By FRANCESCA MOLD
GISBORNE - A political decision to shun expert advice recommending the creation of a national cervical screening register and instead set up 14 sites has come under scrutiny at a Gisborne inquiry.
The cervical screening inquiry heard yesterday that Prime Minister Helen Clark, when she was Health Minister in 1989, decided to set up the programme in 14 locations aligned with area health boards.
This decision was made despite recommendations in a 1989 report by Justice Dame Silvia Cartwright, and from experts in following years, that a national register be set up.
It is the second time this week at the inquiry that politicians have been accused of health reforms which undermined the effectiveness of cervical screening.
On Monday, the Ministry of Health admitted that a split in responsibility for the programme between the ministry and the four regional health authorities could have made the programme dysfunctional.
Yesterday, the inquiry heard that experts wanted the register to be designed so cervical cytology (cell) and histology (tissue) laboratory results would be kept together.
This would ensure the cervical histories of women could be tracked and more effective follow-up care provided.
It would also help to ensure that if women moved they would not be lost from screening records.
Inquiry panel chairwoman Ailsa Duffy, QC, asked ministry witness Judy Glackin whether the makeup of the register in 1989 was determined by the then Labour Government's policy of "decentralisation and devolution."
"Certainly it was," said Ms Glackin.
"Would it have been easier if a single entity which had a chief executive-type role with sole responsibility had been created," asked Ms Duffy.
"If you thought that was the most important criterion, then yes," replied Ms Glackin. "But the Government gave weight to other priorities."
Counsel assisting the inquiry, Hanne Janes, produced a letter written by Helen Clark in August 1989 which said she was not committed to launching a national register that year, although she wanted steady progress made towards a coordinated programme.
Helen Clark's priority instead was to increase the number of women having regular smears.
Ms Janes said that despite the reconfiguration of the register to a national system combining cytology and histology results being considered urgent in 1989, legislation to allow the move was not passed until 1993.
The reconfiguration did not begin until 1996 and was completed a year later.
"Is this an indication of the speed with which the Ministry of Health can move in relation to issues of the cervical screening programme which required urgent attention," asked Ms Duffy.
"In relation to this issue, yes," said Ms Glackin.
Ms Duffy: "Would you consider that slow?"
"Yes, although I believe we moved as fast as was possible to implement the reconfiguration of the register."
Ms Janes asked whether it would have been better to delay the start of the programme in 1989 until it was possible to go with the "optimum" national register.
"Yes, it would certainly have with hindsight. The reconfiguration has greatly increased the usefulness of the register," said Ms Glackin.
Ms Janes suggested that in the haste to implement a screening programme, quality-control measures considered vital by the expert groups might have come "very much later in the piece than ... desirable."
This might have left the programme's quality control vulnerable for a significant period, she said.
Questions were also raised as to when the ministry became aware of concerns about the reading of cervical slides in Gisborne.
Ms Janes said the ministry had a newspaper article from 1998 that quoted Gisborne gynaecologist/obstetrician Dianne Van de Mark saying the rate of cervical and uterine cancer in the Midland region was twice that in the rest of New Zealand.
The article said the high incidence of cervical cancer in young women was particularly alarming and more needed to be done for women in the Gisborne region.
"What did the ministry do?" asked Ms Janes.
"The ministry was aware these rates were high, and would have endorsed the message from this article that smear tests were vital if the trend was to be reversed," said Ms Glackin.
Ms Janes: "So this raised no level of concern about Gisborne?"
"It was seen as a timely reminder for ... women to be vigilant that they had smears taken."
Ms Janes also questioned Ms Glackin about whether the ministry was satisfied with the Health Funding Authority's response to the concerns raised about Gisborne. "I believe so," she said.
Meanwhile, the pathologist at the centre of the inquiry, Dr Michael Bottrill, has filed an appeal against a High Court decision to grant a re-trial of a case involving a woman who sued him for exemplary damages.
The woman, whom Herald readers know as Jane, had four smear slides mis-read by Dr Bottrill and had to have a radical hysterectomy and radiation treatment for invasive cervical cancer.
Justice Young granted a re-trial after new evidence became available from the re-reading of Dr Bottrill's slides by a Sydney laboratory.
Dr Bottrill's lawyer, Christopher Hodson, QC, said last night that the appeal had been filed because of the strict time limits imposed by the Court of Appeal and simply so his client could keep his "options open" until all evidence had been heard by the Gisborne inquiry.
The inquiry's report is due by the end of September.
Inquiry hears Clark shunned top advice
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