Crucial emails show who knew what and when
THE following correspondence shows precisely what two key HSE officials, both of whom have been given roles with the Signiciant Incident Management Team (SIMT), knew about the CervicalCheck crisis. These officials are Colm Henry, National Clinical Adviser, Group Lead for Acute Hospitals Division and Patrick Lynch, National Director Quality Assurance Verification Division. Mr Lynch has been until recently heading up the SIMT, and the SIMT has been reporting to Mr Henry. From: Paul Burke (Chief Clinical Director UL Hospital Group) To: Colette Cowan (Group CEO UL Hospital Group) CC: Colm Henry & Kevin Hickey (Vicky Phelan’s Consultant OB-GYN) Date: 17:56 - 10 July 2017
‘I know you are in receipt of correspondence from Kevin Hickey our consultant gynaecologist with special responsibility for cancer, who is very concerned with the protocol that appears to have been adapted by the National Cancer Screening Programme, in their dealing with the outcomes of their cervical cancer audit process. The consequence of this audit is that the histological diagnosis changed in a number of cases...
‘A number of these cases were initially diagnosed as been normal and were subsequently found to have histological and cytological changes consistent with cancer or early cancer changes…
‘Obviously if this information had been available in 2015 it would have probably impacted on the patient’s treatment. Dr Hickey feels very strongly that the transferring of responsibility back to the treating gynaecologist to tell the patient about the change in the original diagnosis is unfair...
‘I’m sending a copy of the letter to Dr Colm Henry, as I feel we do need some clarification from the Cervical Screening Programme.’ From: Colette Cowan To: Liam Woods (National Director, Acute Hospitals Division) and Patrick Lynch Date: 17:53 - 13 July 2017
‘Dear colleagues, please see attached for information. I expect this issue will arise in other Hospital Groups. We will discuss with Colm Henry to agree the next steps.’ From: Colette Cowan To: Elish Hariman, Gerry O’Dwyer, Ian Carter, Mary Day, Maurice Power, Susan O’Reilly (Hospital Group CEOS) Date: 17:55 – 13 July 2017
‘Dear colleagues, In confidence please see attached – a serious issue that has arisen in UL Hospitals. I expect you may have similar scenarios. I have raised this with Patrick Lynch also.’
From: Colm Henry To: Paul Burke CC: Colette Cowan Date: 27 July 2017 (Letter)
‘I have passed your concerns to Dr Peter McKenna, Clinical Director National Women and Infants Health Programme who intends to discuss this directly with Dr Hickey. I would be greatful if you could keep me informed of the outcomes and would be happy to meet to discuss in the future if necessary.’ From: Elaine Brown (Offical from Colm Henry’s Office) To: Colette Cowan CC: Paul Burke Date: 14:55 - 27 July 2017
‘In addition to my correspondence sent to you this morning; Colm has just discussed this letter and Peter’s views following communication with Dr Hickey. On foot of this they would like to give the Clinical Director for Cervical Screening an opportunity to review and respond to Prof Burke’s letter addressed to you (attached) prior to engaging in a potential meeting with all relevant parties to discuss. I am aware he is on leave until 8/8/2017 but Colm would like me to progress. Are you happy for us to share this letter with the screening programme so we can progress in solving this issue for UL HG? Many thanks!’ From: Grainne Flannelly To: Colm Henry Date: 4/8/2017 (Letter)
‘Dear Dr Henry, Thank you for contacting us and for the opportunity of clarifying some of the issues raised in the communication you have received from Prof Paul Burke…
‘The issue of communication of the outcome of the reviews was considered and the process was updated to include their provision to the treating clinician. In most cases these clinicians are colposcopists working in one of fifteen CervicalCheck colposcopy services nationwide… In the majority of cases the notification of the cancer comes from the services in the first instance...
‘This step of the process involves some of the cases needing close-out meetings with the women which can be difficult communications… However if doubt exists that her disease might have been detected at an earlier time or if she required more intensive treatment than she otherwise might have needed it is our view that women should be made aware of this rather than simply filing the report in the notes. The clinical context is important in evaluating the need for a close out communication – the treating clinician is best placed to make that judgement call on the concept of possible harm. The clinician in our view is acting within a defined process which supports transparency and should not be liable for the reviews. In fact the communication directs the women to the programme to help with any further requirements. From: Colm Henry To: Paul Burke Date: 9/8/2017 (Letter)
‘Subsequent to your correspondence on 10/07/2017 we approached Dr Grainne Flannelly, Clinical Director Cervical Check for comment. She has provided us with detailed response which I have attached. I would be grateful if you could review this correspondence and inform me if your own concerns and those of Dr Hickey have been addressed satisfactorily.’
From: Paul Burke To: Dr Colm Henry
Date: 22/8/2017 (Letter) ‘The responsibility for having this type of meeting must clearly be seen to lie with CervicalCheck. The gynaecologist should be seen to be acting on behalf of CervicalCheck and not the hospital in isolation.’ From: Kevin Hickey To: Grainne Flannelly CC: Colette Cowan, Paul Burke, Colm Henry, Peter McKenna Date: 22/8/2017 (Letter)
‘The tone of these letters would lead one to believe that I was happy with the way that I strongly believe that cervical screening programme had handled the cervical cancer audit process, which is far from the case. I strongly believe that CervicalCheck who conducted this whole audit process should have communicated directly to the women involved… Instead of this what has happened is totally inappropriate.’