ADHB apologises for the events at National Women’s Hospital
6 August 2018
Auckland DHB apologises for the events that led to the Cartwright Inquiry
Thirty years ago this month, the Report of the Cervical Cancer Inquiry (the Cartwright Report) identified significant failures in the treatment of the precursor to cervical cancer (carcinoma in situ) at National Women’s Hospital. At no stage has our District Health Board made a public apology for this failure in our ethics and service to our population. It is now time to remedy this wrong.
Judge Cartwright identified long-standing failures in the ethical values and practices used by clinicians who were conducting research at the hospital, operated by the Auckland Hospital Board (now the Auckland District Health Board).
One of the most profound errors was the failure to respect patient consent, to respect the right all patients have to make informed choices about their medical treatment.
On the occasion of this anniversary, as Chair of Auckland District Health Board, I formally apologise to the women whose lives were affected by these failures, which for many resulted in an early death.
These patients, including mothers, sisters, partners, daughters, friends and colleagues, whaea and tamahine, were failed by people they trusted to care for their health and wellbeing. We apologise to the women affected for these wrongs.
And to those who have been with them, their whanau, supporters and communities, we also apologise.
To learn from the mistakes of the past it is critical that we remember all aspects of our history, including this serious failure in our care.
I want to pay particular tribute to the 84 patients, relatives and supporters whose personal experiences informed the Cartwright Inquiry, and without whom these stories would not have been heard.
In many cases these voices are no longer with us, but their courageous testimony led to far-reaching reforms of patient welfare and rights.
We are deeply sorry for what they went through. We will not forget them.
Book review by Lynda Williams
Ronald W. Jones. Doctors in Denial: The forgotten women in the ‘Unfortunate Experiment’. Otago University Press, 2017; 194 pages.
Members of the AWHC were among the almost 200 people who attended the book launch of Professor Ron Jones’ book, Doctors in Denial: the forgotten women in the ‘unfortunate experiment’, which took place on Monday 13 February 2017.
Ron Jones is a retired obstetrician and gynaecologist and former clinical professor at the University of Auckland. “Doctors in Denial”is his account of Herbert Green’s study into the natural history of carcinoma in-situ (CIS) of the cervix that took place in the 1960s, 70s and 80s at National Women’s Hospital (NWH), a study that subsequently became known as the “unfortunate experiment.” The book documents what happened at the hospital; Jones’ co-authorship of the 1984 scientific paper on the outcome for the women, that was published in the prestigious medical journal Obstetrics and Gynecology, which then led to the publication of an article by Sandra Coney and Phillida Bunkle in Metro magazine in June1987; and the setting up of a ministerial Committee of Inquiry – the Cartwright Inquiry.
Ron Jones joined the staff at NWH in 1973 and soon became what he describes as a silent observer to the “dark secret that was beginning to surface” at the hospital. He met Bill McIndoe, an older doctor who took him into his confidence, and slowly became enmeshed in the resulting national scandal and controversy over Green’s experiment on women who had been referred to the hospital with CIS and, under Green’s management, went on to develop invasive cancer. Many of these women died.
The hospital’s failure to address the concerns expressed by those at the bottom of the hospital’s hierarchy, who were observing and documenting the harm being done to these unwitting victims of Green’s study, is what led to Ron Jones co-authoring the 1984 paper that blew the whistle on Green. The paper came to the attention of two well-known feminists, Sandra Coney and Phillida Bunkle,who wrote the Metro article which led to the ministerial inquiry and a great deal of media attention.
As Ron Jones writes, the Cartwright Inquiry has had more impact on the practice of medicine in New Zealand that any other single event. It resulted in the establishment of a national cervical screening programme, the formation of the office of the Health and Disability Commissioner and the patient advocacy system, the development of a Code of Consumers’ Rights that is enshrined in legislation, and the setting up of ethics committees that placed the welfare and protection of patients at the heart of the approval process for research studies.
Doctors in Denial is an absorbing story that begins with two chapters that set the scene for the events that unfolded at NWH. Ron Jones describes the patriarchal, hierarchical attitudes and behaviours of medical practice within the hospital in the 1950s and 60s, the personalities of those involved, including Professor Denis Bonham, Associate Professor Herbert Green, colposcopist Dr William McIndoe, and pathologist Dr Malcolm (Jock) McLean, as well as society’s deferential attitude towards doctors. He also describes how NWH was structured in terms of the medical administration of the hospital.
The third chapter deals with the proposal that Green put before the Senior Medical Staff Committee, which was then rubber stamped by the Hospital Medical Committee on 20 June 1966. He writes:
“There was a well-established medical hierarchy within the hospital, with academic members of the postgraduate school at the top and non-academic medical specialists making up the bulk of the staff. In matters of research the latter deferred to the academics, whose role included the critical examination of scientific evidence. It was not surprising that when McIndoe, a quietly spoken doctor at the bottom of the pecking order, spoke out against Green’s proposal, his opinion was taken less seriously than it should have been.”
Chapters 4 and 5 record the concerns that were subsequently expressed both nationally and internationally by academics and health professionals about Green’s study and the risks it posed to women. When McIndoe and McLean raised their concerns about the numbers of women developing cervical cancer with the then medical superintendent-in-chief, Dr Fred Moody, he declined to become involved. A subcommittee was set up to examine the 29 cases of concern, but for reasons unknown 15 cases were excluded. The subcommittee’s report was basically a whitewash, leaving both McIndoe and McLean upset but not that surprised.
Chapter 6, “Phoebe’s story” is the first of two chapters that tell the stories of two very different women who were part of Green’s experiment. Phoebe was a widow who had raised several children on her own and whose life had not been easy. Chapter 12, “Mabel’s story,” tells the story of another of Green’s patients, a doctor’s wife, at the other end of the social and economic spectrum who was also involved in Green’s study.
Chapters7 and 8 describe the events leading up to the publication of the 1984 paper in the journal Obstetrics and Gynecology. It took six years to get this paper written and then published. The reasons for this lengthy timeframe make for compelling reading. While the truth was then well and truly out in the international medical and research arena, there was a deathly silence within the hospital. Nobody talked to the authors of the paper. And nobody did anything about the women who were at increased risk of developing cancer.
Chapter 9 deals with the Metro article written by Coney and Bunkle that was published in June 1987 and led to the setting up of the Ministerial Inquiry into treatment of cervical cancer at NWH. Ron Jones records that he “considered their article to be a reasonably fair and balanced account. Their only mistake was to comment that Group 1 patients had had treatment with conventional techniques, and normal smears.” This error was subsequently seized upon by those he describes as revisionists and is still misunderstood by those who continue to deny there was an experiment.
Chapters 10 and 11 document the early backlash to the Cartwright Inquiry and the ongoing refusal by senior doctors at NWH to accept the findings and recommendations contained in the report. In July 1990, Metro published another article titled “Second thoughts on the unfortunate experiment at national women’s.” Did Sandra Coney know what she was doing? Did Judge Cartwright? Did Professor Green get a fair go? Or was the cervical cancer inquiry a witch hunt? These questions featured on the front page of the magazine. These two chapters of the book also describe the contradictory responses to the report by health professional bodies, NWH, the Medical School and the University, and what happened to the authors of the 1984 paper. Ron Jones’ grief at the lack of concern by those responsible for the ongoing welfare of the women at the centre of the Cartwright Inquiry and the danger of developing cervical cancer that many of them were still in, comes through very clearly in these and earlier chapters.
Chapters 13 and 14 put the events that led to the Cartwright Inquiry into context. Ron Jones writes: “The very traditional male medical environment in which Green was so dominant, was challenged by the feminism that was well established in New Zealand by the 1970s and 1980s. Older doctors were generally uneasy and uncertain what feminism actually meant and how it would affect them and their women patients.” He laments the lack of remorse from the doctors who have continued to maintain a ‘defend and deny’ stance during the almost three decades since the Cartwright Inquiry, but welcomes the fact that the victims are at last being heard.
“It is interesting that many of those closest to this tragedy have admitted to the truth in late life mea culpas, while some with more tenuous connections continue to defend Green’s actions.”
Doctors in Denial ends with a brief postscript on the revisionism and denial that has emerged in recent years in books published by associate professor of history Linda Bryder. Bryder has consistently failed to acknowledge the impact on women of Green’s study, and in writing her books she has chosen to interview documents rather than any of those who were witness to events during the 1960s through to the 1980s at NWH. In doing so she has told a “distorted story of blameless doctors, grateful patients, and normal scientific conduct” which if accepted will “set back the profession’s difficult task of acknowledging and trying to learn from error,” Professor Charlotte Paul is quoted as saying.
However, there is a sense in which we can be grateful to Bryder, as it was her rewriting of history that motivated Ron Jones to write his book and set the record straight. It was also made possible by the fact that he kept and still has in his possession numerous letters, memos, minutes of meetings, articles and papers, and various other documents from that time. While Doctors in Denial is Ron Jones’ personal story, it is also a riveting account of professional arrogance and misplaced loyalties, of doctors who turned a blind eye or denied the truth, and more importantly a story that focuses on the needless suffering of the women at the heart of this most unfortunate of experiments.
Doctors' college apologises
After 30 years a public apology has been made from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists for what happened at National Women’s Hospital. the apology was made at Doctors in Denial book launch.