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DR GABRIEL SCALLY released his report into the CervicalCheck scandal this afternoon, highlighting a litany of failures in the governance structures of the screening programme.
In his report, through to his letter to the Minister for Health and during today’s press conference, Scally criticised how the women involved were eventually informed about the audit of their previous smear tests.
In his foreword to the report, he notes:
In my view, the manner in which they were eventually told of their situation in many cases varied from unsatisfactory and inappropriate, to damaging, hurtful and offensive.
Speaking at the launch of the review he described how the family of one woman was told “nuns don’t get cervical cancer” and that the same consultant highlighted the fact the now deceased patient had been a smoker multiple times during the meeting.
“It’s verging on misogyny,” Scally said of those comments. He went on to say some disclosure discussions were well handled, but that the anger of many of the women and their families is “intense and raw”.
The review came about after Vicky Phelan settled a High Court action against the HSE and Clinical Pathology Laboratories (CPL) for €2.5 million over smear test results from 2011, which incorrectly said that her smear was free of abnormalities.
Phelan has terminal cervical cancer and speaking in the wake of the report’s release today, said she will fight to stay alive so that its recommendations are implemented.
The scoping inquiry spoke to women and the families involved at meetings in Dublin, Galway and Cork, as well as by phone, email and letter. The report finds there is a strong feeling from most that the disclosure was “handled badly in most cases, and sometimes very badly indeed”.
Patients detailed how they were addressed and their experience of being told the errors by their consultants. One woman recounted her disclosure meeting:
Woman: “Why didn’t you tell me? Why didn’t you tell my clinicians?” Consultant: “What difference does it make?”
Woman: “How will I be informed from now on?”
Consultant: “Watch the news.”
While another said her consultant told her he decided she didn’t need to know.
He had seen I had had a hysterectomy and decided I didn’t need to know.
In a detailed list of recommendations, Scally said a new emphasis must be placed on the candour with which healthcare professionals speak to their patients.
A statutory duty of candour must be placed both on individual healthcare professionals and on the organisations for which they work.
“This duty of candour should extend to the individual professional-patient relationship.”
Scally has praised the “extraordinary determination of Vicky Phelan not be silenced” in bringing the situation to light.
Reaction
Lorraine Walsh is one of the patient representatives who spoke to Scally. Responding to the report today she said she’s been let down.
We put our lives in the consultants’ hands, in my own case I have lived to tell the tale but also I have been let down badly by not being told.
While Stephen Teap whose wife Irene died from cervical cancer has called for all of Scally’s recommendations to be implemented.
What we’re looking at is a handful of consultants who were dealing directly with the women involved in this that took it upon themselves not to disclose information.
As part of the scoping inquiry Scally said he is satisfied with the quality of the screening labs including those in based in the US.
Overall Scally says CervicalCheck was doomed to fail and has made 50 recommendations aimed at restoring confidence in the system and to prevent a similar situation arising in the future.
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Mandatory training for all healthcare professionals re: open disclosure and transparency please.
@Sean Ryan: …and maybe a class on bedside manners too.
@Sean Ryan: likewise with GPS they have been hardened by years of the same job , lost all empathy .
@Sean Ryan: most definitely. Having experienced meeting upwards of 30 consultants for myself and on the behalf of my premature children and elderly parents in the last 12 years I can safely say about 20% have been exceptional in their care and positive approach and the rest ranged from dismissive to downright ignorant. I have a science background and if I questioned anything many became suspicious and queried if I worked in medicine. I am lucky though to have fantastic GPs for myself and my children.
@Sara McSweeney: It’s hugely ironic, as it is the only profession that requires a test in interpersonal relationships. Maybe it’s time for consultants to maintain and regularly test HPAT, that also includes a test about disclosure and liability.
@Sean Ryan: bed side manners is thin on the grown with doctors generally
@Sean Ryan: civility is all that is required, not training.
I feel for any genuine consultant out there now because this no doubt is going to cast a shadow on their credibility but that’s a seriously minor consequence of this. I feel more for every single woman and family who has been or could be impacted by this malpractice.
There is a number of consultants who live in another world,
they get over paid and lack in empathy to their patients and
are more interested in what time they are meeting up on the
golf course.
They treat their public patients as just numbers on a waiting list
till and unless you go private, suddenly they are now available,
their attitudes change to a caring doctor, what they were when
they qualified in their first year.
All the unfortunate women who developed cervical cancer subsequently had their screening smears rechecked and at that point abnormalities were found. By this stage, they were on treatment and telling them the result of the review would not have had any effect whatsoever on the treatment being undertaken. I have two very good friends, both female doctors who had patients in this unfortunate group. Both decided after much thought, that giving the patient this information at this time, would have no possible beneficial effects on outcome and could conceivably have a negative effect as there is a considerable literature on the negative effects of stress on cancer survival rates and response to treatment. It is not reasonable to characterise these female doctors as being mysogynistic.
@Deaglan Macgiollaphadraig: doesn’t matter, those female doctors shouldn’t have had the entitlement to make that decision. Women can be misogynistic and paternalistic too. If the relatively high possibility of a false negative occurring was explained properly at the outset to all patients, the issue would be better understood.
@Deaglan Macgiollaphadraig: a good friend of mine said a very similar thing to me a few months ago about her friend who is a consultant. Sorry, but you can waffle on all you like about how thoughtful these so called professionals were hiding the truth from their patients for their own good etc, maybe that makes them feel better about their part in this deceitful mess but I as a woman want to know what’s going on in my body, whether it’s good or bad, I should have that right.
@Sara McSweeney: hi Sara, I can see an argument on both sides and there is a real dilemma. On the one hand of course the patient has a right to know but if there is robust research to show that stress (and receiving that news I think most would agree would be extremely traumatic) has a significantly negative impact on outcome the decision becomes a very difficult one. It is not an issue of misogyny as the same dilemma arises in bowel screening and reviews which effects the male population.
I fully agree that patients are poorly informed about the difference between population screening and diagnostic tests and this should be addressed urgently.
@Sara McSweeney: Well said.
@Deaglan Macgiollaphadraig: It wasn’t their decision to make and if you recall, these audits were “retrospective” and only discovered after the women were diagnosed and in the majority of cases, had completed their treatment.
The non disclosure and the subsequent events have damaged the women more than being open and honest with them either when the error was discovered, or if they were in treatment, being open and honest with them then.
@Linda Nolan: The more anyone thinks about it, the “for your own good” excuse doesn’t wash. Being alerted that there was an error in your diagnosis that could potentially have saved your live is far too important to hide. These women could be blaming themselves or their lifestyle for the “sudden” appearance of cancer, while it was dormant and observed for years. It doesn’t matter if it causes stress, or if the recipient has died – every single person or their family has the right to be told immediately, without prejudice.
@Gulliver Foyle: It really doesn’t, well said.
@Deaglan Macgiollaphadraig: What I find disturbing about your comment is that those two doctors did not tell the patients what they deserved to know but yet told you.
While I’m sure your two female doctor friends didn’t name the patients to you and I understand even doctors need to offload the stresses of work to family & friends , there is something that just doesn’t sit right with me that those patients possibly died not knowing the truth of the cover up but yet it was discussed with you, a friend of the doctors.
@Deaglan Macgiollaphadraig:
That was not their decision to make. Very poor on their part. Negative effect a possibility or not, the patients had a right to know.
@Deaglan Macgiollaphadraig:
Stop, just stop. Women are not children. They can handle the truth. Enough of this paternalistic and misogynist thinking about women.
FFS, we give birth, we do the majority of the child rearing and make most of the important decisions that effect everyone in our lives and well as holding down full time jobs.
@Deaglan Macgiollaphadraig: it’s a dilemma for sure but there’s no way of properly managing this except to have women consent to receiving this sort of information (or not) when they get a smear test and whatever the consequences they must receive the information if they’ve consented. It takes the whole dilemma out of it and it comes down to the manner in which that information is communicated (and that debate could go on and on)
@Gulliver Foyle: there was no ‘error in diagnosis’ there was a failing in the screening, which is a completely different thing. I agree these poor women should have been told about the failings in the screening process but anyone who thinks that it was an obvious, easy decision or that the doctors involved didn’t care, is wrong
The HSE should be sliced and diced starting with management through to staff who bully their way around hospitals and prioritise themselves above the care and welfare of patients. The system needs to be culled of people in roles above their education and qualifications. Peter Principle rampant in the HSE, promotions not on merit, ability or qualifications but seemingly based on the “herd” method of protecting each other.
@James Keogh:
Thanks ,I had to look it up
The Peter Principle is an observation that the tendency in most organizational hierarchies, such as that of a corporation, is for every employee to rise in the hierarchy through promotion until they reach the levels of their respective incompetence.
@Johnny Merren: Unfortunately in the HSE promotions don’t cease at the first level of incompetence.
Who do these consultants think they are because they are on big money dosent’s mean they are ‘gods’ they should be hanging their heads in sham, give them jail time for the criminal offence they committed agenst these unfortunate women
@James Moore: You need to rationalise! They were critcised for their interpersonal skills, not any causing an illness by malpractice. We need consultants onside for the main reason we pay them “big money”, but they do need to up their patient experience.
@Gulliver Foyle: agree, though there is some room to question if their behavior, in certain instances, didn’t border on criminal negligence. I believe that some the delays were over 2 years. That could mean the difference between a full on anti-cancer treatment and a less violent one or even between life and death.
@Gulliver Foyle: gulliver, thats is exactly what wrong with this report. It suggest better communication is required but fails to pin point any of these faults or negligences that have caused actual bodily harm. The bedside manner thing should only be a side issue, but withholding information is lying by omission. Lies with consequences. The screening program would have withstood a few shocks so why bury things, is it a professional loyalty that covers the whole field? That loyalty along with the ‘for-our-own-good’ line smacks of the same approach we got from the Church. Like you, I know some great people there, but Irish medicine is rotten at the core.
@James Moore: it’s very unlikely that there is any actual criminal offence… sure, a consultant can be an ignorant, misogynistic person but in these cases it doesn’t affect the health prognosis of the woman… they’ve already got cancer, they’re already in treatment.
Well at least the church can no longer be blamed All those services are run by the HSE whom we now place all our trust and faith in .
@jerry slattery: And that’s what you take away from all this …? You’re lack of empathy is astounding.
@Abbie Cranky: I have not had a chance to read the full report . Click bait quotes tell very little . I would be interested to know what the consultant who has been accused of making this has had to say in response
#Handled # Handled #Handled #Handled
Like I said The Scallyman has been around HSE since 2006. Reported on HSE inpatient safety.
No cover up. Seriously we had a meeting and decided not to tell you. Tony O Brien had to resign over lying on the national airwave he had a memo 2 years ago. No Coverup
# Handled
Why are so many consultants a***oles
@John Connolly: because you let them, simple. Stand up to them, they get paid to do a job, if they dont do that job, then dont pay them
Decided to do a smear test privately this summer, while visiting my family in Eastern Europe. The gynaecologist was astonished to hear that it is the GPs who do such procedures in Ireland. She was also astonished to hear of this scandal (Eastern Europeans still think everything, including healthcare, is better in the West). She said that women there also get one free test every three years, but that this is enough time for benign cells to develop to full blown cancer. So what they do is, GPs refer women to her once a year on some made up diagnosis, and she does a smear test.
I am certainly going for a test every year from now on.
@Zmeevo Libe: sounds like they haven’t got it right either if they are only entitled every 3 years and are getting referred yearly using false reasons.
Not enough consultants or gp s , so we’re left with no choice in some cases but to listen to untouchables , make it easier to get into medicine , there’s no actual reason for it to be 600 points and only gives all the power to the medical professionals . Medicine has become specialized and everyone knows their gp googles anything unusual or just gives out a drug for an ailment that the pharmaceutical agent has recommended with a nice holiday or golf membership ! Information Age ! Doctors don’t need to be encyclopedias !
@lapsy pa: ok so. remind me to engage Dr lapsy pa as my family doctor.
First the church speak to women like they are stupid.. next the so called specialists and now the goverment..well ireland better wake up beause women in this country are not going to be treated like idiots any more..
Interesting that the journal doesnt scream and rant over the cervical check debacle. The State let down so many women, children and men. They should call for Harris and Veradker to resign. The Pope was asked to resign on the unfolding Church Scandals. Why treat politicans with kid gloves? Where is Amnesty Ireland? Is it only some groups are more culpable than others? Even if the Journal doesn’t think so!
@Silence in the City: the journal doesn’t need to rant and rave, they have a perfectly vocal mob to do that in the comments.
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