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Did outsourcing of cancer testing sentence a woman with cervical cancer to death?

Ardillaun

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I remember hearing the name Quest when this outsourcing program began and I just assumed that all the smears were being sent to the same place. Anyway, all Quest labs would be accredited for cytology screening under CLIA legislation. For example, here are the documents for the Irving, Texas site showing that it is accredited by both CLIA and the CAP:


So there was QA going on at the individual US lab level. This is the first time I heard about the Salford lab, though.
 
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Noble Guardian

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At what point does quality assurance become micromanagement? It seems to me that busy labs asked other equally capable labs for assistance in dealing with the workload. This is akin to then hiring extra qualified staff.
Are the public (as represented through their politicians) expecting the HSE to sign off on staffing changes as well? Are contracts so rigidly bureaucratic as to hinder proactive workflow management, and is this really what people think is in the best interests of patients?
 

ruman

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To summarize, while the labs inappropriately subcontracted work, no evidence of any harm has been found by the independent review.
Is that right?
Thats the narrative being pushed by the vested interest groups that took down mandatory disclosure when Varadkar was health minister. Sadly Gabriel Scally doesnt agree as he states quite clearly:

" there is no compelling reason to disclose"

Unfortunately the idea of " doctor knows best" is still rampant amongst senior medics here. Given its mostly women suffering at the hands of male doctor there is more than a whiff of patriarchical attitude here.

Ultimately its quite simple , you have information you give it to the patient immiediately. You make a mistake you admit it.

Where that doesnt happen the individual responsible shouldnt be allowed to continue working in the health service. Obviously mistakes can happen, concealing them from patients is never acceptable.
 

Noble Guardian

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You're consistent at least
 

ruman

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You're consistent at least
Quite clearly there is a pushback against the proposed mandatory disclosure. That is the bigger issue here. Senior Medics are intent on taking it down as they did under Varadkar when they lobbied the Chief Medical Officer extensively leading ultimately to Varadkars u turn.
 

Noble Guardian

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As long as ludicrous definition's of negligence are maintained, medics will little faith they will be treated fairly
 

ruman

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As long as ludicrous definition's of negligence are maintained, medics will little faith they will be treated fairly
Ah thats why they throw their patients under a bus rather than admit failings?

F*ck you mother with the severely disabled child (due to my incompetence) i'm looking after number one.
 

Noble Guardian

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That's clearly how you see medics. I don't know what happened that you hold such an all-encompassing view.
You should read the full Morrissey judgement. Her legal team tried to stick it to everyone involved in her care, not just the labs and the HSE but also her treating clinician who had no part in the process.
 

ruman

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That's clearly how you see medics. I don't know what happened that you hold such an all-encompassing view.
You should read the full Morrissey judgement. Her legal team tried to stick it to everyone involved in her care, not just the labs and the HSE but also her treating clinician who had no part in the process.
Waffle all you like but the reality is no Irish medic admits to their mistakes no matter how obvious it is.

They throw their patients under a bus to save their own necks. Its got nothing to do with " how i see medics". It is what Irish mothers experience on the ground. I have listened to their experiences on many occassions and as a result i have a very low opinion of the Irish medical profession.

I've no problem with mistakes being made ( we are all human) it is the lengths they will go to conceal their mistakes that i have a problem with.

Feigned loss of memory, refusing to return calls, deliberatedly lying to a grieving mothers face, altering medical records, removing and destroying medical records. Behaviour that i believe in many instances to be borderline criminal.

Talk to a mother who has gone through it and stop trying to justify this disgusting behaviour.

The cervical check scandal has far wider implications. Ultimately it is about a patients right to know and the right to be informed when failings occur. Medics ( or HSE managers) who delibetatedly conceal failings should face criminal charges.
 

Noble Guardian

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As you wish.
 

ruman

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G
As you wish.
You wont look at it from the mothers point of view yet you expect me to look at it from the medics ?!

Guess what our maternity service doesnt exist for the benefit of medics it exists for mothers.

The taxpayer funds the legal team to defend a legal case taken by the mother many of whom will never be able to afford to take a case and consequently will never find out why their child is disabled ( or worse) and you whine about medics?

Cop urself on, its not all about you.
 

buttercookie

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The problem with the disclosure is the insane damages awarded here if negligence is found.

It would be much better if every child damaged through negligence could have a fixed sum awarded to them, this would eliminate the legal costs which form a huge part of taxpayers money being handed out. As far as I know this is the system in the Netherlands but it will never happen here because of the huge power of the legal eagles.

Why did the HSE pay out seven million euros to one cervical cancer victim and then a few months later pay another person with cervical cancer just two million. What happens in other countries where there are false negatives, I doubt if many pay out the huge damages paid out here. The Irish medics are operating in a completely different environment so you cant compare like with like.

At the end of the day Scally found no quality issues with the cervical testing and he also found that the US has now moved to three yearly screening in many cases even though the annual screening in the US was howled about at the height of the screening scandal as if the three yearly call here led to women getting cancer.

An awful lot of people who made noise when the cervical cancer screening story broke have a lot to answer for and hopefully some lessons have been learned from what happened, if not newspaper headlines and shrill Radio interviews will be guiding health care policy in the future.
 

ruman

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The problem with the disclosure is the insane damages awarded here if negligence is found.

It would be much better if every child damaged through negligence could have a fixed sum awarded to them, this would eliminate the legal costs which form a huge part of taxpayers money being handed out. As far as I know this is the system in the Netherlands but it will never happen here because of the huge power of the legal eagles.

Why did the HSE pay out seven million euros to one cervical cancer victim and then a few months later pay another person with cervical cancer just two million. What happens in other countries where there are false negatives, I doubt if many pay out the huge damages paid out here. The Irish medics are operating in a completely different environment so you cant compare like with like.

At the end of the day Scally found no quality issues with the cervical testing and he also found that the US has now moved to three yearly screening in many cases even though the annual screening in the US was howled about at the height of the screening scandal as if the three yearly call here led to women getting cancer.

An awful lot of people who made noise when the cervical cancer screening story broke have a lot to answer for and hopefully some lessons have been learned from what happened, if not newspaper headlines and shrill Radio interviews will be guiding health care policy in the future.
Scally eviserated the voluntary open disclosure policy introduced by Varadkar and which failed HSE head Tony O'Brien had been consistently boasting about ( even releasing a video on his " retirement").

You cant have " fixed awards" given the care needs of children will vary. Awards are carefully costed and agreed by both sides with medics coining it preparing " expert reports" ( we cant criticise the medics however so shush!). Most of the awards will be based on salaries for hiring carers and medics so reducing salaries would be a way to reduce awards ( again we cant mention this!)

Scallys comments have far wider implications and it is no surprise that the self serving medical profession are once again engaged in a vigorous campaign to stop the implementation of a statutory duty of candour. That is the important takeaway from the cervical check scandal.

With a number of Judicial reviews into dealing with negligence ongoing its pretty clear what the medics are at here.

As for " guiding health policy" that is ,has always been the vested interest groups working within the health service. With their man the CMO putting any Minister who threatens their interests to right
 
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redmonite

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Scally eviserated the voluntary open disclosure policy introduced by Varadkar and which failed HSE head Tony O'Brien had been consistently boasting about ( even releasing a video on his " retirement").

You cant have " fixed awards" given the care needs of children will vary. Awards are carefully costed and agreed by both sides with medics coining it preparing " expert reports" ( we cant criticise the medics however so shush!). Most of the awards will be based on salaries for hiring carers and medics so reducing salaries would be a way to reduce awards ( again we cant mention this!)

Scallys comments have far wider implications and it is no surprise that the self serving medical profession are once again engaged in a vigorous campaign to stop the implementation of a statutory duty of candour. That is the important takeaway from the cervical check scandal.

With a number of Judicial reviews into dealing with negligence ongoing its pretty clear what the medics are at here.

As for " guiding health policy" that is ,has always been the vested interest groups working within the health service. With their man the CMO putting any Minister who threatens their interests to right
If they had been told about the audit results on their smear tests, would that have had any health impact on them ?
What % accuracy do you want in a screening programme?
What level of compensation would you give someone who screening missed?
 

ruman

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If they had been told about the audit results on their smear tests, would that have had any health impact on them ?
What % accuracy do you want in a screening programme?
What level of compensation would you give someone who screening missed?
Yes that is how the medical profeession is trying to frame it to avoid focusing on the wider issue namely their ongoing concealment of information from patients and the fear that they will be at risk of criminal charges ( as they should be) if they deliberatedly conceal negligence should a statutory duty of candour be introduced.

I've already made clear that my issue is about patient data and the withholding or in certain instances deliberate concealment of information from them. As such your questions dont particularly interest me.

In summary you u have information you give it to your patient. Do you have a problem with that concept?
 
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Ardillaun

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I'm not sure who needs to know that slides are sent from one accredited lab to another for screening, particularly in the same company. In diagnostic imaging, cases are routinely sent to other departments for primary diagnosis.

There’s a big difference of opinion between many labs and lawyers regarding the best way to review a Pap smear in a negligence lawsuit. Labs generally believe that blinded review of the slide mixed in with multiple unrelated slides as a routine unknown case under routine time constraints (say 10 minutes) is the only way to recreate anything like the conditions that the original cytotech experienced to assess the possibility of negligence. Lawyers prefer expert, academic pathologists to review the slides, knowing the outcome, with problem areas circled and taking as long as they like. Judge Cross waffled on this question but he tried to insinuate that blinded review recommendation was just one other way of doing things and he pointed to only one US judgement on this matter which favoured his view. For me, he wasn’t candid enough about how different review by expert pathologists is from routine screening and deserves criticism for that. Here’s some context from the US on this debate:

Telling a jury the truth about Pap tests is not always simple, Dr. Austin notes. “Although I’m primarily a defense expert, I’ve done some cases for plaintiffs, but I’ve always insisted that I would have to show that slides would be repeatedly misread in a blinded review type of exercise. We’ve done that as a first step in cases I’ve testified in, but of course other experts have avoided that because it takes some additional time and effort.”
Whether or not a court agrees with the position taken by the College on expert testimony in cytopathology cases, there can be no doubt that the guidelines were adopted in good faith, Bierig says.

“Testimony that doesn’t meet basic fairness guidelines can skew the adjudicative process. You can have a very sympathetic plaintiff, a woman who died or is dying of cervical cancer because her positive Pap test was missed, and the judge and jury can’t help but feel very sorry for that person,” Bierig says. “But the question is, was the pathologist or cytotechnologist negligent? Dr. Austin would say we want to have a fair evaluation of that question. To have a reviewer come in knowing that the slides were of a person who had cervical cancer, and say, ‘well, this should have been spotted’—that’s not the position the cytotechnologist or pathologist was in at the time of the review.”

“If you talk to cytopathologists, they will tell you that a cytotechnologist or a cytopathologist who is doing a very good job will still, from time to time, miss calling cases,” Bierig adds. “That doesn’t necessarily mean they are negligent, but that there is a certain irreducible number of false-negatives that will occur. And the issue is not unique to pathology. Situations in which there has been a tragic result, but not through the negligence of the physician, come up frequently in malpractice cases. The courts should be asking whether the physician is at fault. But often they ask who is in the best position to pay.”

Bierig offers this analogy to blinded review of slides in cytopathology malpractice cases: Where the police want a witness to identify a suspected perpetrator, they don’t just show the suspect to the witness and ask whether that suspect committed the crime. Rather, they place the suspect in a lineup with several other persons to see whether the witness can make the identification. Similarly, “an expert witness shouldn’t be given a slide that he or she knows has been misread and then asked to opine whether it has been misread. Instead,” Bierig says, “the expert witness should be given numerous slides, most of which are negative, and then asked to identify which of them, if any, are positive.”

18543

Here’s the abstract of the paper Dr. Austin refers to:


And a more recent paper on the subject:

Multiple-slide blinded reviews, supported by professional organization guidelines, should be used to identify and differentiate culpable medical errors from factors primarily associated with the inherent limitations of human screening and interpretation.


I would go further than Dr. Austin and say that the best way to recreate the original screening situation is through blinded review by multiple cytotechnologists of unmarked slides mixed in with other routine cases.
 
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redmonite

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Yes that is how the medical profeession is trying to frame it to avoid focusing on the wider issue namely their ongoing concealment of information from patients and the fear that they will be at risk of criminal charges ( as they should be) if they deliberatedly conceal negligence should a statutory duty of candour be introduced.

I've already made clear that my issue is about patient data and the withholding or in certain instances deliberate concealment of information from them. As such your questions dont particularly interest me.

In summary you u have information you give it to your patient. Do you have a prob
Yes that is how the medical profeession is trying to frame it to avoid focusing on the wider issue namely their ongoing concealment of information from patients and the fear that they will be at risk of criminal charges ( as they should be) if they deliberatedly conceal negligence should a statutory duty of candour be introduced.

I've already made clear that my issue is about patient data and the withholding or in certain instances deliberate concealment of information from them. As such your questions dont particularly interest me.

In summary you u have information you give it to your patient. Do you have a problem with that concept?
No problem with the concept of disclosure.
My problem is the following; Screening is not 100% accurate, but it is a very good way to lower the mortality rate of cervical cancer. Now cervical check costs approx 35m euros but if you give every women that falls through the screening 3m euros ( which is the average so far ) then the cost benefit goes out the window.
The lesson of this saga for health policy makers is do nothing, you can't get in trouble for not doing something. No audit no scandal!
 

Massey

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So say it catches 300 cancers but misses 100, we will have to compensate 300 million euro ?
I think it will have to be abandoned.
 

ruman

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And my problem is the ongoing concealment of information from patients. I wont question your sincerity but i believe you are naive and are being used by the medical profession to take down mandatory disclosure yet again.

The medical profession are engaged in vigorous and aggresive lobbying to prevent them being held liable for deliberatedly concealing information from patients. They bombarded the current forum under Justice Meehan on legislative reform of medical negligence. Where are the patients voices in all of this?
 

Massey

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Every single patient who attends emergency department s will have to be informed of potential harm due to delays , which is recognised to cause harm - do the clinicians apologise for the system failures or do management ?
 


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