WHY COULD HE NOT ANSWER EVEN A SIMPLE QUESTION?
THE following is an edited transcript of an interview on yesterday’s Morning Ireland on RTÉ Radio 1. Asking the questions of Dr Jerome Coffey, director of the National Cancer Control Programme, was radio presenter Gavin Jennings…
Q. One of the issues arising from the case was the delay in informing Vicky Phelan that her original smear test in 2011 had been misreported as clear. It would appear that CervicalCheck knew about that in 2014, but it was 2017 before Vicky Phelan was told that, and 2016 before her doctor was told – why?
A. First I would like to acknowledge it’s a very difficult situation Ms Phelan has been through, every sympathy for that. To get to your question, the first thing to say is that the best available test for screening for cervical cancer, the smear test, is not a perfect test. The cervical screen programme is ten years old. It’s had a QA [quality assurance] built into that, very strong… insurance from the very beginning. The clinical auto process has been designed and implemented. What happens in an audit is that the cancer registry informs the screening programme of all cancer cases, we then look at the screening history. We then see, was that appropriate or was there a need for review of samples; that’s carried out. There was a time factor when the audit was set up but currently when we get notified of a cancer case we do look at the screening history… within two to three months. That time factor is now much reduced.
Q. Can we go back to what happened with Vicky Phelan – a two-year delay in telling her doctor and a three-year delay in telling her – why?
A. We know that some smears can be read as negative but actually be false.
Q. To be fair Vicky Phelan acknowledged that mistakes were made. That wasn’t her issue, her issue was the delay in being informed of that…
A. It took a long time to set up the total clinic audit review, do the work and then to send out the information, that’s why.
Q. Had the review not been taken out in 2014? It was 2016 before her doctor was informed, 2017 before Vicky Phelan was informed?
A. The process was set up and delivered as designed. I can’t give further information than that.
Q. It also appears from correspondence outlined during the case that CervicalCheck and doctors were arguing over whose responsibility it was to tell the patient about the mistakes made – whose responsibility is it to tell patients?
A. In setting up the review, there was a lot of discussion and a lot of thought put into this, international models were looked at. So the advice, and I’m going to read this because clarity is required here: ‘The information to healthcare professions about the cancer audit process clearly states that as a general rule of thumb the outcome should be communicated to the woman. The relationship is between the patient and their treating physician. CervicalCheck provides all information as quickly as possible through the treating physician and then it is a question of the physician communicating with the patient. It is also important to say that patients are made aware once they have a cancer diagnosis that the audit process is there, that the information is made available to their physician and they can get that information from their physician.’
Q. If they know about it – how would a patient know a mistake was made if they weren’t told? You’re saying that the procedure is that if mistakes are made the treating physician is told but is there any obligation to tell the patient?
A. There is… first of all the word diagnosis has to be addressed here – screening looks for abnormalities it doesn’t diagnose cancer. When a person has cancer, there’s a look-back process and the information from that look back is sent to the treating physician and that’s the process getting as much information as possible.
Q. Who tells the patient?
A. The process is that the physician has the information to share with the patient. It’s important to say that the patient is aware the review process is there.
Q. Is there an obligation to tell the patient?
A. There is, the process is as described.
Q. Is there an obligation to tell the patient, does the patient have to be informed if a review shows that a mistake was made?
A. That is between the physician and the patient.
Q. That sounds like a no to me.
A. I don’t know what the statistics are but the information is made available to the physician to discuss that with the patient.
Q. It appears from the correspondence in this case and it was raised by John Shepherd, this was the expert witness called on behalf of Vicky Phelan, that there were a number of other patients for whom there were concerns in this 2014 review. Have they been told?
A. To my knowledge, all information from the review to date, has been and as recently as February, has been communicated to the treating physicians.
Q. Have the patients been told?
A. I don’t have that information.
Q. Do you know how many patients are involved?
A. I know that this audit ongoing process, we know that all cases diagnosed so far, the look-back is complete and looking into the future we know…
Q. This is a 2014 audit, do you know how many patients were affected? We know Vicky Phelan was – how many other cases were there where there were mistakes made or concerns raised?
A. I don’t have those figures here today.
Q. Do you know if those patients were told?
A. I know that all cases have been reviewed from 2014, ’15, ’16 and ’17 and the information back to their treating physician.
Q. Should patients be told? If you were the treating physician, would you feel an obligation to tell your patient that a mistake was made?
A. I am a physician and when I have test information from a patient I tell it to the patient
Q. Are you obliged to tell the patient, or is it a matter of your judgment?
A. My colleagues, myself… I ask a patient how much information they want, if they want it all… I think in an era of open disclosure that there is a need for all information to be shared with all patients when they request it and that they are made aware that information exists.
Q. There will be people out there who will have had tests that would have been carried out within the last three years who are worried, [that] if there was a mistake made, that they haven’t been told. What would you say to them?
A. For people who have been told they’ve an abnormal smear its important they take advice … This is a strong, well-organised, well-resourced screening programme – it is important that people continue attending because it reduces the risk of cervical cancer by about 90%.
Q. When this screening programme was set up, it was outsourced to companies because there wasn’t an ability to do it here but that wasn’t supposed to be the long term plan. Do you plan to continue to use this service?
A. It is currently being provided by two commercial labs on a contract basis in one hospital on the basis of contracts with very detailed quality assurance, detailed mechanism built into it.
Q. Are they our standard or American standard?
A. We define the standards based on international best practice and that’s baked into the contracts.