No triple assessment as promised, staff without specialist expertise and outdated equipment created a recipe for disaster in Portlaoise, writes Eithne Donnellan, Health Correspondent
The current fiasco in relation to breast cancer services in Portlaoise dates back to 2000. The eminent Prof Niall O'Higgins, in a report on the development of services for symptomatic breast disease across the State, stated that the population of the midland region "marginally" supported a single breast unit.
The report specifically said there was a case to be made for locating the breast unit in Tullamore, Co Offaly, because of its geographical location in the midland health board area and because "this would fit in" with previous decisions made by the health board to locate chemotherapy and pathology services there.
However, after heated debate, the midland health board decided in mid-2001 to locate the breast cancer unit in Portlaoise, where there would be breast surgery and mammography services; and an outreach service would be provided in Mullingar, Co Westmeath, where there was already a small breast cancer service.
With breast cancer services in the region then spread across two sites or more, there was no triple assessment provided for patients - which would mean a patient's diagnosis being discussed and decided on by a multidisciplinary team - as had been envisaged.
Instead consultant radiologists, often locums, decided single-handedly whether mammograms on breast cancer patients showed up anything unusual. Some patients, when there were doubts about their mammograms, were sent forward for further radiological tests or biopsies. Otherwise they were given the all clear.
It was as a result of what was perceived as too many patients being sent forward for further tests that the current review of mammograms at the Midland Regional Hospital in Portlaoise was ordered.
The review was announced by the HSE on August 31st last, the same day it sent a consultant radiologist at the hospital on administrative leave. It said at the time it was performing a review of the practice of one consultant radiologist.
However, it emerged this week that the review is covering the work of a number of consultant radiologists, including locums, who worked at the hospital since November 2003.
In all just over 3,000 mammograms are being reviewed by Dr Ann O'Doherty, a consultant with BreastCheck and Dublin's St Vincent's hospital. To date seven women have, on the basis of this review, been told their cancers were missed and they were wrongly given the all clear. Another six patients are undergoing further tests before they will know if they too were misdiagnosed.
Ironically the main concern, which precipitated the review, was that there were too many women being falsely assumed to have breast cancer on the basis of their mammograms and the view was that they were being unnecessarily sent forward for further tests, which undoubtedly were costly. The concern was aired by the director of nursing at the hospital to the local hospital network manager, John Bulfin, on August 15th, 2005. She expressed concern about 10 false positives, in particular.
The review now under way will establish why so many women were misdiagnosed - whether it was as a result of human error, whether the concerns of radiologists in relation to the need for further tests on patients were followed up, or whether old mammography equipment at the hospital was a factor in this debacle.
But already questions are being asked about whether the HSE and the Department of Health acted speedily enough when concerns about the state of radiology services at Portlaoise first came to light. Taoiseach Bertie Ahern told the Dáil on Tuesday that the first Minister for Health Mary Harney knew of concerns about the situation in Portlaoise was in late August this year.
However, it emerged on Wednesday that a surgeon at the hospital, Peter Naughton, had written to Harney on July 4th, 2005, expressing concern that radiological services at the hospital were were being provided "by people who have no expertise in this area".
He went on to describe the service as "a shambles" and pointed out that he would not like his own wife to use it. Expressing extreme frustration at the lack of progress on improving things he wrote: "Nothing has happened to encourage me that things will be different next year or the year after."
Harney told the Dáil she had referred the surgeon's concerns to the HSE. The HSE said the local hospital network manager spoke with Naughton about his concerns and offered to pay for second opinions of mammograms, an offer subsequently taken up by consultants in the hospital.
This was happening by December 2006, Harney said, with women being sent for second mammograms in St Vincent's if required.
But despite Naughton's concerns about staff not having appropriate expertise, a general consultant radiologist was given a permanent post in November 2005, even though she had no specialist expertise in the reading of mammograms. This consultant is now on administrative leave.
Furthermore, it is now known that staff at the hospital continued to express a variety of concerns about the service on offer. About a year later, on December 13th, 2006, the manager of Portlaoise hospital received a letter from radiology department staff saying they were worried that their mammography equipment was old and there was a risk its poorer images could result in tumours being missed, leaving the hospital open to litigation.
The machine, though 15 years old, was not faulty when inspected in May this year, the HSE says. It also stresses that it is mammograms from this machine that are the subject of the current review, which has already found seven women were given a delayed cancer diagnosis.
Nonetheless, equipment of that age is unlikely to be performing at its best and BreastCheck has pointed out that none of its equipment, for example, is more than seven years old. From all that is known so far about the awful events in Portlaoise, it appears Russian Roulette was being played with women's lives: no triple assessment as promised, staff without specialist expertise, and outdated equipment created a recipe for disaster. And those in authority who were aware of the problems on the ground didn't tackle them with the urgency that was required.
Laois Fine Gael TD Charlie Flanagan called last night for an independent inquiry into what happened at the hospital from 2001 on.