Health chiefs concerned screening could ‘grind to a halt’

Senior health service staff this week proposed halting the State's four screening programmes until the implications of last week's High Court judgment in the Ruth Morrissey case is clarified.

The call was made at a crisis meeting on Wednesday of clinicians and managers in the health service, including acting HSE chief executive Anne O’Connor, organised to consider the ruling by Mr Justice Kevin Cross.

“The view was expressed that screening should stop until the situation is clarified,” said Dr Peter McKenna, director of the HSE women and infant programme, who was among those present. “The suggestion was seriously made by serious people and there was serious discussion about it.”

Dr McKenna told The Irish Times there were “mixed views” about the proposal and “the general mood was that screening is more important than that for the moment”.

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He said that ultimately the 30 staff present called for clarity on the judgment and for “serious consideration” to be given to appealing it. “There was a feeling that if the judgment stands as it is, then screening will effectively grind to a halt.”

Ms O'Connor wrote to the Department of Health on Thursday expressing the serious concerns of the HSE and senior clinicians about parts of the judgment.

Quest Diagnostics and MedLab Pathology, the two testing laboratories which were found to have negligently dealt with Ms Morrissey's smear tests, and the HSE are expected to indicate on Friday before Mr Justice Cross whether they intend to appeal his judgment.

Parties normally have 10 days to lodge an appeal, but this has been shortened in view of Ms Morrissey’s terminal illness.

The ruling could double the €30 million running costs of the cervical screening programme, according to estimates within the health service. This is based on the litigation costs arising from an additional 15 cases a year similar to that of Ms Morrissey.

Morale

Caroline Mason-Mohan, director of public health at the national screening service, said morale was low among screening and diagnostic staff who knew their work had been made more difficult by the ruling.

“People are considering their position. They’re asking where does this leave me as a breast radiologist, or a colposcopist.”

Dr McKenna said the main concern of practitioners related to the judge’s declaration that screeners must have “absolute confidence” that there were not abnormalities on a slide before they gave it the all-clear.

He said this would result in more patients being referred for colposcopy, with some risk of complications. Screening staff were uncertain “how they can work within the parameters of absolute confidence when their standards acknowledge there isn’t 100 per cent agreement on the diagnosis of normality or any degree of abnormality”.

Dr McKenna warned that the judgment could have wider implications across medicine.

“Are GPs, for example, expected to conclude every consultation with absolute confidence? Can they say a patient’s headache is not meningitis or a brain tumour, are they allowed to use their intuition and experience and say ‘I’ll see you in a week’?”

Separately, the Faculty of Radiologists said it was concerned that the standard of “absolute confidence” mentioned in the judgment would be impossible to attain and could have multiple unintended consequences, including additional unnecessary tests and procedures on patients who do not have cancer.

Speaking in the Dáil, Minister for Health Simon Harris said the Attorney General Séamus Woulfe was considering the broader implications of the "absolute confidence" threshold set by the judge and of his finding that the primary liability for cases rests with the State rather than testing labs.