The Cervical Cancer Testing Disaster

[C. Flower]

Deeply sad to hear a lovely young woman this morning (RTE 1), who has previously spoken out about the concealment of her negative result three years ago, telling us this morning that she is dying of cervical cancer, and in terrible grief over leaving her six children, and her own life.

EDIT: IT NEEDS TO BE SAID HERE THAT THIS OP, WRITTEN BY ME, IS WRONG START TO FINISH. 12/5/19

This is the status as I understand it now -

Pap tests wherecells are reviewed for abnormality are a diagnostic test forcervical cancer or for pre-cancerous changes. (Where used fortesting HPV they are a diagnostic test for HPV. Presence of sometypes of HPV indicates risk of cervical or penile cancer.)
When wholepopulations are screened for these cell changes (as in Ireland),there is a standard rate of abnormalities that are missed inscreening.
In most states, whena woman is diagnosed with cervical cancer, if she had smear tests inthe past they are normally reviewed in a ‘look back’. Thisapplies the group of women involved in the ‘scandal’ in Ireland.
In most states theresults of the review are not shared with the patients because thepurpose of the review is to monitor standards of screeningperformance, not to treat the women. The ‘look back’ is notdiagnostic as the woman’s cancer is already diagnosed. It is tocheck if obvious cancers are being missed.
In Ireland itappears there was no clear direction from Cervical Check to Gps orConsultants as to whether or not they should inform women of the lookback and its results. Some were informed and some were not. Thosewho were informed started to sue.
Cervical Checkanticipated there would be a furore over the ‘withholding’ ofinformation from some, and risk would result to screening services,but they mishandled communications and didn’t clearly explain theissues to the public.
The media spreadconfusion by constantly omitting to say that the group of womenconcerned were all already diagnosed and receiving treatment.
When a young womanwho has been having regular smear tests done gets full blown cervicalcancer, there is obviously quite a high chance that a previous smearor smear has been misread or that the slide was in some wayinadequate. Statistically speaking this is a relatively small groupof women.
So far as I can see,no one has said that the labs Cervical Check uses were performingdifferently to the previously accepted norm.
The recent judgementthat ‘absolute confidence’ was required by the person viewing theslide before they are said to be negative (rather than positive orunclear) is based on an English judgement of about 10 years ago,which caused consternation there too. However, there is not the samecompo culture and legal costs are lower, so the impact would be moresevere in Ireland.
https://onlinelibrary.wiley.com/doi/...06.00392_3_3.x


Original OP -

No one can say there was no warning that women would die because of Ireland's substandard cervical test system.

Three women have definitely died, and there is no knowledge at this stage of the total number of people who will do, due to non-reporting of positive tests, and to the substandard testing process.

Ireland came late to providing cervical testing at all - decades after it was free on the NHS. Cervical testing was for those who could afford to pay. Poor women who couldn't afford testing died in large numbers.
Doctors walked from Cervical Check ten years ago when the decision was made to outsource a new public service to a not-fit-for-purpose test-reading service in the US, because it gave the lowest tender price. They said that the problems would emerge in ten years time (the time it often takes for a cervical cancer to develop and become fatal). The then head of Cervical Check, Tony O'Brien, dismissed this, saying that those complaining had vested interests in labs in Ireland. (There is also huge lack of clarity as to how Irish based labs are overseen - it may well be that conflict of interest is rife, but that is a separate issue). There was also warning from a WHO agency that lack of open disclosure legislation in Ireland would put patients' health at risk. O'Brien then went on to take a job in a US health firm while still purporting to run the HSE.

Fianna Fail drove the outsourcing (Mary Harney as we know in charge, in the Department of Health). The tender process must have made it clear that the level of accuracy offered was only suited to annual checks, not the one in three years tests in Ireland.

Fine Gael, and Varadkar, as Minister for Health, blocked legislation to require open disclosure of results / medical files to patients. Cosy relations appear to have existed between Varadkar and Tony O'Brien (now HSE head) with Varadkar collecting a donation from a US firm linked to O'Brien.

O'Brien is being allowed to continue at the head of the HSE without the obvious action of suspending him on pay without prejudice.

The HSE has been operating without a Board for years and the Department of Health is stunningly silent in all this (what does it actually do?).

Ireland's very heavily funded health services have thousands of great people working in them, but for others, their jobs and positions are primarily acted on as opportunities for self enrichment.

Two years ago Susan Mitchell wrote this piece in the Sunday Business Post.

[C. Flower]

Three HSE memos emerged at the Dail Committee today which showed that the HSE was only concerned about massaging the news, and not in the least bothering itself about risk and injury to patients.

Really shocking stuff.

[pluralist]

Three HSE memos emerged at the Dail Committee today which showed that the HSE was only concerned about massaging the news, and not in the least bothering itself about risk and injury to patients.

Really shocking stuff.

Unfortunately, I am not remotely shocked. All bureaucracies trend towards amorality. The larger the bureaucracy, the greater the evil.

[C. Flower]

Unfortunately, I am not remotely shocked. All bureaucracies trend towards amorality. The larger the bureaucracy, the greater the evil.

Irish bureaucracy is post-colonial bureaucracy. Just read Jonathan Swift on how the British sent the worst available candidates over to Ireland for church or governmental posts. I've worked in the UK and Irish public sectors - in theory mirror images but there is a rip off attitude here pretty well unchanged since Swift's day, and a very different culture in the UK where they are looking after 'their own'.

[C. Flower]

"Risk mitigation" for the HSE is not to do with patient safety, it's all about saving their asses.

https://www.msn.com/en-ie/news/newsi...id=mailsignout

In 2016, when women were still having positive results for cancer withheld, the HSE was rehearsing how they could spin it when it hit the news.
And not following through on informing women - claiming that US labs opposed passing the information on.

This should have gone to the Board - which did not exist. The Board's role includes risk assessment - and risk should include "lets not create a massive health disaster for people" type of risk. Not "risk to my job". It did go to Tony O'Brien. "Tony's emphasis is on building a better health service for Ireland"
https://www.hse.ie/eng/services/news.../tony-o-brien/

The woman who spoke out today about her terminal diagnosis called for the Government to resign because "they are not looking after us". Can't argue with that.

[C. Flower]

Statement this evening from Ruth Coppinger :

Statement: Ruth Coppinger TD (Solidarity - 10th May 2018)
HSE memos raise serious questions which need immediate answers:
Was Quest the company which engaged in legal correspondence around patients being informed?
When did Ministers for Health Varadkar & Harris know about this scandal?
Did the HSE engage in an attempted cover-up to protect themselves & private firms?
Is a 31% misreading of scans acceptable for the government?
Solidarity TD Ruth Coppinger this evening commented on the memos from 2016 which were released by the HSE to the Public Accounts Committee today.
She said that the memo raised a new series of questions which need to be answered.
She said that it was now clear that Tony O Brien must be sacked. The memo clearly shows that he was aware of the scandal and did not find out about it from media reports as he previously claimed.
Ruth Coppinger TD said "Earlier this week in the Health Committee when Tony O'Brien claimed that he encouraged people to 'speak truth to power', I quoted Chomsky saying that 'Power knows the truth; it is just busy trying to conceal it.' This memo clearly demonstrates that this was the case.
"O'Brien's claim this morning that politicians were spreading 'hysteria' about the scandal are just a continuation of the HSE's approach which is outlined in the letter regarding women speaking to the media and taking legal actions.
"This week in the Dail I have raised questions about the quality of the outsourced screening and variations in their results. The memo adds to those concerns. According to the memo only 69% of cases were picked up, leaving 31% going undetected.
"We know that the Quest lab in the U.S. had an abnormality detection rate much lower than the other two labs. We know that they have had many legal cases taken against them for misdiagnosis and fraud. Now today in the memo we find out that, scandalously, one of the labs was engaged in legal correspondence with the HSE about women being informed of the misdiagnosis of their scans. We need to know whether Quest was the company which was involved in this legal threat which delayed women being informed.
"Tony O'Brien has defended his actions for the last couple of weeks, but his position is completely untenable - the Taoiseach must sack him immediately.
"But beyond O'Brien the memos raise a whole new series of questions about systematic problems in the HSE. But there are also questions for the government in particular for Leo Varadkar and Simon Harris who were both Ministers for Health during this period. Can both of them now say that they only became aware of this scandal in the last couple of weeks?"

[C. Flower]

Tony O'Brien has "stepped down" whatever that means, from the HSE. The moment a dying woman demanded the Government go, he was pretty well done for.
https://soundcloud.com/morning-irela...medium=twitter

Sacrificial goat. It struck me earlier how close O'Brien's spin that what is happening is an hysterical attack on th
e smear service itself (not on the defects of the service) is to Varadkar's spin that "he hopes women won't lose trust in the service". Singing off the same hymn sheet ?

[eamo]

Deeply sad to hear a lovely young woman this morning (RTE 1), who has previously spoken out about the concealment of her negative result three years ago, telling us this morning that she is dying of cervical cancer, and in terrible grief over leaving her six children, and her own life.
............................

I heard the interview this morning. It was heartbreaking.

I am putting the WP statement here not to promote the WP but because it makes the point very well that outsourcing and the old Progressive Democrats "magic markets will solve all problems" ideology combined with a particular Irish inability to learn from others or even our own mistakes is at the root of this tragedy. As is pointed out below even the helplline being used by women to access information about new screenings, is itself outsourced to a for-profit company. Tatcher will never be dead while we have Irish gombeens like our government in power here.

The Workers’ Party have called for the remit of the cervical cancer enquiry to include the appropriateness of cost being used as a criteria for choosing screening labs.

Cllr. Ted Tynan, Workers’ Party representative on Cork City Council, said:
“Outsourcing as a practice has already run down our waste management services, our public transport system and much more. Now, it is clear that it has cost lives.

“The entire motivation for outsourcing is to ‘save costs.’ The government propaganda would have us believe that these ‘savings’ are to be found by reducing waste. But in reality, what it means is that we get shoddy services. And they have cost lives.”

Cllr. Tynan continued:
“There ought to be no profit motivation in healthcare provision – or, for that matter, in housing or education. It is irony heaped upon irony that the helplline being used by women to access information about new screenings, is itself outsourced to a for-profit company. When will we learn?

“But by gradually parcelling off our healthcare system – some to United States labs, some to private providers here at home – we are ensuring that the most basic decisions about our healthcare are being made, not on the basis of people’s health, but on the basis of greed and profit.”

The Workers’ Party councillor concluded:
“I am calling on Mr. Scally, as chair of the Inquiry, to ensure that the inquiry includes an assessment of why cost was ever a consideration in choosing how to process cervical screening results.

“The privatisation of healthcare must be tackled in its totality if we are to prevent other disasters similar to this one. Anything else would simply be saving face, without substantively addressing the problem.”

[eamo]

Here is the interview with Emma Mhic Mhathúna the young mother mis-diagnosed and now terminally ill.

https://www.rte.ie/radio/utils/radio...48_10-05-2018_

Click on the link and give it a minute to start playing.

[C. Flower]

Here is the interview with Emma Mhic Mhathúna the young mother mis-diagnosed and now terminally ill.

https://www.rte.ie/radio/utils/radio...48_10-05-2018_

Click on the link and give it a minute to start playing.

Notable that she called for the Government to go.

[Fraxinus]

Without sounding terrible anyone who reads Noel Brown's book should not be surprised at this. Health has never been truly taken seriously, for the right reasons,since his brief ministership. Still no national health service and appalling government inaction. The only difference is we can't blame the church this time.

[C. Flower]

Without sounding terrible anyone who reads Noel Brown's book should not be surprised at this. Health has never been truly taken seriously, for the right reasons,since his brief ministership. Still no national health service and appalling government inaction. The only difference is we can't blame the church this time.

Indeed, the Irish government handed over and continues to hand over delivery of health services to the Church voluntarily, passing over massive amounts of state funding. The Church continues to interfere in the treatment of women, through it's involvement in "ethics committees" on hospital boards. Women are still being refused cancer treatments on "ethical" grounds. Savita Halapannavar was refused treatment because "we are a Catholic country". But it has always suited the Irish governments to hand health over to its social ally, the Church, in a joint social control project and to avoid a citizens' rights approach to health. It's a colonial legacy in my view. The British very much saw the Catholic Church as a convenient force for social control in Ireland. They funded Maynooth, and passed the National Schools over to the Church. The Magdalene laundries and industrial schools were built with government grants to the Church.

I couldn't say if Ireland's very late introduction of a cervical screening related to a Catholic ethos, but the whole tone of discussion on the current disaster is to do with motherhood. A woman is not allowed just to be a person, with a right to a life. She has to be "mother of six" or "not yet had a chance to have a baby". The whole thing is deeply enmeshed. Women are seen primarily as a vessel, in these circumstances. The cervical smear test is a public health issue, not a "womens issue" surely ?

[C. Flower]

The whole Memo in which the HSE reviewed the audit process is here:

https://static.rasset.ie/documents/n...ive-hse-en.pdf

The snippets in the media do not accurately represent it.

The look back seems to have been exclusively a look back of cases of women already diagnosed with cancer.

Inevitably there are women whose precancerous cells have been missed by the substandard US lab/s and who have undiagnosed cancer, are not being discussed.

[C. Flower]

Tony O'Brien has "stepped down" whatever that means, from the HSE. The moment a dying woman demanded the Government go, he was pretty well done for.
https://soundcloud.com/morning-irela...medium=twitter

Sacrificial goat. It struck me earlier how close O'Brien's spin that what is happening is an hysterical attack on th
e smear service itself (not on the defects of the service) is to Varadkar's spin that "he hopes women won't lose trust in the service". Singing off the same hymn sheet ?

Regina Doherty on RTE radio has just made it clear that O'Brien is still being paid and the terms of his contract - on the employer's side - unchanged.

The only thing that seems to have changed is that he has stopped working.

The whole thing was a nauseating piece of spin, by Government and O'Brien.

[Kev Bar]

Indeed, the Irish government handed over and continues to hand over delivery of health services to the Church voluntarily, passing over massive amounts of state funding. The Church continues to interfere in the treatment of women, through it's involvement in "ethics committees" on hospital boards. Women are still being refused cancer treatments on "ethical" grounds. Savita Halapannavar was refused treatment because "we are a Catholic country". But it has always suited the Irish governments to hand health over to its social ally, the Church, in a joint social control project and to avoid a citizens' rights approach to health. It's a colonial legacy in my view. The British very much saw the Catholic Church as a convenient force for social control in Ireland. They funded Maynooth, and passed the National Schools over to the Church. The Magdalene laundries and industrial schools were built with government grants to the Church.

I couldn't say if Ireland's very late introduction of a cervical screening related to a Catholic ethos, but the whole tone of discussion on the current disaster is to do with motherhood. A woman is not allowed just to be a person, with a right to a life. She has to be "mother of six" or "not yet had a chance to have a baby". The whole thing is deeply enmeshed. Women are seen primarily as a vessel, in these circumstances. The cervical smear test is a public health issue, not a "womens issue" surely ?

Perhaps a little inappropriate given that devastating interview but on the subject of vessel

https://www.youtube.com/watch?v=ScWD...youtu.be&t=53s