Future of breast screening at risk over payouts

The growing threat of legal action and multimillion-euro payouts are putting the future of the national breast screening programme at risk, it has been claimed.

BreastCheck’s national clinical director, Ann O’Doherty, said her biggest fear was that the litigation was going to be so costly that politicians would stop funding screening and put the resources into symptomatic breast cancer services.

Prof O’Doherty said she has worked in breast screening for 30 years and would not have more than one medico-legal case a year. 

In the last two weeks, the BreastCheck screening unit in Dublin’s St Vincent’s Hospital, where she works as a consultant radiologist, has been notified about 15 potential legal actions.

She told the Oireachtas health committee that escalating legal costs could make BreastCheck unsustainable.

“What my great concern is in this country is that the litigation is going to cost so much that [politicians] are going to come to us and say we are going to have to stop screening because it is costing so much.”

Arnie Hill, a consultant surgeon at Beaumont Hospital and adviser to the National Cancer Control Plan, echoed her fears.

Prof Hill said if 100 women with breast cancer underwent a mammogram, the disease would not show in 10 of them.

If these women got a good solicitor, he said, they could each get up to €1m. These payouts would increase in the future and that would be unsustainable.

He said: “There needs to be urgent medico-legal reform and we have known this for a long, long time.

The problem is that you have vested interests that will block it. We have a great programme. It is saving lives. It is doing really well and I would really encourage you to try and make sure there is balance in this.

Prof O’Doherty said they are not against a payout where a woman has been harmed and an error has occurred.

“But it should be commensurate with the error and it should not be dependent on the most aggressive solicitor.

“What we were thinking, when we were talking about it, is not that women should not be compensated, but that there should be some sort of mediation process because we are really scared that we will not be able to continue screening.”

The director of the HSE’s national screening services, Damien McCallion, said the State Claims Agency was dealing with four alleged misdiagnoses cases involving BreastCheck. These are at a “tentative” stage.

Prof O’Doherty told Labour’s Alan Kelly she was only aware of the HSE having written one letter of apology to a patient in the South of Ireland in the past year.

Mr Kelly said he was aware of the case and that the letter was issued in February. He said he was a “massive supporter” of BreastCheck but there is a need to figure out the scale of the misdiagnoses and find out if there is a bigger issue.

Prof Hill said it would be routine to offer a “look back” at the screening records of a patient diagnosed with breast cancer but less than 10% took it up. Most were focused on their treatment.

He told Fianna Fáil’s Stephen Donnelly a patient was always told if a “false negative” had occurred.

Prof O’Doherty said BreastCheck would introduce open disclosure early next year and has already designed the consent form.

Earlier, the Academy of Clinical Science and Laboratory Medicine told the committee that the decision to outsource the analysis of cervical smear tests was “short-sighted”.

In 2008, a decision was taken to tender for screening cytology and that resulted in the service, previously undertaken in hospital laboratories in Ireland, being largely undertaken by laboratories in the US.

The academy’s president, Irene Regan, said the Irish laboratories that tendered for the service in 2007 and 2008 were told they had scored highly in all areas except cost.


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