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THE NATIONAL CLINICAL director of BreastCheck has raised concerns about “the medical legal environment that has developed in recent weeks”.
Professor Ann O’Doherty told Morning Ireland on RTÉ Radio 1 that she has received 15 solicitor’s letters in the last two weeks, despite receiving less than one a year before this.
“We’ve had 15 in the last two weeks in my unit alone and I wouldn’t have had even a single letter a year in the last 30 years I’ve been involved in screening.”
O’Doherty said BreastCheck picks up the vast majority of cancers, “We’ve picked up 11,500 cancers through screening” but added that “one of the issues with screening is that we know we don’t detect all cancers”.
“For every 10,000 woman we screen, 9.6 will present between screening with a cancer and they’re called interval cancer. They’re not all human error, it’s an inherent problem with the test, we don’t detect all breast cancers. We tell women that at the outset.”
The BreastCheck programme began in 2000 but O’Doherty said she’s worried about the “medical legal environment that has developed in the very recent weeks”.
Women who developed breast cancer between screenings for the last number of years are contacting solicitors and we’re being contacted.
“Now I’m not saying they’ve gone to litigation yet and maybe they won’t but it is a huge concern that you see this amount of increased medical legal activity in a very small amount of time.”
“It’s not that I don’t think women who have been harmed shouldn’t be compensated, I absolutely do, but I think we need to have some sort of forum where the legal profession, the medical profession and other services come together and afford women the opportunity to have a settlement that is commensurate with any damage and doesn’t divert taxpayer funds to legal costs and expert witnesses.”
O’Doherty said that BreastCheck needs to be screening woman and reducing mortality by 20% to be cost effective.
“I don’t want us to be diverting taxpayers funds on litigation services.”
Open disclosure
O’Doherty explained that previous screenings are looked back at to determine the rate when a cancer diagnosis is made and that this is done in real time when patients ask about their previous screenings.
“Any patient who requests information we give it to them at the time but we know screening has an inherent failure to detect and, exactly the same as any European program, we do look back to determine the rate.
She added that the only country in Europe that has introduced an open disclosure screening to this date is England.
Am I sitting on a list of my patients that I haven’t told? The answer to that is no. We are doing exactly the same as every European country.
She added that patients can request for their previous screen to be reviewed if they are diagnosed with cancer.
“When you sit down with women they are most understanding, we actually show them the monogram and show them there really wasn’t anything and if there was something there we tell them.”
When asked if BreastCheck operates a policy of open disclosure, she said, “We do if we’re asked but it’s not a routine policy yet.
“If the woman asks for her mammogram to be reviewed than we do tell them but we don’t actually seek to tell every woman back as far as 2011, that wasn’t part of our policy. But we are very advanced in introducing open disclosure hopefully probably in January or February 2019.
“It will mean that we’ll be doing exactly what they do in Europe, we will have a forum and we will ask women if they want their mammogram reviewed and if they want it reviewed they will get it reviewed in real time.”
She also pointed out that only 45% of women in England have accepted this offer, adding, “If we do this, it’s important we have counselling available to women and we look after them.”
Asked if Breast Check would have to close it’s services if they had to pay out on the 15 cases or got more cases, she said:
I can’t answer that at the moment but I know for certain we have to be cost effective … and I’m hoping we can sort this out and resolve it through mediation.
She added that a process is needed “which allows for open disclosure without the cost to the taxpayer that will cost so much that we can’t afford to screen”.
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If they didn’t hide the outcomes to save their own mistakes than it should not have been a problem. Dishonesty from the HSE is the problem.
@Hans Vos: no the problem, as with cervical screening is that NO test is 100% accurate and you will always have false negatives. It’s nobody’s ‘fault’.
@Ciaran Bolger: I agree that no test is 100% accurate. But hiding the results so woman didn’t know their test was suspicious and ultimately ended up in full blown cancers was.
@Ciaran Bolger: false negatives might be nobody’s fault but covering up certainly was somebody’s fault.
@Hans Vos: In a blame culture like ours, informing a patient of a false negative will likely result in a legal action and collapse of the service- thats what they were afraid of , and that is what is going to happen.
The breast screening program was hit with 15 solicitors letters- best course of action would be to stop “look back” audits -to protect the programs.
@paul kelly: So you saying that women who are in the past willingly misleaded can’t have their rights executed?
@Hans Vos:
Of course you can , it just will cost millions.
@paul kelly: Don’t you think that being honest from the beginning could have avoided all the hassle. That’s the problem with the HSE . There are people, and don’t get me wrong not everybody, who think that they are more important than the truth. When it’s going wrong than they blame : 1 Somebody else.
2 Politics
.3 The system.
4 The cost.
And I can get on and on but they never blame them self.
@Hans Vos: No, being honest with a look back audit showing the screen to be a false negative will lead to a substantial payout.
Solicitors are looking at a definite new income stream.
@paul kelly: contrary to you I like to be honest.
@Hans Vos: Oh I believe honesty is the ideal , but it will cost hundreds of millions, the collapse of screning and the deaths of far more women.
@paul kelly:
Make that 16 from Monday next. There will be no collapse of the service that’s scaremongering. I never knew there was a look back service nobody ever mentioned it OR A REVIEW
I really hope that this is not:
A) Another case of our healthcare system failing women
B) People jumping on the bandwagon hoping to make a few euro!
@Jenny Kelleher: I have to disagree with your statement about looking for a few quid… in most cases including the cervical cancer cases the hse deny everything and in fact try to cover up what has happened…. nobody goes to jail, nobody is held responsible… the only retribution these people receive is a pay out… and let me tell you that it’s not an easy decision to make about bringing a case because it is a long and very difficult process.. and is even more so difficult when all you can think is,what if people think I’m doing this just for money !!
@Tommy Byrne: There was no cover up. There were false negative results discovered retrospectively (an inevitable feature of any screening programme), some women were told of this others weren’t due to failure of HSE procedures. There is no suggestion that the women’s outcomes were adversely affected as the prior false negatives were only discovered on review after a diagnosis of cancer had been made. The lawsuits pertain to the false negatives themselves. If a situation emerges where there are payouts for every false negative result then the screening programmes will be driven to bankruptcy as false negatives are an inherent statistical feature of large scale screening programmes.
@Damon16: in the cervical cancer cases it most definitely was a cover up … and who is to say there isn’t something similar happening here ? We don’t know the facts of any of the future cases that may come of this. All we are hearing is one side of the story so far… so to judge people as only in it for a few quid is very wrong
@Tommy Byrne:
Indeed ..very wrong
The medical profession and the Gov need to do a better job explaining to the public the difference between a screening test and a diagnostic test. A screening test such as breast check will invariably have some false negatives results. The Gov need to introduce legislation capping or limiting claims in the context of screening programmes. If they don’t the HSE is the HSE are going to stop running screening tests and or not bring in new screening tests due to legal exposure. This will cost many lives.
Alternatively, push for a national Irish healthcare system that looks after patients to internationally recognised, excellent standards. Adopt a class action suit with one aim; justice and improved medical standards. Don’t force individuals to take individual cases and slog through alone. Too many people end up going abroad – men who need hip replacements badly, and have been waiting in pain on long lists, for example. Don’t inflict symphysiotomy on women while the rest of the world is not crippling their own citizens with decades-old clumsy practices. Don’t sweep the outcomes under the carpet until a few suffering families have to spend all their resources to highlight real and ongoing issues and appeal to higher courts separately until they die and the files are closed.
There are lots of pros and cons to screening. Some medics (and not crackpots) would argue against most kinds of screening and a lot of unnecessary screening takes places privately (ie a money spinner). Total transparency and full disclosures are needed in public and private health care.
Do they not have ambulances to chase?
It’s no good in trying to shift the blame for problem onto women who had smear checks carried out on systemic failure on the HSE full stop.
The circus continues with the legal profession rubbing their hands with glee ,the government have to take responsibility ,this has been kept back from the media to prevent the effects it may have on the referendum .again no accountability ,put your trust in LEO and simon everything will just be fine
My god,these people think the public are fools.
@@mdmak33: Clearly some are.
Where were the tests carried out?
Were they the cheapest option?
@The Irish Bull: tested in Ireland and results read in Ireland. Totally different process to cervical screening.
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