CervicalCheck controversy

James Brown

My understanding is people were misdiagnosed. They either died or were later discovered to have cancer and are receiving treatment or in some cases it's too late to bother. Also the company wanted this kept quiet as per the Phelan case.
What am I missing here?

Was this 100% purely administrative error or a cover up or both remains to be seen.

Mr.Micro

2Scoops wrote: »

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.

No. It's sheer number of specimens that causes delay. Any slide under a microscope is looked in a certain fashion. Obvious positives will show up relatively quickly, through the large number of cells that are abnormal. When there are less abnormal or doubtful cells on the slide, these can be missed. Every cell cannot possibly be looked at by a technician. Like any test, it is not foolproof or without flaws. It is an indicator.

Amirani

Matt Barrett wrote: »

My understanding is people were misdiagnosed. They either died untreated or were later discovered to have cancer and are receiving treatment or in some cases it's to late to bother.
What am I missing here?.

You're missing that the misdiagnosis was only discovered AFTER a subsequent test established that they had cancer.

So it was only when treatment already began that the HSE/Labs discovered that the initial diagnosis was wrong. At this point, telling the patient of the misdiagnosis achieves nothing from a medical point of view as it's already established that they have cancer now.

James Brown

Amirani wrote: »

You're missing that the misdiagnosis was only discovered AFTER a subsequent test established that they had cancer.

So it was only when treatment already began that the HSE/Labs discovered that the initial diagnosis was wrong. At this point, telling the patient of the misdiagnosis achieves nothing from a medical point of view as it's already established that they have cancer now.

There's almost an accidental strawman happening here. You assume I do. When it was allegedly discovered is not my full point. They decided not to inform patients, because they decided there was no point. Medically or not, this was wrong IMO. They wanted this kept out of the media when a victim had to take them to court. Par for the course, nothing to see here?

The facts we do know remain. People thought they got the all clear when in fact they had cancer. For Emma Nhathúna we can tell her it's par for the course and we don't see any scandal.
Then we've the chain of communication on the issue once discovered.
Also we've yet to find out any connection between this US company and others home grown business or political Irish interests may have a stake in.

Red_Wake

Matt Barrett wrote: »

Amirani wrote: »

You're missing that the misdiagnosis was only discovered AFTER a subsequent test established that they had cancer.

So it was only when treatment already began that the HSE/Labs discovered that the initial diagnosis was wrong. At this point, telling the patient of the misdiagnosis achieves nothing from a medical point of view as it's already established that they have cancer now.

There's almost an accidental strawman happening here. You assume I do. When it was allegedly discovered is not my full point. They decided not to inform patients, because they decided there was no point. Medically or not, this was wrong IMO. They wanted this kept out of the media when a victim had to take them to court. Par for the course, nothing to see here?

The facts we do know remain. People thought they got the all clear when in fact they had cancer. For Emma Nhathúna we can tell her it's par for the course and we don't see any scandal.
Then we've the chain of communication on the issue once discovered.
Also we've yet to find out any connection between this US company and others home grown business or political Irish interests may have a stake in.

This was left to the discretion of the doctors. It as not explicitly forbidden to inform patients, nor was it ordered for patients to be told.

The same policy is in effect over in the UK. It seems to be a fair one imo.

Sierra Oscar

boombang wrote: »

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

Well it's looking like the Department of Health were aware of the cover-up effort as far back as March 2016. Leo Varadkar was Minister for Health at the time. So there's big potential for this to turn into a scandal which, to be honest, could collapse the Government.

Amirani

Sierra Oscar wrote: »

Well it's looking like the Department of Health were aware of the cover-up effort as far back as March 2016. Leo Varadkar was Minister for Health at the time. So there's big potential for this to turn into a scandal which, to be honest, could collapse the Government.

Chief Medical Officer tells PAC that the memo relates to the 'known phenomenon' that uptake of screening programmes drops when there is negative media coverage that damages their reputation.

This scandal will likely cause worse health outcomes for women, not better.

James Brown

Sierra Oscar wrote: »

Well it's looking like the Department of Health were aware of the cover-up effort as far back as March 2016. Leo Varadkar was Minister for Health at the time. So there's big potential for this to turn into a scandal which, to be honest, could collapse the Government.

That would only happen if Fianna Fail get embarrassed by association, which would be the height of Irony.

2Scoops

Mr.Micro wrote: »

No. It's sheer number of specimens that causes delay. Any slide under a microscope is looked in a certain fashion. Obvious positives will show up relatively quickly, through the large number of cells that are abnormal. When there are less abnormal or doubtful cells on the slide, these can be missed. Every cell cannot possibly be looked at by a technician. Like any test, it is not foolproof or without flaws. It is an indicator.

They look at every cell. But it's not about the number of abnormal cells in a smear, it's about how abnormal they are. The difference between a normal cell and HSIL can sometimes be obvious. The difference between normal and LSIL is subtle. The difference between normal and ASCUS can be ridiculously subtle. Those would all qualify as smears that are "not normal".

Relatively few cases are barndoor normal or HSIL. When you need to look at every cell and make a judgement call, it takes time.

boombang

Sierra Oscar wrote: »

Well it's looking like the Department of Health were aware of the cover-up effort as far back as March 2016. Leo Varadkar was Minister for Health at the time. So there's big potential for this to turn into a scandal which, to be honest, could collapse the Government.

CervicalCheck changed their policy in 2016 to inform women of prior screen misses, subject to clinical discretion. Moving towards disclosure is the opposite of cover up. Plus, I think it's not very meaningful to speak of covering up something that most doctors know happens. There's no big secret that false negatives occur.

James Brown

boombang wrote: »

CervicalCheck changed their policy in 2016 to inform women of prior screen misses, subject to clinical discretion. Moving towards disclosure is the opposite of cover up. Plus, I think it's not very meaningful to speak of covering up something that most doctors know happens. There's no big secret that false negatives occur.

Again, can we take it as given everyone knows no tests are 100% accurate 100% of the time? That's not the issue here.
Also deciding when and how to divulge a persons medical information to them is one thing, seeking a media black out is another and of course they had all the best intentions, in a timely manner, in the world, because they said.

boombang

Matt Barrett wrote: »

Again, can we take it as given everyone knows no tests are 100% accurate 100% of the time? That's not the issue here.
Also deciding when and how to divulge a persons medical information to them is one thing, seeking a media black out is another and of course they had all the best intentions, in a timely manner, in the world, because they said.

Given the total panic caused by the media shít fit over this it seems they were dead right to put the breaks on.

James Brown

boombang wrote: »

Given the total panic caused by the media shít fit over this it seems they were dead right to put the breaks on.

For who's benefit?
Maybe if there were no errors, no deaths, not delays in passing on information and no Vicky Phelan needing to take them to court and no attempt to keep it all quiet, no Emma Nhathúna given a virtual dead sentence, no basket case HSE and questions regarding possible conflict of interest, the media would have no material to work with. Why we need the breaks put on escapes me.

With the old chestnut;

CervicalCheck memos 'were not brought to health minister's attention'
https://www.rte.ie/news/politics/2018/0510/962495-public-accounts-commitee/

being wheeled out, it can only mean there's more to come.

I thought this was a nice touch for Taoiseach;

It said the documents were not shared outside of the department's Chief Medical Officer and the HSE's Acute Hospitals Division and were not brought to the attention of any Minister for Health.

boombang

Matt Barrett wrote: »

For who's benefit?

Given that so many have misunderstood the facts of this controversy (including you apparently) it seems there would have been an advantage of finding a way of getting the truth to women whose PREVIOUS smear results were found to be in error in a way that did not cause grossly disproportionate concern among the population. They evidently failed. The media can't seem to handle the truth here and have gone for headlines. This has prompted unnecessary concern, rescreening and congestion in the primary care system.

boombang

Matt Barrett wrote: »

no Emma Nhathúna given a virtual dead sentence

I wish people could show some class and not throw statements like this around. The matter is too grave. No virtual death sentence has been given to that poor lady: she's the mostly likely simply the very unfortunate victim of probability.

boombang

TOB has gone now anyway. Hope the pitchfork brigade are satisfied.

ouxbbkqtswdfaw

Can anyone clarify if he gets a lump sum and full pension?

Foggy Jew

Oh FFS. Tony O Brien accepted a high powered job with a huge salary. The downside to collecting mega-bucks weekly was to take responsibility. He f*ucked up. Royally. Women are dying. He tried to deny knowledge & responsibility. Off with him, and for God's sake Do Not Pay Him His Pension. Let there be a modicum of responsibility here. May Vicky, Emma & all the others find some solace. God help them.

Hes actually being supported by some GPs on twitter.

https://twitter.com/ConorTMcGrane/status/994677311483019269

boombang

Foggy Jew wrote: »

He f*ucked up. Royally.

What, specifically, did TOB mess up? Can you show clear evidence of what particularly he did wrong?

Sierra Oscar

boombang wrote: »

What, specifically, did TOB mess up? Can you show clear evidence of what particularly he did wrong?

He was made aware of an attempt to cover up failings with the Cervical Check programme by withholding information from people impacted by screening errors. He as head of the HSE should have been aware of the seriousness of the situation and ensured that there was full disclosure with patients.

The memorandum that was shared with him placed concerns of negative media coverage well above what should have been the overriding concern - i.e. that patients are always made aware of pertinent details relating to their case. This is something that the HSE itself commits to. Tony O'Brien has admitted that this should always be an overriding concern, as has the Government. That's why the Government has committed to bringing forward legislation to ensure open disclosure is made mandatory.

It's fairly straightforward stuff.

blanch152

Matt Barrett wrote: »

For who's benefit?
Maybe if there were no errors, no deaths, not delays in passing on information and no Vicky Phelan needing to take them to court and no attempt to keep it all quiet, no Emma Nhathúna given a virtual dead sentence, no basket case HSE and questions regarding possible conflict of interest, the media would have no material to work with. Why we need the breaks put on escapes me.

With the old chestnut;



being wheeled out, it can only mean there's more to come.

I thought this was a nice touch for Taoiseach;

Other than the normal level of false negatives, what errors were there?

It has not been established that there was anything other than the normal level of false negatives.

Foggy Jew

He was made aware of cancer mis_dianoses. He chose to conceal these misdiagnoses from the actual sufferers, thereby reducing their chances of treatment & possible cure. Shame on him, and shame on the clowns he has surrounded himself with.

smurgen

blanch152 wrote: »

Matt Barrett wrote: »

For who's benefit?
Maybe if there were no errors, no deaths, not delays in passing on information and no Vicky Phelan needing to take them to court and no attempt to keep it all quiet, no Emma Nhathúna given a virtual dead sentence, no basket case HSE and questions regarding possible conflict of interest, the media would have no material to work with. Why we need the breaks put on escapes me.

With the old chestnut;



being wheeled out, it can only mean there's more to come.

I thought this was a nice touch for Taoiseach;

Other than the normal level of false negatives, what errors were there?

It has not been established that there was anything other than the normal level of false negatives.

It wasn't it was 30% higher than irish labs.

glenfieldman

I dont mean any disrespect for the unfortunate women that were affected by this HSE fup up. But where are the professional protesters marching the street like they were for a court case which didn’t involve us directly.
But this tragic case affects all women in the Republic and not one pop up protest has been organised

boombang

Foggy Jew wrote: »

He was made aware of cancer mis_dianoses. He chose to conceal these misdiagnoses from the actual sufferers, thereby reducing their chances of treatment & possible cure. Shame on him, and shame on the clowns he has surrounded himself with.

Not correct. You don't understand the facts.

Foggy Jew

Wow. I'm going to bow out of this thread now. Once again the Irish 'system' has let women down. Catastrophically. Mothers of young children will die because of the 'Yes Minister' flaffing of grey men in grey suits arguing over who is to blame. This is dispicabe

boombang

Sierra Oscar wrote: »

He was made aware of an attempt to cover up failings with the Cervical Check programme by withholding information from people impacted by screening errors. He as head of the HSE should have been aware of the seriousness of the situation and ensured that there was full disclosure with patients.

The memorandum that was shared with him placed concerns of negative media coverage well above what should have been the overriding concern - i.e. that patients are always made aware of pertinent details relating to their case. This is something that the HSE itself commits to. Tony O'Brien has admitted that this should always be an overriding concern, as has the Government. That's why the Government has committed to bringing forward legislation to ensure open disclosure is made mandatory.

It's fairly straightforward stuff.

I can't dispute much of that really. However, I think what we've seen from the media recently justifies the concerns that the programme could be damaged by media response to inevitable false positives.

boombang

Foggy Jew wrote: »

Wow. I'm going to bow out of this thread now. Once again the Irish 'system' has let women down. Catastrophically. Mothers of young children will die because of the 'Yes Minister' flaffing of grey men in grey suits arguing over who is to blame. This is dispicabe

Think it's important that you attempt to understand what did and didn't happen. Don't mean to be hostile in my previous post to you, just plain.

blanch152

smurgen wrote: »

It wasn't it was 30% higher than irish labs.

Has that been established? It was claimed in 2008, but has it been established as fact?

boombang

blanch152 wrote: »

Has that been established? It was claimed in 2008, but has it been established as fact?

That was asserted (correctly I believe) with information that related to a period before CervicalCheck started. TOB has stated that recognising the limitations of a screening procedure in designed for American annual screening they required a reconfiguration for Irish need with screening every 3/5 years. CervicalCheck sources have stated in a Dáil Committee that they can't find a difference between the labs in terms of rates.

I thinks it's essential that we see the evidence to support the claims that the labs worked to the required standard.

I did note that TOB didn't say that the labs worked equally well, but that the US lab met the required standards. I don't know if that's significant. It might just be careful wording to ensure that aspects of statistical significance weren't misinterpreted.

blanch152

boombang wrote: »

That was asserted (correctly I believe) with information that related to a period before CervicalCheck started. TOB has stated that recognising the limitations of a screening procedure in designed for American annual screening they required a reconfiguration for Irish need with screening every 3/5 years. CervicalCheck sources have stated in a Dáil Committee that they can't find a difference between the labs in terms of rates.

I thinks it's essential that we see the evidence to support the claims that the labs worked to the required standard.

I did note that TOB didn't say that the labs worked equally well, but that the US lab met the required standards. I don't know if that's significant. It might just be careful wording to ensure that aspects of statistical significance weren't misinterpreted.

Interesting.

Given the way TOB responded, it could be that the tender specified no more than X% of false negatives, and all of the labs have met this target, but some have done better.

Merry_Hell

smurgen wrote: »

It wasn't it was 30% higher than irish labs.

10 years ago. Of the 200 + audited cases that found false negatives, I've only heard definitively that Vicky Phelan's was done in an American lab. Has the percentage of false negatives broken down by lab location been published yet?

boombang

blanch152 wrote: »

Interesting.

Given the way TOB responded, it could be that the tender specified no more than X% of false negatives, and all of the labs have met this target, but some have done better.

Absolutely. Nobody picked up on it in the Dáil session.

boombang

Merry_Hell wrote: »

10 years ago. Of the 200 + audited cases that found false negatives, I've only heard definitively that Vicky Phelan's was done in an American lab. Has the percentage of false negatives broken down by lab location been published yet?

Not as far as I know. They must have this information though. It should be published.

There are some tricky caveats. The labs don't all take the same number of smears and they're drawn from different parts of the country, so the number of true positives going to each will differ. Some careful statistics will be required to get a representative comparison.

If CervicalCheck was running well their own inhouse QA should provide evidence on the error rates from the lab. They weren't definitive about this in the Dáil committee meeting last week. On the basis of what they said, they indicated that there wasn't a difference between the labs. However, the basis of that assertion wasn't made clear. I would expect that they have this information. It would be a failing if they didn't.

oscarBravo

Foggy Jew wrote: »

Off with him, and for God's sake Do Not Pay Him His Pension.

On what legal basis do you propose denying him his pension?

Merry_Hell

boombang wrote: »

Not as far as I know. They must have this information though. It should be published.

There are some tricky caveats. The labs don't all take the same number of smears and they're drawn from different parts of the country, so the number of true positives going to each will differ. Some careful statistics will be required to get a representative comparison.

If CervicalCheck was running well their own inhouse QA should provide evidence on the error rates from the lab. They weren't definitive about this in the Dáil committee meeting last week. On the basis of what they said, they indicated that there wasn't a difference between the labs. However, the basis of that assertion wasn't made clear. I would expect that they have this information. It would be a failing if they didn't.

If it in anyway vindicates Cervical Check, you'd think it would be produced by now? Especially since the current main accusation against them, is that they cheaped out on the contract, at the cost of lives.

Either it doesn't vindicate them (unlikely if they're on the record asserting there is no big difference between the labs).

There is a legal request from the labs not to publish the figures. There was in 2016 anyway.

And/Or they don't want to publish until all women/families affected have been formally informed

glenfieldman

oscarBravo wrote: »

On what legal basis do you propose denying him his pension?

He resigned, afaik, if you leave your job your not entitled to a pension

Amirani

glenfieldman wrote: »

He resigned, afaik, if you leave your job your not entitled to a pension

That's not true whatsoever.

Mr.H

Amirani wrote:

That's not true whatsoever.

He belongs in jail

Amirani

Mr.H wrote: »

He belongs in jail

For breaking which law exactly?

Mr.H

Amirani wrote: »

For breaking which law exactly?

Surely there is some sort of law that covers conspiracy, and the death and potential deaths of others because of non actions?

Someone definitely deserves jail time because of this. Whoever wrote the memo ordering that women shouldnt be told, is a prime candidate for that.

There is definitely a couple that should go down hard for this because a lot of women were given death sentences to save jobs for the lads.

Uriel.

Mr.H wrote: »

Surely there is some sort of law that covers conspiracy, and the death and potential deaths of others because of non actions?

Someone definitely deserves jail time because of this. Whoever wrote the memo ordering that women shouldnt be told, is a prime candidate for that.

There is definitely a couple that should go down hard for this because a lot of women were given death sentences to save jobs for the lads.

When did this happen?

Mr.H

Uriel. wrote: »

When did this happen?

Not quiet sure if you are being serious?

So what is your definition of accountability? What consequences do you think that the people involved in the cover up, should face?

Women have died. Do you think someone resigning is enough?

Uriel.

Mr.H wrote: »

Not quiet sure if you are being serious?

So what is your definition of accountability? What consequences do you think that the people involved in the cover up, should face?

Women have died. Do you think someone resigning is enough?

You requested jail time. For what crime and who committed it?
Where and what is the conspiracy?
What is the cover up?

Mr.H

Uriel. wrote: »

You requested jail time. For what crime and who committed it?
Where and what is the conspiracy?
What is the cover up?

The HSE memos released today were telling employees to not notify patients that they were misdiagnosed. They stopped the release of valuable information so they could "lawyer up". That is a conspiracy. That is a crime. The person who made that call is responsible. The person who is in charge is responsible. The people who knew about this information and kept it quiet are responsible.

You keep asking what conspiracy. My question is do you even know anything about what happened or did you stumble in here thinking we were talking about something completely different?

How can anyone with any bit of a mind even think the words "what conspiracy"?"

Mr.H

blanch152 wrote: »

Other than the normal level of false negatives, what errors were there?

It has not been established that there was anything other than the normal level of false negatives.

Absolutely laughable comment.

How about the keeping of information from people??

False negatives aside, The HSE and everyone involved are responsible from holding back infortmation in an attempt to cover it up.

emo72

is it not that someone resigned (10 years ago?) warning that doing the checks in the usa every year where not as good as the detailed ones done in ireland because we had a "deeper" check?

Mr.Micro

2Scoops wrote: »

They look at every cell. But it's not about the number of abnormal cells in a smear, it's about how abnormal they are. The difference between a normal cell and HSIL can sometimes be obvious. The difference between normal and LSIL is subtle. The difference between normal and ASCUS can be ridiculously subtle. Those would all qualify as smears that are "not normal".

Relatively few cases are barndoor normal or HSIL. When you need to look at every cell and make a judgement call, it takes time.

Goodness me. Usually a cytology slide takes 6-10 mins to examine but one can take up to 20 mins. Using x10 objective covering 250-300 fields. Usually a person will examine about 50- 80 per day. So I am not sure where you are getting the time thing from.

2Scoops

Mr.Micro wrote: »

Goodness me. Usually a cytology slide takes 6-10 mins to examine but one can take up to 20 mins. Using x10 objective covering 250-300 fields. Usually a person will examine about 50- 80 per day. So I am not sure where you are getting the time thing from.

You said reading a smear is easy and that not every cell is looked at. I'm saying that's wrong. I'm getting my info from the fact that I have read smears professionally.