A senior medic yesterday told the High Court he raised concerns about the outsourcing of the smear slides of Irish women to US laboratories 11 years ago and warned of "problems in the long term".
Dr David Gibbons resigned as chair of the Cytology/Histology Group within the Quality Assurance Committee of the National Cervical Screening Programme along with seven others after raising their concerns in 2008.
"We were very worried. We felt it would cause problems in the long term," he said.
He told the High Court up to eight Irish testing laboratories were "mothballed" when the first contract for testing of the Irish smear tests was given to a US laboratory in 2008.
A consultant pathologist, Dr Gibbons was giving evidence on the ninth day of-of the action by terminally ill Ruth Morrissey who has sued the HSE and two US laboratories over the alleged misreading of her smear slides in 2009 and 2012.
Dr Gibbons told the court that data from slides which had been tested by US laboratories around 2008 showed 2.4% of all slides tested in Irish laboratories reported pre-cancerous cells whereas the US laboratories he said found 40% less.
He said the US had a low sensitivity test but a shorter recall time of one year compared to Ireland at the time which had a three-year recall.
He said he and other pathologists raised their concerns about outsourcing with the then head of the National Screening Service Tony O'Brien.
"We were very worried, we felt it would cause problems in the long term," he told the court.
He said the main problem was that two different systems were being put together and you could not have low sensitivity testing with a long recall interval.
"You run the risk of missing pre-cancer over a period and there was a danger of allowing cancer to develop that would not have developed otherwise," he said.
There was a huge furore at the time about the issue.
Cross-examined by Patrick Hanratty SC for the HSE, Dr Gibbons when asked if he had a grudge against the HSE over outsourcing, said he "certainly didn't."
It was the ninth day of the action by Ruth Morrissey and her husband Paul Morrissey of Kylemore, Schoolhouse Road, Monaleen, Co Limerick who have sued the HSE and the US laboratory 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 there was an alleged misinterpretation of her smear samples taken in 2009 and 2012. A situation it is claimed allegedly developed where Ms Morrissey’s 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 review results which showed her smears were reported incorrectly.
The HSE the court has already heard admitted it owed a duty of care to Ms Morrissey. The laboratories deny all claims.
Earlier US laboratory CervicalCheck Programme Manager John Gleeson said US laboratory Quest Diagnostics questioned the need to release the results of audits on Irish smear tests but it was short-lived. He said he did not agree with the Scally Report which referred to Quest Diagnostics disagreeing strongly with the release of audit information.
Mr Gleeson said a legal letter arrived but he would not say they strongly disagreed but they questioned the need for it.
“It was short lived and put aside,” he added and he presumed the laboratory was concerned about litigation.
Ruth Morrissey's counsel Patrick Treacy SC asked why the results of the audit review of her smear slides were sent to Ms Morrissey's treating consultant in 2016, one year and two weeks after they became known.
Asked what was the explanation for the delay of over a year, Mr Gleeson said: "We were working on a historic caseload, we got to Ruth Morrissey in June 2016."
Mr Gleeson was also asked about the Quest Diagnostics laboratory contract with the HSE and that Ruth Morrissey's 2009 slide was sent to a laboratory in Grands Rapids, Wyoming which it is claimed was not specified in the HSE contract.
Asked by Mr Treacy if he heard about the Wyoming laboratory before he was asked in court about it’ Mr Gleeson said it was raised in the Scally Report and before that his immediate response was he did not remember hearing that name.
Asked if the slide had been sent to a laboratory not agreed with the HSE, he said he would be unhappy to learn about it. He said he would be unhappy "if it were done without our say so".
The case before Mr Justice Kevin Cross continues tomorrow.