CervicalCheck was drafting a leaflet as recently as last March to send out to women with cervical cancer to ask if they wanted to receive details of an audit showing past incorrect smear tests, new documents show.
In a letter released to the Dáil Public Accounts Committee on Thursday, the screening programme’s then clinical director, Prof Gráinne Flannelly, wrote that the leaflet “took a surprising amount of time to sign off” following “multiple iterations of the leaflet”.
The letter shows a leaflet was still being prepared two years after Health Service Executive and Department of Health officials were made aware that CervicalCheck had decided to "pause" letters to the women's doctors telling them about false smear tests uncovered by audits while they sought legal advice.
Prof Flannelly suggested in her letter to Limerick gynaecologist Dr Kevin Hickey, who treated Vicky Phelan, who exposed the controversy, that the best place to post the leaflet was on CervicalCheck's website where it would be "downloadable and printable".
CervicalCheck planned to include a “notification slip” that the affected woman could tear off and send directly to the screening programme if they wanted to “opt in” to receiving information about false tests.
“This leaflet is designed to inform women about the cancer review or look back progress and gives them an option to contact CervicalCheck if they would like to be informed about any outcome,” Prof Flannelly wrote.
She told Dr Hickey that the woman “would be able to tear off the notification slip and send directly to the CervicalCheck programme to opt in to receiving this information.”
The letter was among records shared by the Limerick hospital group to the committee while senior HSE and department officials were providing testimony on the CervicalCheck scandal.
Another document shows that at least six of 11 women with cervical cancer being treated by the Limerick hospital were not told about the clinical audit until after Ms Phelan's High Court settlement on April 25th that led to the revelation that at least 162 women were not informed about false smear tests.
Two women were informed about the audit on April 30th while four were told the following day.
Since Ms Phelan’s case, it has emerged that at least 162 women were not informed of false smear tests.
Dispute history
Prof Flannelly wrote to Dr Hickey in response to a letter he wrote on March 1st last setting out the history of his dispute with CervicalCheck over who should tell the women: the doctors or the programme.
He wanted to see that changes the screening programme had agreed to at meetings with CervicalCheck’s “lead colposcopists group”on September 1st and October 26th, 2017 – namely that the programme would inform cervical cancer patients about the audit prior to their diagnosis – were being implemented.
"I would be most grateful if you could provide me with written confirmation that these changes are now being implemented by Cervical Check," wrote Dr Hickey, copying, among others, John Gleeson, CervicalCheck's programme manager.
Labour TD Alan Kelly expressed dismay that the only achievement in six months since the colposcopists' meeting in terms of informing women about the clinical audit was "a leaflet" for patients.
“Open disclosure? Opt in? Tear off a slip? After six months and we now know 80 per cent of women not being told. This was the conclusion,” he said.
The department released the minutes of the September 1st meeting to the committee, showing that the doctors felt it was “not correct” that CervicalCheck was “putting the onus” to initiate the conversation with the women and that this caused concern and “negative feelings towards the programme from clinicians”.
The doctors argued, the minutes show, that they were being “put at a disadvantage” in deciding who should or should not be offered a “close-out meeting” – the term they used to describe women being told.
