BreastCheck director calls for mediation forum to deal with false negatives

Doctors concerned that spiralling legal costs could lead to the screening programme being closed down

 

The national clinical director of the BreastCheck programme, Professor Ann O’Doherty, is calling for a mediation forum including medical, legal and counselling services to deal with any cases where a breast cancer diagnosis was missed by screening.

Doctors involved with the BreastCheck service have expressed strong concern that spiralling legal costs could lead to the screening programme for breast cancer being closed down.

In the past two weeks , Prof O’Doherty told RTÉ’s Morning Ireland, she had received 15 legal letters while in the previous 30 years of her work with the service she had not received more than one a year.

“I think we need to have some kind of forum where the legal profession, the medical profession and counselling and other services come together and afford women the opportunity to have a settlement that is commensurate with any damage and doesn’t divert huge tax payer funds to legal costs and expert witnesses.

“That really is the issue, in order for us to be cost effective we need to be screening women and reducing mortality by 20 per cent.”

Prof O’Doherty said that the programme has to be cost effective. The service is well funded, but that money is needed to provide screening services, not for paying legal costs.

“We know we don’t detect all cases, that’s not human error, it’s an inherent risk of the service.”

She explained that 9.6 per 10,000 cases are not detected, “but we pick up the vast majority.

“We know false negatives are going to happen.”

Any patient diagnosed with breast cancer who requests her screening history is provided with that information, she added. “If they want a review we will do so. If they do this then it is important to have counselling services.

Prof O’Doherty said that the only country that has open disclosure was the UK and it had taken many years for that service to be implemented. BreastCheck is working towards that situation, but it would be 2019 before it could be introduced.

Oncologist Professor John Crown defended screening services in Ireland saying that they are among the best in the world.

However, he warned that “people have to understand the arithmetic”. BreastCheck and CervicalCheck cost €70million a year to run, he said while the cost of law suits “would be many times the current cost of running the programme.”

Professor Crown explained on RTÉ’s Today with Sean O’Rourke show that screening is not diagnostic. “Screening tests are lower tech, it is not precision medicine.”

The test given to someone symptomatic is different from a screening. If a mistake is made at that stage, then there is accountability, he said.

Doctors in Ireland are many times more likely to be sued than in the UK, he added, with Ireland second only to the US in terms of litigation.

Prof Crown pointed out that both the invitation letter to a screening and the results letter both state that screening is not a guaranteed “all clear” and advise that if there are problems then the patient should go see their doctor.