The women, from the midwest, were being treated at the colposcopy clinic at University Maternity Hospital Limerick (UMHL).
Their charts were forwarded to Gráinne Flannelly, then clinical director of CervicalCheck, by Kevin Hickey, consultant obstetrician and gynaecologist at UMHL.
Dr Flannelly subsequently wrote to Dr Hickey to say she had attached the review of 10 cases and highlighted those “suitable for a communication of the results (if they wish, and there are no other circumstances which make this inappropriate)”.
He replied that there were other women where the review process called into question the outcome of their original smear report and he questioned whether they should also be told of the review and its outcome.
On June 20, 2017, Dr Hickey wrote: “You have highlighted three ladies... there were other ladies where the review process had altered their original smear report and it looks from your notes that you have felt that these should be filed in the patient’s notes and that no review is necessary.
“I just wanted to confirm that you are happy with this whole process centrally from the Cervical Screening Unit given that it looks that some of the review smears were different from the original.”
Dr Flannelly replied: “Yes — a balance needs to be struck in deciding who needs a formal communication of the outcome of the audit. The possibility of resultant harm is crucial.”
Dr Hickey wrote again on July 11, 2017, saying he felt more than three cases merited open disclosure:
There are a number of others that look as though there are significant discrepancies and we are somewhat uncomfortable about just recalling the three that you have highlighted.
Out of concern for these other women, Dr Hickey said his unit had “taken it upon ourselves to discuss the findings with these patients of their audit smear results”.
This action was not something Dr Hickey was keen to pursue, as highlighted in repeated correspondence with Dr Flannelly. He felt CervicalCheck should be responsible for passing on the outcomes of audits it conducted to the women who took part in its national screening programme.
The exchanges between Dr Hickey and Dr Flannelly are contained in discovery documents obtained by the legal team representing Vicky Phelan, who ended up developing cervical cancer after a smear test failed to detect cancer warning signs.
Ms Phelan, 43, from Co Limerick, took a case against CervicalCheck and the US lab that analysed her smear tests and it emerged, during her case, that at least 209 other women with cervical cancer also had information withheld from them in relation to false negative smear test results.