CervicalCheck controversy

boombang

listermint wrote: »

Wait is there a poster hear blaming the media for a lab doing incredibly poor work. Awarded a contract under the management of Tony o Brien and the HSE doctors covering up the bad test results with 3 women dead and many others on the way.

And it's the media's fault..



Riiiggghht....

No evidence of "incredibly poor work".

CervicalCheck had modified their policies to tell women of past errors and were doing so.

We'd expect some screened women still to develop cancer and sadly die because screening isn't perfect.

Lots of people have totally unrealistic expectations of screening and a near conspiracy theory level of paranoia about this because the media haven't been giving a level-headed interpretation of things. Scandal gets better rating than grim reality.

listermint

boombang wrote: »

No evidence of "incredibly poor work".

CervicalCheck had modified their policies to tell women of past errors and were doing so.

We'd expect some screened women still to develop cancer and sadly die because screening isn't perfect.

Lots of people have totally unrealistic expectations of screening and a near conspiracy theory level of paranoia about this because the media haven't been giving a level-headed interpretation of things. Scandal gets better rating than grim reality.

Everyone knows that the testing isn't full proof.

But trying the make the cover up fooool proof is beyond me.

Let's mark your posts here and come back in June.

boombang

listermint wrote: »

Everyone knows that the testing isn't full proof.

But trying the make the cover up fooool proof is beyond me.

Let's mark your posts here and come back in June.

If there was a cover up why didn't CervicalCheck keep the findings out of Vicky Phelan's notes? Definite cock-up rather than conspiracy.

The 5 hours Dáil committee meeting on Tuesday last week explained a lot.

Totally happy to revisit this following the scoping report.

NickNickleby

boombang wrote: »

No evidence of "incredibly poor work".

CervicalCheck had modified their policies to tell women of past errors and were doing so.

We'd expect some screened women still to develop cancer and sadly die because screening isn't perfect.

Lots of people have totally unrealistic expectations of screening and a near conspiracy theory level of paranoia about this because the media haven't been giving a level-headed interpretation of things. Scandal gets better rating than grim reality.

My understanding, as a lay person, is pretty much along the lines of your posts in this thread. However, RTE and the newspaper headlines seem to suggest that women died because the HSE didn't tell them they had cancer.

While being told your diagnosis was wrong first time around won't affect the outcome, I can't understand why they (the HSE) seems to have withheld that information.

So, people are calling for heads to roll, is it the heads of those who failed to communicate the info on previously missed cancer? Is it the heads of the technicians/medical staff at the labs who presented false negative results?

Is it possible to guarantee absolutely no false positives or false negatives?

listermint

boombang wrote: »

If there was a cover up why didn't CervicalCheck keep the findings out of Vicky Phelan's notes? Definite cock-up rather than conspiracy.

The 5 hours Dáil committee meeting on Tuesday last week explained a lot.

Totally happy to revisit this following the scoping report.

I assume because the admin staff just put then there a cover up doesn't always have full compliance.

The probably thought she'd never get to see the notes.

Lovely stuff though how the HSE is being obsolved from blame and their crap cheap out sourcing

blanch152

NickNickleby wrote: »

My understanding, as a lay person, is pretty much along the lines of your posts in this thread. However, RTE and the newspaper headlines seem to suggest that women died because the HSE didn't tell them they had cancer.

While being told your diagnosis was wrong first time around won't affect the outcome, I can't understand why they (the HSE) seems to have withheld that information.

So, people are calling for heads to roll, is it the heads of those who failed to communicate the info on previously missed cancer? Is it the heads of the technicians/medical staff at the labs who presented false negative results?

Is it possible to guarantee absolutely no false positives or false negatives?

I don't understand the RTE and newspaper headlines.

In every single screening process, there are false negatives and cases are missed. What I have seen is that the HSE, in a culture of secrecy, and actually, more the doctors than the HSE administration, withheld the information about false negatives when it was discovered.

That cover-up seems to be the crime, but I don't think any lives could have been saved.

However, there are two caveats. One, were the numbers of false negatives out of line with other labs? If they were, then there is a problem with the labs. Two, when false negatives were discovered in the audit, were there any women who hadn't been diagnosed?

At the end of the day, we have to live with false negatives across all kinds of screening.

boombang

NickNickleby wrote: »

My understanding, as a lay person, is pretty much along the lines of your posts in this thread. However, RTE and the newspaper headlines seem to suggest that women died because the HSE didn't tell them they had cancer.

I'm glad you said this. This is why I'm annoyed by the media coverage. They're not explaining this issue calmly. If you look at the number of people on Twitter calling for the Guards to be called in many have been confused by the poor coverage.

NickNickleby wrote: »

While being told your diagnosis was wrong first time around won't affect the outcome, I can't understand why they (the HSE) seems to have withheld that information.

I don't know either and it's poor. But note CervicalCheck had changed their policy in 2016 and they were moving to tell people.

NickNickleby wrote: »

So, people are calling for heads to roll, is it the heads of those who failed to communicate the info on previously missed cancer? Is it the heads of the technicians/medical staff at the labs who presented false negative results?

The court award went against the screening company. The case against the HSE for not telling Nicky Phelan was not successful.

Personally I think there's a mob mentality looking for a head. TOB's a big one. However, I think it doesn't help the cause of accountability as he wasn't making decisions over who to tell what (specifically in the CervicalCheck case).

NickNickleby wrote: »

Is it possible to guarantee absolutely no false positives or false negatives?

No, certainly not at the level of population screening programme. You can reduce the false negatives (to a degree) by ramping up the intensity of the screening programmes to save women like Nicky Phelan, but it means way more false positives for everybody else and it's really expensive to catch the last few cancers. Annual understood to be a very cost inefficient way to prevent cancer deaths. Screening every 3/5 years is considered to be a good use of money.

boombang

listermint wrote: »

Lovely stuff though how the HSE is being obsolved from blame and their crap cheap out sourcing

Not saying HSE is blameless or that we shouldn't scrutinize the performance of the labs. But there isn't good evidence to say the outsourcing was crap yet. Nobody's moaning about the Irish outsource firm. Plenty of agendas at stake here too.

boombang

blanch152 wrote: »

That cover-up seems to be the crime, but I don't think any lives could have been saved.

I would say there has been no crime of cover up crime, rather cock up that looks like cover up. Since anybody involved in screening or cancer care will know that any woman with a screening history and a positive diagnosis will understand that there's a good chance that they've had a screen miss rather than a rapidly developing disease. That these women will quite possibly have had a miss would have been no secret to the health professionals involved.

boombang

blanch152 wrote: »

Two, when false negatives were discovered in the audit, were there any women who hadn't been diagnosed?

The audit is only prompted by a diagnosis. You have to have cancer/high grade CIN for you to discover that you had a previous false negative. The audit isn't something that was just done on everybody. That would be searching old haystacks in which you previously had found no needle.

This is also the reason why no cancer care could have been improved by telling women of the findings from the audit. They already had a diagnosis at that stage.

boombang

https://twitter.com/susmitchellSBP/status/993871172491272192

Good example of Mary Lou (read her replies to Susan Mitchell) either not understanding the issue (which I don't believe) or making it out to be something that it isn't. The HSE did not withhold results when then were clinically relevant, they only discovered the errors AFTER the correct diagnosis was discovered. I believe this is exploiting the sad but primarily inevitable failure of screening for political advantage. Asking for accountability is justified, but I think this oversteps that mark and is political point scoring.

listermint

Surely this threads premise is just laughable, The only own goal we should be concerned with here is the HSE.

But sure the usuals are out to play. Obsolve obfuscate and never get answers.

It will be interesting in June if we receive the usual hand wringing which we as citizens we have had for decades under successive governments. We can all name the enquirers at will.

James Brown

boombang wrote: »

Not sure I get what you're saying here. The US screens every year, we screen every 3/5. The test spec in the US lab is tailored to our frequency. No informed doctor or health official in Ireland would recommend annual screening.

We did every three years, in more detail.
They did every year, in less detail.

They ended up doing every three years, in less detail than we would give.
We got the worse of both systems.

boombang wrote: »

No evidence of "incredibly poor work".

CervicalCheck had modified their policies to tell women of past errors and were doing so.

We'd expect some screened women still to develop cancer and sadly die because screening isn't perfect.

Lots of people have totally unrealistic expectations of screening and a near conspiracy theory level of paranoia about this because the media haven't been giving a level-headed interpretation of things. Scandal gets better rating than grim reality.

That's a very administrative and clinical way of saying they did not inform patients of false negatives and during that period some had died or gone beyond the point of early treatment, and they decided they may tell some patients affected if they deemed it worth the bother, egged on by a patient taking legal action.
This isn't a case of averages for a scientific tests findings, it's about decisions not to inform people and doing a more cursory check every three years instead of one.
They made a conscious decision not to inform patients of the flawed results. They decided it didn't matter. What civil servants did or didn't know and when, why we went with this particular company, is there more conflict of interest regarding this particular contract and O'Brien? We may or may not find out, but the media coverage is certainly warranted. Mary Lou might be premature looking for convictions, but if not for the media and opposition politicians would we be aware? If not best practise, would it be changed? If any wrong doing were found, would it be actioned? We need the media, especially in a state that tends not to do accountability, criminal or otherwise.

boombang

Matt Barrett wrote: »

We did every three years, in more detail.
They did every year, in less detail.

They ended up doing every three years, in less detail than we would give.
We got the worse of both systems.

Incorrect. The CervicalCheck contract in 2008 explicitly required that the smears were done in detail to correspond with our 3/5 interval not the annual interval. Tony O'Brien has explained this in detail.

If we had got quick screening done every three years as you describe the, yes, we would have got worse of both worlds. This is part of the reason why there's the 1.2 vs 1.8 difference that Dr Gibbons pointed out in the initial analysis before the configuration was tailored to Irish needs.

Matt Barrett wrote: »

That's a very administrative and clinical way of saying they did not inform patients of false negatives and during that period some had died or gone beyond the point of early treatment,

They did not have the opportunity to give this information at point where earlier treatment would have helped. They only found out about the errors AFTER women had got treatment.

Matt Barrett wrote: »

This isn't a case of averages for a scientific tests findings, it's about decisions not to inform people and doing a more cursory check every three years instead of one.

1. Again, we don't do a cursory check every three years, we do a careful check every 3/5 years.

2. If you want to make reliable statements about the performance of the labs then you need to look at averages of scientific test findings. You can't get away from that.

Matt Barrett wrote: »

Mary Lou might be premature looking for convictions, but if not for the media and opposition politicians would we be aware? If not best practise, would it be changed? If any wrong doing were found, would it be actioned? We need the media, especially in a state that tends not to do accountability, criminal or otherwise.

I would be surprised if much if any would need to be changed about screening on the basis of this. More accurate HPV testing is already coming in at the end of the year. You have a positive view of the media. I think they've shone a light (good); but they've also hyped the issue and scared women unnecessarily (bad). I think the bad outweighs the good here.

James Brown

boombang wrote: »

Incorrect. The CervicalCheck contract in 2008 explicitly required that the smears were done in detail to correspond with our 3/5 interval not the annual interval. Tony O'Brien has explained this in detail.

If we had got quick screening done every three years as you describe the, yes, we would have got worse of both worlds. This is part of the reason why there's the 1.2 vs 1.8 difference that Dr Gibbons pointed out in the initial analysis before the configuration was tailored to Irish needs.




They did not have the opportunity to give this information at point where earlier treatment would have helped. They only found out about the errors AFTER women had got treatment.




1. Again, we don't do a cursory check every three years, we do a careful check every 3/5 years.

2. If you want to make reliable statements about the performance of the labs then you need to look at averages of scientific test findings. You can't get away from that.




I would be surprised if much if any would need to be changed about screening on the basis of this. More accurate HPV testing is already coming in at the end of the year. You have a positive view of the media. I think they've shone a light (good); but they've also hyped the issue and scared women unnecessarily (bad). I think the bad outweighs the good here.

The lower detection rate in the US laboratory was brought to the attention of the country's Health Service Executive (HSE) but appears not to have been acted upon.
http://www.bbc.com/news/world-europe-43961552

I have a positive view of the media because everybody has a bias and/or agenda, including various media outlets. If we were left with the government press office we would be in a very dark place, based on the states record and it's caliber of government politicians. With various sources we can decide for ourselves what is and isn't important, what is and isn't warranted. These woman didn't have that choice. If the tests are not fit for purpose we should move to improve, I know people die, things happen, but it would be nice if we tried to avoid that IMO, rather than dismissing it as par for the course. That's why it's important the people know about things, so they can drive change. One mans few patients dying due to poor standards, is another man's scandal.
There was a conscious decision to withhold information regarding clinical errors. People died as a direct result.

boombang

Matt Barrett wrote: »

There was a conscious decision to withhold information regarding clinical errors. People died as a direct result.

100% this did not happen [edit - the dying as a result bit].

James Brown

boombang wrote: »

100% this did not happen [edit - the dying as a result bit].

Sick people told they were fine, the company discovering they were not and nobody informing them of the find in a timely manner, if at all. Vicky Phelan for example?
Sick people being told they were fine, therefore not seeking treatment and dying.

boombang

Matt Barrett wrote: »

Sick people told they were fine, the company discovering they were not and nobody informing them of the find in a timely manner, if at all. Vicky Phelan for example?
Sick people being told they were fine, therefore not seeking treatment and dying.

But they only found out the error after the women had been identified as sick.

That's very different from information consciously being withheld from sick people. People weren't told they were sick because the screening test didn't indicate they were sick.

A world of difference.

James Brown

boombang wrote: »

But they only found out the error after the women had been identified as sick.

That's very different from information consciously being withheld from sick people. People weren't told they were sick because the screening test didn't indicate they were sick.

A world of difference.

You've not shown how this is incorrect:

Matt Barrett wrote: »

There was a conscious decision to withhold information regarding clinical errors. People died as a direct result.

People died as a direct result of false readings. The company withheld false readings. We are investigating who knew what, when and why. We know Vicky Phelan only found out through her own due diligence.
If the errors were discovered sooner or when discovered patients were told immediately, could lives have been saved?

NickNickleby

I've just read two online articles in Independent.ie

One by a Kim Bielenberg who refers to Vicky Phelan suffering because of 'botched tests'. It does not say whether or not Kim Bielenberg has any medical qualification.

The other by a Doctor Ciara Kelly, who explains the international experience of less than 100% accuracy of screening. She also refers to auditing, the purpose of which (if I read her piece correctly) is to ensure that the program being audited does not stray significantly from the international norm - in terms of its accuracy. Not to guarantee 100% accuracy.

I believe its because of this mixed type of reporting that we can have almost diametrically opposite opinions on what has happened.

Sadly, our Public Service Broadcaster has not clearly and unambiguously reported THE FACTS.

BTW, Dr Kelly's article is not written in a way to exonerate the HSE - she highlights their deficiencies in subsequently* communicating the information about the false negatives.

James Brown

NickNickleby wrote: »

I've just read two online articles in Independent.ie

One by a Kim Bielenberg who refers to Vicky Phelan suffering because of 'botched tests'. It does not say whether or not Kim Bielenberg has any medical qualification.

The other by a Doctor Ciara Kelly, who explains the international experience of less than 100% accuracy of screening. She also refers to auditing, the purpose of which (if I read her piece correctly) is to ensure that the program being audited does not stray significantly from the international norm - in terms of its accuracy. Not to guarantee 100% accuracy.

I believe its because of this mixed type of reporting that we can have almost diametrically opposite opinions on what has happened.

Sadly, our Public Service Broadcaster has not clearly and unambiguously reported THE FACTS.

BTW, Dr Kelly's article is not written in a way to exonerate the HSE - she highlights their deficiencies in communicating the information about the false negatives.

While we should ensure the right heads roll, if any, we should also not be too quick to go down the time honored, 'nothing to see here, move along' route.
I believe O'Brien and Varadkar have taken part in a conflict of interest elsewhere, (Lynch/Taisoseach then health minister/head of HSE) time will tell what develops here, as long as we don't follow the ALT-Right Trump agenda of dismissing all media we don't like for what ever reason.

Red_Wake

NickNickleby wrote: »

I've just read two online articles in Independent.ie

One by a Kim Bielenberg who refers to Vicky Phelan suffering because of 'botched tests'. It does not say whether or not Kim Bielenberg has any medical qualification.

The other by a Doctor Ciara Kelly, who explains the international experience of less than 100% accuracy of screening. She also refers to auditing, the purpose of which (if I read her piece correctly) is to ensure that the program being audited does not stray significantly from the international norm - in terms of its accuracy. Not to guarantee 100% accuracy.

I believe its because of this mixed type of reporting that we can have almost diametrically opposite opinions on what has happened.

Sadly, our Public Service Broadcaster has not clearly and unambiguously reported THE FACTS.

BTW, Dr Kelly's article is not written in a way to exonerate the HSE - she highlights their deficiencies in communicating the information about the false negatives.

RTE has an extensive and very disturbing history of misrepresenting facts about governmental organisations. Why the political establishment tolerates this is beyond me, but if I was in the Dail, RTE would be shut down immediately for it's agenda driven biases.

Matt Barrett

Matt Barrett wrote: »

People died as a direct result of false readings. The company withheld false readings.

How and why?

Aren't a certain percentage of false negatives expected as part of the normal screening process?

James Brown

Topgear on Dave wrote: »

How and why?

Aren't a certain percentage of false negatives expected as part of the normal screening process?

Yes. That's not the point. I'll not repost the same conversation just had.

Rechuchote

Fintan O'Toole has it right in The Irish Times - "culture change" is just another word for "delay, delay and have an inquiry, and they'll forget about it and nothing will change."

In France, it's different - two emergency call staff mocked a sick woman who called for an ambulance; she died - they were instantly sacked. https://www.irishexaminer.com/breakingnews/world/young-mother-dies-after-she-is-mocked-and-her-call-for-help-is-ignored-by-ambulance-service-operator-841841.html

If Ireland started sacking civil servants and enormously-paid public service bosses who eff up their jobs to the ruination of the country, there would be a wave of sudden efficiency.

boombang

Matt Barrett wrote: »

People died as a direct result of false readings. The company withheld false readings. We are investigating who knew what, when and why. We know Vicky Phelan only found out through her own due diligence.
If the errors were discovered sooner or when discovered patients were told immediately, could lives have been saved?

Matt, I'm not mudslinging here, but if this is your understanding your understanding is wrong. This is really important. People need to understand what happened to appreciate the importance of what went wrong.

The company did not withhold false readings. Women received a correct diagnosis and then they looked back at previous results. At this point they found errors in the previous results. Whether the women were told or not at this stage would not alter their care because they already had a correct diagnosis at that point. It would have been more open an honest to tell them that there had been a previous error, but nobody knew these previous screens were in error till it was too late. Hence no knowing withholding of information.

If people don't understand the order of events, then they're likely to misunderstand the story and overstate the significance of what went on.

boombang

Rechuchote wrote: »

Fintan O'Toole has it right in The Irish Times - "culture change" is just another word for "delay, delay and have an inquiry, and they'll forget about it and nothing will change."

In France, it's different - two emergency call staff mocked a sick woman who called for an ambulance; she died - they were instantly sacked. https://www.irishexaminer.com/breakingnews/world/young-mother-dies-after-she-is-mocked-and-her-call-for-help-is-ignored-by-ambulance-service-operator-841841.html

If Ireland started sacking civil servants and enormously-paid public service bosses who eff up their jobs to the ruination of the country, there would be a wave of sudden efficiency.

Grainne Flannelly was (effectively) sacked within about 3 days of this story breaking.

Rechuchote

Oh, they'll choose one person - but really the buck stops at the top in something like this.

boombang

NickNickleby wrote: »

I've just read two online articles in Independent.ie
Sadly, our Public Service Broadcaster has not clearly and unambiguously reported THE FACTS.

You only have to look within this thread and on twitter to see how many people have got the very important aspects of this story completely backwards.

That results would knowingly be withheld from people allowing them to further develop cancer and die would certainly be criminal negligence to a gross degree. But this isn't what happened. However, this idea has clearly taken root in many people's minds.

We should ask hard questions of the lab performance, but misinformation and misplaced outrage about disclosure gets in the way of that.

Rechuchote

What doctors say is that when the tests were done in Ireland, if the doctor was a bit doubtful, you could phone up and say "Could you ever take another look at that scan?" When they were 'outsourced', this could no longer be done.

James Brown

boombang wrote: »

Matt, I'm not mudslinging here, but if this is your understanding your understanding is wrong. This is really important. People need to understand what happened to appreciate the importance of what went wrong.

The company did not withhold false readings. Women received a correct diagnosis and then they looked back at previous results. At this point they found errors in the previous results. Whether the women were told or not at this stage would not alter their care because they already had a correct diagnosis at that point. It would have been more open an honest to tell them that there had been a previous error, but nobody knew these previous screens were in error till it was too late. Hence no knowing withholding of information.

If people don't understand the order of events, then they're likely to misunderstand the story and overstate the significance of what went on.

I read and understand what you are saying. I interpret it differently to you. It's your reasoning I disagree with. There were errors, we do not know the finer details or the entire issue yet. Your view exonerates the company and doubts any wrong doing on anyone's part before we've even completed looking into it.

The storm over cervical cancer screening began when terminally ill mum-of-two Ms Phelan was awarded €2.5m in a High Court settlement against a US lab after she was not informed about an incorrect smear test in 2011.https://www.independent.ie/irish-news/health/three-women-whose-cases-are-similar-to-vicky-phelan-have-died-state-claims-agency-confirms-36885928.html

These errors only came to light because of the Phelan case.

THE US LABORATORY at the centre of the cervical cancer screening controversy in Ireland sought a confidentiality clause in the legal challenge brought forward by Vicky Phelan.
http://www.thejournal.ie/cervicalcheck-scoping-inquiry-3999094-May2018/

The minister said he is "mad as hell" about the information that has come to light in recent days about the controversy, and the impact it has had on women across the country.

Mr Harris said that people who were in important positions in the health service have let people down and he wants a statutory inquiry to get answers.
https://www.rte.ie/news/politics/2018/0502/959759-cervicalcheck-reax/

Someone tell Harris, sh*t happens?

boombang

Matt Barrett wrote: »

The company withheld false readings.

It's not a matter of interpretation. The company did not withhold results from women. They made errors. What the errors represent is a matter of interpretation. However, it is a solid matter of fact that nobody knowingly withheld results from women that would have advantaged their care.



Error - yes, by the labs


Withholding knowledge of errors from women -yes, by CervicalCheck/Doctors


Withholding knowledge of errors at a time that compromised women's chances of survival - No, not by CervicalCheck or the company.

boombang

Matt Barrett wrote: »

These errors only came to light because of the Phelan case.

No, they came to light because of the CervicalCheck audit.

Anybody with knowledge of screening will know that the errors happen. It's no secret.

That women weren't told that they had been subject to errors came to light because of Nicky Phelan.

boombang

Rechuchote wrote: »

What doctors say is that when the tests were done in Ireland, if the doctor was a bit doubtful, you could phone up and say "Could you ever take another look at that scan?" When they were 'outsourced', this could no longer be done.

A representative of Dublin's Well Woman on the radio said that this was possible with the Coombe lab. I don't know if it's possible with the Irish commercial lab.

James Brown

boombang wrote: »

It's not a matter of interpretation. The company did not withhold results from women. They made errors. What the errors represent is a matter of interpretation. However, it is a solid matter of fact that nobody knowingly withheld results from women that would have advantaged their care.



Error - yes, by the labs


Withholding knowledge of errors from women -yes, by CervicalCheck/Doctors


Withholding knowledge of errors at a time that compromised women's chances of survival - No, not by CervicalCheck or the company.

You are welcome to that belief and your seemingly complete faith in the company, O'Brien and the HSE. I'll await the outcome of any investigation.

We all know errors happen, again, that's not the complete issue at hand.

boombang

Matt Barrett wrote: »

You are welcome to that belief and your seemingly complete faith in the company, O'Brien and the HSE. I'll await the outcome of any investigation.

We all know errors happen, again, that's not the complete issue at hand.

I don't have complete faith in TOB, the HSE and the company, but I'll wait the outcome of the investigation before I call for sackings etc.

The point is that the withholding of errors didn't compromise care is the hard point that I'm trying to get across. I accept everything else can be questioned and debated, but it is incontrovertible that the withholding of knowledge of the errors did not compromise these women. This is separate from the opinions that you and I are entitled to hold.

James Brown

boombang wrote: »

I don't have complete faith in TOB, the HSE and the company, but I'll wait the outcome of the investigation before I call for sackings etc.

The point is that the withholding of errors didn't compromise care is the hard point that I'm trying to get across. I accept everything else can be questioned and debated, but it is incontrovertible that the withholding of knowledge of the errors did not compromise these women. This is separate from the opinions that you and I are entitled to hold.

So say the company.

boombang

Matt Barrett wrote: »

So say the company.

No, so says logic. Errors were discovered AFTER women received a correct diagnosis.

James Brown

boombang wrote: »

No, so says logic. Errors were discovered AFTER women received a correct diagnosis.

Speaking today, Taoiseach Leo Varadkar said he is “very angry” that women were not told earlier about their smear tests being reviewed.
http://www.thejournal.ie/cervical-check-timeline-3985728-Apr2018/

This gives the impression the information was at hand but nobody notified. If I were told I received a false negative on a test, I'd want to be re tested. They took that option away.

27.9.2017 – Dr Hickey writes to Limerick GP Dr Valerie Keating informing her that he discussed with Ms Phelan the audit of smear tests. He also says ‘we just wanted to let you know the results of this audit process as it was only sent to us in communication as the treating gynaecologists and not to the patients themselves or the GPs.’

This letter comes over 14 months after the correspondence began, six years after the initial botched test, and three years after Mrs Phelan is finally given her (delayed) cancer diagnosis.
https://extra.ie/2018/04/29/lifestyle/health/vicky-phelan-timeline-smear-test-scandal

The idea that all these deaths would have happened anyway, despite these errs and conscious decisions to withhold the information, remains to be seen in entirety, regardless of what the company may say.
Also, in the least how these companies operate is obviously lacking.

2Scoops

Mr.Micro wrote: »

It is easy for a trained cytologist or technician to read a smear test slide. Such persons know the morphology of cells and will detect any abnormal ones straight away. Not every cell on a slide is looked at, it would take forever.

It's not easy even for trained cytologists - otherwise there wouldn't much false negatives/positives. Cellular atypia is not a simple game of good and bad. Every cell is looked at, or at least it's supposed to be, and it does indeed take forever as a result - that's why there was a 6 month backlog before the HSE outsourced tests to the US lab.

Sierra Oscar

The interview with Emma Ní Mhathúna on Morning Ireland was harrowing stuff. It's available to listen back on here. Perhaps one of the most profound interviews I have ever listened to on Irish radio.

It's a disgrace that there has been absolutely no accountability over this scandal. Fair play to Sinn Féin for putting the pressure on. If Harris doesn't act on Tony O'Brien then he himself should resign.

boombang

As harrowing as it is there's no clear scandal yet.

I think we need to very carefully assess the false positive rates of the three labs. CervicalCheck have stated in a Dail committee that they don't see a difference between the labs in this respect. I think this needs to be scrutinised carefully (by medical statisticians) to see if this stands up.

There are certainly questions to be asked. They need to be asked and answered carefully.

McMurphy

Sierra Oscar wrote: »

The interview with Emma Nhathúna on Morning Ireland was harrowing stuff. It's available to listen back on here. Perhaps one of the most profound interviews I have ever listened to on Irish radio.

It's a disgrace that there has been absolutely no accountability over this scandal. Fair play to Sinn F for putting the pressure on. If Harris doesn't act on Tony O'Brien then he himself should resign.

That's pretty hard to listen to tbh.

That poor woman, those poor kids.

tretorn

Tony O Brien is being very bullish and obviously confident enough to know the enquiry wont find he was neglgent in anyway.

I dont think any public servant has stood up to the hyprocrisy of politicans the way he has.

Its nauseating to think Simon Harris and Leo Vradkar actually requested a meeting with Vicky Phelan, if anyone needs to take responsibility for this "scandal" its them.

I dont believe there was a scandal though. No one knew Vicky Phelan had cancer and kept this information from her, that is what we we ned to remember even though the media have whipped this up. It was on Joe Duffy for days with women ringing up saying they had demanded a check on Thursday morning and they were getting it regardless of other people who needed the services of their GPS. Most of these women didnt need to be rechecked but they thought they did because of irresponsible media reporting. Joe Duffy was followed by Ray of sunshine Darcy and then Mary Wilson and her pals continued with it for another two hours.

NickNickleby

How is a False Negative identified? I'm going to presume a lot here:

One would expect that ALL negative results are treated as True Negative when first presented.

Is a review done of ALL test results? Would this be the same thing as conducting tests twice in quick succession (I'm talking about time and cost)?

If ALL results are reviewed,are THOSE updated results subject to the same acceptable failure rate, or are the reviews more rigorous? If the audit results are expected to be foolproof, presumably much more rigour is applied. Presumably then, trying to audit ALL results is an almost impossible task - not to mention time and cost.

Bear with me, this is going somewhere.....

Therefore, is the rationale :
"well, let's go back to the previous result for each person who tests positive, just in case they were actually positive last time - which we'll find out by using more rigorous (ie expensive and time consuming)methods."

Why??? we know the unfortunate person has the disease, what will change after the audit??

"yes, but if we find the last one was actually a positive that was missed, its important TO THE PROCESS, because if too many of these are happening, somethings wrong"

So (at last) we come to the nub.

How many is too many?

Well a politician with plenty of someone's else's money and little knowledge of, or thought for the realities of the screening process might say "ONE is too many". (this is quite different from "my mother is one too many" - I don't believe that emotion can be brought into it, because as with anything there can be no absolute guarantee). So now, some politician having declared that a totally foolproof screening system is possible if only people would pay for it, people will believe that.

That last paragraph in particular was written because I heard a one liner on the radio yesterday that the Board of the HSE was going to be replaced, sort of suggesting that the problem would now be fixed, and perhaps raising people's expectations that there'll be no more False Negatives.

By the way, I'm all for a no blame compensation policy in a case like this. Trying to establish blame is what creates all the additional heartache. If blame is appropriate, the audit should reveal it.

NickNickleby

By the way, in my speculation about the audit, I wondered how a choice was made on which results to audit. It would sound absurd if the audit was random, hence my choice of going after the now-positive-results.

boombang

When a woman with a prior screening history is diagnosed with cancers they go back to audit her previous smears to see if they miss anything. The audit is triggered by a diagnosis for each woman.

James Brown

boombang wrote: »

As harrowing as it is there's no clear scandal yet.

I think we need to very carefully assess the false positive rates of the three labs. CervicalCheck have stated in a Dail committee that they don't see a difference between the labs in this respect. I think this needs to be scrutinised carefully (by medical statisticians) to see if this stands up.

There are certainly questions to be asked. They need to be asked and answered carefully.

Your idea of 'scandal' differs from others.
Not passing on information that could prevent deaths, be it due to negligence or conscious decision is a scandal.

Amirani

Matt Barrett wrote: »

Your idea of 'scandal' differs from others.
Not passing on information that could prevent deaths, be it due to negligence or conscious decision is a scandal.

Passing on information in these cases could not have prevented deaths, the women in question had already been diagnosed and were receiving treatment.

Red_Wake

Matt Barrett wrote: »

boombang wrote: »

As harrowing as it is there's no clear scandal yet.

I think we need to very carefully assess the false positive rates of the three labs. CervicalCheck have stated in a Dail committee that they don't see a difference between the labs in this respect. I think this needs to be scrutinised carefully (by medical statisticians) to see if this stands up.

There are certainly questions to be asked. They need to be asked and answered carefully.

Your idea of 'scandal' differs from others.
Not passing on information that could prevent deaths, be it due to negligence or conscious decision is a scandal.

Matt, it's been explained to you multiple times that the smears weren't known to be inaccurate until after the women in question had already been diagnosed with cancer, and as such the decision not to inform them of the smear's inaccuracy had no bearing on their subsequent and ongoing treatment.

Not telling the women that the smears were inaccurate did not kill anyone, as they had already been diagnosed with, and were receiving treatment for cancer at this point.