Monday 17 December 2018

We can't allow more victims of this rotten culture

The HSE culture of denial, deflection and dysfunction has never been publicly challenged by any government, writes Miriam O'Callaghan

BATTLE: Brigid McCole
BATTLE: Brigid McCole

Miriam O'Callaghan

Eighteen years ago, a mother hung, atomised, like a plume of Saharan dust, over the whole of Dublin Bay. For weeks, she might have shimmered as the fog-horn pulsed long and low over the city limits of the Irish Sea. Or watched ferries, small sailors, sandpapery swimmers, dog-walkers, power-walkers, still-tethered souls haunting the East Pier, calculating how high, how deep, how long.

In truth, she has no idea what she did in those weeks. She remembers only how she got there. In a coastal clinic, she'd expected to discuss with a doctor, test-results for her small son. Instead, with tanned hands and dazzling cuffs, the doctor produced a rocket-launcher from the manila folder on his desk. Shot her, point blank, in the chest. Afterwards, only her severed legs made it to the car park, the rest of her was blown so small, far, high, that the capital C between Howth and Bray seemed to her like the nail-tip of a newborn.

But then the man with the rocket-launcher contacted the atomised woman. He'd noted equally dramatic results in another patient, asked the UK lab to retest. The results were wrong. Based on them he had made a misdiagnosis. She could do as she wished. Not only was this man behaving impeccably as a doctor, he was behaving impeccably as a human. Here was full, immediate disclosure. No delay, no conditions, no cover-up. Far from running to lawyers, she recommends him to this day, because in a crisis, he can be trusted to do, not simply what is 'correct' by external controls, but to do what is right within himself.

If Vicky Phelan had known of the mistakes in her results, she says she wouldn't now have a terminal-cancer diagnosis. She has been mesmerising the country with her strength, dignity, resolve. We point her out to our daughters: 'See Vicky Phelan? That, my girl, is how to be a woman'. The gaps she has exposed in quality-assurance, disclosure and communications in the health services contracted and operated by the State, could save women's lives. Critically, it was Ms Phelan, and Ms Phelan alone, who brought this information to the public, fighting a try-on gag order to do so. CervicalCheck, the Department of Health and the HSE, all paid for by the State, all knew this audit information. All said nothing. Why? Because of the HSE's lethal secrecy and its cultural refusal to afford dignity, show respect.

Small continents of words are being written, read and posted about Ms Phelan and the CervicalCheck scandal. Generally, people accept that mistakes will be made. What concerns them is how they are managed. The Government is frantic to show us how seriously it's taking it. On our screens Leo Varadkar looks wan. Simon Harris is melting like a Dali clock. On radio, Regina Doherty shares her own cervical history to the degree we can hear the jingle of the speculum. Stop, love.

Individually, they are good people, sincere in their efforts. But so were Enda Kenny, Brendan Howlin and Micheal Martin. I could go on and on, in the same way the HSE scandals go on and on, because learning curves are granted by governments ad infinitum, expensive lessons involving malfeasance found by the courts, deaths in care, rape in care, body parts removed from dead infants, the Grace case, the Ann case, Portlaoise births, are externally learned and internally forgotten. Or plain ignored.

Last week, a woman raped in foster care spoke of the HSE/Tusla "wall of silence" in her efforts to get justice. Last Thursday came the delayed report on the babies at Portiuncula, the devastation of their families. For governments though, no HSE wrong is unforgivable. Wash it in its €60m-a-year legal fees and it's whiter than snow.

Even without CervicalCheck, this execrable HSE culture of denial, deflection and dysfunction has never been publicly challenged head-on by any government. Now, this new and young Government has a choice to make. Collectively, publicly, they can either do for the lethal secrecy, the uncaring arrogance of the HSE, or it will do for them. And by extension, that culture will go on doing for us, in loss after loss, scandal after scandal. The Government has heard this before, but since ministers realise they can't even trust the information they're bringing to the Dail, now it might listen.

The Government wants to do right. But its position is precarious. Crucially, it allowed the Department of Health to dissuade it from legislating for full disclosure and almost immediately was living with the consequences. Furthermore, the department considers Ms Phelan's case, involving delay in disclosure and a diagnosis of terminal cancer, not to be "a patient safety" issue. Its blithe memo references to Ms Phelan's court case and attendant publicity are revelatory. They prove that, like the HSE, the department is relentlessly focused inward on the well-being of the institution, not outward on the people it's paid to serve. The memo shows the department - and the HSE, which Ms Phelan was forced to take to court - have learned nothing from the experience of the institutional savaging of Brigid McCole in the Hep-C scandal. Or if they did, they chose to ignore it. Simply because they can.

Not content with poisoning Brigid Ellen McCole, the State pursued her, harassed her, even as she died. It was only at the end of her life that the State accepted liability, apologised, offered to settle. Even then, its capacity for vindictiveness wasn't spent. If she were to persist in seeking punitive/exemplary damages and fail, the State would pursue all additional costs. When the State threatened the dying woman, it already knew it was legally liable. It threatened her simply because it could. The subtext? 'Fight us Brigid, and though we're wrong, and we know it, we'll terrify you on your deathbed that your children will lose both their mother and their home. Nobody will stop us.'

In her report on the crisis, Judge Alison Lindsay found "there should be greater co-operation and exchange of information among the doctors". The health services promised to learn. Politicians swore, never again. Yet, here's Ms Phelan, with eminent doctors corresponding over her head for 15 months, having to sue the HSE to get the truth. Having settled with the US lab, her HSE case was struck out. If by chance she had lost, the State would do as it does, hound her for its costs. Because no minister ever took the risk - or the opportunity - of tackling the vicious HSE culture.

The facts the Government faces are stark: 17 women dead, cause of death yet unknown. Other women with false-negative smears, now with established, advanced or terminal cancer. Possibly 3,000 women involved. Last week, Emma Ni Mhathuna, who received a false-negative result and developed cervical cancer, was debating whether to have her two boys, Seamus and Mario, Confirmed at the same time. Mario is only in 4th Class. She doesn't need to elaborate.

Consequently, the women of Ireland are worried, particularly those with past issues. Last Tuesday, I phoned the helpline. The woman was lovely. Could tell me nothing. Took my details. Booked me a call-back. I'm still waiting. By contrast, giving the same information to the Wellwoman Clinic, they could tell me, immediately, where my free, annual smears had been tested: The Coombe.

But women are worried, too, that despite the delays and the cancers and the scattergun information, and Ms Ni Mhathuna's boys and their Confirmation, Tony O'Brien is still head of the HSE. The Government has not asked for his resignation. He, himself, "declines" to give it. He deems the CervicalCheck scandal "a personal blow" to him, vows to work on it until he retires. He says he learned about the CervicalCheck scandal from the media. As did the HSE's Director of Communications. Really. But Mr O'Brien is not Joe Public slathering on the Kerrygold to the jingle for Morning Ireland. He's the head of the HSE. It's his job, his responsibility, to know the CervicalCheck issues. Inexplicably, the Government gave the HSE head permission to take on another health-related role in the US, while still in his State position.

This Government, more than any other, is exquisitely sensitive to the optics of its work, the public perception of its performance. It must be relieved that while there were large public protests in solidarity with the complainant in a rape case in another jurisdiction, there isn't a street-peep or a placard about CervicalCheck. Presumably #WeBelieveHer.

But the publicity sensitive Government is now facing a major test. In its urgent need to get to the truth - and so demonstrate its own accountability - will it prioritise the women of CervicalCheck and the patience of the populace, over the declinations and desires of the HSE head? Will Varadkar make history by being the man who napalmed the lethal secrecy, the uncaring arrogance of the HSE? Publicly, finally.

But what the Government does about CervicalCheck could be irrelevant to some women, particularly those currently receiving calls, because they can act independently. Given the lack of confidence in the HSE, a woman who believes her cancer could have been prevented, found or treated earlier, can go to her local garda station, make a statement and ask gardai to investigate the matter under Section 13 (Reckless Endangerment) of the Non-Fatal Offences Against the Person Act 1997.

The benefits of a Garda option are threefold. Since a Garda investigation supersedes all other inquiries within the HSE, it could be speedier than that initiated by the Government. Secondly, she removes her case from the vagaries of political expedience, the survival of the Government, the dysfunction of the health services. Thirdly, instead of risking yet another report where nobody is responsible for anything, she has the chance to see real accountability in the justice system, if damage has been done to her and her family.

Brigid McCole died 22 years ago, poisoned by the State. Speeches were made, apologies proffered, inquiries launched, reports written. Nobody was accountable.

Today, Vicky Phelan is in the headlines. If this asphyxiating, mutilating culture continues, in 22 years, who will be the new Brigid, the new Vicky? Look at your beautiful daughter, reader. Will it be her?

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