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CervicalCheck controversy

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  • Options
    #32
    boombang
    Registered Users Posts: 2,108 ✭✭✭boombang


    hatrickpatrick wrote: »
    In what kind of sick, sick world is this not considered a serious criminal offense deserving of a custodial prison sentence? These people literally have blood on their hands. Sacking isn't enough, they should be receiving a criminal record and being hauled off to a cell for the next few years.

    I think this sentiment must be based on a misunderstanding of what went wrong at CervicalCheck. A lot of people are under the impression that relevant diagnoses were withheld from women in a way that let the disease to progress. This is NOT what happened. The screening errors were discovered AFTER women had received a correct diagnosis for cancer and had start appropriate treatment. It was the diagnosis of cancer following later screenings that followed a review of earlier screening and in some cases it was found that earlier signs of disease had been missed. Given that women had received the correct diagnosis at the time there is no possible way what was not communicated to women could have helped their prognosis.


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    #33
    boombang
    Registered Users Posts: 2,108 ✭✭✭boombang


    Aegir wrote: »
    17 women have died due to incompetence and literally thousands more worried sick that the results they have been given were wrong.

    17 women have died because a fallible test failed in a predictable and expected way. This isn't due to some terrible failing of CervicalCheck management.


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    #34
    Mr.Micro
    Registered Users Posts: 5,336 ✭✭✭Mr.Micro


    boombang wrote: »
    I'm not a pathologist, but I've seen the smear reading process and I would say that it is difficult to read smears. Check through 10,000 cells on a slide an spot differences in the staining of them. If it's easy to read smears why do we get false negatives and why does it take time to train screeners?

    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.

    Problems arise when vast numbers of slides are examined in that, not enough time may be given to each slide, thus missing detection. Other factors, incompetent staff, poor staining procedures, poor training etc.


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    #35
    boombang
    Registered Users Posts: 2,108 ✭✭✭boombang


    Mr.Micro wrote: »
    Problems arise when vast numbers of slides are examined in that, not enough time may be given to each slide, thus missing detection. Other factors, incompetent staff, poor staining procedures, poor training etc.

    Screening necessarily requires vast numbers of slides to be read quickly and consistently to achieve high sensitivity, specificity and at viable cost. The contracted labs seem to have been achieving this. We could make screening more accurate, but if it takes longer per slide then that's more labour cost and the cost-effectiveness of screening is compromised.


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    #36
    WoollyRedHat
    Registered Users Posts: 10,462 ✭✭✭✭WoollyRedHat


    boombang wrote: »
    17 women have died because a fallible test failed in a predictable and expected way. This isn't due to some terrible failing of CervicalCheck management.

    In over 200 cases it was found that they should of been sent for treatment but because of faiilure of detection this didn't happen

    During the tendering process the US lab was found to have a one third lower detection rate of pre-cancerous cells compared to the equivalent labs in Ireland. The US system is designed for annual checks whereas the Irish system is every 3 years. That means the pathologists were handling a larger amount of tests for analysis which increases the likelihood of human error, which in the U.S isn`t as serious because they test every year. We don't.

    Furthermore a number of gynecologist staff warned about outsourcing and how it could lead to missed diagnosis due to mismatch of systems. Dr. Gibbons was on the Quality Assurance committee and would of been fully aware of the process. Just because TOB dismissed his claims doesn't make him incorrect. He resigned for good reason. I would like to see the minutes of that meeting.

    The level of cover up involving HSE is shocking.. they tried to get Phelan to sign an NDA because they didn't want it to be made public. There`s a reason why the insurance company paid.out to Vicky Phelan. TOB should go and with no pension. An full independent inquiry needs to be established free of HSE. The likes of Harney should be called to give evidence.


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    #37
    WoollyRedHat
    Registered Users Posts: 10,462 ✭✭✭✭WoollyRedHat


    boombang wrote: »
    Screening necessarily requires vast numbers of slides to be read quickly and consistently to achieve high sensitivity, specificity and at viable cost. The contracted labs seem to have been achieving this. We could make screening more accurate, but if it takes longer per slide then that's more labour cost and the cost-effectiveness of screening is compromised.

    Cost-effectiveness and peoples lives, there's your problem right there.


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    #38
    Fann Linn
    Registered Users Posts: 7,770 ✭✭✭Fann Linn


    And I think the consensus is that SF have not scored an og.


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    #39
    boombang
    Registered Users Posts: 2,108 ✭✭✭boombang


    WoollyRedHat wrote: »
    Cost-effectiveness and peoples lives, there's your problem right there.

    As paradoxical as it may seem if you ignore cost-effectivenes the worse your health system will be. The optimal screening service is not a perfect one. I don't expect many to agree with or understand this perspective.


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    #40
    boombang
    Registered Users Posts: 2,108 ✭✭✭boombang


    WoollyRedHat wrote: »
    In over 200 cases it was found that they should of been sent for treatment but because of faiilure of detection this didn't happen

    During the tendering process the US lab was found to have a one third lower detection rate of pre-cancerous cells compared to the equivalent labs in Ireland. The US system is designed for annual checks whereas the Irish system is every 3 years. That means the pathologists were handling a larger amount of tests for analysis which increases the likelihood of human error, which in the U.S isn`t as serious because they test every year. We don't.

    Furthermore a number of gynecologist staff warned about outsourcing and how it could lead to missed diagnosis due to mismatch of systems. Dr. Gibbons was on the Quality Assurance committee and would of been fully aware of the process. Just because TOB dismissed his claims doesn't make him incorrect. He resigned for good reason. I would like to see the minutes of that meeting.

    The level of cover up involving HSE is shocking.. they tried to get Phelan to sign an NDA because they didn't want it to be made public. There`s a reason why the insurance company paid.out to Vicky Phelan. TOB should go and with no pension. An full independent inquiry needs to be established free of HSE. The likes of Harney should be called to give evidence.

    The US lab not the HSE sought the NDA.

    I would bet money the inquiry will not find against TOB. Not because it will be shoddy, but because he didn't do anything wrong as far as I can see. I watched all 5 hours of the Dáil committee on the issue from Tuesday.


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    #41
    James Brown
    Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    boombang wrote: »
    The US lab not the HSE sought the NDA.

    I would bet money the inquiry will not find against TOB. Not because it will be shoddy, but because he didn't do anything wrong as far as I can see. I watched all 5 hours of the Dáil committee on the issue from Tuesday.

    He said he was going to use his remaining time to concentrate on this scandal...then he takes early leave with vacation. Not to mention the company in the US he is a board member of and a share holder in is chaired by a man who chairs the Matter hospital, (not to mention a financial supporter of Varadkar's). So there's conflict of interest there, where else? Can all be dismissed of course. Very reminiscent of the Bertie era.


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    #42
    boombang
    Registered Users Posts: 2,108 ✭✭✭boombang


    Matt Barrett wrote: »
    He said he was going to use his remaining time to concentrate on this scandal...then he takes early leave with vacation. Not to mention the company in the US he is a board member of and a share holder in is chaired by a man who chairs the Matter hospital, (not to mention a financial supporter of Varadkar's). So there's conflict of interest there, where else? Can all be dismissed of course. Very reminiscent of the Bertie era.

    Yep, but the report will be assessing the CervicalCheck controversy. I doubt he'll be found lacking with regard to it. He might have other questions to answer on other topics, but they are other topics, not CervicalCheck.


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    #43
    James Brown
    Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    boombang wrote: »
    Yep, but the report will be assessing the CervicalCheck controversy. I doubt he'll be found lacking with regard to it. He might have other questions to answer on other topics, but they are other topics, not CervicalCheck.

    It will be interesting to learn about the tendering process, who was involved and why they were picked despite a poorer record than those at home.


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    #44
    boombang
    Registered Users Posts: 2,108 ✭✭✭boombang


    Matt Barrett wrote: »
    It will be interesting to learn about the tendering process, who was involved and why they were picked despite a poorer record than those at home.

    Again I go back to TOB's point that the evidence put forward by the man who ran a cervical screening service in Ireland was not relevant to the specification of the service that CervicalCheck subsequently purchased from Quest. I will look closely at the error rates that have come from those labs in the CervicalCheck era. Annoyingly the selection of samples that go to the three labs are not done on a randomised basis, so a simple comparison of the rates of high grade lesions found won't be representative as some areas may be taking in higher risk areas than others. CervicalCheck have said that they can't see any of the labs underperforming in the data that they have.

    Vicky Phelan's miss does not mean that there's been a systematic problem.

    I suspect two of the good reasons why we didn't go with more Irish services is that they apparently didn't have the required capacity and they were more expensive.


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    #45
    James Brown
    Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    boombang wrote: »
    Again I go back to TOB's point that the evidence put forward by the man who ran a cervical screening service in Ireland was not relevant to the specification of the service that CervicalCheck subsequently purchased from Quest. I will look closely at the error rates that have come from those labs in the CervicalCheck era. Annoyingly the selection of samples that go to the three labs are not done on a randomised basis, so a simple comparison of the rates of high grade lesions found won't be representative as some areas may be taking in higher risk areas than others. CervicalCheck have said that they can't see any of the labs underperforming in the data that they have.

    Vicky Phelan's miss does not mean that there's been a systematic problem.

    I suspect two of the good reasons why we didn't go with more Irish services is that they apparently didn't have the required capacity and they were more expensive.

    What in your view was/is the problem then? Is there a 'scandal' at all?


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    #46
    blanch152
    Registered Users Posts: 27,174 ✭✭✭✭blanch152


    Matt Barrett wrote: »
    It will be interesting to learn about the tendering process, who was involved and why they were picked despite a poorer record than those at home.


    https://circulars.gov.ie/pdf/circular/finance/2008/22.pdf


    The answer may well be found in the detail of Circular 22/2008. I can't find a copy online of the document mentioned.


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    #47
    boombang
    Registered Users Posts: 2,108 ✭✭✭boombang


    Matt Barrett wrote: »
    What in your view was/is the problem then? Is there a 'scandal' at all?

    Certainly not as large a scandal as the media are making out.

    1. Tests fail: sadly this happens, it's screening.

    2. Is there a problem of bad labs being hired? Quite possibly, but no strong evidence (yet) to suggest this. Legitimate question to ask though. We need to scrutinise the evidence.

    3. Women weren't told that there had been missed previously. Far from ideal, but it was irrelevant to their outcomes at the time it had been discovered. Are CervicalCheck a big disgrace for not telling women: well, they were in the process of doing it in Vicky Phelan's case but got delayed by doctor who didn't comply. The did leave it in the judgement of other doctors, which paternalistic as it is, doesn't seem like any negligence.

    4. Terrible terrible explanation from CervicalCheck top staff on what was going on, which then made a information vacuum for HSE and politicians. Very poor communication, but not necessarily active damage to health.

    All in all it's certainly not the Irish health system's finest hour, but I don't think it was worth getting everybody THAT concerned about it. Huge numbers of women getting repeat smears is unnecessary. Let's check the stats carefully to see if the US lab is performing worse than the two Irish labs.


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    #48
    James Brown
    Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    boombang wrote: »
    Certainly not as large a scandal as the media are making out.

    1. Tests fail: sadly this happens, it's screening.

    2. Is there a problem of bad labs being hired? Quite possibly, but no strong evidence (yet) to suggest this. Legitimate question to ask though. We need to scrutinise the evidence.

    3. Women weren't told that there had been missed previously. Far from ideal, but it was irrelevant to their outcomes at the time it had been discovered. Are CervicalCheck a big disgrace for not telling women: well, they were in the process of doing it in Vicky Phelan's case but got delayed by doctor who didn't comply. The did leave it in the judgement of other doctors, which paternalistic as it is, doesn't seem like any negligence.

    4. Terrible terrible explanation from CervicalCheck top staff on what was going on, which then made a information vacuum for HSE and politicians. Very poor communication, but not necessarily active damage to health.

    All in all it's certainly not the Irish health system's finest hour, but I don't think it was worth getting everybody THAT concerned about it. Huge numbers of women getting repeat smears is unnecessary. Let's check the stats carefully to see if the US lab is performing worse than the two Irish labs.

    Your posts read like 'these things happen, therefore it's not such a big deal'.

    We have this:
    mistakenly cleared at least 208 women who later received diagnoses of cervical cancer.
    The 208 women received false negatives between 2010 and 2014. At least 17 of these women have since died.
    https://www.nytimes.com/2018/04/30/world/europe/ireland-cervical-cancer-screening-scandal.html

    If not for Vicky Phelan it seems it may never have been revealed.
    Emails released in the Phelan case showed that the CervicalCheck program had advised some doctors not to tell their patients about the 2014 review, arguing that finding out about the false negatives would not affect their current treatment.

    Seems they were deciding what personal medical information patients 'needed' to know.
    Speaking on RTÉ's Ray D'Arcy programme on Saturday, Mrs Phelan said she discovered there was a mistake with her smear test results when she was reading her own medical file.

    And here lies the case of incompetence, putting admin above patient care IMO;
    Detailed tests for Ireland's CervicalCheck screening programme, which has operated for the last 10 years, normally take place every three years but because of a backlog they were outsourced to a US company.

    This company normally carries out less detailed tests but does so every year to compensate for that lack of detail.

    The US company, however, continued to test Irish samples every three years.

    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

    It's seems they went with the US option, with the one year review instead of the Irish once every three years, but the US firm did it every three anyway. So we got the less detailed review every three years. I'm wondering was it cost, was there conflict of interest? I'm expecting some form of conflict of interest down the road.


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    #49
    boombang
    Registered Users Posts: 2,108 ✭✭✭boombang


    Matt Barrett wrote: »
    Your posts read like 'these things happen, therefore it's not such a big deal.

    Pretty much,.

    We'd expect there to be false negatives of the order that have occurred. That's just the way it is for the most part. Screening is not perfect and they'd no point in scaring women with sensational headlines. Your still far better if being screened than not.


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    #50
    boombang
    Registered Users Posts: 2,108 ✭✭✭boombang


    Matt Barrett wrote: »
    It's seems they went with the US option, with the one year review instead of the Irish once every three years, but the US firm did it every three anyway. So we got the less detailed review every three years. I'm wondering was it cost, was there conflict of interest? I'm expecting some form of conflict of interest down the road.

    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.


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    #51
    listermint
    Registered Users Posts: 33,613 ✭✭✭✭listermint


    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....


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    #52
    boombang
    Registered Users Posts: 2,108 ✭✭✭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.


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    #53
    listermint
    Registered Users Posts: 33,613 ✭✭✭✭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.


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    #54
    boombang
    Registered Users Posts: 2,108 ✭✭✭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.


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    #55
    NickNickleby
    Registered Users Posts: 1,813 ✭✭✭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?


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    #56
    listermint
    Registered Users Posts: 33,613 ✭✭✭✭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


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    #57
    blanch152
    Registered Users Posts: 27,174 ✭✭✭✭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.


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    #58
    boombang
    Registered Users Posts: 2,108 ✭✭✭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.


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    #59
    boombang
    Registered Users Posts: 2,108 ✭✭✭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.


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    #60
    boombang
    Registered Users Posts: 2,108 ✭✭✭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.


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    #61
    boombang
    Registered Users Posts: 2,108 ✭✭✭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.


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