Telling woman of audit results would not have changed prognosis – consultant
Terminally ill woman (37) breaks down in witness box in case against the HSE and labs
Ruth Morrissey and her husband Paul Morrissey are pictured at the Four Courts on Tuesday. Photograph: Collins Courts.
A consultant obstetrician has disagreed before the High Court that, had he told a Limerick woman in 2016 of audit results of her smear slides, she would have got treatment and be probably facing life now rather than death.
Dr Matthew Hewitt said he did not inform Ruth Morrissey for nearly two years of the audit results, which showed her slides had been incorrectly reported as negative, because he forgot to do so.
When he met the now terminally ill Ms Morrissey in July 2016 soon after getting a letter from CervicalCheck on the audit results, he forgot about the letter filed in the patient’s notes, he said.
He has hundreds of letters coming all the time relating to cancer diagnosis and could not say he remembers “every single letter”.
When Jeremy Maher SC, for Ms Morrissey, put to him, had she been told about the audit results in 2016, she would have got a scan and treatment and in all probability, would now be facing life rather than death, he disagreed. “I don’t believe the cancer would have been necessarily visible or present,” he said.
Asked by Patrick Hanratty SC, for the HSE, if the manner of his follow up in Ms Morrissey’s case departed in any way from international guidelines, Dr Hewitt replied: “None whatsoever.”
At the outset of Mr Maher’s cross-examination, Dr Hewitt said he completely acknowledged it is awful Ms Morrissey has had a recurrence and wished her all the best. He did not miss the cancer recurrence, he said.
Asked what prompted him to tell Ms Morrissey in May 2018 of the audit results, Dr Hewitt said there were instructions from the HSE to tell patients immediately. When the first letter came from CervicalCheck in January 2016, there were no clear instructions, he said. He did not feel it necessary to tell patients and it was a screening test, not a diagnostic test. He said he changed his mind later as he became uncomfortable with having the information.
Asked did he accept Ms Morrissey had raised the possibility of a scan on three occasions, Dr Hewitt said it would not surprise him because patients frequently asked. If he felt it was affecting their patient doctor relationship or the well being of the patient, he would do a one off scan, not for clinical reasons, but to reassure the patient. There was no evidence MRI or CT scans were of any benefit in such cases for reasons including those could give false positive results and lead to patients having potentially invasive, unnecessary procedures.
He did not think it could be ascertained exactly when Ms Morrissey had the recurrence.
He did not believe she was at a higher risk of recurrence based on the fact the original tumour was small and the depth was not one to make her high risk.
Scans are not part of a routine follow up, he said.
Earlier, Ms Morrissey broke down in tears as she told how she had put her trust in her consultant to monitor her after she had surgery to remove her first bout of cervical cancer.
She said her consultant should have spotted the recurrence of her cancer which was diagnosed last year. He did not see it for over three years, she said.
Ms Morrissey, who has at maximum two years to live, was recalled to the witness stand on the 27th day of her action over alleged misreading of her CervicalCheck smear slides.
She said she trusted Dr Hewitt to give her the required surveillance and, on three occasions, asked for scans, ultrasound or other imaging.
When Mr Hanratty, for the HSE, put to her the question of imaging only came up after she knew of the audit review of her cervical smear slides last year, she disagreed and said she asked for imaging for three and a half years.
When counsel put to her the consultant had explained scans would not be routine follow up after her procedure in 2014 to remove the cancer from her cervix, she agreed he “did tell me it was not part of the surveillance”.
In her action, Ms Morrissey and her husband Paul Morrissey, of Monaleen, Co Limerick have sued the HSE and two US laboratories, Quest Diagnostics Ireland Ltd with offices at Sir John Rogerson’s Quay, Dublin along with Medlab Pathology Ltd with offices at Sandyford Business Park, Dublin 18. It is claimed there was an alleged failure to correctly report and diagnose and misinterpretation of her smear samples taken in 2009 and 2012 and her cancer spread unidentified, unmonitored and untreated until she was diagnosed with cervical cancer in June 2014. 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 but she was not told until May 2018 of those results which showed her smears were reported incorrectly. The HSE admitted it owed a duty of care to Ms Morrissey but not her husband. The laboratories deny all claims. The case before Mr Justice Kevin Cross continues.