Victims of this scandal deserve an end to spin
The management of the Scally review was a perfect example of the cold and cunning capacity of the State - in the guise of the permanent Government - to defend itself from attack.
Since this story broke from the High Court settlement of Vicky Phelan's case on April 25, an effective, even ruthless, rearguard action of damage limitation ensued.
Irrespective of politicians, any battle between ordinary citizens such as terminally ill cancer patients and State interests is a mismatch. Just like the hepatitis C Blood Transfusion Board disaster (1994-2004), officialdom deploys every tactic to minimise damages, legally oppose and even subtly undermine victims. Those tactics ultimately cost taxpayers €1bn.
A concerted stealth campaign sought to defuse the CervicalCheck scandal. Neither the terrible truth of how 'false-negative' smear test results were wrongly given as healthy "all-clears" to trusting women, nor the officially sanctioned concealment of wrong results would have come to light without litigation.
Solicitor Cian O'Carroll, whose persistent tenacity finally obtained justice for women, has found himself demonised in some quarters for his efforts.
The deliberate leak of one partial aspect of Dr Gabriel Scally's report this week was the latest sinister tactic to spin this story. None of the 50 recommendations were leaked. What was selectively fed to some media was that Dr Scally believed there is no need for a commission of inquiry.
This amounted to clear manipulation to get ahead of or distort the news. The objective was to set the agenda by drawing a line under deeper personalised probes. All this was done without recognising the fact that commission decisions were beyond Scally's specific terms of reference.
Dr Scally's review couldn't name names, nor compel or cross-examine witnesses under oath. It did not have statutory sworn powers. Neither Departments of Health or Finance, HSE, State Claims Agency, State Solicitor's Office nor especially the laboratories want any judicial probe.
Their strategic response to the 221 women, 18 of whom have already died, has been to create an alternative narrative that emphasises three key points.
Firstly, they refute any reference to the word "misdiagnosis", arguing the screening process isn't a diagnostic test, that it was always the case that the accuracy and certainty around locating pre-cancerous cells from smear slides was an inexact, 80pc, science.
Secondly, they reject any reference to the term "negligence" in relation to false negatives, saying this wasn't proven in court, only because cases have been settled on the basis of no admission of guilt.
Thirdly, while creating confusion as to whose precise responsibility it was in not revealing the audit details of the 1,482 cases among GPs, hospital clinicians or CervicalCheck itself, they insist communication of the information made no difference to the patients as they were already separately diagnosed with cervical cancer.
Moreover, recently, they've indicated the entire cervical screening system runs the risk of being abandoned unless the State renews contracts with laboratories on the basis of providing a taxpayer indemnity against any future liability compensation claims. Apparently, laboratories won't touch Irish screening due to the controversy.
Additionally, they've peddled that a prospective change to different screening tests, based on HPV tracing, means this dated laboratory process will soon be in the past. So put this sorry saga behind us. Move on. Focus on the HPV vaccine uptake levels.
This is a self-serving agenda. It cleverly diverts the deeper discovery of the truth. The full facts about the accuracy of the laboratories' slide analysis is at the heart of this disaster. Dr Scally's overly trusting assurances about existing contractors is based on ensuring continuity. US regulations may yet prove deficient.
Only the peer review by the UK's Royal College of Obstetricians and Gynaecologists into the 3,112 cases, adding the additional 1,630 women from the National Cancer Registry, will reveal negligence or culpability of particular US laboratories, which carried out 50pc of the analysis. Dr Scally didn't scrutinise slides.
Dr Scally's rejection of an official cover-up defies published evidence before the Oireachtas committees. There were deliberate attempts to deny patients access to their own medical records. A protocol was put in place by the HSE/Department of Health/CervicalCheck to deliberately not communicate directly to patients their audit results of false-negatives.
A paternalistic culture of concealment, leaving discretion to the patient's clinicians, is the most benign attributable explanation. The wording of memos released to the Public Accounts Committee revealed a much more pernicious purpose. False-negative cases were being revealed at the rate of four to six a month. The fear was that patients would go to the media or lawyer-up if they were armed with the full scale of failed cancer detection.
Defying HSE policy of full open disclosure since 2013, since these results became available, from 2014 there was a calculated denial of the duty of candour. These culprits weren't outed by Scally.
Government has floundered since May, with Taoiseach Leo Varadkar and Health Minister Simon Harris making unsustainable promises. Mr Varadkar promised a redress scheme, subsequently repeatedly insisting mediation would replace litigation.
Dr Scally delivered nothing on redress, only a lousy ex-gratia €2,000. Victims may continue to litigate from Monday. Vague references to 'no-fault' systems are mere tokenism to dying patients.
None of the timetables for each of the four inquiries (Scally, Hiqa, Judge Charles Meenan and peer review) has been met. Legislation on mandatory disclosure is still not enacted.
Creating a culture of accountability in the HSE, the largest public organisation, is best achieved by harsh judicial process. Painful lessons of Garda reform were that only when bosses forfeit posts is lasting change achieved.
Victims were told this week any commission would halt implementation of Scally's recommendations. It's untrue, an implicit intimidating threat.
As more women die, their legacy demands an outcome that goes beyond Scally's 50 creditable recommendations. We need to know which laboratories incorrectly read slides. And how. We shouldn't be blackmailed into offering indemnities under duress.
Vicky, Emma, Irene (RIP), Ruth and unnamed victims deserve unstinting public support - we must call out the suspicious spinning that seeks to diminish their cause.