# Professionalism/Vicky Phelan, Grainne Flanelly, David Gibbons, and Cervical Check
## Background

In 2008, CervicalCheck was established in Ireland to provide women ages 25-60 with free cervical cancer screening. As the program was being established, contracts were settled with labs to process smear tests. Due to the quantity of tests collected, the program outsourced to labs not in Ireland, namely Quest Diagnostics and Clinical Pathologies Laboratory in the United States. Controversy regarding the program began with the main whistleblower of the case, Vicky Phelan. In 2011, she received a negative result from CervicalCheck. At the time, no one knew that the result was false. In 2014, an audit of the program revealed that Phelan's 2011 result, along with results for over 200 other women, was inaccurate. However, the women were not informed of the false negatives. In 2017, Phelan finally learned that CervicalCheck had misdiagnosed her, but many of the other women remained unaware. The case drew public attention in 2018 when Phelan took legal action against the diagnostic laboratories and the Health Service Executive (HSE), both of whom were implicit in her false negative.

## Participants
### The Victims
#### Vicky Phelan

Vicky Phelan is a lead campaigner of the 221+ advocacy group, representing the 221+ women in Ireland who were impacted by incorrect CervicalCheck results. Phelan was diagnosed with cervical cancer in 2014 following a false negative CervicalCheck result in 2011. CervicalCheck investigated the 2011 test result following Phelan's diagnosis, but did not inform her of the mistake until 2017. Phelan responded with legal action in 2018, triggering the controversy. The case settled for €2.5 million. Although Phelan originally beat her cancer, she has since relapsed and is taking part in a US clinical trial as of May 2021.

#### Emma Mhic Mhathuna

Emma Mhic Mhathuna is another prominent victim of the CervicalCheck scandal. She was a devoted mother of five, diagnosed with cervical cancer in 2016 after two false negatives with CervicalCheck. Like Phelan, Mhathuna took legal action and settled for €7.5 million. She emphasized how the hardest part for her was that she should never have gotten cancer and how she was leaving her children without a mother, after working so hard to raise them and make sacrifices for them. She remarked, "I feel like I've essentially been murdered. I should be here another 50 years. The end of life is part of God's plan but this isn't God's plan. I'm dying because of human error". More specifically, she explained, "The 2013 smear said that I was healthy when I wasn't. And because of that then, I developed cancer. I'm dying while I don't need to die". She passed away in 2018 at the age of 37.

### CervicalCheck Program
#### Dr. Grainne Flannelly

Grainne Flannelly was the clinical director of the CervicalCheck program from 2010 to 2018. On June 20, 2017, Dr. Kevin Hickey, a gynecologist in Limerick, noticed that only three women on the 2014 audit were recommended to be informed of the false results. Dr. Hickey wrote an e-mail to Dr. Flannelly to confirm the authenticity of this decision from the Cervical Screening Unit. “A balance needs to be struck in deciding who needs a formal communication of the outcome of the audit,'' Dr. Flannelly replied on July 7, "The possibility of resultant harm is crucial". She instructed the gynecologist to "simply file the (audited test) reports in the medical notes" if the patients "have not had cancer" or "have local and fertility-sparing surgery". Based on her judgment, only those three women in the 2014 audit "merited a closeout meeting". Dr. Hickey, however, still informed all the women involved. After all of the public attention in 2018, Dr. Flannelly resigned from her position at the CervicalCheck program on April 28.

#### Dr. David Gibbons

In 2008, David Gibbons, the former chair of Cytology and Histology in the National Cervical Screen Program (NCSP), had already detected the issues in cervical smear tests. Between 2006 and 2008, Ireland did not have enough resources to process every smear test. Therefore, they outsourced some of the smears to the United States. When NCSP got the cervical screening results back from the US, they noticed a significant discrepancy between the test results from American labs and the Irish labs. "We were finding 1.8 per 100 and they were finding 1.2," said Dr. Gibbons, "which was a third less”. This mismatch was due to the difference between the Irish and US systems, where women screen every year in the US and once every 3 years in Ireland. The US labs have more smear tests to process every day, which may increase the possibility of false-negative. Nevertheless, the higher inaccuracy could be offset by higher frequency of cervical screening in the US but would cause a huge problem in Ireland. Dr. Gibbons and his fellows raised their concerns to Tony O’Brien, the head of HSE, by stating that outsourcing is dangerous and “over a ten-year period, this will cause problems and the problems won’t become apparent for ten years”. However, O’Brien dismissed their concerns and "continued to push on with introducing the outsourcing," said Dr. Gibbons. Subsequently, several scientists, including Dr. Gibbons, were resigned from the NCSP.

#### Tony O’Brien and HSE

The HSE provides health services to all of Ireland. Therefore, it was directly involved in overseeing the CervicalCheck program. Days after the CervicalCheck scandal became public, the HSE released a statement saying, "over 50,000 cases of pre-cancer and cancer have been detected and treated following cervical screening". The HSE was trying to emphasize their positive impact by highlighting all the good accomplished by the program, in an attempt to save its reputation.
The head of HSE at the time was Tony O'Brien. Initially, O'Brien declined to step down from his position following the controversy. In a statement released on May 2nd, he said "I can't take full responsibility for it". O'Brien maintained that the failures of the system were not his fault and therefore that he should not be held accountable. In this way, he is very similar to the Convair employee Dan Applegate. Both men acknowledged the issues they were involved in but assumed innocence. Both Applegate and O'Brien are careerists concerned with reputation. On May 10, O'Brien was exposed as a careerist when it became public that O'Brien had known about the outcome of the 2014 audit. He knew that patients were not being told about their inaccurate results. His innocence was shattered. It became clear to the public that his original statements were simply an attempt to save face and that he was being dishonest for the sake of his career. As a result, he stepped down from his position.

### Investigators
#### CervicalCheck Tribunal

The CervicalCheck Tribunal, established in October 2020 for the hearing and determination of eligible claims, promises to provide key benefits to the victims of the scandal such as avoiding the High Court, a quick turnaround for review of claims and subsequent determination, and an emphasis on case-specific and case-sensitive accommodations. The Tribunal, however, is not supported by victims as its quick formation and inability to delay action forced victims to testify in court before they were ready. Phelan remarked that she and the other 221+ victims felt "betrayed." She says, "The Minister KNEW that the 221+ were NOT happy with the format of the Tribunal and that we would not support it, the Minister should NOT have signed the order. The Tribunal is NOT fit for the purpose." She expands, "I am really weary from all the fighting. I really thought the tribunal was a good outcome for all the women and families, yet here we are, two years later, and nowhere nearer having something that is for the women and has women at its heart". This conflict between the Tribunal and the victims mirrors that between Maya Lin and the Vietnam War Veterans during the design of the Vietnam Veterans Memorial. In both cases, the two opposing parties share the same goal (to properly commemorate and honor the Vietnam Veterans and to find justice for the victims), yet they disagree on the approach. As Maya Lin, the professional in her example, ultimately took responsibility for the integrity of the design, this comparison suggests that perhaps the professionals in the Tribunal example should be charged with leading the approach. Beyond this, the Maya Lin example elucidates that communication between opposing parties is vital for the optimal result to be reached.

#### Dr. Gabriel Scally

Dr. Gabriel Scally was the president of the Epidemiology and Public Health section of the Royal Society of Medicine at the time of the scandal. In 2018, he was appointed as the leader in the investigation of CervicalCheck. In his 170-page report on the scandal, he found the incident was the result of a "system wide failure". A main component of this failure was the complete lack of "grace and compassion" with which the program was managed. There was not enough thought about what was best for the patients. On a related note, Dr. Scally concluded that there were multiple issues with the open disclosure policy at the time, which left non-disclosure as a distinct option. Ireland's open disclosure policy in 2018 maintained that if it could be argued that the disclosure of information was not in the patient's best interest or that it might harm the patient, it was not required to disclose that information. Thus, the program was making decisions on patients' behalves, which could be viewed as inappropriate given that the patients' health was at stake. In his report, Dr. Scally set forward 50 recommendations for changes to be made in the program administration. Dr. Scally saw personal benefits from leading this investigation. He turned the investigation into a business opportunity by opening up his own consulting firm. The firm was paid €1.13 million as a result of this case alone. Therefore, Dr. Scally was possibly motivated by profit. This could have impacted his findings, specifically the extensive changes he suggested he oversee. However, Dr. Scally reported, "I’m not motivated by money... I would have done it for nothing," emphasizing that Dr. Scally does not want to appear as though he was influenced by money.

## Outcomes and Analysis

In this case, we see three prominent themes. The first is the conflict between personal interest and public interests (professionalism vs. careerism). Tony O’Brien prioritized his reputation and self-image over the victims and their health. In this way, O’Brien is exhibiting his careerism. Similarly, Grainne Flannelly chose to keep news of the false negatives from the women to preserve CervicalCheck's appearance, again exhibiting careerism. The second theme we see in this case is that empathy is an important aspect of professionalism. If O’Brien or Flannelly had put themselves in the victims' shoes or aimed to optimize others' safety, they likely would have made different choices. Specifically, they would have shifted their priority from themselves and their jobs onto the health and safety of others, making them professionals. Finally, this case shows us that transparency is critical to integrity. If CervicalCheck had simply been transparent about their false-negative results and their faulty system, lives would have been saved and the company’s reputation would have been spared.

## References

* ↑ O’Brien, Tim (2018, May 2). CervicalCheck 10-year timeline. https://www.irishtimes.com/news/health/cervicalcheck-10-year-timeline-1.3482051
* ↑ Wall, Eva (2020, February 11). Vicky Phelan gives devastating update as she confirms ‘my cancer is back’. https://extra.ie/2020/11/02/news/irish-news/vicky-phelan-devastating-update-new-tumour
* ↑ Browne, Dara (2021, January 29). Who is Vicky Phelan, how did she expose CervicalCheck scandal and what treatment is she getting now? https://www.thesun.ie/news/6484038/who-vicky-phelan-cancer-family-treatment-america/
* ↑ Irish Times (2018, October 13). Emma Mhic Mhathuna obituary: Young mother at the centre of the cervical cancer scandal. https://www.irishtimes.com/life-and-style/people/emma-mhic-mhath%C3%BAna-obituary-young-mother-at-the-centre-of-the-cervical-cancer-scandal-1.3661741
* ↑ Devine, Catherine, Doyle, Kevin, & Begley, Ian (2018, October 18). Emma Mhic Mhathuna passes away aged 37. https://www.independent.ie/irish-news/emma-mhic-mhathuna-passes-away-aged-37-37392791.html
* 1 2 3 IrishCentral Staff. (2018, April 30). CervicalCheck director told doctor to not tell women of false results. IrishCentral.Com. https://www.irishcentral.com/news/cervical-check-director-ireland
* ↑ Hall, E. (2018, April 29). Cervical Check Boss Steps Down Amid Smear Test Blunder. Extra.Ie. https://extra.ie/2018/04/29/lifestyle/health/grainne-flannelly-cervical-check-boss-steps-down
* 1 2 3 Bodger. (2018, April 30). HSE Boss ‘Dismissed My Concerns’ About Cervical Screening Results. Broadsheet.Ie. https://www.broadsheet.ie/2018/04/30/hse-boss-dismissed-my-concerns-about-cervical-screening-results/
* ↑ Cionnaith, N. B. and F. Ó. (2018, May 1). Expert warned against cancer test outsourcing. Irish Examiner. https://www.irishexaminer.com/news/arid-20470111.html
* ↑ HSE (2018, May 1). CervicalCheck Statement—1st May 2018. https://www.cervicalcheck.ie/news/cervicalcheck-statement-1st-may-2018.13384.html
* ↑ Wall, M., & Hilliard, M. (2018, May 2). HSE’s Tony O’Brien declines to step down over CervicalCheck controversy. The Irish Times. https://www.irishtimes.com/news/politics/hse-s-tony-o-brien-declines-to-step-down-over-cervicalcheck-controversy-1.3481564
* ↑ Bohan, C. (2018, May 10). Tony O’Brien has stepped down as HSE Director amid cervical cancer scandal. TheJournal.Ie. https://www.thejournal.ie/tony-obrien-gone-hse-director-general-4005228-May2018/
* ↑ CervicalCheck Tribunal (n.d.). Homepage. https://www.cervicalchecktribunal.ie/
* ↑ O'Regan, Eilish & McLoughlin, Ciara (2020, October 27). Vicky Phelan feels 'betrayed' by CervicalCheck tribunal. https://www.independent.ie/irish-news/health/vicky-phelan-feels-betrayed-by-cervicalcheck-tribunal-39675773.html
* 1 2 3 Scally, Gabriel (2018, Sep.). Final Report – Scoping Inquiry into the CervicalCheck Screening Programme. http://scallyreview.ie/?page_id=90
* ↑ Deegan, Gordon (2021, March 5). Gabriel Scally firm paid €1.13m for work on CervicalCheck inquiry. BreakingNews.Ie. https://www.breakingnews.ie/ireland/gabriel-scally-paid-e1-13m-for-work-on-cervicalcheck-inquiry-1091567.html
* ↑ Clarke, Vivienne & Power, Jack (2021, March 9). CervicalCheck: Gabriel Scally says he has not been paid fees for work on inquiry. https://www.irishtimes.com/news/ireland/irish-news/cervicalcheck-gabriel-scally-says-he-has-not-been-paid-fees-for-work-on-inquiry-1.4505307