Does the Minister of Health want to know how reliable the national cervical screening programme has been - or does she want the Gisborne inquiry to draw its conclusions from the errors of one elderly pathologist running an isolated laboratory?
When she inherited the ministerial inquiry at the change of Government, Annette King seemed ready to let it roam as widely as it thought necessary. Now she is trying to dissuade those conducting the inquiry from going to court in their quest for the information needed for research on women screened in other centres.
In a message faxed privately to the chairwoman, Ailsa Duffy, QC, the minister has asked the committee of inquiry to explain why it feels it necessary to go to the High Court, although the committee has given its reasons publicly. The minister points out that she is accountable to the cabinet and Parliament for the "resource implications" (costs) of a decision to go to the High Court.
It is an extraordinary missive, and Ms Duffy clearly regards it as quite improper. She has done the right thing in making it public, saying it could be seen as an attempt to influence the committee. By releasing the minister's fax, the chairwoman has effectively negated the pressure and sent a message of her own - that insidious correspondence of that sort is futile and will be exposed.
Annette King deserves to be embarrassed by the episode. It is she who owes an explanation for her ministry's reluctance to seek a legal ruling on the use of information on its register. The reason cannot simply be the expense as she claims. How costly could it be to obtain a High Court ruling? It is unlikely the application would be contested. No suggestion has been made that women who have allowed their information to go on to the register would oppose its use for research. Most probably assume that to be precisely the reason they were asked to allow their tests to be recorded.
The attitude of the minister - who is merely echoing her ministry's concerns conveyed to the inquiry earlier - is all the more astonishing because the question of patient confidentiality goes much further than the present inquiry.
If the national cervical screening programme is ever to be regularly and independently audited, the information on the register will have to be available. Some such medical audit is almost certain to be a consequence of the Gisborne inquiry. For that reason, the minister and her ministry should be as anxious as anybody to clarify the law.
Perhaps they would prefer to set up an audit of the screening programme on the strengths of the Gisborne experience alone, and would be content to see the committee wrap up its inquiry without wider research. That might save the ministry wider embarrassment, but it would not serve the interests of women, particularly those in several other centres where cervical cancer rates are above average.
This month we have been reporting the case of a Paihia woman, Colleen Poutsma, whose cervical cancer not only escaped the attention of Whangarei gynaecologist Graham Parry, but may have gone unnoticed in as many as seven smear tests read at the Northland Pathology Laboratory since 1989. Last week, the Health Funding Authority said it was investigating Mrs Poutsma's tests but would not check the rest of the laboratory's work. It was an "isolated case," said the authority, just as Gisborne is supposed to be.
The Northland laboratory was one of six that caused concern in a study of comparative performances for the HFA. The authority has refused to name them, initially citing the inquiry's suppression of the identity of the Northland laboratory. The inquiry promptly lifted the suppression order, but the HFA still refuses to name the rest.
Now the Health Ministry says it believes it could find a way around the privacy provisions of the national screening register in order to check the other centres of most concern - Northland, Eastern Bay of Plenty and part of Otago. Ailsa Duffy's committee is not prepared to count on that and no wonder, considering the way it has been treated. The committee seems doubly determined to pursue its inquiry wherever it may lead, and we can be grateful for that.
<i>Editorial:</i> No way to treat a public inquiry
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