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TOP TIPS FROM INTERIOR DESIGNER TO THE STARS JO HAMILTON
ARE you shocked and disillusioned by what Vicky Phelan describes as the “appalling breach of trust” she suffered at the hands of the State’s agents? Me neither. Unfortunately, a wronged citizen standing on courtroom steps after the unnecessary cruelty of protracted and stressful litigation is a recurring spectacle.
When called to account for shortcomings, officialdom’s strategy is to obfuscate, delay and fail to disclose all relevant information. If that doesn’t work, a range of threadbare excuses is advanced. It’s followed by some senior manager or other going through the motions of handwringing, before walking away in the knowledge they’ll never be held responsible. No one ever is.
And so citizens continue to be mistreated by a system that fails to learn from its mistakes. This time, it was a mother-of-two with cervical cancer. Ms Phelan took a case after abnormalities were missed in a 2011 smear test, and a delay of almost six years followed before she was informed. If her cancer had been detected initially, a simple procedure would have given her a 90pc chance of being cured.
She follows a long line of victims on the receiving end of the State’s brutal ramming machinery. One who springs to mind is Brigid McCole, poisoned by contaminated blood products, and then hounded and denied justice by those representing the Department of Health. It’s barbaric to watch people ill-used in our name.
Why does the State’s default setting continue to be to lawyer up and adopt a confrontational manner towards terminally sick patients? Apologies from those responsible, plus fair financial settlements, have to be dragged out.
Here’s what should be the norm when a mistake comes to light: an apology, a full explanation for what went wrong, and proper reassurances that procedures have been changed to prevent any repeat.
A culture of openness is needed where mistakes are admitted, discussed and learned from – transparency is not an optional frill. It’s an essential. Hospital administrators and doctors acknowledging mistakes and acting quickly on them is not an optional frill. It’s an essential. Patients’ rights are not an optional frill. They are an essential.
Lip-service is paid to the principle of open disclosure for patients. The HSE’s website, defining open disclosure, says: “We want our services to support an open, timely and consistent approach to communicating with service users and their families when things go wrong.” However, voluntary disclosure is largely practised, instead of mandatory arrangements that would safeguard citizens’ rights.
The HSE must be more upfront about what it makes public rather than drip-feeding information about the CervicalCheck scandal. We should know the chain of events that led to the shameful sight of Ms Phelan standing outside a court.
Why did it take two years for doctors to learn of errors identified in her scan reading? Why did it take another year before she was told? On what basis were those decisions reached? Where does public policy stand on medics communicating test results to patients?
Doctors were told it was down to them whether they informed patients about a cervical cancer misdiagnosis, according to documents before the High Court. High-handed? Paternalistic? Verging on god-like? Take your pick.
Doctors have an obligation to convey any test findings, because information belongs to the patient and not the medic. Only dysfunctional management would suggest anything to the contrary.
But medics were sent a highly questionable circular by CervicalCheck, the free national screening service that falls under the HSE’s ambit. “Clinicians should use their judgment in individual cases where it is clear that discussion of the outcomes of the review could do more harm than good,” it says. And it adds: “In cases where a woman has died, simply ensure the result is recorded in the woman’s notes.” To précis: don’t tell her relatives, keep this bungle under your hat and maybe nobody will find out.
No one doubts that members of the medical profession do a vital and difficult job but, inevitably, the doctor-patient relationship has been damaged by this profoundly unpleasant episode.
While errors can’t be prevented in life, how they are dealt with is instructive. Mistakes in 43-year-old Ms Phelan’s diagnosis were compounded by the wall of silence erected by medical authorities. Presumably, they were attempting to minimise financial liability and reputational damage. If so, those are inadequate reasons for the appalling way she was treated.
Transparency should be the default setting, rather than something a petitioner is able to insist on at the end of a costly legal process. Where is the integrity? The duty of care to citizens? The recognition that a wounded party is gravely ill, and an early resolution would be humane? Ms Phelan settled a High Court action against a US-based clinical laboratory subcontracted by CervicalCheck for €2.5m, but the legal battle has surely overshadowed precious time with her husband and young family.
One wonders how, in all conscience, those who manage and lead the screening service can defend their procedures. A terrible wrong was done not only to Ms Phelan, but to 15 other women identified as having cancer after a 2014 internal audit of smear tests which were found to be incorrect. Has CervicalCheck treated them as cavalierly as Ms Phelan?
Millions of women have been tested by the screening programme since 2008, and there is no question it saves lives. But its standing is now dented. I’m one of many women wondering whether my last all-clear was a misdiagnosis. Doubt has sprung up. Conscious of this, Health Minister Simon Harris is putting CervicalCheck’s operations out to international peer review, a welcome move.
The HSE is funded by the populace and exists to serve us. But its bureaucracy is emotionally deficient, judging by the insights we received this week.
When problems emerge, patients seem to be the least important in the process. Any recognition they are human beings entitled to compassion is, apparently, in short supply. That’s obvious from the frequent pageant of HSE apologies offered long, long after the event.
Finally, the courageous Ms Phelan has started using a new drug, and hopes to be accepted onto a US programme offering radical innovative treatment. May we take this opportunity to wish her well.
Doctors have an ethical obligation to convey test findings