A chronology of Events
A chronology of events related to the Cartwright Report 1987-1993
- Phillida Bunkle and Sandra Coney publish 'An "Unfortunate Experiment" at National Women's Hospital' in Metro magazine. The article outlines how a research programme on carcinoma in situ (CIS) of the cervix, commenced at National Women's Hospital (NWH) by Dr G H Green in 1966 and never formally terminated, had resulted in a number of women developing cervical cancer. The trial followed women with CIS without treating them to eliminate the disease. The purpose was to attempt to demonstrate that CIS did not lead to invasive cervical cancer. Despite the efforts of two doctors within the hospital - the pathologist-in-charge, Dr Malcolm McLean, and the cytologist, Dr William McIndoe - hospital and hospital board authorities take no action to halt the trial or recall women. In 1984 McLean and McIndoe (and Dr R WJones and P R Mullins) publish a paper in Olostetrics and Gynaecology which shows that among the women who had had continuing abnormal smears, 22 percent had developed invasive cancer, compared to 1.5 percent among women with normal cytology after treatment. The Metro story focuses on one patient - 'Ruth' - who attended the hospital over a period of fifteen years, from 1964 to 1979, and who finally was diagnosed as having cervical cancer in 1985.
10 June 1987
- The Minister of Health, Dr Michael Bassett, sets up a Committee of Inquiry into Allegations Concerning the Treatment of Cervical Cancer at National Women's Hospital and into Other Related Matters. It is to be headed by District Court Judge Silvia Cartwright. The inquiry hears from sixty-seven witnesses. The judge also interviews in private eighty-four patients and relatives of patients, four nurses and two general practitioners. Before the release of her report, under Term of Reference 3 (TOR3), Judge Cartwright provides the Minister of Health with the names of over 130 patients and former patients of NWH who need to be contacted for further advice or treatment.
- The Auckland Women's Health Council is formed to represent the views of women in Auckland. The Cartwright Inquiry and the establishment of area health boards in 1988 provide the impetus for the formation of this group; other regional councils follow. In 1990 a Federation of Women's Health Councils of Aotearoa/New Zealand is formed as a national voice for women on women's health issues.
5 August 1988
- The Cartwright Report is released. It recommends sweeping changes in the practice of medicine and research, and various measures to protect patients' rights. Judge Cartwright also recommends the establishment of a national cervical screening programme.
- The Government, Auckland Area Health Board (AAHB) and University of Auckland all pledge that they will implement the recommendations.
- Clare Matheson - 'Ruth' of the Metro article - announces she will sue for $1.5 million damages. By October, nine women have announced they will sue.
- The Department of Health releases a discussion paper which develops the concepts of a health commissioner and patient advocates as recommended in the Cartwright Report.
- The Auckland branch of the New Zealand Medical Association (NZMA) asks the Medical Council to investigate whether any doctors should be charged with professional misconduct arising out of the findings of the Cervical Cancer Inquiry.
- The Medical Council warns all doctors and medical students that they must follow the recommendations of the Cartwright Report.
- Professor Dennis Bonham takes early retirement from his position as head of the Post-Graduate School of Obstetrics and Gynaecology at NWH.
- The new Minister of Health, David Caygill, asks the AAHB to proceed with the appointment of a patient advocate at NWH. In August 1989 Lynda Williams is appointed to the post.
- The Department of Health convenes a working party to develop the concept of a health commissioner further. This group contains representatives of the department, the Department of Justice, the Ministry of Women's Affairs, the Hospital Boards' Association, the Human Rights Commission and consumers. The group reports in March 1989.
- Dr Gabrielle Collison, medical superintendent of NWH, invites consumer representatives to take part in a series of working parties with staff of NWH to examine each of the Cartwright Report's terms of reference. Consumers report these are unproductive experiences, with many staff defensive and resentful.
- Prof. Colin Mantell approaches the Auckland Women's Health Council for women to act as 'teaching associates' to teach students pelvic examination. Instead, the council develops a module for teaching women's health including pelvic examination, but this is not acted upon by the university.
- The Department of Health releases a national standard for ethics committees throughout the country.
- David Caygill announces he will appoint a health commissioner and establish patient advocates in hospitals throughout New Zealand.
- The recall of TOR3 patients starts again on the advice of the Monitoring Committee of the AAHB (a committee set up to oversee implementation of the Cartwright Report recommendations). An earlier recall, conducted by NWH, had failed to follow the guidelines set down by Judge Cartwright; many of the women had not been counselled and were unaware they were part of the recall. The new recall is set up by the AAHB and follows Judge Cartwright's specifications: the patients are to be offered counselling and an independent review of their case. Any treatment is to be paid for by the board. A quarter of the women are found to have cervical abnormalities.
- The Minister of Health, David Caygill, announces a cervical screening programme will be up and running by November 1989.
- Dr Graeme Overton, a NWH doctor, and the gynaecologist consulted by 'Ruth' when she developed cervical cancer, claims in the Dominion Sunday Times that the Cartwright Inquiry was 'based on a scam'. Overton maintains that the statistics used in the 1984 paper are faulty, and promises a formal paper detailing his criticisms. He never publishes one. Dr Karen Poutasi of the Department of Health describes the accusations as 'unsubstantiated and inconsistent', the AAHB and the NWH medical superintendent, Dr Gabrielle Collison, reiterate their commitment to implementing the Cartwright recommendations. A week after publishing the story the Dominion Sunday Times apologises to Judge Cartwright for implying that her findings were based on anything other than an objective analysis of the facts as presented at the inquiry.
- Minister of Health, Helen Clark, sacks the elected members of the AAHB and appoints a commissioner, Harold Titter. With the board goes most of the standing committees of the board, including the Monitoring Committee.
- Silvia Cartwright is made a Dame Commander for her services to women.
- The New Zealand Health Council Working Party on Informed Consent releases a discussion paper and draft standard on informed consent. The document is welcomed by consumer groups, but generally condemned by medical groups as prescriptive and impractical. A second working party is formed by the Department of Health and develops considerably watered down grudelines for informed choice and consent.
- Helen Clark announces a $36 million cervical screening programme to be launched by the end of the year. There is immediate criticism of the design of the programme from Sandra Coney, the NZMA, and the Cancer Society. The criticisms relate to plans for a voluntary register, and the failure to involve consumers and medical experts in the design of the programme as recommended by Judge Cartwright. Because of the criticisms, Helen Clark appoints a Review Committee to advise her on any changes needed to the programme.
5 August 1989
- The Auckland Women's Health Council hosts a Cartwright One Year On conference in Auckland. Over 400 women attend. Judge Silvia Cartwright is present and is thanked by the women present for her efforts on behalf of women. At the conference Helen Clark promises action in appointing a health commissioner.
- Lynda Wllliams begins work as patient advocate at NWH.
- The Department of Health publishes the National Consensus on a Treatment Protocolfor Management of Women's Abnormal Cervical Smears.
- Wellington GP Dr Erich Geiringer publishes 'Trial In Error' in the Listener; he attacks the recommendations of the Cartwright Inquiry as ill-founded and impractical. He says the inquiry was 'unbalanced' because the matter was raised by feminists; this 'infected' the judge with negative attitudes.
- Helen Clark announces she has accepted most of the recommendations of the Review Committee on the National Cervical Screening Programme. She establishes an Expert Group to oversee implementation of the programme.
- The Medical Council announces that several doctors will face disciplinary charges arising out of the Cervical Cancer Inquiry. They are Dr G H Green, Prof. D G Bonham, Prof. R Seddon and Dr B Faris.
- The Medical Council announces it will not proceed with the charges laid against Dr G H Green because he is not mentally or physically fit to defend the charges of disgraceful conduct. The council says if Green is ever sufficiently recovered it will proceed. Prof. Bonham appeals to the High Court and later the Court of Appeal in an attempt to prevent the Medical Council hearing his case, but is unsuccessful.
- Metro magazine publishes an article by Jan Corbett entitled 'Second Thoughts on the Unfortunate Experiment at National Women's Hospital'; in this Metro recants on its earlier 'unfortunate experiment' expose. It repeats the accusations of Dr Graeme Overton, various unnamed NWH doctors, and Valerie Smith, Dr Green's ex-neighbour who has circulated a 'dossier' on personalities involved in the inquiry alleging a feminist/Labour Party conspiracy. The 'Second Thoughts' article says the inquiry was a 'radical feminist witchhunt'. Throughout July, supporters of Dr Green and Metro staff keep up a barrage of letters in the media, criticising the inquiry.
- Justice Barker strikes out proceedings instituted by Dr B Faris and Valerie Smith seeking a High Court Review of the findings of the Cartwright Report. The order to strike out is made on the application of the Attorney-General and Mrs Smith consents to it, agreeing that the grounds on which she had sought the review had no substance. She acknowledges through her counsel that she has misunderstood the judge's findings with regard to the 1984 paper.
- The Health Commissioner Bill is introduced by the Labour Government. The proposed date for implementation is 1 May 1991.
- Minister of Health Helen Clark issues a strongly worded statement defending the findings of the Cartwright Inquiry.
- The Medical Council schedules hearings in private in the case against Prof. D G Bonham.
- The Public Issues Committee of the Auckland District Law Society says that having examined the Cartwright Report it can find no legal basis for the criticisms in the 'Second Thoughts' article in Metro or those of Valerie Smith and Dr B Faris in seeking the judicial review.
- The Labour Government is voted out of office at the general election.
- Minister of Health in the National Government, Simon Upton, says that the health sector will be restructured. This is elaborated in the July 1991 Budget.
- Drs Charlotte Paul and Linda Holloway, medical advisers to Judge Cartwright during the inquiry, publish a detailed rebuttal of the claims contained in the 'Second Thoughts' article, letters to the media and letters to the New Zealand Medical Journal by supporters of Dr Green. Paul and Holloway note that the inquiry is being 'misrepresented' and that 'there appears to be continued, and possibly wilful, confusion' about Dr Green's experiment.
- The Medical Council finds that Prof. D G Bonham has been guilty of disgraceful conduct - the most serious charge. He is censured and fined the maximum amount. He is not struck off, says the council, because there has been no criticism of his clinical competence.
- Later in the month Bonham reveals he retired in February 1988 under pressure from the NZMA, and that he disagreed with Dr Green's views of CIS. In hindsight, Green's work was 'a bad thing'. Bonham says he should have distanced himself from Green at the Cervical Cancer Inquiry, but did not do so out of loyalty to his staff.
- A death from cervical cancer occurs in the TOR3 women.
- The Associate Minister of Health Katherine O'Regan disbands the Expert Group. She establishes a 'technical group' to advise her in the future. There are no consumer representatives on the new group.
- The AAHB finally announces the death earlier in the year of one of the TOR3 women and that another woman has been diagnosed with cervical cancer. This announcement only occurs after lobbying from Fertility Action. Previously supporters of Dr Green have claimed publicly that no cases of cervical cancer have appeared in TOR3 women.
- Dr Faris files a High Court action to have charges of professional misconduct against him thrown out.
- The Social Services Select Committee begins hearing oral submissions on the Health Commissioner Bill.
5 August 1991
- Associate Minister of Health Katherine O'Regan says there will be a health commissioner by Christmas 1991.
- Dr R W Jones publishes 'Reflections on carcinoma in situ' in the New Zealand Medical Journal - a rebuttal of the Metro 'Second Thoughts' article.
- A review of the position of the patient advocate at NWH reveals overwhelming client satisfaction but entrenched medical opposition.
- The advocacy service at NWH is privatised.
- Nineteen women who had sued the AAHB, the University of Auckland, Dr G H Green, Prof. D G Bonham, and the former superintendent of NWH for damages arising out of the cervical cancer experiments receive $1.02 million in an out-of-court settlement.
- Prof. Derek North, Dean of the School of Medicine at Auckland University, apologises to the victims of the NWH experiments. The delay in making such an apology he explains had been caused by the university's lawyers preventing him doing so before settlement had been reached with injured women.
- The High Court in Wellington rules that most of the disciplinary charges brought against Dr Bruce Faris and Prof. Richard Seddon will go ahead. The charges relate to the doctors' part in an internal review of cases of cervical cancer at NWH in the mid-1970s. The charges are that they failed to express concern about cases of invasive cancer and one death.
- The AAHB is criticised for not exempting the TOR3 women who need medical follow-up and treatment from user charges in the board's hospitals.
- Associate Professor Margaret Vennell reports to the Minister of Heath on the health commissioner and patient advocates. She recommends separating the advocates from the commissioner's office, and a single tribunal for hearing all complaints against health professionals.
- Dr Gillian Turner is formally appointed to the post of head of the Post-Graduate School of Obstetrics and Gynaecology at NWH; the position has been vacant for four years. She takes up her post in early 1993.
- Fifteen women are awarded accident compensation for medical misadventure resulting from their treatment at NWH.
- The Social Services Select Committee considering the Health Commissioner Bill seeks submissions from the Law Commission, the Federation of Women's Health Councils, disability groups and the N~MA on proposed major changes to the complaints process outlined in the Health Commissioner Bill. These are: to separate patient advocates from the Office of the Health Commissioner and to require that the commissioner, in most cases, refers complaints to the relevant disciplinary body rather than pursue them through an independent tribunal as originally proposed.
5 August 1993
- The Government introduces a Supplementary Order Paper on what is now to be called the Health and Disability Services Commissioner Bill. The advocates are removed from the Office of the Health Commissioner. A position of Director of Health and Disability Services Consumer Advocacy is created within the Ministry of Health to administer the advocacy service, oversee the training of advocates and monitor the operation of the service. These services will be purchased. Complaints which are not resolved by advocates can then be referred to the Health and Disability Services Commissioner. He or she will investigate and refer complaints to the Accident Compensation Corporation, the police, the Ombudsman, or to the newly appointed Proceedings Commissioner. The Proceedings Commissioner is required to consult with the relevant disciplinary body before deciding whether a case will be taken to the disciplinary body or the Complaints Review Tribunal. There is immediate criticism from women's health groups that these changes weaken the intention of the original bill. The management of advocacy services within the ministry could give rise to political interference; the advocates could be supplied by contracts to private businesses; and many complaints from consumers would be forced into the doctor-dominated medical disciplinary committees which have little credibility with the public.
See Unfinished Business: What happened to the Cartwright Report? Ed Sandra Coney 1993 for more information on this book.