Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

At the outset, I commend the bravery of Ms Vicky Phelan. Without her determination and fight, this scandal probably would never have come to light and those affected and their families may never have known the truth.

Truth, compassion, and honesty should be evident at all levels of our health service, and even more so at the higher institutional levels of our screening programmes, our hospitals, and the HSE. Nobody is saying for a moment that a health service can be run without human error but when a mistake is made, there should be an apology and the relevant parties must be informed. The reality could not have been more different for Ms Phelan and those women affected by misdiagnosis or, indeed, for the potential considerable number of cases only notified to us this evening.

The scale of the problem is still not known. That is outrageous. There are women who are watching this who are very concerned. There are women who are watching us this evening who are not aware of their own medical records. That is outrageous.

When we look at what has happened, we see the response of the State was to fight a terminally ill woman and her family, to force her to give evidence in a courtroom, to talk about her personal life, her health and her sex life in a room full of strangers. It was then to try to force that same woman into a confidentiality agreement so that she could not speak about what had happened. That was the response of the State. The response was for CervicalCheck to tell doctors treating women to exercise their judgment on whether to tell them about the misdiagnosis and to "simply ensure the result is recorded" if any of the women affected by this had died in the meantime. It should not be at the whim of a doctor to exercise judgment in whether to inform a woman where her health is at risk, and even more so in the incidence of a misdiagnosis. We have the right to know.

Where we should have truth, compassion and honesty, we had malice, vindictiveness and dishonesty. How did the scope for this dishonesty materialise? Why is it not mandatory for the health service to disclose errors and to always tell the truth?

We saw it in this House on 8 November 2017. On a vote on Report Stage of the Civil Liability (Amendment) Bill 2017, the Government, in concert with Fianna Fáil, which abstained, voted through amendment No. 31 which ensured that the process for open disclosure would be voluntary and not mandatory. I welcome yet another U-turn on this issue and I hope that we will now see mandatory reporting - voluntary reporting is simply not good enough. We in Sinn Féin opposed making it voluntary. We voted to make it mandatory but we lost.

A year earlier in a Joint Committee on Health debate on open disclosure, I argued forcefully for mandatory open disclosure. Indeed, I argued for it again on Leaders' Questions with the Taoiseach, Deputy Varadkar, on 21 February last in light of the case of Ms Alison McCormack, who had a breast cancer misdiagnosis. The practice of keeping quiet when things go wrong is often prevalent in our medical culture and only a statutory duty of candour will address the situation. I welcome that the need for mandatory open disclosure with legislative underpinning is now accepted right across this House but it should not take a scandal to achieve this.

The gendered nature of this scandal is not lost on me, my friends, my daughter, my mother or any of the women who are affected by this. In fact, many women who contacted me have said they are not surprised at the failures of the health service and the State as regards how it treats women. The Minister described it as "bizarre". No woman who has spoken to me about it has described it as bizarre. Unfortunately, it seems to be par for the course. We are not surprised at the gendered nature of this.

Three times in the past six months I have taken Leaders' Questions and raised significant issues which solely affect women. In November last, I raised the issue of the drug Epilim and the side effects for children born to women who took the drug while pregnant. In January, I raised the transvaginal mesh scandal, and in February, I raised the case of misdiagnosis of breast cancer. Men often talk about historic injustices perpetrated against women in this State but when we women talk about it, we talk in terms of the present day. This scandal reinforces for women why we should be afraid of the gendered nature of our health service and how the State treats us.

The outsourcing of women's healthcare through testing of smears in the United States was warned against in 2008. Concerns were raised at that time by Dr. David Gibbons, the chair of the cytology-histology group within the quality assurance committee of the National Cervical Screening Programme. I want to know whether complaints were made at that time to HIQA and how HIQA responded to those complaints because when we know that we will be able to judge whether HIQA is, indeed, the correct authority to undertake this investigation. The then CEO of the National Cancer Screening Service, the outgoing head of the HSE, Mr. Tony O'Brien, insisted that it would be possible for doctors to talk to the person who analysed the smear test in the United States through teleconferencing. There is no evidence that this happened and the Minister might be able confirm that for us.

The then Sinn Féin health spokesperson, Deputy Ó Caoláin, criticised the 2008 decision of the Fianna Fáil-led Government to outsource the screening service during a Dáil debate, stating: "The Minister for Health and Children would rather listen to corporate executives in the private health business". The Deputy went on to state that the "HSE has awarded the contract for cervical cancer tests to Quest Diagnostics, a US company that has an unacceptably high rate of errors and has been convicted of fraud." Deputy Ó Caoláin has been proved right and the issue of outsourcing must be incorporated into any investigation.

The Minister must explain to this House if any concerns were raised with the Department of Health over the past ten years regarding the outsourcing of these tests and if any internal concerns were raised about the efficacy of the tests. Were any audits carried out on the companies concerned and does Clinical Pathology Laboratories still hold a contract with the State for smear tests or any other screening or diagnostic work?

The Minister says he became aware of Ms Phelan’s case on 17 April. Was he aware of the audits from 2014 and subsequent analysis of the misdiagnosis which was continuing since 2017? Tony O’Brien has said he only found out about the issue when he heard of Vicky Phelan’s case from the media. I find it hard to believe the Minister only found out on 17 April but it is even harder to believe that Mr. O’Brien found out from the media. I do not see it as plausible. The State was being sued for a substantial sum of money. Surely the nature of the case and the cost involved would have sent alarm bells through the HSE, the Department of Health and up to the level of Government.

The Minister articulated his lack of confidence in the leadership of CervicalCheck last week. It will be interesting to ascertain his confidence in Mr. O’Brien and in his role in this scandal. Maybe it is the case that their fortunes are inextricably intertwined and it might account for his reluctance to relieve him of his duties. The general public would also welcome a statement from Eunice O'Raw, general counsel for the HSE, on the decision of the HSE to fight the case of Vicky Phelan and on what information was provided to Ms O’Raw regarding the case by the HSE and what information she provided to the HSE and the Minister.

The toxic culture of concealment and harassment pursued by the HSE and the Government against women who have been wronged by this State is now in full public view. It is a disgrace that the State, the Government and the HSE consistently behave the way they do when such cases arise. It is unacceptable that agents of the State pursue victims of their failures and do so in such an aggressive manner. They behave this way because they take their cue from Government. The Minister must ensure that other affected women are not forced to fight the State through the courts as Vicky Phelan and others have been made to do.

I will finish by saying that in the course of my work before I was elected, I had occasion to represent people who were engaged in a dispute with the HSE. I have seen how vicious and aggressive it is when it pursues people. I have seen people's lives destroyed by the HSE, some by virtue of the fact they were whistleblowers and others by virtue of the fact that they found themselves on the wrong side of a reported incident and of which they were subsequently found innocent. I have seen what the HSE and the machinery of the State is like when it goes up against an individual. For that reason, I commend Vicky Phelan on what she has done. She should not have had to do it.

Nobody believes the health service can be run without error or risk but they demand that it will show compassion and be truthful and honest. That is not what has happened to date. The people deserve better than this. Vicky Phelan deserves better than this. The victims of misdiagnosis deserve better than this. Not only do the women of the State deserve better, but we demand better than this. I hope for the Minister's sake that he has the answers the women of Ireland seek this evening.

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