layers of mismanagement, obfuscation and, yes, concealment.

Let us start with the testing process. CervicalCheck presumably pays the Texas lab a lot of money to check the smear tests, but after the contract was awarded, what steps were taken to ensure procedures were adhered to? We are all human and can make mistakes, which is why all such tests are double-checked. At that geographical remove, can we be sure that actually happened in Texas? After all, here, in this very country, there was scant double-checking of breast scans and colonoscopies in Wexford General, and women and men who had cancer were instead told they were clear.

Did anyone from CervicalCheck ever call to Texas unannounced to ask for a thousand random scans that could be subject to independent third-party review, just to make sure the job was being done correctly? Was any attempt made to ensure the checks were robust? We don’t know.

Disclosure

It took court disclosure of documents in Vicky Phelan’s case to reveal that at least 15 other women were put at risk because of the misreading of smear tests, and that this was discovered in retrospective checking – in other words, only when they had cancer did someone look again at the smears and realise the abnormalities had been missed the first time around. What that does not tell us is whether any other tests were misread, tests of women who as yet do not know they have cancer, or of women who maybe have moved out of the country.

Ultimately, though, this is about three decisions that defy understanding. The first was to tell only the consultants treating the women, and not the women themselves. The logic apparently runs that a doctor and patient have a relationship and such news is best disclosed in that atmosphere of trust. Instead, the consultants were arguing with CervicalCheck about whose responsibility it was to pass on the dreadful news.

The second decision was apparently that if a woman died of cervical cancer and it was later found her smear test had shown missed irregularities, a note would be added to her medical records, but no family member would be told – not a husband, not parents, not children. This is profoundly wrong. In that situation, there is only one thing to do, and that is to tell the family and apologise, even if it leads to the steps of the High Court.

The third decision, and the most pernicious of all, was that someone decided the wider public and the Dáil would not be made aware of the misreadings. By rights, a Minister for Health should have been on his feet in 2014, saying: ‘I have disturbing and troubling news that some smear tests from 2011 were misread, but we have contacted everyone involved directly, and our priority now is that they all get the care they need. We have set up a compensation system to avoid anyone having to go to court. Meanwhile, every other woman should rest assured that all smear tests are currently under review.’

That is what happens in any civilised society, but as we have seen before, when it comes to healthcare issues that primarily affected women – symphysiotomy, the hepatitis C transfusion scandal, radiography failures in Wexford General and University Hospital Kerry, mismanagement of births – the default position appears to be to keep quiet, then fight claimants every step of the way. Even Vicky Phelan had to go to court to get the compensation she deserved, when the last months of her life should instead have been dedicated to caring for herself and spending time with her family.

Not only that, but as her solicitor Cian O’Carroll yesterday told Liveline, she was also being pressured to sign a confidentiality agreement. Even in her condition, she was being bullied into remaining silent, bullied into making sure no one found out. Bravely, she refused.

And here is the only conclusion. Someone signed off on this, and others must have acquiesced by staying silent. They carried on as if nothing untoward had happened, they kept paying the same laboratory that failed to spot smear test irregularities, and they hoped it all would just go away.

And that, honestly, is horrifying. It betrays a culture at the heart of healthcare that is the very antithesis of the remit of any publicly funded, transparent and accountable national health service.

Those people must be identified and, no matter how high up the ladder they are – whether in HSE senior management or even in politics – they must do the honourable thing and resign. If they do not, they must be fired.

That is the very least this country owes to Vicky Phelan, who spoke so movingly of the betrayal of trust it represents. Trust is a sacred bond, and every woman must be reassured that her trust in the system is rewarded with honesty, integrity and information – and, when things go wrong, also with genuine remorse expressed in one heartfelt word.

‘Sorry.’