I'm dying when I don't need to die

May 12, 2018 8:07 AM

As Ireland prepares for a referendum on abortion, the country is gripped by a health scandal over cervical cancers that were missed by a US lab, found via a later audit, with the results never communicated to the women involved. The whole scandal only came out because a terminally ill Vicky Phelan refused to sign a gagging agreement in return for a settlement, winning her case and making the scandal public. Also terminally ill, Emma Mhic Mhathna has spoken out demanding answers and heads to roll. Other families are only now being notified of the situation. The directly of the HSE, responsible for overseeing healthcare in Ireland, Tony O’Brien has resigned reluctantly but only after attacking TDs frustrated with him. The number of dead is still unknown, and not all the women involved (209) have been contacted.
posted by lesbiassparrow (27 comments total)

.
This is horrific.
posted by AnhydrousLove at 8:30 AM on May 12, 2018 [4 favorites]

Vicky Phelan is a legend. Her composure is extraordinary and her unwillingness to agree to the gagging clause will have saved lives, but the stress they put her under is unforgivable considering SHE WAS FUCKING BATTLING TERMINAL CANCER BECAUSE OF YOU CRIMINALS!
posted by Wilder at 8:45 AM on May 12, 2018 [21 favorites]

Did I miss somewhere in the articles why exactly Ireland was(is?) sending lab tests all the way to frickin’ Texas??
posted by romakimmy at 8:53 AM on May 12, 2018 [1 favorite]

I got depressed gathering the links to this, so didn't include it, but the answer is they were cheaper. The Irish labs were better, but cost more.
posted by lesbiassparrow at 8:55 AM on May 12, 2018 [17 favorites]

I would really like to think that if I were the victim of some kind of egregious corporate or governmental wrongdoing and I were offered a fat settlement check in exchange for my silence, I would have the courage to say FUCK YOU, ASSHOLES and go to court. Vicky Phelan is a hero.
posted by Anticipation Of A New Lover's Arrival, The at 9:00 AM on May 12, 2018 [25 favorites]

The Irish labs were better, but cost more.

I know this horseshit happens in every capitalist industry, but for fucking real.

We have got to stop looking for fucking cost savings at every turn when it comes people's fucking health.

I mean, Christ, the long-term benefits alone of having a fucking healthy society are massive...
posted by deadaluspark at 9:31 AM on May 12, 2018 [26 favorites]

So what about all the offices in the US that used the Texas lab? Are women there dying as well because of this mistake?
posted by congen at 9:36 AM on May 12, 2018 [22 favorites]

...cervical cancers that were missed by a US lab...

WTF? You'd think other nations would know better than to ever involve any part of the US health system for their services, no matter how low the cost.

Deep respect to Vicky Phelan.
posted by Thorzdad at 9:38 AM on May 12, 2018 [8 favorites]

So the Irish patient samples were sent to several labs in the US. The one in Texas, at least, appears to use better procedures for US patient samples. Both the labs and the Irish governments should be dragged for allowing tests to be done with shoddy standards for cost savings.
posted by congen at 9:43 AM on May 12, 2018 [15 favorites]

This is awful.

What's a "TD?"
posted by rhizome at 10:08 AM on May 12, 2018

What's a "TD?"

Member of parliament
posted by ArbitraryAndCapricious at 10:12 AM on May 12, 2018 [1 favorite]

Thank you, I should have googled. [insert morning coffee excuse]
posted by rhizome at 10:23 AM on May 12, 2018

I live in Austin and the murderers at CPL have done at least one of my past labs. I am seeing a new OBGYN on Wed. I already put down a deposit on an IUD (nevermind that they're "free" now, but I have to cover the doctors cost to order the thing out of pocket before they will charge my insurance and reimburse me) before I read about this. I am not looking forward to the awkward conversation where I ask "so, where are you sending my labs?" because if they say CPL and I say hah, hell no, there goes my IUD deposit. I'll have to go to another OBGYN in network who doesn't contract with CPL to get my "free" preventative care, and who knows if there are any; CPL is massive here. I guess I should be more thankful I'm not dead or dying but can't muster that feeling, just rage at how disposable women are no matter the outlines of the system that is supposed to care for them.
posted by slow graffiti at 10:55 AM on May 12, 2018 [9 favorites]

I'm having a hard time sorting out exactly what happened. Why did the lab (or labs: I can't figure out if this was all a problem with one lab or not) initially give the wrong results? Was it a problem with the lab, or did the Irish government decide only to pay for a cheaper but inferior method of evaluating the tests?
posted by ArbitraryAndCapricious at 11:01 AM on May 12, 2018

Holy shit
posted by bq at 11:50 AM on May 12, 2018

Without wishing to defend the HSE's secrecy around this issue it's not clear to me that there is, as yet, any evidence that the screening process fell below international standards for a cervical screening programme. A proportion of false negatives is expected in any screening programme and this issue came to light when the HSE audited the smears of women who had developed cancer following a 'normal' smear. More on this in the links below:

As yet there is no evidence that our [Ireland's] screening programme is substandard.

Dr Ciara Kelly: Despite everything, women should still feel reasonably secure that checks work

Dr Kelly's Twitter. Susan Mitchell's Twitter .
posted by roolya_boolya at 11:54 AM on May 12, 2018 [2 favorites]

Let’s leave aside to question of the qualifications of the pathologists at CPL for now, hired because they were the low-bidder. This is one of the allegations of a class action suit in the US.

An audit of Pap smears from 2011 on was conducted in 2014. The HSE was informed of the erroneous results in 2014 but did not notify, contact, or recommend repeat screening for the affected patients.

It’s the cover-up. Heads should roll and the HSE management should see some significant prison time.
posted by sudogeek at 12:01 PM on May 12, 2018 [34 favorites]

What sudogeek said. They knew *four years ago* that there were issues with at least 209 tests from from 2011 to 2014. They did nothing, apparently in the hopes the women would die quietly rather than HSE facing embarrassment. That should be grounds for *criminal* proceedings, in my opinion.
posted by tavella at 12:37 PM on May 12, 2018 [26 favorites]

24 years since the blood transfusion scandal and it seems that nothing has been learned.
posted by kersplunk at 12:55 PM on May 12, 2018 [2 favorites]

As I understand it the issue with the US labs is that they have a lot more work to do, so miss a larger percentage of problem scans, but the frequency of routine retests the US is higher. But the issue here is not really with the labs, it's the failure to tell women they were sick until it was too late.
posted by GallonOfAlan at 4:24 PM on May 12, 2018 [2 favorites]

At the very least - I hope that this moves some voters into the YES column as an example of healthcare being all about information and having all options available. The fact that this incredible failure affected women only should sharpen the point and overturn the abortion amendment to the Irish constitution.

Also Wikipedia tells me that Varadkar was Minister of Health in '14. How is that playing out?
posted by drowsy at 5:32 PM on May 12, 2018 [1 favorite]

My god, they're monsters. What punishment would be sufficient? Something Old Testament, maybe?
posted by aramaic at 7:01 PM on May 12, 2018

Regarding Varadkar, an article today revealed that memos about this were directed to him in 2014. To quote the piece: “One memo, compiled when Leo Varadkar was the Minister for Health, warned of the need for a plan to deal with headlines such as 'screening did not diagnose my cancer'.”

This is coming to light now in a batch of correspondence released by Mr. O’Brien. I don’t know if the scandal will take Varadkar down, but there will be tough questions. The scandal could have been covered up to clear the way for his ascension to Taoiseach.
posted by sudogeek at 8:05 PM on May 12, 2018 [3 favorites]

I'm having a hard time sorting out exactly what happened. Why did the lab (or labs: I can't figure out if this was all a problem with one lab or not) initially give the wrong results? Was it a problem with the lab, or did the Irish government decide only to pay for a cheaper but inferior method of evaluating the tests?

I am not sure we know any of the true answers yet, as the story changes day by day for the worse. There will be an inquiry which is supposed to sort out who knew when what and so forth within a short time frame.
posted by lesbiassparrow at 4:54 AM on May 13, 2018 [2 favorites]

As I understand it the issue with the US labs is that they have a lot more work to do, so miss a larger percentage of problem scans, but the frequency of routine retests the US is higher.

Reading between the lines, it sounds to me like the standard protocol in the US is to test for HPV at the same time as the pap smear test. If the HPV test is positive, they upgrade to evaluating the pap smear sample using computer imaging, which is more expensive and more accurate. In the US, at least, almost all women with cervical cancer also have HPV. So basically, the lab technicians are used to a situation in which they're using computer imaging on any sample that is at all likely to be positive, and they're only manually evaluating samples that are almost certainly negative. I'm wondering if they're sloppier about manual evaluation than techs would be in labs where they were routinely manually evaluating high-risk samples.
posted by ArbitraryAndCapricious at 7:19 AM on May 13, 2018 [4 favorites]

> it sounds to me like the standard protocol in the US is to test for HPV at the same time as the pap smear test. If the HPV test is positive, they upgrade to evaluating the pap smear sample using computer imaging, which is more expensive and more accurate.

Other way around. If your pap comes back with any abnormalities, even minor, THEN they do an HPV test on the sample that checks for just the several strains of HPV that are responsible for most cervical cancer.

They don't proactively test every normal pap for HPV because most people contract and clear the virus many, many times with zero complications. It's basically not medically relevant unless it causes cellular abnormalities.

In the US, at least, almost all women with cervical cancer also have HPV.

Just to clarify, yes, almost every single case of cervical cancer worldwide is caused by HPV.

/cervical cancer survivor in the US
posted by desuetude at 8:06 AM on May 14, 2018 [1 favorite]

And the HSE has just released a bunch of documents relating to the crisis.
posted by lesbiassparrow at 1:06 PM on May 15, 2018