Sunday 15 September 2019

Victims who were treated like a mere PR problem

Clearly it was felt in the HSE that emotional women could not be trusted with the truth, says Brendan O'Connor

CERVICAL CHECK SCANDAL: Terminally ill Emma Mhic Mhathuna, pictured near her home in Ballydavid in West Kerry, last Thursday. Photo: Don MacMonagle
CERVICAL CHECK SCANDAL: Terminally ill Emma Mhic Mhathuna, pictured near her home in Ballydavid in West Kerry, last Thursday. Photo: Don MacMonagle

Well, they got their headlines. The thing they worried most about, the HSE got in spades.

Walking into work last Thursday morning it was easy to see the people who were listening to Emma Mhic Mhathuna through their headphones. Some people just looked a bit shocked or upset.

Some women walking along to work actually had tears rolling down their faces. Kurt Vonnegut said the truth is powerful stuff, because people aren't expecting it. And this was certainly a dose of hardcore truth and reality to be hit with on a Thursday morning.

You couldn't blame the presenter, Audrey Carville, for becoming emotional at the end. She seemed to represent all of us. "Do you understand me?" Emma asked her. "I do, Emma. There's nothing I can say. I'm so, so sorry."

There is nothing to say to death, to a young mother of five young children who is needlessly dying in slow motion. There is nothing to say that makes it better.

And it brought us back again to the awful reality at the heart of this. As we listened to Emma tell us how she doesn't even know if her little baby will remember her, how she tried to do everything right, sacrificed everything for her kids, and how she is now going to die and there's no need for it, we were acutely conscious that there is nothing anyone can do to change Emma's reality.

It seems that the massed forces of the State, of public opinion, all the goodwill in the world, cannot change her future, cannot change the fact that during the week she had to ask her five kids whether they want to be kept together after she is gone.

Nothing can change the fact that her six-year-old wants to know if she will be coming back, that her kids worried last week that if they went to school she would be dead when they came back.

Politicians and ministers were being stopped in their tracks too. Paschal Donohoe described it perfectly. The world slowed down, and then stopped.

Tony O'Brien, the head of the HSE, was still in fighting mode even after Emma's interview had cast a pall over the jaded environs of Leinster House. O'Brien hadn't heard the interview. Perhaps he didn't realise, as he stuck to his logical defence of his position last Thursday morning, that everything had changed, that the truth, that powerful stuff, a truth that defied his internal logic, had taken over.

He didn't realise that, conscious that there is nothing much we can do for Emma right now, or Vicky Phelan, or the other women, the country had decided that the least we could do was offer them some of the accountability they needed to make their final journey less angry.

Just after eight o'clock last Thursday morning everything changed and the country decided O'Brien had to go, and that that would only be the start of the reckoning.

Luckily, if you will, for O'Brien, the memos came out later that day, and even he realised the truth.

You can make all the arguments you want about how screening is not an exact science, and we all accept that. Tragic mistakes will happen. But the memos revealed the priority. And the priority was that CervicalCheck and the HSE were concerned only with ass covering.

In the morning, before we saw them, O'Brien recalled that the memos were reassuring, and that they set off no alarm bells. This perhaps shows how deep the mentality went in the HSE. He recalled them as good memos. He didn't even recall the fact that they showed no regard for the patients at all, that the patients, the sick and dying women, were mentioned only in so far as they might become a problem for the HSE.

There were so many of them to be informed that one of these silly, emotional women, who don't understand that screening is not an exact science, might run to the papers, with a sensationalist story. And that's why the HSE needed to be careful about telling these silly, hysterical, emotional women about how their cancers had been missed.

They could not be trusted with that information. They just wouldn't get it. So the thinking in the HSE was that the superior beings of the medical world must be careful about telling these mere civilians how they might be needlessly sick, how they might needlessly die.

Of course, we do have to accept that screening is what it is. This was not perhaps conveyed very well to the women who took part in the screening programme, but we all know it now. You get false negatives and positives.

It should be said equally that Emma's story is more complicated than just a false negative in 2013. In 2016, during her last pregnancy, she says she knew something was wrong. She complained of discharge and tiredness, two symptoms of cervical cancer, but she says her concerns were dismissed and put down to her pregnancy.

She also had Crohn's disease, which seems to be linked to cervical cancer risk. On July 4, 2016 she went to A&E where she was put down for an ultrasound in October and sent home, despite the fact that she was bleeding on the floor.

Her cancer was finally diagnosed only in September that year. She also seems to have been given an all-clear at the start of last month, despite the fact that she is now riddled with cancer. So it's not as simple as one false negative, one 'acceptable' mistake in reading a test.

And anyway, this story is not about missed diagnoses now. An inquiry will ultimately determine whether CervicalCheck had an abnormal amount of false results. It would seem from the audit already conducted that there were many cases where tests were badly read.

Presumably the reason Vicky Phelan's case was settled was because her expert witness Professor John Shepherd said her slide showed obvious abnormalities. But Tony O'Brien has a point when he says we must await the outcome of an inquiry before we know the extent of the problems in screening.

What we can say for sure is that these women were subsequently treated like dirt by the HSE, and that this was clearly acceptable, and part of the general culture. No alarm bells were raised for the head of that organisation by a memo that treated these sick and dying women merely as a potential PR problem. The thing that mattered most to the HSE about these women was that one of them would go public, and the HSE's energies were directed toward managing that situation. And this was clearly the normal thinking in the HSE. Patient has problem. Patient has potential inconvenience. Patient has wild card, emotional, doesn't get it, likely to blab and cause a scene if told the truth.

Of course you could argue that ass covering remains the central focus here. One of the main things to be ascertained last Thursday seemed to be that no Health Minister, especially Leo, had seen the memos in question. Leo didn't recall seeing them, and he had someone check it post-haste. Leo got a good result. As did Simon Harris, as did both their advisers.

Never mind that no one, like O'Brien, or Tony Holohan, thought it even worth telling a minister or an adviser about this situation. Never mind what that says about what was considered normal in the HSE. No one told the ministers, and that's what matters now to the ministers. They got the all-clear. But then, these things are not an exact science. And the truth is powerful stuff, and can be unexpected.

And there isn't a lot we can do for these women, so we must at least try to do right by them in any way we can. So none of these powerful men should rest easy yet.

Sunday Independent

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