Over the last decade or so, the investigation and diagnosis of breast cancer in Ireland has improved greatly. These changes occurred in large part because a few women stood up against a bad system, told their story and took legal action that forced our government and health services to change the way symptomatic breast care is delivered.
Before 2008, if a woman felt a lump in her breast and went to her GP, she was at risk that the only treatment offered was to be sent to a local hospital for a mammogram - that is an x-ray examination of the breast. That mammogram might be read in isolation and if the radiologist found nothing sinister, the woman might be given the ‘all clear’. This happened in many cases where the mammogram was either misleading or was read incorrectly with the tragic result that the woman went home relieved, carried on with her life and the opportunity for early diagnosis and treatment was lost. In too many cases that Cian O'Carroll medical negligence solicitors have worked on, that delay proved catastrophic for the woman and her family. Many lives were lost needlessly and the cost to families has been immeasurable. In most of those cases, there were young families left behind.
Clearly a great deal of good came from this loss of life and the system changed, which is not what we normally see in medical negligence practice. Mary Harney was the Minister for Health at the time and she responded to these cases. Eight specialist centers were established for the investigation of what is called Symptomatic Breast Care and a protocol was enforced whereby these centers looked not only at a mammogram but also used ultrasound, biopsy of the lump and a clinical review with a team of specialists reviewing each case in what are called Multi-Disciplinary Teams (MDT). Treatment was also concentrated in these centers of excellence and by focusing and developing the specialist medical expertise into these eight centers, it was inevitable that the skills and experience of the MDT members would grow, further improving outcomes. It has been a major, if generally un-celebrated success story of our health services. It is the kind of improvement that our clients would be proud to have been a part of; indeed several of them lived to see it happen and knew their part in it.
That however is not to say that delays in diagnosis do not still occur. Some private hospitals or radiology clinics continued to offer 'stand-alone' mammography and because private hospitals fall outside the remit of HIQA, they are effectively unregulated by the State. They are of course subject to the usual Medical Council governance, for whatever purpose that serves - and in the experience of this practice, this doesn't amount to very much.
Before 2008, if a woman felt a lump in her breast and went to her GP, she was at risk that the only treatment offered was to be sent to a local hospital for a mammogram - that is an x-ray examination of the breast. That mammogram might be read in isolation and if the radiologist found nothing sinister, the woman might be given the ‘all clear’. This happened in many cases where the mammogram was either misleading or was read incorrectly with the tragic result that the woman went home relieved, carried on with her life and the opportunity for early diagnosis and treatment was lost. In too many cases that Cian O'Carroll medical negligence solicitors have worked on, that delay proved catastrophic for the woman and her family. Many lives were lost needlessly and the cost to families has been immeasurable. In most of those cases, there were young families left behind.
Clearly a great deal of good came from this loss of life and the system changed, which is not what we normally see in medical negligence practice. Mary Harney was the Minister for Health at the time and she responded to these cases. Eight specialist centers were established for the investigation of what is called Symptomatic Breast Care and a protocol was enforced whereby these centers looked not only at a mammogram but also used ultrasound, biopsy of the lump and a clinical review with a team of specialists reviewing each case in what are called Multi-Disciplinary Teams (MDT). Treatment was also concentrated in these centers of excellence and by focusing and developing the specialist medical expertise into these eight centers, it was inevitable that the skills and experience of the MDT members would grow, further improving outcomes. It has been a major, if generally un-celebrated success story of our health services. It is the kind of improvement that our clients would be proud to have been a part of; indeed several of them lived to see it happen and knew their part in it.
That however is not to say that delays in diagnosis do not still occur. Some private hospitals or radiology clinics continued to offer 'stand-alone' mammography and because private hospitals fall outside the remit of HIQA, they are effectively unregulated by the State. They are of course subject to the usual Medical Council governance, for whatever purpose that serves - and in the experience of this practice, this doesn't amount to very much.
Breast cancer misdiagnosis and BreastCheckOur team of medical negligence solicitors at Cian O'Carroll Solicitors have also seen errors with the non-symptomatic screening program called BreastCheck and errors in the staging of a diagnosis – where tragically the opinion of one hospital was overruled by the treating hospital and the cancer was treated less aggressively than it ought to have been leading to recurrence of the cancer.
The work of improving patient safety will never be done, mistakes will always happen simply because we all make mistakes, but adherence to the carefully researched protocol for the diagnosis of symptomatic breast cancer queries at one of the eight centers of excellence is currently the best way to ensure a timely diagnosis. |
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Breast cancer misdiagnosis cases
One recurring feature of all the breast cancer misdiagnosis cases we have worked on stands out however. In virtually every case, the woman, while naturally delighted to be told her scan was ‘clear’, deep down she doubted it. Something didn’t feel right and in most of those cases she persisted and sadly often experienced either resistance to further investigation or had a second incorrect result. Sometimes this happened even a third time and in one extreme case, there were four successive errors which when rechecked by the independent experts that we asked to review the case were all found to have been grossly negligent – right back to the first.
Of course, by the nature of the work we do here, our perception of the quality of care generally given is skewed. We mostly see the errors and their consequences, not the many wonderful success stories of a health service that for the most part works well and achieves good outcomes for its patients. Our job then is to establish the medical facts, get an opinion from a senior expert in the relevant field, be it radiology, histopathology or breast oncology and if such medical expert states that there has been an unacceptably poor standard of care that caused harm or loss to our client do we act. Such cases tend to move very quickly, often lasting just several months due to the nature of the disease and the focus is on providing for the best possible care for my client as ‘patient’ and providing – for the future – for her family and their needs. There are no happy scenes of celebration at the end of such cases. Sadness prevails every task but it is necessary work that we have the experience to lead.
Of course, by the nature of the work we do here, our perception of the quality of care generally given is skewed. We mostly see the errors and their consequences, not the many wonderful success stories of a health service that for the most part works well and achieves good outcomes for its patients. Our job then is to establish the medical facts, get an opinion from a senior expert in the relevant field, be it radiology, histopathology or breast oncology and if such medical expert states that there has been an unacceptably poor standard of care that caused harm or loss to our client do we act. Such cases tend to move very quickly, often lasting just several months due to the nature of the disease and the focus is on providing for the best possible care for my client as ‘patient’ and providing – for the future – for her family and their needs. There are no happy scenes of celebration at the end of such cases. Sadness prevails every task but it is necessary work that we have the experience to lead.
LocationIndaville, Boherclogh, Cashel, Co. Tipperary, E25 V448
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