Miriam Lord: Scally report exposes a heartless, paternalistic culture

Scally has shown up a noxious current in Irish medicine in all its arrogant swagger

Dr Gabriel Scally has published a 200-page report into the CervicalCheck scandal. The report says the current policy and practice in relation to open disclosure in the health service was “deeply contradictory and unsatisfactory”. Video: Bryan O'Brien

 

Page 20, chapter four, paragraph ten: one stark, matter-of-fact observation. A brisk sentence easily lost among the competing pages of extraordinary quotes, uncomfortable detail and damning conclusions.

It reads like a line from a textbook on Irish medical history, mislaid at the printers and inadvertently dropped into the Scally report on the cervical cancer scandal.

“There was a period when women’s health was taken very seriously.”

When might that have been? (Hint: it’s not now.)

During the Brehon Laws?

In the wake of Catholic Emancipation?

When the men marched off to war?

No. It was in 1997, writes Dr Gabriel Scally, “when the then health minister established the Women’s Health Council with a remit to advise the minister, and other ministers, on all aspects of women’s health”. This council had a long and comprehensive list of functions.

As time went by it was decided that this council should be “integrated” into the Department of Health and the HSE. After years of huffing and puffing, this was supposedly achieved in 2008.

“It is probably more accurate to refer to it as having been a ‘disappearance’ rather than a ‘merger’ ”, Scally tartly concludes.

He says it would be “presumptuous” of him to recommend its return, but he wants to see “women’s health issues” given serious and consistent attention once again.

He wants Ireland, in the year 2018, to bring back those halcyon days when the health of Irish women was “taken very seriously” by the people who call the shots in the medical system.

In this day and age, that’s astonishing.

And what’s equally astonishing is that the Government and the Minister for Health have solemnly pledged to act on this recommendation and make sure that the health issues of half the adult population are now afforded proper consideration.

Because the concerns of women, as the appalling treatment of the cervical cancer patients in Scally’s report demonstrates, are too easily and routinely overlooked.

Arrogant assumption

The investigation specifically addresses the ordeal endured by more than 200 cancer sufferers denied their own information by clinicians who arrogantly assumed these women had no right to know. Only one in five of the women affected was informed at the time the information about the smear test audits became available.

Others, like Vicky Phelan, had to wait years more to know the truth about their diagnoses, along with all the wondering about whether they could have approached their treatments differently had they had the full facts that bit earlier.

“The anger of many woman and families about how they have been treated in respect of disclosure is intense and raw,” notes Gabriel Scally.

The scandal emerged earlier this year after it was revealed that 221 women who developed cervical cancer had had their test results audited by Cervical Check but the majority were never told.

And when they were, the manner in which most of them were told was dreadful: inappropriate, unsatisfactory, damaging, hurtful and offensive were among the words used by the author.

His 170-page report, with its 50 recommendations, is shot through with direct quotes from the women and family members caught up in the “demonstrable deficit of clear governance” at CervicalCheck. The quotes are highlighted in shaded boxes throughout the text and they elevate the subject matter of this exercise to a different emotional level.

“I believe that these serve to highlight the real, lasting damage done to these women and their families and to ensure that their voices are heard.”

Some of the things said to those women by doctors and consultants would make your toes curl.

The heartlessness and hauteur, the arrogance, condescension and insensitivity of certain clinicians who either didn’t want to get involved or couldn’t be bothered, leapt from the pages.

The woman whose consultant couldn’t look her in the eye.

The consultant who said “what difference does it make?” to the woman who asked why she hadn’t be told. The same one who answered “Watch the news” when the woman asked how she would be informed in future.

And the one where the consultant repeatedly mentioned that the patient was a smoker while pointedly remarking “nuns don’t get cervical cancer”.

Or the one who wouldn’t answer any questions and ushered the woman out the door of his office.

And so on.

CervicalCheck was like a clown-car of an operation for much of its existence. The concept of “open disclosure” only “filtered down” in 2014, and that was by coincidence, apparently after a staffer got a HSE email on the topic because they were still on the email distribution list from a former hospital employer.

In the case of CervicalCheck’s audit of the test results, material relating to “the decision about how the women should be informed did not include any suggestion that the woman herself might have a say in the matter.”

A terrible mess, but systems, in theory anyway, can be fixed. Minister for Health Simon Harris was out of the traps early yesterday promising a big fix. All of Scally’s 50 recommendations, and more, would be implemented.

Three outcomes

The campaigners want three main outcomes – the truth; “someone, who means it, to say sorry”; and assurances that this won’t happen again.

Not so easy, one suspects.

“One key point that surfaced on several occasions was that most of the doctors involved in the disclosure (and non-disclosure) process were male,” Scally points out, because sometimes the obvious must be stated.

Understandably, the women began to think the awful attitudes towards them “were accounted for by paternalism in the health system”.

None of this should matter when mandatory disclosure is introduced, which the Minister has now promised. Of course, it should already be the law, except that the Civil Liability Bill was amended before it was passed last November and mandatory disclosure became voluntary.

Seemingly it was done at the request of the HSE. According to Minister for Justice Charlie Flanagan, who moved the amendment, it was to “promote a climate of cultural buy-in”.

In his excellent report, Gabriel Scally has shown up that noxious culture in all its paternalistic swagger. Time to close the closed shop.

Who now is innocent enough to believe that the way the women in the cervical cancer scandal were treated by the medical profession is a one-off?

The Scally report may be down to the bravery of those women and their families, but they have fought for all the women of Ireland.

This climate change can’t happen fast enough. The culture is bad. No more buying in from the HSE. We’re not buying it any more.

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