The resignation this week of the head of the 26 County Health Service Executive (HSE) has added to demands for full accountability in a scandal over cut-rate cancer testing and a subsequent cover-up which has claimed the lives of 17 women.
A total of 209 women should have received earlier intervention in their cancer diagnosis.
The discovery that cervical cancer testing had not been carried out in an effective manner only emerged after one of the victims, Vicky Phelan, refused to sign a confidentiality cause in her successful High Court challenge.
It emerged this week in memos from March 2016 that officials at the HSE were focussed on coping with the media fallout of the scandal and had advised that letters warning patients of incorrect smear test diagnoses be suspended.
After weeks of defiant bluster, the position of HSE boss Tony O’Brien (pictured) became impossible following the release to the Public Accounts Committee of the Dublin parliament of three extraordinary memos he had received on the background to the issue of cervical screening audit findings.
They expressed concern about a risk that communicating individual audit findings to doctors could result in patients going to the media with stories that the cervical screening process did not diagnose their cancer.
Drawn up in March 2016, they said the HSE planned to “pause all letters” regarding the audit findings and continue to prepare a reactive communications response for a possible media headline that said “screening did not diagnose my cancer”.
Earlier in the week, Emma Mhic Mhatuna, a 37-year-old mother of five from Kerry, spoke out to relate her anger at discovering she had terminal cancer after previously receiving a clear result from the HSE’s Cervical Check programme.
“The 2013 smear said that I was healthy when I wasn’t. And because of that then, I developed cancer. And now I’m dying,” she said.
“And if the smear test was right and I was told that by my gynaecologist, who is over three hospitals so he knows his stuff, this guy is amazing. He told me himself that if my smear test was right in 2013, I wouldn’t be where I am today.
“That’s what makes it so heartbreaking. I’m dying while I don’t need to die. My children are going to be here without me, and I’m going to be without them. I tried to do everything right by breastfeeding and being a full time mum and sacrificing my own life for them, and now I’m going to miss out. I don’t even know if my little baby is going to remember me.”
She added: “The government need to go. They’re not actually - and I’m not being insulting, it’s genuine - they’re not actually capable of minding us, and that is their job. To make sure that we’re okay.”
But news that O’Brien had finally resigned raised her spirits.
Ms Mhic Mhathuna said: “It’s long overdue and it’s a disgrace in the end that it took me to the point here I had to break down for that to happen.”
Limerick woman Vicky Phelan, whose High Court case brought the scandal to light, said that while the resignation came later than it should have, she welcomed it.
“A win is a win as far as I’m concerned. It’s a small victory for women. I think it’s the beginning of a cultural shift”.
There was little sign of that in Fine Gael. The Minister for Health Simon Harris refused to accept that he should have sacked O’Brien over the scandal, even in light of the apparent cover-up by the HSE. He is also now facing calls to resign, as is the Taoiseach Leo Varadkar, who was Minister for Health while the cover-up was ongoing. Both have denied any knowledge of the controversial memos.
Much now depends on who was aware of the plan to outsource the testing as well as the fallout over its failure. A ‘scoping inquiry’ has been ordered ahead of what is expected to be a public, judge-led Commission of Inquiry.
Other systemic failures within the HSE, including mismanagement in the maternity units of hospitals in Portlaoise and Ballinasloe which have cost the lives of seven babies in recent years, may also be included.