Limerick women kept in the dark over tests

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Vicky Phelan

OTHER women being treated by Vicky Phelan’s Limerick gynaecologist went on to develop cancer after having smear tests misread.

Letters released to Ms Phelan’s solicitor, show correspondence between gynaecologist Kevin Hickey and Dr Grainne Flannelly, CervicalCheck’s clinical director, about whether women attending the University Hospital in Limerick should be told their original smear test results were wrong and who should tell them.

When asked by the Limerick Post about the other women involved, a spokeswoman for the HSE said they couldn’t comment on individual cases.

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Yet, despite recent revelations, she maintained that the audit was undertaken after the women were diagnosed.

“That is to say that the Cervical Screening Programme did not withhold information from any woman that delayed their diagnosis of cancer. Rather the audit process of their previous smears was undertaken as a response to them having been diagnosed,” she explained.

Vicky Phelan from Annacotty underwent a smear test in 2011 that showed no abnormalities but she was diagnosed with terminal cervical cancer in 2014. It emerged from a 2014 audit of smear tests that she had wrongly received the all-clear, but she did not learn of this until September 2017.

Last week, she settled her case against the US clinical laboratory for €2.5 million.

Mr Hickey escalated the matter to inform UL hospital group chief executive Colette Cowan about the clinical director’s insistence that individual medics should decide whether it was good for the women concerned to know about the reviews.

The chain of letters started on July 21, 2016, when CervicalCheck contacted Mr Hickey, to tell him that his patient’s smear test had been reviewed, abnormalities had been detected, and left it up to him to tell Mrs Phelan “if open disclosure is indicated”.

But the consultant did not feel that this was his responsibility. In a letter to Dr Flannelly, he made reference to a number of women who were diagnosed with either invasive disease or in situ carcinoma, who were all “thankfully” alive and well, and undergoing follow-up.

“We feel it is inappropriate to contact them at this point to tell them that original smears have now been re-reported as showing different findings. We think this would only heighten their anxiety levels and not confer any advantage to them now in their clinical course, as they have all been managed appropriately,” Mr Hickey wrote.

He added it was the “responsibility of CervicalCheck to judge for themselves as to whether they have a responsibility to these ladies and acknowledge the alteration of their original smears after review”.

Dr Flannelly replied on August 5, 2016, saying “There is a balance in terms of communicating the results of an audit, particularly where women are unaware of its existence.” This balance was “best judged by the clinician, who knows the patients and has been looking after the women”.

In October 2016, Mr Hickey offered to photocopy charts on the affected patients and to send them up to CervicalCheck so “she can decide if she wants to call the ladies in to discuss the audit with them herself”.

He repeated his objections again in a letter to Dr Flannelly in December 2016 because the treating clinicians “did not conduct the audit in the first place and also did not come up with the results”, he wrote.

In June 2017, Mr Hickey raised the matter with Professor Cowan and other senior clinicians in the UHL group.

He said that he had passed the women’s files to Dr Flannelly and “requested her to deal with the matter as I felt it was the responsibility of the Cervical Screening Programme”.

The following month, Dr Flannelly selected three women from those charts whose smear tests had been audited for review who she felt should have “disclosure”.

Mr Hickey wrote back: “There were other ladies where the review process has altered the original findings on the smear audit review and it looks from your notes that you have felt that these should be filed in the patient’s notes and that no review is necessary. I just wanted to confirm that you are happy with this whole process centrally.”

She replied by email on July 7, writing: “Yes — a balance needs to be struck in deciding who needs a formal communication of the outcome of the audit. The possibility of resultant harm is crucial.”

Mr Hickey again challenged Dr Flannelly, pointing out one woman whose initial smear was “atypical squamous cells of unknown significance” which changed to a high-grade lesion in an audit review. “Could you further review the other cases to ensure there is not any other discrepancy that arises?”

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