Cervical screening expert tells of ‘missed opportunity’

A cervical screening expert has told the High Court there was "a missed opportunity" to treat a woman when he believed, "on balance", that pre-cancer was present in 2012.

Cervical cancer, “on the balance of probabilities”, was there in 2012 when a smear slide tested by MedLab laboratory was reported as negative, Dr Michael McKenna said.

He was continuing his evidence on the fourth day of Ruth Morrissey’s resumed action against the HSE and two US laboratories over alleged misreading of her cervical smear slides.

Ms Morrissey, who is seriously ill with cervical cancer, was diagnosed with the disease in 2014 and it reoccurred last year.

On Friday, Dr McKenna, a consultant cytopathologist in charge of one of Northern Ireland’s four laboratories responsible for screening cervical smear tests, said he believed, if Ms Morrissey had been brought back three months after a MedLab test in 2012, he believed a test would have given an abnormal result, whether high or low grade.

The recommended recall of three years on the MedLab test was inappropriate and there was a missed opportunity to refer Ms Morrissey for treatment, he said.

Acceptable standard

“The recording of the sample by MedLab fell below the acceptable standard of care,“ he said.

Dr McKenna said he knew the 2012 slide was going to be inadequate before he tested it. He said 5,000 cells are required on a smear slide “for you to be certain” and he considered the 2012 MedLab slide to be inadequate and scanty.

It took him less than a minute to decide the smear test was abnormal, he said.

Ms Morrissey (37), and her husband Paul Morrissey, of Kylemore, Schoolhouse Road, Monaleen, Co Limerick, have sued the HSE; the US laboratory Quest Diagnostics Ireland Ltd, with offices at Sir John Rogerson's Quay, Dublin; and Medlab Pathology Ltd with offices at Sandyford Business Park, Dublin 18.

It is claimed there was failure to correctly report and diagnose and alleged misinterpretation of her smear samples taken in 2009 and 2012.

A situation developed where Ms Morrissey’s cancer spread unidentified, unmonitored and untreated until she was diagnosed with cervical cancer in June 2014, it is claimed.

It is further claimed a review of the 2009 and 2012 smears took place in 2014 and 2015 with the results sent to Ms Morrissey’s treating gynaecologist in 2016. She claims she was not told until May 2018 of those review results which showed her smears were reported incorrectly.

Claims denied

The Morrisseys further contends, if Ms Morrissey had been told the results of the smear test audits in late 2014 or early 2015, she would have insisted on an MRI and other scans. The HSE has admitted it owed a duty of care to Ms Morrissey but not to her husband. The laboratories deny all claims.

On Friday, Dr McKenna said cervical screening is not to test for cancer but to detect changes before you get cancer. When he examined the 2012 MedLab slide under the microscope, he observed a group of cells which were stained darker and were hyperchromatic which is one of the features “that could lend itself to not being benign”.

One group of cells on the slide would have been interpreted as abnormal, he said. Dr McKenna agreed with Patrick Treacy SC, for Ms Morrissey, the Republic of Ireland is the first country which has outsourced its cervical screening to two private multi national companies.

The case continues before Mr Justice Kevin Cross on Tuesday.