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Child Item

Smear Test Scandal

Sam Quentin

So are we about to have another enquiry?
It's already taking up valuable time in the Dail,.. with the 'opposition' parties shouting and blaming everyone but themselves!? When at the end of the day nobody as such is to blame, nothing is fool proof.. Cant we just be glad that the smear tests globally have saved millions of lives.....

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meep

Try_harder wrote: »

This is a national disgrace - it must be investigated - 17 Women are dead

This is the biggest fallacy I've seen in this entire episode.

No-one has died because screening test review results were communicated late. As I understand it, in all cases, those reviews were triggered by a cancer diagnosis, part of a process review and improvement practice that is/was in place.

The core issue is the effacacy of the screening test itself and how so many false-negatives were reported (~200 from ~1000 reviews).

A lot of people expressing outrage seem to be mistakenly conflating the development of cancer and death with the delayed reporting process which is not the case. This is exacerbated by very poor reporting on the issue across our media and general hysteria and hyperbole on social media.

I feel our energies should be directed at the core issue of improving screening and processes and preventing more illness rather than focusing on procedural 'after the fact' issues which can and should be fairly easily fixed.

McCrack

I have listened and watched Vicky Phelan and she is such a remarkable lady, she impressed me on Ray Darcy and again on Prime Time. Her courage has brought this to national attention and the people of Ireland owe her gratitude.

Her legal team also deserve huge credit too for bringing what is a difficult and complex case on so quickly and sucessfully.

LirW

joe40 wrote: »

Maybe an annual screening schedule would work better.

An annual screening is pretty much the only way to effectively battle this complex issue of pre-stages of cervical cancer. It's usually a slowly developing cancer but the cells can be abnormal a while ago. It is important to closely monitor these changes every few months, in many cases they go away on their own but left unobserved they can develop into cancer and once cervical cancer is around you're in huge trouble and can say goodbye to your reproductive organs or your life.
Cervical cancer can develop without symptoms until the stage where it is already terminal, it absolutely is a silent killer.
Many other countries have an annual screening schedule.

It affects half the country's population, especially with pretty much every adult coming in touch with the virus causing it at some point in their life.

Neyite

meep wrote: »

I've thought about this a lot over the past few days.

If I was terminally ill, I would prefer not know that a review of a screening test prior to my illness revealed that the result was incorrectly reported.

Of course, I would prefer that the test was more accurate and that my potential illness had been picked up in time to allow treatment. But if it was too late, I think the knowledge that it could have been prevented would add additional anguish.

Maybe that's just me and of course such informatiuon should be used to better the process but trying to put myself in that kind of sitution, I don't think I'd want to know.

I would. My family is based on us being a two income family until retirement. If our family lost one of those incomes due to HSE incompetence, that's 20+ years of a salary that's lost. That would affect my kid going to college, or risk him being homeless if his dad was unable to meet mortgage repayments.

So yes, I'd want to make sure that if the HSE were responsible for my death, that my family won't be destitute into the bargain.

Lackey

Deise Vu wrote: »

Maybe you misunderstood the question. I asked what personal benefit is there for the person who finds themselves in the truly awful situation that they are receiving Chemo and radiation treatment and surgery to discover that they might have avoided it. Obviously we need transparency when it comes to the overall running of the system.

If nothing else Financial security for themselves and their family.

It doesn't just affect the patient financially, but the WHOLE family, during treatment kids still have to be brought to school and minded. Bills have to be paid etc. Appointments for hospital stays,
Not only is the patient unable to work but their family have to take time off work to cover all this.

Also people would not want to know...but on the other hand people would.
They would want answers and to see some kind of justice served, I would.

meep

Neyite wrote: »

I would. My family is based on us being a two income family until retirement. If our family lost one of those incomes due to HSE incompetence, that's 20+ years of a salary that's lost. That would affect my kid going to college, or risk him being homeless if his dad was unable to meet mortgage repayments.

So yes, I'd want to make sure that if the HSE were responsible for my death, that my family won't be destitute into the bargain.

Even though that means you're into a legal process in which you try to prove that a screening test that is known not to be 100% accurate resulted in a false negative in your case?

OK, if there was a delay in the delivery of a positive screening test result that meant you had a delayed diagnosis, or other incompetence that was a causal factor in your late diagnosis, absolutely go for it. I would too.

But if you are unfortunate enough to be one of the statistical probabilities of a false negative result, and you only find this out after the fact when it's too late, where's the benefit in knowing (or suing?)

Maybe I tend to be fatalistic but if I end up on the wrong side of something that ultimately comes down to bad luck, I think I'd write it off as such rather than lash out and seek to apportion blame and seek recompense.

I might, of couse, react differently if in the situation and thankfully it has not happeded to myself or immediate family so I feel somewhat unqualified to speculate, and uncomfortable doing so.

Amirani

I'd be broadly supportive of a move to 1 year screenings if it was likely to improve outcomes and economics were reasonable.

I think it's a dangerous attitude to suggest that compensation should be available to anyone who receives an incorrect result based on a screening test. Screenings aren't diagnostic tests and as such results won't be completely accurate - we must accept this. If we create a situation whereby people are entitled to compensation for any sort of failed screening or mis-diagnosis then we no longer have a health system as it becomes completely un-affordable to operate. Obviously if procedures aren't followed or there are clear cases of negligence then compensation should be provided.

In terms of the issue here; I do think that the best approach was probably to deal we this on a case-by-case basis. People who are already receiving treatment for cancer generally won't benefit (and will likely suffer more) if they are informed of an incorrect smear result. I don't think I'd want to know in such a scenario. Outsourcing to lab that operates under a different testing-time scale is concerning and should not be done. This is particularly the case when early indications were of different statistical outcomes for similar samples across the different labs.

seamus

Deise Vu wrote: »

The dilemma after discovering a false negative is do you inform someone who is receiving debilitating cancer treatments such as Chemo and radiation that, you know what, we should have spotted this three years ago when it would have been relatively straight forward to treat. Would that have helped her or depressed her? I don't know the answer to that and we obviously should develop a protocol around it.

I honestly think it's irrelevant. There should definitely be protocols and procedures about presenting the information sensitively, but we should not be tasking doctors with presupposing their patients' state of mind and authorising them to keep patients in a state of blissful ignorance.

Taken to a logical conclusion, one could argue that if a patient has an untreatable terminal illness, then doctors perhaps should say nothing?

No, death comes to everyone, so painting over it or trying to protect the patient from difficult information is not only insulting, it's pointless. It's not up to the doctor as to whether a patient should live their final days in blissful ignorance. That's not their job, that's not their right.

No, it may not help some patients to know. But it may help others. And nobody has the authority to make the decision on a patient's behalf. So they must be told.

Deleted User wrote: »

I learned this week, in the Western world, the third biggest killer after
Cancer
Heart Disease
is
Medical error
Consider that for a moment.

Sure, but also consider context. Eliminate medicine and simple diseases will start climbing the ranks again.

That "medical error" figure is the price we pay for 99.6% of children making it to their fifth birthday. For having an expectation of making it to 82 years old (on average!).
Of course, that's little consolation to the family of someone who has died because a surgeon lost a knife in their colon, but as a whole it needs to be seen in context.
Practically all of the time I see the "medical error causes lots of deaths" figures bandied about, it's virtually always used as proof of why vaccines should be avoided or why some "natural" treatment should be preferred over medicine.

So long as we continue to work on improving medical processes, and we see a decrease in overall death rates, we should be aiming for the day where medical error is the biggest cause of death in the western world. As counter-intuitive as it sounds, if we ever make that day, it would be an absolute triumph of technological advancement.

McCrack

Amirani wrote: »

I'd be broadly supportive of a move to 1 year screenings if it was likely to improve outcomes and economics were reasonable.

I think it's a dangerous attitude to suggest that compensation should be available to anyone who receives an incorrect result based on a screening test. Screenings aren't diagnostic tests and as such results won't be completely accurate - we must accept this. If we create a situation whereby people are entitled to compensation for any sort of failed screening or mis-diagnosis then we no longer have a health system as it becomes completely un-affordable to operate. Obviously if procedures aren't followed or there are clear cases of negligence then compensation should be provided.

In terms of the issue here; I do think that the best approach was probably to deal we this on a case-by-case basis. People who are already receiving treatment for cancer generally won't benefit (and will likely suffer more) if they are informed of an incorrect smear result. I don't think I'd want to know in such a scenario. Outsourcing to lab that operates under a different testing-time scale is concerning and should not be done. This is particularly the case when early indications were of different statistical outcomes for similar samples across the different labs.

If there is a delayed/mis-diagnoses that causes a person harm then compensation should be payable

Nobody is suggesting a false/delayed negative without any harm should be compensated for nor can it be - one of the essential ingredients of any personal injury/medical negligence claim is injury or harm to the person.

And people should most certainly be informed to allow them an opportunity to investigate the error and seek compensation for themselves/their family they may leave behind early as a consequence of delayed treatment

HandsomeBob

Sam Quentin wrote: »

So are we about to have another enquiry?
It's already taking up valuable time in the Dail,.. with the 'opposition' parties shouting and blaming everyone but themselves!? When at the end of the day nobody as such is to blame, nothing is fool proof.. Cant we just be glad that the smear tests globally have saved millions of lives.....

Someone close to me died over a decade ago at the age of 38 after she had been misdiagnosed at a key time. Was in the papers and all...her father and brother tried their best at the time to make it a national discussion but unfortunately it never became the national scandal we're seeing now. I guess at the end of the day she was only just one person as opposed to 17 so no one gave a sh1t.

So in short I'm only delighted that this issue is now getting the attention it needs and they can take up all the time they want debating it in the Dail as long as it's not being used for political point scoring.

I'm amazed that it's still happening tbh and worse swept under the rug even after the fact.

Neyite

meep wrote: »

Even though that means you're into a legal process in which you try to prove that a screening test that is known not to be 100% accurate resulted in a false negative in your case?

OK, if there was a delay in the delivery of a positive screening test result that meant you had a delayed diagnosis, or other incompetence that was a causal factor in your late diagnosis, absolutely go for it. I would too.

But if you are unfortunate enough to be one of the statistical probabilities of a false negative result, and you only find this out after the fact when it's too late, where's the benefit in knowing (or suing?)

Maybe I tend to be fatalistic but if I end up on the wrong side of something that ultimately comes down to bad luck, I think I'd write it off as such rather than lash out and seek to apportion blame and seek recompense.

I might, of couse, react differently if in the situation and thankfully it has not happeded to myself or immediate family so I feel somewhat unqualified to speculate, and uncomfortable doing so.

I've never sued anyone in my life and wouldn't sue over a statistical anomaly. But this scandal is not about that. I think we are agreeing with each other though - If I happened to be one of a statistical % that is standard for the test to miss, fine. But if I was one of these women who's results were buried/ hidden/ ignored and as a result they are terminally ill then yes, I'd be suing.

McCrack

I think the title of this thread should be amended

It's quite frankly insulting to many people affected by this

meep

McCrack wrote: »

If there is a delayed/mis-diagnoses that causes a person harm then compensation should be payable

Nobody is suggesting a false/delayed negative without any harm should be compensated for nor can it be - one of the essential ingredients of any personal injury/medical negligence claim is injury or harm to the person.

And people should most certainly be informed to allow them an opportunity to investigate the error and seek compensation for themselves/their family they may leave behind early as a consequence of delayed treatment

Would you distinguish between a diagnostic test and a screening test in this regard?

McCrack

meep wrote: »

Would you distinguish between a diagnostic test and a screening test in this regard?

Clearly in Vicky Phelan's case if the screening test was read properly and it could have been read properly in 2011 she would have been referred for a colposcopy

meep

Neyite wrote: »

I've never sued anyone in my life and wouldn't sue over a statistical anomaly. But this scandal is not about that. I think we are agreeing with each other though - If I happened to be one of a statistical % that is standard for the test to miss, fine. But if I was one of these women who's results were buried/ hidden/ ignored and as a result they are terminally ill then yes, I'd be suing.

Yes, we are agreeing on that point.

However, as I understand it, no one is terminally ill (or has died) becuase results were buired/hidden/ignored in this case.

People are ill, terminally ill or have died possibly becuase results of a screening test which is known not to be accuarte were not reported corrctly and so they did not receive imely treatment.

The buried/hidden/ignored data relates to a review of those tests when the patient had been already diagnosed. Regardless of whether we think they should receive such updated information, receipt of the review results would hve no impact on their prognosis.

Deise Vu

seamus wrote: »

I honestly think it's irrelevant. There should definitely be protocols and procedures about presenting the information sensitively, but we should not be tasking doctors with presupposing their patients' state of mind and authorising them to keep patients in a state of blissful ignorance.

Taken to a logical conclusion, one could argue that if a patient has an untreatable terminal illness, then doctors perhaps should say nothing?

No, death comes to everyone, so painting over it or trying to protect the patient from difficult information is not only insulting, it's pointless. It's not up to the doctor as to whether a patient should live their final days in blissful ignorance. That's not their job, that's not their right.

No, it may not help some patients to know. But it may help others. And nobody has the authority to make the decision on a patient's behalf. So they must be told.

Just for clarity here, I said I didn't know what the correct answer was and I also said I would welcome whatever protocol was decided upon and eliminate another difficult grey area. I am just not convinced everyone would benefit in this case.

I do not know why you have extended this to keeping a patient in the dark about the fact that they are dying. That would be appalling and deny them the opportunity to do a lot of things they might need to do (making a will eg) let alone things they might want to do if they knew they were dying.

McCrack

meep wrote: »

Yes, we are agreeing on that point.

However, as I understand it, no one is terminally ill (or has died) becuase results were buired/hidden/ignored in this case.

People are ill, terminally ill or have died possibly becuase results of a screening test which is known not to be accuarte were not reported corrctly and so they did not receive imely treatment.

The buried/hidden/ignored data relates to a review of those tests when the patient had been already diagnosed. Regardless of whether we think they should receive such updated information, receipt of the review results would hve no impact on their prognosis.

Possibly however to be denied the opportunity to seek compensation because they were not told of the error is to deny terminally ill people the opportunity to have the money to travel for treatment and seek other cancer treatments not currently available from the HSE

seamus

Deise Vu wrote: »

Just for clarity here, I said I didn't know what the correct answer was and I also said I would welcome whatever protocol was decided upon and eliminate another difficult grey area. I am just not convinced everyone would benefit in this case.

Sure, my apologies if my post made it look like you'd said that.

I guess my point is that if we do say that <Insert 3rd Party Here> has the authority to say that a patient is too fragile/risky/etc to receive bad news, and having that knowledge doesn't affect their treatment, then what's the line?

If a suicidal patient has been diagnosed with an end-stage glioblastoma, would that qualify as a case where the doctor shouldn't tell them?

I do agree, absolutely, that for some people there will be no benefit in knowing. And for some it might actually make it worse; there is something of a correlation between optimism and outcome. So it's not a straightforward thing.

But, IMHO, I think it's so impossible to draw a line between tell/don't tell, that it would be inappropriate to empower doctors with that responsibility. It's giving them authority of autonomy over another person.
Tell everyone, but figure out a way to do it properly.

joe40

I agree in principal that doctors should be fully open and honest with patients, however it is not always in the best interest of the patient.
I'm talking about my own experiences with elderly parents, where bad news meant the last few months were harder than they could have been. I still believe they had a right to know but it would have been easier for them had they not known full extent.
This case did not involve withholding medically relevant information though. The cancer diagnosis was already determined at that stage.

meep

McCrack wrote: »

Possibly however to be denied the opportunity to seek compensation because they were not told of the error is to deny terminally ill people the opportunity to have the money to travel for treatment and seek other cancer treatments not currently available from the HSE

Agreed. If there are cases where peoples screening tests were incompetently processed (beyond statistical parameters), by all means. And it now seems to be emerging that this might be the case.

So it seems that even though there was, in my opinion, an out of proportion reaction to the original issue of delayed reporting of review results, the bandwagon jumping is helping to unearth more serious failings and therefore can be said to be jsutified.

I wonder if the government will be suing the US labs in order to fund the mooted redress scheme?

laserlad2010

The media circus and emotional fallout over the CervicalCheck system has completely clouded people's judgement.

There are two issues here:

1. The Cervical Check Screening Programme, like all screening programs, has false negatives. Several of those false negatives have led to cancer (which is what a false negative does - "you don't have cancer" when you do). It's unavoidable. Every screening programme in the world misses things. What it does do, is catch people who would otherwise go on to develop cancer. Without the Screening Programme, there would be many more women dying from cervical cancer than are currently doing so, even when accounting for the false negatives.

2. The issue around communication. In the UK, the Cervical Cancer Screening guidelines advise that doctors use their own judgement when deciding who to tell, and who not to tell. Same as us.
The communication from Dr. Flannelly - who, coincidentally, has been a champion of women's healthcare, succeeding in bringing the Cervical Check programme to Ireland - is regrettable. However, given her track record in saving women's lives, I'm inclined to give her the benefit of the doubt and not accuse her of maliciously witholding information.

My sympathies are with the women affected by the fallout. The unpalatable reality, however, is that every single screening programme in the world allows people to fall through the cracks and have cancer that was missed. It's inevitable. However, what they do is they identify some people who do have cancer, and these people go on to receive treatment.

I am happy to wait for the outcome of the investigation into the deaths of the 17 women (remember, those going for screens are more likely to be engaged with their GPs, possibly from other illnesses - and also screening goes up to 60 years of age so cardiovascular disease could have a role to play) and into the service as a whole before passing judgement.

EDIT: I should add that the most concerning aspect of the "scandal" is the audit process and it's analysis. Audits target a sample of results to see if the standard is being maintained. In no country ever could an audit cover every single result. Women weren't "missed in an audit".

Here's the bottom line. Screening programmes reduce late stage cancer diagnoses and subsequent deaths. They miss some. Hence the word reduction]

ChikiChiki

Sam Quentin wrote: »

So are we about to have another enquiry?
It's already taking up valuable time in the Dail,.. with the 'opposition' parties shouting and blaming everyone but themselves!? When at the end of the day nobody as such is to blame, nothing is fool proof.. Cant we just be glad that the smear tests globally have saved millions of lives.....

What the fcuking fcuk have I just read??

FFFG is that you? Shower of cover up merchants. No accountability ever is what has this country in the ****ter.

People have died because of this fcuk up. Get that into your head.

As far as I can see the HSE are not doing their job correctly in many areas. Who has oversight over the HSE and must ensure they are doing their jobs correctly??? The fcuking government, thats who!! Therefore they are to blame.

Having seen people die because of our inept health system, deflecting posts like the OPs make me absolutely sick. There needs to be accountability always and heads should roll.

Too many Sam Quentins in the country, thats the problem. Nothing will change. Your tune would be different if it was your own family member.

joe40

If an inquiry finds out that the screening process was not robust enough or lacked sufficient quality assurance that will be a serious issue, and should have serious consequences for management of the screening system, especially since concerns were raised in 2008 about the relative low number of positive results compared to other labs. (This would indicate larger no. of false positives)

I don't know how a redress scheme would work though, since how would you determine which individuals were the result of poor quality screening and which fall under the accepted statistical no. of false readings.
Eg A good screening test with 90% accuracy will produce 10 false results for every 1000 people screened.
If poor quality screening results in an 80% accuracy that will be 20 false results for every 1000 people screened.
But how to you provide redress to individuals in this case. Obviously there are failings in the system but who gets compensation and who falls into the statistically acceptable number,
Ideally the screening would be 100% accurate but it seems to be accepted this will not happen in reality.

[Deleted User]

ChikiChiki wrote: »

.

Having seen people die because of our inept health system, deflecting posts like the OPs make me absolutely sick. There needs to be accountability always and heads should roll.

Too many Sam Quentins in the country, thats the problem. Nothing will change. Your tune would be different if it was your own family member.

If it would make you happy we could have an internet vote on which politician and which of the medical staff that we should publicly hang as a lesson to the others.

However what will this gain for us other than make you feel better?

The HSE has to have some kind of no blame culture developed. Medics have to be able to put their hand up and admit when there is a problem and everybody be open to finding a solution, not try to cover up because they will get in trouble.

Medical professionals are human and make mistakes like you and I, working with very sick people where things are high risk and not everything is black and white.

Deise Vu

laserlad2010 wrote: »

The media circus and emotional fallout over the CervicalCheck system has completely clouded people's judgement.

There are two issues here:

1. The Cervical Check Screening Programme, like all screening programs, has false negatives. Several of those false negatives have led to cancer (which is what a false negative does - "you don't have cancer" when you do). It's unavoidable. Every screening programme in the world misses things. What it does do, is catch people who would otherwise go on to develop cancer. Without the Screening Programme, there would be many more women dying from cervical cancer than are currently doing so, even when accounting for the false negatives.

2. The issue around communication. In the UK, the Cervical Cancer Screening guidelines advise that doctors use their own judgement when deciding who to tell, and who not to tell. Same as us.
The communication from Dr. Flannelly - who, coincidentally, has been a champion of women's healthcare, succeeding in bringing the Cervical Check programme to Ireland - is regrettable. However, given her track record in saving women's lives, I'm inclined to give her the benefit of the doubt and not accuse her of maliciously witholding information.

My sympathies are with the women affected by the fallout. The unpalatable reality, however, is that every single screening programme in the world allows people to fall through the cracks and have cancer that was missed. It's inevitable. However, what they do is they identify some people who do have cancer, and these people go on to receive treatment.

I am happy to wait for the outcome of the investigation into the deaths of the 17 women (remember, those going for screens are more likely to be engaged with their GPs, possibly from other illnesses - and also screening goes up to 60 years of age so cardiovascular disease could have a role to play) and into the service as a whole before passing judgement.

Logic and common sense is all well and good but people have pitchforks to wield and torches to burn.

endacl

ChikiChiki wrote: »

What the fcuking fcuk have I just read??

Was worse before the edit.

Go down a few posts for the quoted original.

meep

ChikiChiki wrote: »

What the fcuking fcuk have I just read??

People have died because of this fcuk up. Get that into your head.

There is certainly a lot wrong but right now, you can't say that with any degree of certainty.

17 people whose screening test results were reviewed after the were diagnosed with cancer have died. There is no data on what they have died from. For a FACT they have NOT died because their review results were delayed or not communicated. There is no causal relationship between delayed review results and illness or death.

In many cases, smear test results were incorrect and patients received false positive or false negative results. The accuracy of this particular test is somewhere between 70-80% (apparently). Again, you cannot apply negligent causality of illness or death to false negative reporting in this process as that's just the way it is. (you can argue for a better test, if scientifically possible and availbale).

However, it now appears that there MAY be cases where some test results were returned as false-negatives that fall outside these margins of error and may be due to incompetence or some other reason.

By all means, if these cases exist, we should all be up in arms and outraged. However, right now, that information is unavailable and under investigation. Any outrage is presently misplaced.

I'd prefer not put incorrect 'facts' into my head and will wait until the actual story emerges.

I agree, the actual story might not have emerged without the fuss around the delayed results reporting but it's too soon to be attributing deaths and casuality. (thoigth I do think there will be illness and death that could have been avoided and it will likely come down to the basis on which the screen labs were engaged).

laserlad2010

meep wrote: »

I agree, the actual story might not have emerged without the fuss around the delayed results reporting but it's too soon to be attributing deaths and casuality. (thoigth I do think there will be illness and death that could have been avoided and it will likely come down to the basis on which the screen labs were engaged).

Agreed. A process with only one check of a smear rather than the two check which is traditionally done here for cancer diagnoses was destined to run into trouble.

goat2

https://www.independent.ie/irish-news/quality-fears-over-us-lab-conducting-smear-tests-26531634.html The name of the screen lab, and the other faults that went with it

Copied and Pasted from above link.

THE controversial US laboratory giant contracted to analyse smear tests for Irish women has had to pay more than $300m to the US government for marketing faulty kidney testing kits.

New Jersey-based Quest Diagnostics, which won the lucrative contract to service Ireland's cervical screening programme, will pay the sum after one of its subsidiaries, Nichols Institute Diagnostics, was found to have sold the defective test kits for dialysis patients.

Commenting on the revelation, Fine Gael health spokesman Dr James Reilly said that while the matter did not relate to smear tests, it was essential that a quality control review be carried out on the work they are doing for the Irish health service.

When Quest won the Irish contract, it effectively meant that staff in laboratories here involved in the cervical testing had to be re-deployed and their skills will be lost.

However, the Health Service Executive said the laboratories here could not meet the demand for the national free programme.

gctest50

meep wrote: »

..........

In many cases, smear test results were incorrect and

The accuracy of this particular test is somewhere may be due to incompetence or some other reason.

That's not the problem, the US screening doesn't suit the Irish testing system

Worse , when concerns were raised :

Dr Gibbons also said he and a group of "very well-qualified scientists" resigned after their concerns were allegedly dismissed.

Someone knew, they buried it