More shock, more indignation, more disbelief – another day, another Oireachtas committee hearing into missed smear tests that should have flagged cancer warnings and the failure to tell women about them.
The Dáil Public Accounts Committee was dealing with such a deluge of records that landed overnight from the Department of Health and Health Service Executive that it had to adjourn for an hour to examine them further.
"This is, frankly, just disgraceful," said Labour TD Alan Kelly.
Social Democrats TD Catherine Murphy thought it was part of a "management strategy" from the HSE to effectively hamper the committee's work.
Their anger set the tone for the meeting that carried on for most of the day.
As health chiefs sought to explain how they assumed (wrongly) as far back as early 2016 that women were going to be told about audits showing incorrect tests, Sinn Féin TD Jonathan O’Brien zoned in on what CervicalCheck was telling the families of women who had died of cervical cancer.
Memos circulated to the clinicians in 2016 showed CervicalCheck just wanted the audit results added to the women’s medical records and that families were not going to be told.
Like the rest of the committee, and the public at large, he was flummoxed that few, right up to the State’s chief medical officer, never thought to escalate concerns about the audit.
“It is absolutely astonishing that there seems to be a lack of communication between senior management, middle management, across all of it, all of ye,” O’Brien told Department of Health and HSE officials
‘It stinks’
“People not being informed – for me, that is not a coincidence. It stinks.”
Dr Stephanie O’Keeffe, who as HSE’s director of health and wellbeing at the time had overall responsibility for the screening programmes, said she had no idea that patients were not being told.
This was despite attending monthly meetings with CervicalCheck's management, seeing memos being circulated about communications strategy and being aware of legal claims going to the State Claims Agency.
Dr O’Keeffe said that “the feelings” she had from one CervicalCheck meeting was that there were “no systemic errors arising from the audit and that information could be informed to the patient”.
Fine Gael TD Kate O'Connell asked: "Do you base your clinical judgment on feelings or science?"
Dr O’Keeffe explained that she was a psychologist, not a medical doctor, and the meeting was so long ago that she could not remember what was said but that her feeling was there was no concern raised.
“In the world of science, we like to separate fact and feelings,” replied O’Connell, who is a pharmacist.
Dr O’Keeffe responded: “Feelings are exceptionally important in this world, especially about what we’re talking about right now.”
O’Connell replied: “Perhaps if feelings are so important we should have used them when we were trying to decide how to deal with telling patients.”
Open disclosure
The committee's chair, Fianna Fáil TD Seán Fleming, was "utterly at a loss" as to how Dr O'Keeffe had met Cervical Check "month in, month out" and yet did not ask whether women were being told at a time when 80 per cent of the women affected still had not been notified.
“It makes a mockery of the concept of open disclosure; it was wholesale ignored,” he said.
Dr O’Keeffe replied: “I feel absolutely terribly, terribly sorry with the fact that I didn’t have an opportunity to respond to it.” She said she believed letters were going out to doctors.
Kelly, near the end of the meeting, summarised how he believed the public viewed it all.
“They don’t understand why somebody didn’t just shout stop,” he said.
