3.30 When the Committee first heard the evidence from
women affected by misread smear tests it was disquieted to learn that
in some cases interspersed with smear tests read as normal at Gisborne
Laboratories and later found to be abnormal by the Sydney re-read, were
smear tests that had been read as normal at other laboratories. The
Sydney re-read of smear tests organised by the Health Funding Authority
only involved a re-examination of smear tests read at Gisborne Laboratories.
In some cases, for example witnesses A, C and F, they had some normal
smear test reports from other laboratories that came after smear tests
reports from Gisborne Laboratories. The Committee was, therefore, concerned
to know if these smear tests from other laboratories indicated a more
widespread under-reporting problem.
3.31 During the first session of the Committee’s public
hearings it was advised that Professor David Skegg was attempting to
carry out a cancer audit of all the cases of cervical cancer from the
Gisborne region. At that time Professor Skegg thought this was the best
way to determine if there had been an unacceptable level of under-reporting
in the region. A cancer audit would also have revealed any errors in
the reporting of other laboratories. However, the cancer audit could
not proceed, as Professor Skegg was unable to gain access to the information
he needed to carry out the audit. More will be said about this in the
Committee’s report on term of reference three.
3.32 During the second session of the public hearings,
the Committee learnt that Professor Skegg could not gain access to the
information he needed for the audit to proceed. The Committee, therefore,
proposed an approach which it considered would allow the information
to be accessed. The Committee had been set up under s.47 of the Health
& Disability Act. Pursuant to s.47 (3) the Minister had extended
the Committee’s power by giving it the power of a Commission of Inquiry
under the Commission of Inquiry Act 1908. As the information was relevant
to the terms of reference the Committee considered the obstacles Professor
Skegg had encountered could be overcome if the Committee obtained the
information by exercising its power under s.4D of the Commissions of
Inquiry Act to subpoena the Director-General of Health to produce the
information to it. The Committee could then appoint Professor Skegg
as its agent under s4A and provide him with the information in order
to carry out the cancer audit. Because the Committee had become concerned
about the statistical information on cervical cancer incidence produced
to it for other regions (Eastern Bay of Plenty and Northland) it had
intended that the audit cover those regions as well as a region where
the registered incidence of cervical cancer was low. Hence, the Committee
issued a subpoena to the Director-General of Health requiring her to
produce to it personal information of certain persons registered on
the Cancer Register and the National Cervical Screening Register. It
also suggested to the Ministry of Health that another way to obtain
the information needed to enable the cancer audit to take place would
be to appoint Professor Skegg or any other qualified person as a separate
committee of inquiry under s.47 with the extended powers of a commission
of inquiry.
3.33 However, by the second session of the public hearings
Professor Skegg had reached the view that there was already sufficient
evidence before the Committee to enable it to reach a conclusion on
whether or not there had been an unacceptable level of under-reporting.
For this reason he saw no need to proceed with his audit of cases of
cancer in the Gisborne region. Nevertheless, the Committee continued
to want the information sought in the subpoena as it considered that
an audit of cervical cancer cases in three other regions would assist
it to reach a view on term of reference three as to whether or not there
was a systemic problem as regards the National Cervical Screening Programme.
3.34 The Ministry of Health provided information from
the Cancer Registry. However, it refused to provide information from
the National Cervical Screening Register. It contended that the Committee
could not gain access to this information by using its powers under
s.4D of the Commissions of Inquiry Act. The Committee had considered
referring this question to the High Court for resolution pursuant to
s.10 of the Commissions of Inquiry Act. In the end it did not do so
as the Health and Disability Services Act was about to be repealed and
there was no provision similar to s.47(3) in the draft version of the
replacement legislation which was made available to the Committee. This
would have meant that a court ruling on the power of a committee of
inquiry under s.47 to obtain this information under subpoena would have
been of academic interest only.
3.35 In addition the Committee’s concerns were somewhat
allayed by the knowledge that the Ministry of Health’s national evaluation
of the National Screening Programme, which the Committee was informed
would soon be underway, included a cancer audit. This would reveal any
problems with other laboratories. However since the third session of
the public hearings which took place in September the Committee has
learnt that there has been little or no progress with the national evaluation.
The circumstances surrounding this are more fully discussed in the report
under term of reference three. Here it is sufficient to say that the
national evaluation, which was first contracted for in June 1997, has
still not been fully completed. The audit of cases of cervical cancer
has not been carried out. The persons who originally formed the team
responsible for the evaluation have resigned and the Ministry of Health
is in the process of engaging other persons to carry out this task and
is attempting to frame the evaluation in such a way that it can overcome
the obstacles to obtaining certain information which up to the present
time have stalled the evaluation. The result of all this is that the
questions, which arise from the other laboratories’ reports on smear
tests for women in the Gisborne region, remain unanswered. Until an
audit of these women’s cases is carried out, whether or not other laboratories
under-reported their smear tests will remain unknown.
