Emma Mhic Mathúna with her solicitor Cian O’Carroll at the High Court in June
This morning.
Following the death of mother-of-five and cervical cancer victim Emma Mhic Mhathúna, 37.
Emma’s solicitor Cian O’Carroll spoke to Seán O’Rourke on RTÉ Radio One.
In June, Emma sued both the HSE and the US laboratory which studied her smear tests, Quest Diagnostics, and agreed a settlement of €7.5 million.
Quest Diagnostics misread her two smear slides in 2010 and 2013 and she was diagnosed with cervical cancer in 2016.
Some 221 women have been affected by the CervicalCheck controversy.
Further to this.
Mr O’Carroll has asked why all of the errors haven’t been investigated.
He told Mr O’Rourke:
If you wanted to have a confidence in a laboratory, you must know that each error is investigated. And we’ve spoken to cervical screening experts around the world involved in Canada, Finland, New Zealand and the UK.
And they have all said to us here that it is essential that whenever a single critical error occurs that it’s investigated within the laboratory and that involves debriefing the person who made the error and finding out what caused it.
And that has never been done.
[Emma] was adamant all the way through that she wanted accountability. She was adamant all the way through that errors must be stopped. She said that so much money had to be paid by the laboratory would hopefully make them be more careful in future with screening.
But the State, the National Screening Service, has a primary obligation and, under the contract, they have the right to send in HIQA to investigate why those errors happened in those laboratories and they have an obligation to do it under normal standards of public health and public safety.
They haven’t done it.
…If you are going to have an analytical process, a scientific process within a laboratory – that must be investigated by a suitable set of cytologists who go in and that’s what HIQA do.
And I’m left wondering why is the HSE and the NSF so bent on avoiding the laboratory issue?
Why are they so determined to constantly refer to, as the minister again did yesterday, Minister Harris, spoke about Emma’s death in the context of the non-disclosure?
And didn’t acknowledge that non-disclosure did not kill that woman, failures in a laboratory in 2010 and 2013 did.
And it is inexcusable that today, following her death, there is still not a clear and determined statement from the State saying we will investigate why those slides and so many hundreds of others were critically misread in those laboratories.
In the US and in Ireland, it just so happens that Emma’s two errors were in the same laboratory Quest Diagnostics in New Jersey.
Listen back in full here
Keep pushing for answers Cian!
Why? Corruption.
Probably yes, although, I think its far simpler , if they investigate , then they will be hassled to take action on what they discovered, but that wont work, because they are either unwilling or unable to sanction anyone , I think it more the latter…
It’s not about sanctioning anyone but making sure procedures for a lab are up to scratch…although a poor lab tech woyld be weeded out with good procedures and proper oversight.
when blushirt health ministers tread, dying women are dragged through the courts..
They want nothing to do with it is why. It’s called turning a blind eye. They go in & find out errors are not being managed, that there’s no oversight, then they can’t shirk responsiblility like the lab.
What procedures are in place to do spot checks on reviewing other peers analysis? What percentage of smears are double checked?
In any proper lab any false results are analysed to see why a mistake was made and the lab technician buddied up for a period if needs be. Is it one technician responsible or a handful? What continual assessment is in place for lab workers? Are operating procedures up to date?
What’s the process of deciding suitability by the HSE to use this lab?
Speaking of suitability, was there not some issue around timing, that the lab is geared more towards the more regular US screens than in Ireland?
If the HSE get into any sort of critical analysis of that lab, it is possible that the reasons why they awarded that contract to them in the first place may be brought into question, by the lab itself.
Gabriel Scally investigated the labs as part of the Scoping Inquiry into the CervicalCheck Screening Programme.
It states “The Scoping Inquiry considers there is no reason, on quality grounds, why the existing contracts for laboratory services should not continue until the new HPV testing regime has been introduced.”
https://health.gov.ie/wp-content/uploads/2018/09/Scoping-Inquiry-into-CervicalCheck-Final_Report.pdf (P71)
And…
) Based on revised programme standards, a specification for a new and more
robust quality assurance procedure should be documented and form part of the
contract for services with cytology providers.
12) CervicalCheck should adopt a formal risk management approach to parameters
which do not reach acceptable standards despite full intervention and monitoring.
13) CervicalCheck should document which organisation (e.g. CervicalCheck, HSE,
Providers) has responsibility for pursuing issues of continued non-compliance
and the consequences thereof