Friday 23 August 2019

Eilish O'Regan: 'Why 'absolute confidence' is a benchmark in the UK, but not here'

Smear test ruling: Ruth and Paul Morrissey share a kiss outside the High Court after the judgment. Photo: Collins
Smear test ruling: Ruth and Paul Morrissey share a kiss outside the High Court after the judgment. Photo: Collins
Eilish O'Regan

Eilish O'Regan

What can a woman expect when she goes for cervical screening?

If the staff in the laboratory who examine her slide have a lingering doubt, however small, that it does not look normal then should they still give her the all-clear, even if they believe on the balance of probabilities she is fine?

It is this kind of scenario referred to in a High Court judgment, which appears to have convulsed so many doctors in the past week. Judge Kevin Cross who delivered the ruling a week ago yesterday described some of the response since as "hysterical".

In his ruling in the case of Ruth Morrissey, whose smear test was found to be negligently read by Quest laboratories in the US, Judge Kevin Cross said the standard to be applied by screeners and doctors is "absolute confidence".

In other words, if there are any doubts about a result, don't take a chance and pass the slide as clear. Recommend the woman for more investigation.

On the face of it this ruling hardly seems like setting too high a bar. What would a woman choose? What if the choice was put to her?

She has a choice of being told she has nothing to worry about, even though there is a slight uncertainty.

Alternatively she can be informed there is a question mark and go for the extra diagnostic tests even though she risks side effects or, in a small number of cases, unnecessary treatment.

Judge Cross, in his judgment in the Ruth Morrissey case, said a "screening programme cannot operate safely if screeners are left to judge the slides and whether they are safe merely on the balance of probabilities".

We are told by Health Minister Simon Harris this standard is applied in the UK and other countries.

So how in the space of a few days has it led to such concern from senior doctors that if applied here it could lead to the collapse of the country's screening programmes and have wider implications for diagnostic services?

The Faculty of Radiologists, which is involved in breast and colon cancer screening, said the "absolute confidence" bar is impossible to attain and may have multiple unintended consequences - including additional unnecessary tests and procedures on patients who do not have cancer.

All screening tests are associated with a small number of false-negative results. "We are concerned that if false negative screening tests are regarded as a breach of care, this position may potentially threaten the viability of the screening programmes altogether," it said.

Its concern is this will lead to a flood of compensation cases and expensive payouts.

Doctors say the difference between Ireland and the UK in terms of screening is the higher level of litigation here.

Health Minister Simon Harris said yesterday the screening programmes will continue, but the Attorney General is looking at whether to go to the Supreme Court for clarification.

The HSE has added to the public confusion about the fallout from the judgment in the last week. Senior staff have incorrectly termed the ruling as "absolute certainty" instead of "absolute confidence". A Supreme Court clarification may be what is needed now to decide what our standard should be. Once there is legal clarity it is up to the HSE to accept it, respond and go forward.

Irish Independent

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