Earlier this year on the 25th of April Vicky Phelan stood on the concrete steps of the high court and told the media of the deliberate concealment of an oversight in what was deemed to be a routine smear test back in 2011. She was not informed of the blatant abnormalities that should have warranted further examination and subsequent treatment. Three years later in 2014, Phelan’s test results were reviewed following an audit which included an investigation of the smears of ten women in total, three of which would later die from the progression of their cancer. That year Phelan underwent a second smear test which detected the possibility of cancerous cells within her cervix. This case features countless unnecessary and prolonged delays at crucial intervals in Phelan’s illness. Her own personal physician was not told of the bleak prognosis until 2016. A further year had passed before Phelan was informed of the diagnosis. At the beginning of this year she was told she had between six to twelve months left to live. She was given €2.5 million. In the days that would follow questions involving the competency of the screening programme Cervical Check and the HSE as a whole were tossed around in the media and discussed fervently in the Dáil. The minister for health Simon Harris was confronted by the public who sought for their fears to be assuaged. However Vicky conceded on a late-night Irish talk show that she was urged to sign a contract with a confidentiality clause, which condemned her from speaking publically on her misdiagnosis before she received any compensation. Alan Kelly offered an apt warning to politicians who scurried to find a fitting solution, stating the common consensus lead to a belief of “one big, massive cover up.” She refused to be silenced and a lengthy court case ensued.
The Cervical Check programme began in 2008, as a free screening service offered to women aged between 25 and 60. Every year 80% of the female population of age who are invited to avail of the service do so. Despite the controversy Phelan advocated for women to continue to engage in regular smear testing, stating “I think cervical smears do save lives.” In the immediate aftermath of Phelan’s admissions on the steps on the high court to a barrage of microphones Dr Grainne Flannelly relinquished her position as the clinical director of Cervical Check over mounting pressure surrounding her perceived accountability. She left saying she wished to thank those involved in the programme for “their continued hard work and commitment towards delivering a first-class service for the women of Ireland.” There was a huge disparity between the “first-class service” Flannelly spoke of and the blatantly fractured healthcare organisation that forced a terminally ill woman to navigate her way through a gruelling court system. With the veil of pretence ripped away, it presented itself as a gaping black chasm in the ground that people wanted to fill with words and weighty promises but women kept getting swallowed up. The HSE revealed over 200 cases, involving cervical smear results that should have prompted earlier action. Flannelly was publically praised by the HSE and quietly left.
An official inquiry into these events, known as the Scally Report has begun and will investigate the extent to which the state’s treatment of women’s health has been grossly violated and neglected. Phelan’s test among countless others had been outsourced to a lab in the US. Information involving the various test anomalies of over 162 women were withheld and only uncovered after audits and further investigation. Of the women that were diagnosed with cervical cancer following detection by the screening service 1,500 of those did not receive further review to decipher if the disease could have been potentially pin-pointed at an earlier date, or screening. It is now the task of cytologists from the Royal College of Obstetricians and Gynaecologist to assess the screenings that predate all the cervical cancer diagnoses made by Cervical Check from the programme’s inception in 2008 to the present, scanning a full decade of screening history for of hundreds of women, to distinguish further liability.
At the time a feverish cut-throat debate gripped hold of the country on whether or not the constitution should be altered in regard to the eighth amendment in which the State acknowledged “the right to life of the unborn and, with due regard to the equal right to life of the mother.” The cervical cancer check controversy was largely coloured by the context in which it found itself. Pictures of unborn foetuses were hung on bus shelters, billboards and electrical polls, adorn with words like murderer and kill, yet mothers were having their lives abruptly taken from them by a neglectful healthcare system and were in exchange given a wad of cash for their trouble. As Miriam Lord noted “another day in the Dáil and another gallop of TD’s into the chamber to agonise over the latest sorry episode concerning this states disordered relationship with women from the waist down.”
A similar blatant disregard for female anatomy occurred in the Irish medical profession with the use of a barbaric procedure that was pervasive in many maternity wards around the country from the 1940’s up until the 80’s before it was banned outright. Many women were subjected to symphysiotomies, in which the cartilage and ligaments surrounding the pelvic region or the bone itself were cut during child birth, to artificially widen the cavity and ensure a “natural” birth. These operations were often done without consent, and led to severe health complications that spanned many decades. Symphysiotomies were grim explorations in medieval medical practices that were derived out of a simmering disdain for the female body. The Catholic Church largely endorsed symphysiotomies as an alternative to caesareans which they largely condemned due to the belief the procedure deviated from the religious dogma of the time, one that was highly stifling and conservative. Decades later court cases involving the women who had encountered such cruel treatment at the hands of the health service and state unfolded. These women were elderly. Their fingers twisted from arthritis. Their hair had turned white and silver. The minds of some of these women had been wiped clean from the fog of Dementia, or Alzheimer’s. Their family spoke of the horror, of their mother, grandmother having a baby but having to teach herself how to walk again. These women were too dragged through the Court system for months to reach an adequate settlement for their suffering, and anguish, women who were elderly and who were likely to pass at any time were made fight for the money that was rightfully owed to them. The minister for health at the time was the now Taoiseach Leo Varadkar. The country has a flippant disregard for woman that has become internalised in so many institutions, the medical practice being just one of many. The gross negligence that is rife in the Cervical Check programme is now being largely refuted by the Dáil who previously vowed to support the women at the very heart of this controversy. Harris and Varadkar walk a finely plucked tightrope. They are passing the accountability to the Clinical Pathology Laboratories (CPL) in Austin Texas, the labs they outsourced the Irish smear tests to from 2010 to 2013. They themselves outsourced 1/3 of the Irish tests to various labs around the US, which were subsequently tended to by staff who only occupied training roles within the company. CPL also failed to supply appropriate accreditation with regard to the standard necessary to meet competency requirements, which was a blatant breach of their contractual obligation. The government have made it clear their desire to settle with the women affected, and then subsequently pursue the American labs they outsourced their tests to. However the government will require a series of court cases involving the women affected to adequately ensure the accountability does not lie at least partly with them, and the negligence of those operating within the HSE. Dr Scally condemned the matter as a “whole system failure.” The remarks made by one physician told by the family of a woman who has since died was unearthed in the ongoing inquiry. The woman was told “nuns don’t get cervical cancer.” I can write pages and pages about women’s bodies and religion and the paternalistic nature of medicine and the” god complex” it has the capacity and tendency to evoke but I think that single statement sadly says it all.
