HSE Boss ‘Dismissed My Concerns’ About Cervical Screening Results

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From top: Director General of the HSE Tony O’Brien and Minister for Health Simon Harris; Dr David Gibbons

This morning.

On RTÉ One’s Morning Ireland.

RTE’s Jackie Fox interviewed Dr David Gibbons, a former member of the National Cervical Screen Programme, who raised serious concerns about the outsourcing of cervical smear tests to US labs ten years ago.

He raised his concerns when he realised that the US lab tests were detecting fewer cases of cervical cancer than the tests done in Ireland.

When nothing changed as a consequence of him raising his concerns with the head of the HSE Tony O’Brien, he resigned.

But not before he warned health officials that there would be problems in ten years’ time – 2018.

David Gibbons: “From 2006, to 2008, I was the QA chair, the Quality Assurance chair of the Quality Assurance Committee for Cervical Cytology and Pathology in the Cervical Screening Programme, just as it was about to be rolled out. I was also running a large cytology screening laboratory in Dublin.”

Jackie Fox: “Now David, you had some concerns about the cervical screening programme. Tell me about them.”

Gibbons: “Well at that time, we had a backlog and we never sacrificed quality for [inaudible] and we had a backlog, due to under resourcing, the backlog was outsourced, some of it was outsourced to America. And when we got the smears back from America, we looked at their figures and they were finding significantly fewer high-grade dyslpasia [pre-cancerous changes] then we were in the same population. We were finding 1.8 per 100 and they were finding 1.2 – which was a third less.”

Fox: “So these are high-grade smears, is it?”

Gibbons: “High-grade smears. Predicting pre-cancer – the smears you’re trying to intercept.”

Fox: “OK, what are the differences between the US system and the Irish system?”

Gibbons: “The US system screens on a yearly basis and they do a quick screen every year so they get repeated bites at the cherry. In Ireland, the system was being set up for an every three years scheme. And a three-year scheme works. A three-year recall works, if you have a deep screen every three years. Our scientists were screening 25 to 30 cases a day, whilst the American scientists were screening 80 to 100, so they were screening three to four times as many in a day. So we were worried. With the figures we were getting back from America and with this mismatch of the systems, that there was going to be a problem. The three-year screening interval – it’s what they use in Britain – was the system we were introducing. But we were using an American screen for the three years but the American screen is repeated every year. So even though they screen quickly, they do it often. And we weren’t doing it often so we were having a substandard smear once every three years which lead to, which could potentially lead to problems.”

Fox: “Just to make it clear though as well. It wasn’t that there was an issue with the American system, it’s just that they do things differently compared to the Irish system?”

Gibbons: “Yeah, in the United States, they screen yearly. So the percentages of miss go down each year because you do it three times for each one time we were doing it here. The programme was based on a British system of a three-year screen but that would be based on a screen done as we were doing it in Ireland at the time, not based on a screen done as it was done in America at the time. The American system works for them but it’s just a different approach.”

Fox: “So what kind of results were you getting back then?”

Gibbons: “Well, when we got the figures back, at one point, we were getting one third of the high-grade cases that we were finding in our population, they were finding one third less – that was worrying for us. Now you might think we were finding too many, or we were over calling, but we were heavily audited and we doing positive [inaudible] for our cases and our cases were real. So they were finding too few.”

Fox: “What did you do about those concerns?”

Gibbons: “Well as QA, chair of the QA committee, I went to see Mr Tony O’Brien, who was at that time, heading up the Cervical Screening Programme and I met him in his office, there was one other person there, I can’t remember who it was.

“And I started off saying ‘lads, QA advisor’ and then I continued, I expressed those concerns and I said that over a ten-year period, this will cause problems and the problems won’t become apparent for ten years. And he dismissed my concerns.

So, subsequently…I resigned then from the committee and the committee was composed of very talented scientists – all resigned as well.

“So then, representing the faculty of pathology, myself and three people who were running lab, went to see Tony O’Brien and there were two other people in the room on his side, to talk about our concerns about this outsourcing problem – to tell him that we thought it was dangerous, that we thought it could lead to problems, that the problems wouldn’t become apparent for ten years.

They didn’t really address our concerns, they continued to push on with introducing this outsourcing – despite our advice.”

“So it went to the Dáil then, passed through the Dáil, but it became a political football, as democracy works, the majority pushed it through and unfortunately, this is where we’ve got to now.”

Fox: “Did you make any predictions, any estimates at the time of when these, when your concerns would become apparent?”

Gibbons: “We did, we estimated ten to 15 years and I don’t think we were wrong.”

Fox: “Did you make any predictions or estimates aswell on how many people might be affected?”

Gibbons: “We estimated from our figures, that we got back from America, that approximately 1,000 cases a year might be missed of high-grade dysplasia [pre-cancerous cells] but we couldn’t be at all certain. They were so many variables but that was our best estimate.

Concern raised over outsourcing smear testing in 2008 (Jackie Fox, RTE)

Listen back in full here

Meanwhile…

Saturday night.

The Ray D’Arcy Show on RTÉ One.

Vicky Phelan is told by host Ray D’Arcy of the resignation of Dr Gráinne Flannelly from her position as the Clinical Director of CervicalCheck following the current controversy over smear test results.

Watch full interview here.

75 thoughts on “HSE Boss ‘Dismissed My Concerns’ About Cervical Screening Results

  1. Ron

    Medical manslaughter prosecutions NOW!
    Political and HSE Resignations NOW!
    Massive Protests and a national strike until they go NOW!

    Enough is enough! They need to be removed by force from Dail Eireann and I am not being over dramatic.

    THIS IS MEDICAL MANSLAUGHTER!

    1. Truthful Ulsterman

      Ron who would you like to resign?

      Mary Harney is retired.
      Brian Cowen is retired.
      Grainne Flannelly has resigned.
      Tony O’Brien resigned a month ago.

      Perhaps we should simply close the cervical check program?

      1. Anomanomanom

        See that the problem, Backward old Ireland, its grand we boo boo-ed up (sorry purposely didnt listen) because we’ve retired now. Anybody at a level high enough to have actually been able to get these concerns checked but that decided not to should be done for manslaughter. Because as we’re seeing the concerns turn out to be bang on correct.

        1. Robert

          Whether they’re culpable or not it makes sense to put them in the dock. Make a few heads sit up and pay attention … you can’t have the moral hazard of unaccountability in the running of a health service.

          1. Cian

            “Whether they’re culpable or not it makes sense to put them in the dock”
            You make no sense. You are looking for a show trial.

          2. Truthful Ulsterman

            Put who in the dock Robert? Brian Cowen and Michael Noonan? The men who didn’t do their jobs when Ministers for Health and delayed the introduction of Cervical Screening?

            I’ll tell you who belongs in the dock! The cursed wrectches of Offally who made Barry Cowen top the poll!

      2. david

        Its not about retiring its about stripping them of their pensions and a criminal investigation leading to jail if found guilty
        If this was Israel this would be done
        But sadly we are in Ireland which runs on corrupt little people with dirty sweaty hands
        A land of no accountability

        1. mildred st. meadowlark

          What has Israel to do with our affairs david?

          I’m not saying you’re wrong, but what has the comparison to Israel to do with it?

      3. david

        Tony O’Brien did not resign he was retiring
        I wonder what are government employees blogging while they are being paid to work
        I do not know if you are from Leo verruca’s SCUnit or the HSE

    2. david

      Plus a class action suit against the US company and an immediate court request of freezing of their bank accounts so they cannot declare bankruptcy in the USA
      This is a matter of urgency

  2. Cian

    “From 2006, to 2008, I was the QA chair, the Quality Assurance chair of the Quality Assurance Committee for Cervical Cytology and Pathology in the Cervical Screening Programme, just as it was about to be rolled out. I was also running a large cytology screening laboratory in Dublin.”

    Nobody worried about the (potential) conflict of interest here?

    1. Ron

      Listen to me very carefully Cian… Everyday I come on this website and I see you write your bullsheet comments. There is a saying that says; its better to remain quiet and have everyone assume your an idiot rather then open your mouth and confirm it for everyone. Im not listening to your bullsheet today.

      This is about 12 women dead… DEAD!!! This is about the state being complicit in the medical manslaughter of citizens! Yet you go and call into question the very man who is blowing the whistle on who knew what! Are you assuming he was running a private cytology lab? Is this what you are implying? Are you implying he was Chair of the QA committee and was against outsourcing because he stood to profit from such a decision? Is that what you are implying Cian? Because if it is, you are wrong AGAIN!

      I don’t know what political party you represent nor do I care, so take your pathetic deflections elsewhere and stop trying to cast aspersions on a man who stood true to his professional ethics and chose not to be a part of what was happening.

      What sort of a despicable human being writes what you wrote above? What sort of a person are you? Now sit down and unless you have something genuine to say I suggest you mosey off back to whatever cesspit you crawled out of this morning.

      1. david

        I would go further
        Tony O’Brien was the head of the department that awarded the licence for screening
        He then moved to head the HSE
        Questions serious questions must be asked
        Then there is the fact of the way the HSE could of deliberately stalled the women finding our the scans were wrong, on the orders of Tony O’Brien
        Harris must not be allowed to get off the hook
        The fact that Tony O’Brien has not been even suspended pending a complete criminal investigation shows boy Harris like the HSE is not fit for purpose
        Now we hear the NMH has problems regarding the manner in which the hospital will be run and why is the state spending hundreds of millions of euro on a building they will never own
        Boy Harris must explain himself on the way to collect his P45

        1. Truthful Ulsterman

          Why would Harris resign?
          That’s just silly.
          It is the Chancellor of the University of Limerick (Mary Harney) who approved this decision.

          TONY O’BRIEN HAS ALREADY RESIGNED

          1. Truthful Ulsterman

            In 2009 Mary Harney said (in reference to the outsourcing of tests)
            She is the Chancellor of Limerick University now.

            The main issue is quality and cost. The Deputy knows from the report that our turn-around time is bad, our quality is poor and our cost is enormous. Clearly, from any perspective, that is not satisfactory. The intention is to go to tender and there has been discussion with stakeholders. One would hope that the public service would be successful in that tender but clearly it must compete on the basis of quality, turn-around time and cost. That must be the future because if we waste €200 million on this service that could be used in areas where we have deficiencies, be that in the child protection area or the many other areas where there are deficiencies, no one could defend that. Quest Diagnostics is in discussions about a public facility in Ireland with a view to putting facilities in place.

          2. david

            He is minister of health
            Also the debacle of the NMH which was built with taxpayers money which will when abortion on demand arrives refuse to do abortions because of the conscience clause
            Which means as I have been pointing out all along provide a lottery regarding the savitas
            So abortion on demand provided the hospital consents
            They have already cocked it up
            And you want the people to allow these clowns at our constitution
            Then what about abortion clinics that need planning ?
            All these issues not thought out
            But the NMH is reason he has to be sacked

          3. ReproBertie (SCU)

            It’s interesting that you are now concerned about women in Ireland not having access to abortion but as the vast majority of abortions are at less than 12 weeks it’s just a pill. Hospital consent is utterly irrelevant in those situations.

          4. GiggidyGoo

            Tony O Brien didn’t resign. He retired. That’s twice youve posted that lie.

    2. Martco

      Cian, seriously? Are you gonna start picking holes in this one?? If so I think you might need to go see someone for a bitta help like.

    3. Frilly Keane

      Cian
      it’s not really a Conflict if
      everyone knows the risk – he has already declared it kinda thing, and it is a matter of record so that any interested parties/ on lookers can see for themselves

      and he is still acting professionally and responsibly, and is seen (usually recorded as minutes etc) to be making decisions for the good of the organisation and not for his own self interest

      btw, for Paddy Ulsterman there and a few other storm-troopers, Cian was right to flag it

      Because it is something Vicky Phelan and the other ladies, and their nearest and dearest, should be made aware of.

  3. JD

    Is there a significant conflict here?

    He resigned his appointment after he was alarmed that major concerns were not being addressed and now 10 years later, we have this tragic situation. That would highlight his bona fides.

    If we had more people who were wiling to make a stand, then the situation might be less egregious.

    1. Cian

      From wiki:
      “A conflict of interest (COI) is a situation in which a person or organization is involved in multiple interests, financial or otherwise, in situations where serving one the interests could involve working against one of the other interests. Typically, this relates to situations when the personal interest of an individual or organization might adversely affect a duty owed to make decisions for the benefit of a third-party.

      The presence of a conflict of interest is independent of the occurrence of impropriety. ”

      So, yes, there is a conflict of interest (IMO). But that doesn’t mean anything inappropriate happened.

      1. GiggidyGoo

        Dr Gibbons trained and worked in the United States for five years and headed up the gynaecologic cytology screening service in St. Luke’s Hospital.
        Cian – you’re full of it.

        1. Cian

          Thanks for the clarification – I wasn’t aware that it was St. Luke’s screening service. That is different.

        2. Nigel

          There are people who do that ‘I’m just asking questions’ thing to troll and deflect and distract and annoy. Cian is not one of those people so far as I can tell. He values precision and sources when it comes to facts and figures and I get no sense of malicious intent when he asks questions like this one, just an honest desire for clarification.

          1. Listrade

            Couldn’t agree more. Sometimes I agree, sometimes I disagree with him, but Cian’s fact-checking is always welcome. Never malicious and sometimes challenging to your own opinions.

            He’s on the good side of an open debate and discourse, even when he disagrees or wants clarity on a specific issue.

          2. mildred st. meadowlark

            +1

            That’s why #pullingacian is still top of the charts this week, only narrowly winning against #buylistradeapint.

          3. GiggidyGoo

            I’d tend to disagree. The piece of information I posted, I found in 20 seconds using google. Now why would someone looking for answers not research before throwing out questions that are intended (IMO) to cause confusion and deflection?
            There’s only so many times one can use the ‘oh thanks for that’ line. If he sounds like someone that likes to get proper information then why depend on a forum such as this? GIYF as they say.

          4. david

            My references regarding this weeks ago and doctors refusing through conscience is now a fact and this is the NMH
            So abortion on demand dependent on if you can secure one
            Bit of lottery
            So as it turns out if abortion on demand is passed then we still will have savitas same situation
            This is the absolute mess I was warning about grammar or not spelling or not minus comma full stop
            This is why we cannot allow these clowns to tamper with our constitution
            The cat is out of the bag and Harris is going to try and worm his way put of this
            Today at 11am apparently reported many could not get through on the hot line
            These are women facing death not from denial of abortion but a complete criminal scandal meaning women were not informed about wrong testing and their lives put at risk

          5. Listrade

            Ironic then that you condone eliminating one source of harm by repealing the 8th and continuing to lie about the consequences of that repeal. But good to see you’re such a champion of women’s health all of a sudden.

          6. Nigel

            We allowed the clowns to tamper with the constitution when the 8th was introduced. Now we can fix it.

  4. GiggidyGoo

    A very telling paragraph. “So, subsequently…I resigned then from the committee and the committee was composed of very talented scientists – all resigned as well.”
    But obviously Tony O Brien knew better. Putting prices on lives.

    1. Truthful Ulsterman

      Total anachronistic bullpoo. I wonder what happened to the national finances in 2008?
      There are false negatives in every single screening programme in the world.
      Smears have a high false negative rate.

      That’s just a fact.

      When Dr Gibbons says there was a backlog because they would never sacrifice quality for inaudible. What was the inaudible (speed??)

      The HSE had no ability to hire new doctors in 2008. What is the tradeoff between a WORSE service and a longer wait?

      This backlog was not trivial — there were 40,000 delayed smear test results when the outsourcing began.

      There is no evidence that I have seen that the failure to communicate information to these women has harmed them. It was paternalistic, infantilising and wrong but Vicky Phean is not dying because she was not told. She is dying because of the missed 2011 diagnosis (we can’t say it was negligent because she settled).

      1. GiggidyGoo

        Three years ago the HSE knew about Vicky Phelan. Your post above is pretty disgusting. Had she been told when the HSE knew, she has a very very high chance of living a long life. Your reference to 2008 and finances are pure deflection, as she had the test regardless of finances, but tell me how 2008 finances would affect someone lifting the phone to tell her three years ago?
        By the way, we’ve had a resignation. That blows your bull out of the water.

        1. Truthful Ulsterman

          She didn’t have the test regardless of finances you twittering ignoscento. She had the test and it was sent to the USA for analysis for financial reasons (and because there was 40,000 test backlog in Ireland) . The failure to lift the phone did not kill her. The missed diagnosis killed her. It is unfortunate that your tedious, predictable, misdirected and boring fake outrage is shared by so many and allows the real villian (your hero Mary Harney) to escape unscathed.

          1. GiggidyGoo

            Once you start calling people names you’ve lost any credibility. Are you saying that had she been made aware in 2014 and not 2017 that those three years could have not been spent treating it?

          2. Cian

            @GiggidyGoo
            She had a subsequent test in 2014 (it’s done every 3 years) and this was positive for cancer. So she was told in 2014 (albeit 3 years too late).

            On foot of this positive test – which is unusual for someone that was cleared 3 years earlier – Cervical Check reviewed her historical records and realised that the earlier test was incorrect. This is the key fact that they didn’t communicate with her.

            https://www.rte.ie/news/courts/2018/0425/957122-vicky-phelan/

      2. david

        I see the SCUnit are really racking their brains to get the government off the hook
        Nice try but that dose not explain the HSE and considering Tony O’Brien head of HSE awarded that contract there are questions
        Did he receive a back hander?
        Was the delays due to the game is up and he can quietly ride into the horizon with massive pension and golden hand shake?
        Was varadka aware of this?
        Was it a hush up?

        1. GiggidyGoo

          Yep The apologists for these FG laddo’s tend to crawl out and try to deflect. Cries of ‘it was the other crowd’ are par for the course. And of course resorting to insulting other contributors and calling them names. They’re the same in real life mind you.

    2. Anomanomanom

      It all comes down to money. Outsourcing work that while done well but not up to our actually standards is cheaper than hiring staff for an underfunded and understaffed department. Sure so what if in years to come it kills peoples, Pppffftt women’s health is not that important.

      1. Truthful Ulsterman

        Yes it all comes down to money. No doubt about that. They process 300,000 smear tests a year and pathologists don’t work for nothing.
        In 2008 Lehman Brothers collapsed. Did that have any implications for the Irish national finances?

      2. SOQ

        Yes the HSE outsource a lot of work, including the screening of applicants from their recruitment campaigns.

    3. david

      Listen to them latching on to everything and twisting it to make it something its not
      And they cannot refute one fact I posted
      Good old listrade and Nigel

  5. dav

    The Parrells between this and the Hemp C scandal are almost uncanny.
    A Health Service makes a business decision when it comes to medical care (ie the lowest cost) and ignores any suggestions that this is the wrong move. Fast forward a few years and it takes another dying woman being dragged through the courts to show how, once again, the state put money above it’s citizens welfare.

    1. Cian

      Rubbish. If the state put money above it’s citizens welfare it wound never have funded “BreastCheck” or “CervicalCheck” or any of the other screening services.

  6. Martco

    I particularly enjoyed /s listening to Varadker being interviewed earlier…did anyone else hear it? he literally shouted the term “APPALLING COMMUNICATION FAILURES” into the mic.
    ‘cos yeah that’s what this is at end of day innit, mainly just poor communications, nothing atall to do with a cheapshit outsourcing program that he or anything connected to him had presided over of course!
    fupp off.

  7. GenerationScrewed

    Vicky Phelan is a phenomenal woman. She has a long list of things to be worrying about yet still has to fight the state in court to get some smidgen of justice and redress.

    How many more women will the state drag through the courts? Such a long rap sheet from Bridget McCole and the Hepatitis scandal to Magdalene survivors and symphysiotomy – all to protect the institution and be damned with the victims.

    1. Cian

      If you were running the HSE, and Vicky Phelan came in and told you what had happened to her – what would you do?

      1. GiggidyGoo

        Action it. Be professional. Man up. Tell the truth as to why the information was withheld.

        1. Cian

          Okay – open disclosure – I agree with that.

          What about compensation? Would you offer money? or wait for her to ask?

          1. GiggidyGoo

            That would not be the remit of anyone employed by the HSE anymore than it would be in the remit of a company employee advising a client or offering money to someone who fell on a wet floor (to advise her to seek compensation or to offer compensation). But the open disclosure would guide her in her decision as to how she would proceed.
            Week in, week out there are examples of the HSE working against people that have been wronged. Forcing them into court to have it eventually apologise etc

      2. david

        I suppose nail her to the wall
        Is that what you mean
        At the Nuremberg trials many used the defence I was only doing my job
        And so were they
        Maybe we need a Nuremberg trials tribunal where they are processed and jailed and in front of the world where people can actually see them and they are no longer faceless cretins

  8. Pip

    Odd isn’t it that ‘we’, if asked, would most likely be in favour of support for all these damaged ones, however costly.
    Not so much in favour of other, wasteful expenditure, corruption and general squandering though.
    Not to mention the gravy train.

    1. Frilly Keane

      and has totally defeated the purpose of Smear testing anyway
      to, simply put,
      detect pre-cancer cells,
      abnormal cells
      and treat, usually with laser, as an out-patient

      rather than wait on full blown cervical cancer,
      which if caught early enough
      is curable
      and promise long term savings for the Health Service

      btw, anyone know of any issues with Prostrate Screening?

      although a discussion for another day, but I have to wonder if it was 206 Prostrate Smears that were wrong, would they have covered that up to and left the men in the dark

  9. Truthful Ulsterman

    JAMES REILLY in May 2008:
    Reilly became Minister for Health in 2011.

    Most important, however, is the issue of reliability and the quality of testing. A study done by St. Luke’s Hospital looking at the results of 14,500 smears read by Quest showed a 30% difference in the pick-up rate for high grade pre-invasive cancer of the cervix. Critics of the study from the NCSS have claimed it did not allow for urgent cases, but it did factor this in. Two other laboratories, Cork and the Royal College of Surgeons in Ireland, examined the figures for the Quest smears that went from their laboratories. They discovered that it was a 50% difference but they had not corrected for the urgent cases.

    1. david

      You forgot in 2008 this contract was awarded by Tony O’Brien and James orielly was spokesman for health in opposition and he tried to raise the folly in the dail
      Only to be shouted down
      I think you are HSE blogging to get people off the hook
      And if I am right sir you are just the lowest form of life

  10. Frilly Keane

    I don’t know where to begin
    but I’ll leave this one with ye

    Remember the length of time, cribbing, and all-round bollockology about getting the HPV vaccine

    and although I have applied the following previously, I’ll say it again in this context
    We are not safe

    1. Cian

      Sorry Frilly, I’m not understanding you. Is that:
      a) our health service is rubbish – get the HPV vaccine so you reduce your chance of getting cancer and need treatment? or
      a) our health service is rubbish – don’t get the HPV vaccine because we can’t trust them and the vaccine will cause more harm than good

      1. Frilly Keane

        Women’s Health Care; and prevention and early detection for a form of Cancer that only occurs in Women

        Basically

        But just to be clear
        Smears under the National Screening Programme, Cervical Check, like the Breast Check programmes proffer two benefits to the community at large

        Pre-Cancer detection; the cell activity that can be cauterized. Or Early detection, which enhances the success of treatment

        And the long-term savings of avoiding costly treatment

        The HPV vaccine is an opportunity to eliminate the risk altogether

        Tell me Cian
        If you thought a vaccine was available to prevent testicular cancer do you think there’d be the delay in rolling it out like the HPV vaccine was subjected to ?

        Or
        How do you think the HSE would have managed the news of 20 lads getting an incorrect Prostrate Test result?
        Naw mind 200+

        1. Cian

          I felt your post could be read in one of two ways.

          But I’m still not sure what you think that women arent safe. We do have comprehensive screening exclusively for women. These are generally well regarded (current scandal aside) and even with the current scandal it’s no worse than the rest of the HSE. I’m confused why you brought gender into it.

          Do you really think the HSE is sexist and would suddenly become world class to roll out a testicular cancer vaccine? Are men put into beds and women left on trolleys? No. So why would you think it would be different?

  11. Lilly

    So should we all be going back for repeat smear tests even if given the all-clear a year ago?

  12. SOQ

    @BS. Please stop linking to the RTÉ player, at least for the time being. I doubt if it is current administrators who are responsible for foreign channels being easier to stream than national. Tnx.

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