CervicalCheck gave instructions that a reference to “open disclosure” in letters to doctors, telling them about audits showing patients’ incorrect smear test results, should be deleted in cases where the woman had died.
The template letter that the programme sent to doctors from mid-2016 was disclosed to two Oireachtas committees this week among more than 120 pages of records released by the Department of Health.
A long-running dispute between CervicalCheck and doctors over who should inform the women with cervical cancer about incorrect smear tests ultimately meant at least 162 women were not told until the High Court settlement of terminally-ill Limerick woman Vicky Phelan revealed widespread non-disclosure.
Last night the Health Service Executive said the number of people who had called a special helpline set up in response to the CervicalCheck controversy had reached 19,659.
Almost one in five women who had requested a call back still had not received a returned call. Some 8,702 calls had been returned to 11,031 women who requested one.
The CervicalCheck template letter disclosed to the committees this week shows how the programme intended to inform the women’s doctors, but not the women themselves about the audit results.
‘Hospital guidelines’
The doctors were told to check up on any “difference in interpretation” between the original smear and the audit result but the only apparent reference in the letter on whether the patient should be told appears to be the line: “If open disclosure is indicated in this case, please follow the local hospital guidelines.”
However, notes in the margins of the template document include the instruction on the “open disclosure” paragraph: “Do not include if the woman is known to have passed away.”
A HSE investigation has found that there were 209 women where the audit showed a previous test could have provided a different result and that of these 18 have since died.
The name of Dr Gráinne Flannelly, who resigned as CervicalCheck's clinical director last month over the controversy, appears at the bottom of the letter, which is also copied to CervicalCheck's programme manager John Gleeson. The notes in the margins of the letter are marked with the initials "JG."
Ms Phelan's solicitor, Co Tipperary-based Cian O'Carroll, told the Public Accounts Committee on Wednesday that the letter and other documents released this week shows a trend suggesting "a meditated and orchestrated plan to keep this information from patients who had died in particular".
‘I’m not certain’
Mr Gleeson told the committee on Thursday that CervicalCheck believed the “best channel” to tell women about the audit was through doctors but he never checked that the women themselves were told.
“I didn’t know it was my responsibility to check. I’m not certain,” he said.
He acknowledged that CervicalCheck erred by not following up to ensure the women were told.
Last night Ms Phelan, responding to the letter, said Mr Gleeson still had questions to answer about his role in the failure to tell affected women and to conceal audit results from the families of patients who had died.
“The attention to detail in drafting template letters to send to clinicians and the deliberate lack of open disclosure where a woman had died during or following the audit shows just how deliberately the CervicalCheck management team tried to hide the truth about the results of their audit,” she said.
