Inquiry Transcript - Bottrill's Apology
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THURSDAY 13 APRIL 2000
THE HEARING RESUMED AT 9.30 A.M.
MR HODSON called –
MICHAEL BOTTRILL (Sworn)
DR BOTTRILL: I would like, first of all, to explain why I am making this statement at this time because it’s some months before I am likely to be called to give evidence in this inquiry.
Most patients see their doctors face to face and get to know them in the course of their medical treatment. Pathologists, however, practise in laboratories and specimens are received for examination and reports are sent out. The pathologist is only a name on a report. Often the patient may not see the report itself, or may not be told the name of the person who’s made the report.
In March last year, I was present in the High Court in Auckland for 5 days. I gave evidence there and answered the questions asked of me. For a year since then, my work has been under review. Many women heard of me for the first time. The re-screening in Sydney has produced results which have caused this inquiry to be set up. I've been asked to give interviews and appear on TV. I've not done so and I did not intend to speak again until it was my turn to come up before this committee.
In the week before the inquiry started, I was given to read the evidence of the 8 women who've testified on Monday and Tuesday. What they had to say was deeply moving and was intensely distressing to me. One point they all made is that they all feel that I have let them down and they feel that I'm unknown to them. What has been said made it clear to me that I should ask to appear now so that I can speak directly – I was going to say face to face –and on record to the people who want me to acknowledge their situation. I am grateful to the committee for allowing this to happen. I do not know the names of all the women who've been affected by all my actions. I don't know how many of them there are, but what I have to say is meant for everyone whose life has been affected by incorrect reports. I've come today to tender my apologies.. I wish to express my deepest regret to those who have suffered after relying on my reports. I offer sympathy to them and to their families and friends who have supported them. I am very sorry that this has happened. I hope that this inquiry will answer many of the questions which have arisen and I shall provide it with as much assistance as I can.
Thank you for hearing me.
CHAIR: thank you, Dr Bottrill, you may withdraw now.
JUDITH GLACKIN (On former oath)
[Ms Glackin continues reading from paragraph 141, p45 of her brief of evidence]
MID-MORNING ADJOURNMENT 11.00A.M. TO 11.15 A.M.
CHAIR: lifted the suppression order made yesterday. I reaffirm the suppression order made at the beginning of the hearing in respect of those witnesses who did not want any names or material that could identify them being published. Witness No. 3 – anything Dr Boyd might have said about her in her evidence is to be reported in a form which does not lead to her being identified. If the media have any difficulty with the current orders, please see counsel assisting immediately after lunch for clarification.
MS SHOLTENS: re the study by Professor Gillian Turner and others, that was referred to this morning, it is Exhibit 49.
[Ms Glackin continues reading brief from p90]
[paragraph 301 of Glackin brief of evidence - refer to Exhibit 73]
[p107, end of paragraph 354 pp62 and 63 - Straton Report]
MS SHOLTENS: you have an appendix to your brief of evidence ..... I do. It begins on p127, and that sets out the roles and membership of the various national committees you have referred to ..... yes. [Appendix taken as read]
Leave granted for Mr Corkill, Mr Kirton, Mr Hodson to XXN Ms Glackin. Leave reserved for Ms Phipps to XXN if necessary and Ms Kapua in respect of the reports of the Programme Manager and a matter relating to Maori policy and those matters that are not carried through in Ms Earp’s evidence.
LUNCHEON ADJOURNMENT 1.00, TO RESUME AT 2.00 P.M.
XXD BY MR CORKILL:
I would just like you to look at a document. The information you see on this piece of paper is derived from the documents but you will be able to assist us. We have the national co-ordinators in the first column ..... yes
And those dates have been extracted from your evidence and you will confirm them ..... I couldn't confirm them definitively without checking my evidence.
You may take it from me they have been derived
from your evidence ..... Tina Handisides’ name is not spelt
Each of those national co-ordinators were answerable to a manager were they not ..... they were.
are those the only managers over the course of this
chronology ..... I'm not tremendously sure about the very
early period when Gillian Grew was co-ordinator, I can
confirm the latter three although I do believe that Gill
Grew actually acted as manager in the Population services
section in a period before the screening programme
co-ordination transferred to prevention policy, which I
believe was around October or November 1995
Could we please move through each of those managers and assign dates in so far as you are able ..... I'm afraid I'm not able to do this except in respect of myself.
CHAIR: perhaps in the interim period you could look at the exhibits which you've produced and obtan the dates because crtnoly from my readings of the documents these names are famoliar with me ..... yes, I could.
MR CORKILL: each national cordr would have been accountable to a manager ..... yes.
And each manager would have been accountable to who ..... the Deputy Director-General or for a period of time those positions were descrtibed as General Managers.
Which period of time were they described as General Managers ..... I would need to check that.
CHAIR: I understand that there were national Maori co-ordinators as well, ..... yes there were two and they should be added for completeness. Maria and Raina Meha.
When the table is amended the Maori national co-ordinators, the names and which they held those positions could be included ..... yes.
MR CORKILL: turning to the Director-General, I think there was also an acting Director-General Mr D Smythe at some stage ..... yes, he fits in between Chris Lovelace and KaREN Poutasi.
Are you able to assign the dates of each Director-General ..... I would need to do that over the weekend.
We have heard from Dr Boyd that his direct involvement included, in 1989, and you rprt that fact in your evidence ..... yes.
Your own evidence is your direct involvement commenced in 19996 ..... yes, that is correct.
And you and Dr Boyd are the two main witnesses for the Ministry are you not ..... we are.
And so is it the position that no witness is to be
called from the department or the Ministry for the period
1990 to 1996 ..... it is my understanding that the Ministry
would be prepared to call other witnesses if necessary
But at this stage, in establishing the basic chronology and the critical events which we are concerned, the Ministry is calling no witness in respect of the relevant period ..... that is correct. The intention of my evidence was to provide an overview over a 10 year period and ii believe I was asked to do this as I had been in the Ministry in a number of related roles over that period. I did make clear at the beginning that my evidence was based on my own experience from extensive searches of the Ministry’s files and also from my direct involvement and conversations with past/present staff members of the programme who still work with the Ministry.
Its correct you have no medical qualfctns ..... that is correct.
Is it also correct you have no public health qualfctns ..... that is correct.
Is it correct that the national co-ordinators and managers show on on the interim exhibit had no public health qualfictns ..... I'm not sure about that. I would prefer to be able to check that if it were acceptable over the weekend.
MR CORKILL: Can you please turn to volume 7, tab 35, and turn to p2 of that document. You will be no doubt familiar with this document, the octd 1994 report of Cervical Screening Advisory Committee on monitoring and evaluation ..... yes.
And on p2, recommendation 2, to address the multifaceted aspects of the programme paid staff with expertise from several disciplines are required, skills include medicine, epidemiology, statistics, computing and cytology ..... yes, that’s what it says.
You did not have any of those skills ..... no, that is correct.
Did any of
the persons on the interim exhibit have qualifctns in any of
those disciplines ..... I do not believe so. However,
obviously Dr Poutasi and Dr Salmond are qualified in
Do they have training in public health to you knowledge ..... I would prefer to check that.
Please turn in your evidence to paragraph 9 where you make a reference to the expert and advsir9y committee’s whose terms of reference you give in the appendix ..... yes.
In fact it will be helpful if you go to the appendix. There's one matter – p128 of your brief ..... yes.
Having located that, will you please go back to the 1994 document you had a moment ago in volume 7 ..... yes.
And turn up the first appendix which is on p17 and you will see there the committee’s own understanding of its terms of reference for the period May 91 to June 1993 ..... yes.
Which seems to
differ from yours. ..... from mine in relation to?
You have described original terms of reference which are quite different I think you will see ..... yes, that is correct.
I'm not trying to be difficult here, but I think it’s a matter of what the source of your documentation was, can you assist us ..... one of the difficulties we have had in compiling this evidence is the vast quantity of paper which the Ministry searched in order to produce the briefs. It is quite possible of the terms of reference that belonged to later in the life of the Cervical Screening Advisory Committee have been advised here.
What I went to put to
you is that the committee would clearly know its own terms
of reference which it has set out at appendix 1 ..... that
is correct, although you asked me why I believed
and we see on p18 the subsequent terms of reference for the period MaY 93 TO September 94 ..... YES.
I want to suggest that those two documents give the correct terms of reference up to September 94 ..... that may well be so.
Coming on to paragraph 14, of you evidence, and there resuming the chronology that we began with Dr Boyd yesterday, you refer to the widespread concerns that results in the Ministry of Health, the Hon Helen Clark appointing a Ministerial review committee ..... yes.
I just want to elaborate on the context at this stage. In August 89 are you aware that there was some publicity in connection with the first annul anniversary of the publictn of the Cartwright Report ..... I have been told about this, yes.
I want you to look at this document please. I'm afraid the clarity of the print leaves a little to be desired, but in the opening paragraph of the Dominion piece Health Campaigner Ms Sandra Coney was reported as saying that the cervical screening programme had been hijacked. Later on she says “the Cartwright recommendations had been reworkd to suit the bureaucrats”. In the right hand column we see Professor Skegg reported as having chaired a w/party in 1995 and neither he nor his medical advisers since had been consulted apart from attending the December workshop. The next paragraph refers to the chair of the medical association Dr King who feard consultation to be too late and lastly Dr Cook, chair Royal College of general practitioners is quoted as saying they are not following the Cartwright Report as intended.
Are you able to recall those were the kinds of concerns that led to Hon Helen Clark appointing the Ministerial review committee ..... I have no knowledge of that and I haven't previously seen this article.
I want to show you another
document now. This is a leading article of which the author
was Professor Skegg who had been a central player in
Cartwright and previous events ..... yes he had
Are you familiar with this article ..... no I believe I have seen it previously but not this year.
To put the matter shortly,
he also had a number of concerns about the manner in which
the programme was being set up – if you look at the right
hand column please peruse it. It would seem that his
central concern on the right hand side of that Medical
Journal article was the possibility of an opt on register
than opt off . I'm referring on the right hand column to
the passage where he says “despite the lack of details one
aspect of the New Zealand scheme sounds particularly ominous
… which will be ….part of the programme” and then later, 2/3
down “few would dispute … can only be described as dotty.
In opting for a limited … Sandra Coney has criticised there
.. approach”. That was clearly a very strongly expressed
view at the time ..... yes
From a highly reputable expert in the field ..... yes it was
I suggest to you that it was that comment, the comments in the 2 documents that I have referred to you which it appears as you say led the minister to respond to w/spread concerns ..... as I said, I'm not completely familiar with the context, I believe the Minister was concerned about implementation delays.
CHAIR: Accepted article in respect of this witnesses comments on it Professor Skegg will comment on it when he gives evidence. The article accepted (Sandra Coney) so far as she has made limited comments.
Leading article JMFG/Minister of Health/81 and the Sandra Coney jmg/Minister of Health/082.
MR CORKILL: Could the witness be shown Dr
Boyd’s exhibit 37, the “Unfinished business” article of
yesterday, p170. just read under the section “Helen Clark
intervenes”. I think you see reference to the events we
have just been discussing, and you will see also Ms Coney
describing the minister acting swiftly , she refers to a
letter in which she is quoted as saying “the timetable is
not satisfactory to me, is that the point you were making a
moment ago ..... yes
You understand one of the causes of the Ministerial review was a timing issue ..... I believe it was concern s about the ability to meet the time frames for implementation. This is however covered in my exhibit, which is the report of the Ministerial review.
Ms Coney on p171 also refers to what she describes as the tension between the departments desire … for screening to the Area Health Boards … leadership was important”. Do you understand that was a live issue at the time as well ..... well I have no personal knowledge of this, so I would have to take this is ether true of the author’s opinion.
you. I want you to come on to the Ministerial review and
take up volume 1, tab 1.and go to p2 please. Paragraph 1.5,
the review team made a comment that there had been poor
communication between the department and other relevant
bodies so that few people outside the implementation
Had any understanding of the proposal ..... that’s what it reads.
That would appear to be the consensus view of this “high powered” review committee ..... yes, I believe so.
Come on to p16, paragraph 3.6, there you will
note that the committee thought there was a high degree of
urgency associated with the appointment of a national
co-ordinator ..... yes
That the status attached to the job should be such that it enabled the co-ordinator to work effectively within the department, that I take it was a reference to the co-ordinator being of sufficiently high status within the department as to ensure that sufficient priorities as the programme might have could be implemented ..... I'm not sure that that is necessarily implied by the words to work effectively within the department
What do you think those words mean ..... certainly it could imply that but what it says is work effectively within the department. I would presume that would related to carrying out the terms of reference for the job.
The effectiveness issue is associated with the status to be attached to the job and I suggest it was a matter of seniority in the minds of the review committee ..... that may well be so but I can't read the committee’s minds.
Come on please to p31
and the recommendations concerning the Expert Group. Dame
Sylvia Cartwright had recommended an expert group, as you
would acknowledge ..... yes I believe that is correct
And it was for that reason the Ministerial review committee was endorsing and recommending the actual appointment of such a group ..... yes that would appear to be so.
Coming on to p52 and following, this is a section entitled “smear-readers and standards of competency, and I particularly want to draw attention to p55 under the heading “smear-reading standards”. In 8.10 they noted that pathology laboratories had gone a considerable way down the track of establishing quality control checks, and they described some of those, they described at 8.11 the concept of 10% review, but at 8.12 in the second sentence they said “if consistency of reporting at a national level is to be achieved thse systems should be developed further … by another laboratory on a regular basis considered”. And in the next paragraph they thought that there should be a set of minimum standards of competency of laboratories and smear-readers. That is correct, isn’t it ..... yes, that is correct.
And at 8.15 dealing with the issue of histology, they thought that it was important that work on incorporating histology results be carried out in the near future, not only for quality control but for identifying high risk groups, is that correct ..... I don't see the words – yes, sorry. Yes, that is correct.
I think in your own evidence you in dealing with that topic said the Ministerial review committee had described that particular need as urgent ..... it is possible I was quoting from a different part of the report.
P58, under recommendations, paragraph 3 “set of … should be developed” and they spelt out what they thought that meant , and the following “ … immediately as .. decision ” that is possibly what you had in mind when you said urgent ..... yes, possibly.
So it is quite clear that the Ministerial review committee saw quality control as a critical issue ..... yes.
And that was entirely consistent with all the previous advice we heard about yesterday from 86 onwards ..... yes.
P8 you refer to the expert group appointed by the minister, this was a large group and it had a number of (p27 of your evidence) key players in relation to the development of those programmes outside the Ministry ..... yes I believe that’s so.
From not only consumer
groups but also relevant medical and other disciplines, such
as Dr Teague, the Cancer Society, the Family Planning Cancer
Society, Royal New Zealand College of General Practitioners
and the college of obstetricians and gynaecologists .....
Would you take up Ms Coney’s article again
”Unfinished business” and go to p172. I ask you read 172, 173. to yourself. In that part of her article she said that information was drip fed or not forthcoming at all from the department at the foot of 172. ..... yes does.
Next, she says there was a failure to consult with women’s groups to explain the programme ..... yes, she does say that.
Towards the foot of that column she says there was a
failure to see a budget ..... yes, she sees that
Over the page she says that was eventually remedied after the Chair wrote to the Minister, and the final point is halfway down 174 where she speaks of the ideology that was the driving force, that of devolution, namely the department wanting to transfer responsibility to Area Health Boards ..... yes.
These are Ms Coney’s views, in your researches, including the correspondence of the expert group, were you aware of the frustrations on the part of members of that group ..... yes from my reading and the papers that I have tabled it is clear there was tension between the expert group and the Ministry.
And that tension in large measure
focused on the issue of devolution ..... I'm not aware that
that was the issue.
What do you say the issue was ..... I would actually prefer to refer to an appropriate exhibit in relation to that.
Can I provide you with an exhibit. That is a letter from a member of the Expert Group, Dr Teague to the Chair, Mrs Koopman Boyden, in May 1990 and it would seem in paragraph 2 he emphasises the recommendation from the Cartwright Report of a national population based screening programme but in paragraph 4 expresses the opiion that he blves the Ministry would be devolving the programme almost totally to the Area Health Boards, so I suggest to you, just as this letter suggest and as Ms Coney in her article suggests, the possibility of devolution to the Area Health Boards was a critical part of the tension between the group and the department ..... the materials you've shown me would certainly suggest that.
What other factdors do you say contributed to that tension ..... I bvle that the Straton Report which I exhibited and a later document f the Ministry refrs to ongoing tension in the relationship between the Ministry and the expert group, I suspect there were a number of tensions causing that tension, such as the difficulty with implementation and one item I do recall is a comment that it was difficult to gain consensus opinions from the Expert Group given issues the department decided at one meeting were in fact changed at the next.
We will come onto the Straton Report in a moment, but in any event it’s clear that at this stage there was a good deal of difficulty and debate as to whether or not the programme should be a national programme ..... it would appear from these exhibits that that was the case, I think the issue though is more what a national programme would be rather than in fact whether it would be a national programme. I think I would like to comment as well.
We will leave that to your counsel. A moment ago you said that you thought that the minutes or correspondence of the Expert Group indicated a lack of consensus or difficulties in determining precisely what the Expert Group, thought, I note at your paragraph 21 you say no agendas or minutes have been located on the department’s files ..... a later report from the Ministry to the minister concerning the expert group raised that issue.
But we don't have the benefit of agendas and minutes in order to take that further ..... that is correct. I was referring to the opinion of the people who wrote to the minister.
You referred to the Straton Report, tab 4. [Dr Teague’s letter produced gmg/Minister of Health/083. Please go to p3 of Straton, I just want to draw aztten to a number of the key recommendations for this report. Would you agree before I do so that Dr Straton was clearly regardcd as avery high powered expert in public health f m the unit of Australia ..... it would appear that was why she was asked to do the report.
Her recommendations had to be treated with considrable respect ..... I believe that was the case. I note she had only 2 weeks to write this report.
During that time she consulted very widely indeed ..... it would certainly appear so from the report.
P7, we see recommendation 2.2, that the only choice … not receive mail directly from the register ..... that is what the recommendation says, yes.
P8, I just draw attention to her views on previous smear history because we touched on that topic a day or so ago. P21, she returned at recommendation 2.14 to the topic of histology and she thought a w/party should be established to develop mechanisms for history data ..... yes, that’s what it says.
And on p25, paragraph 2.18, she again endorsed strong national co-ordination and support ..... in relation to the central register.
In paragraph 5.1, p48, p47, she dealt with the topic of acredtn and quality control and third sentence in she said “thought there should be a system of accreditation of laboratories … which is tied to the … for reading smears.” ..... yes.
That never happened in
the opening years of the programme did it ..... that
accreditation was tied to reimbursement
That’s my question ..... that is correct, except that in later years the requirement for accreditation became a requirement for Regional Health Authority contracting.
We will come to that on Monday.
CHAIR: this letter of Dr Teague’s, second page, there is a reference to the national Ca Registry, I note his letter was written in 1990. was there a national Ca Registry at that time ..... I believe there was. However, I could be incorrect and that is something which I could check for you.
It would be helpful to know in chronological order. ..... we could check that for you over the weekend.
THE HEARING ADJOURNED AT 4.00, TO RESUME ON MONDAY 17 APRIL 2000 AT 10.00 A.M.