Agony before secrets laid bare

After 19 days at the cervical screening inquiry, FRANCESCA MOLD reviews the key evidence.

GISBORNE - The last woman to appear at the Gisborne cervical cancer inquiry agonised for weeks before she gathered courage to lay bare her most intimate secrets.

She had planned to give evidence about the death of her mother from cervical cancer in secret but at the last minute decided to go public.

Her evidence, at the end of the first five weeks of the inquiry, wrenched the focus back from debate over health reforms, quality assurance for laboratories, contractual relationships and politics, to the reason it was originally formed.

The woman spoke of the trauma of learning her mother was terminally ill and watching the cancer ravage her body for several years until she died in 1999.

She also shared details of her own battle to recover from an overdose of morphine pills she took because she could not cope with her mother's illness.

The Herald cannot publish all of her story because it would breach a suppression order, but it has reported that several of her mother's cervical smears appear to have been misread in the six years before her death. Three were reported by former Gisborne pathologist Dr Michael Bottrill as normal and one by Tairawhiti Healthcare reported "no cellular abnormality" but called for a new smear in six months.

By that time, the woman had invasive cancer.

The inquiry panel must consider cases like this to decide by the end of the second set of hearings in July whether there has been an "unacceptable" level of "under-reporting" of cervical smears in Gisborne.

And in its report to the Health Minister in October, it must make recommendations about action the Government needs to take.

The main points of evidence revealed at the inquiry so far include:

* Clues dating back to 1989 may have pointed to concerns about Dr Bottrill and his laboratory but were not acted on by health officials.

* Dr Bottrill may have had only three months' training in cervical cytology (cell-reading).

* The scientific validity of a rereading of almost 23,000 of Dr Bottrill's slides by a Sydney laboratory may be suspect.

* A proposal to audit the cases of 40 Gisborne women who developed invasive cervical cancer in the past 10 years could be stymied by section 74A of the Health Act which forbids the release of information about women enrolled on the register.

* A group called Kaitiaki, set up to act as a "gatekeeper" for the release of cervical screening information about Maori women, may be making it difficult for researchers and health officials wanting the information for statistical reports and evaluation of the programme.

* Expert advisory groups set up before the inception of the screening programme in 1990 have been consistently ignored by the Government.

* The screening programme has been "piggy-backed" on to the health system and forced to ride out constant reforms throughout the 1990s rather than being set up as a stand-alone agency as initially recommended.

* The split in responsibility between regional health authorities and the Ministry of Health in the mid-1990s may have been detrimental to the programme.

* Health officials relied largely on the association of pathologists with professional bodies to ensure their competency, but ethical rules and standards set by the Australasian Royal College of Pathologists and Association of Community Laboratories are not mandatory for members.

In the final section of hearings beginning on July 3, the Health Funding Authority will present the long-awaited results of their investigation into the Gisborne misreading.

The high point in July is likely to be the appearance of Dr Bottrill and his cross-examination by lawyers representing women whose slides he misread.

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