Cartwright Inquiry
Encyclopedia
The Cartwright Inquiry was a Commission of Inquiry held in New Zealand
from 1987 - 1988. It was commissioned by the then Minister of Health
, Michael Bassett
to investigate the alleged malpractice
of Associate Professor Herb Green
, a gynaecology
and obstetrics
specialist. The inquiry was headed by then District Court Judge Silvia Cartwright
, later High Court Justice, Dame, and Governor-General of New Zealand
.
, pathologist, gynaecologist and a statistician
, referred to an 'experiment' that had occurred at New Zealand's The National Women's Hospital from 1966 onwards. This experiment involved deliberately not treating women with abnormal cervical smears
, when these abnormalities could potentially lead to cervical cancer
. Two prominent women's health advocates and writers, Sandra Coney
and Phillida Bunkle
, had already heard rumours about this paper while they had been researching material about another matter
. Coney and Bunkle published an expose in Metro
Magazine in June 1987, titling it after a 1986 letter in the New Zealand Medical Journal by Professor David Skegg
, a Public Health expert with a strong interest in screening condemning what he called the "Unfortunate Experiment". This led to widespread public outcry and the then Minister of Health
, Michael Bassett
calling an inquiry.
had been intentionally undertreating women with cervical cancer and experimenting on his patients without their consent or proper approval.
Following the development of the Pap smear
by Georgios Papanikolaou
in 1928, there had been worldwide interest in developing screening programmes for cervical cancer, such as that begun in British Colombia, Canada in 1949 http://www.ccpcn.ca/en/about-ccpcn/what-is-ccpcn/history.php. Although Herb Green was an early proponent of cervical screening, by the mid-1960s he had formed a minority view that cervical dysplasia does not always progress to cervical cancer.
In 1966 he submitted a proposal to the Hospital's Medical Committee to:
, Dr Charlotte Paul, Epidemiologist, University of Otago
Medical School
and Dr Linda Holloway, Pathologist, University of Otago
Wellington School of Medicine.
Overall 1200 patient files were reviewed.
The Inquiry ran for seven months and experts were brought from around New Zealand as well as from Australia, United States and Norway, to comment on Green's work. They testified that Green's work varied significantly from what was considered good practice and put his patients at risk.
was established, with a Code of Health Consumers' Rights which enshrined informed consent. Teaching practice was changed at National Women's Hospital and Auckland Medical School
to conform to international practice, independent health ethics committees were set up throughout New Zealand, and a national cervical screening programme was established.
insertions on unconsenting women anaesthetised for operations.
ill-equipped to design or carry out a better experiment. Others such as Bryder repeat Green's claims to the Inquiry that there was no experiment.
New Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...
from 1987 - 1988. It was commissioned by the then Minister of Health
Minister of Health (New Zealand)
The Minister of Health is a minister in the government of New Zealand with responsibility for the New Zealand Ministry of Health and the District Health Boards.The present Minister is Tony Ryall, a member of the National Party.-History:...
, Michael Bassett
Michael Bassett
Michael Edward Rainton Bassett, QSO is a former Labour Party member of the New Zealand House of Representatives and cabinet minister in the reformist fourth Labour government...
to investigate the alleged malpractice
Malpractice
In law, malpractice is a type of negligence in, which the professional under a duty to act, fails to follow generally accepted professional standards, and that breach of duty is the proximate cause of injury to a plaintiff who suffers harm...
of Associate Professor Herb Green
Herb Green
George Herbert "Herb" Green was the doctor at the centre of the Cartwright Inquiry, a commission set up to examine claims that he had been illegally experimenting on patients without their consent between 1966 and 1987...
, a gynaecology
Gynaecology
Gynaecology or gynecology is the medical practice dealing with the health of the female reproductive system . Literally, outside medicine, it means "the science of women"...
and obstetrics
Obstetrics
Obstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy , childbirth and the postnatal period...
specialist. The inquiry was headed by then District Court Judge Silvia Cartwright
Silvia Cartwright
Dame Silvia Rose Cartwright, PCNZM, DBE, QSO, DStJ was the 18th Governor-General of New Zealand.She is a graduate of the University of Otago, where she gained her LL.B degree in 1967, and a former student at Otago Girls' High School.- Public life and family :In 1989, she became the first female...
, later High Court Justice, Dame, and Governor-General of New Zealand
Governor-General of New Zealand
The Governor-General of New Zealand is the representative of the monarch of New Zealand . The Governor-General acts as the Queen's vice-regal representative in New Zealand and is often viewed as the de facto head of state....
.
Background to the Inquiry
In 1984 a medical paper by a colposcopistColposcopy
Colposcopy is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva. Many premalignant lesions and malignant lesions in these areas have discernible characteristics which can be detected through the examination...
, pathologist, gynaecologist and a statistician
Statistician
A statistician is someone who works with theoretical or applied statistics. The profession exists in both the private and public sectors. The core of that work is to measure, interpret, and describe the world and human activity patterns within it...
, referred to an 'experiment' that had occurred at New Zealand's The National Women's Hospital from 1966 onwards. This experiment involved deliberately not treating women with abnormal cervical smears
Pap smear
The Papanicolaou test is a screening test used in to detect pre-cancerous and cancerous processes in the endocervical canal of the female reproductive system. Changes can be treated, thus preventing cervical cancer...
, when these abnormalities could potentially lead to cervical cancer
Cervical cancer
Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. One of the most common symptoms is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer is in its advanced stages...
. Two prominent women's health advocates and writers, Sandra Coney
Sandra Coney
Sandra Lorraine Coney, QSO is a New Zealand feminist and women's health campaigner who is currently an Auckland Councillor.-Activist career:...
and Phillida Bunkle
Phillida Bunkle
Phillida Bunkle is a former New Zealand politician. She was born in Sussex, England.She was educated at Keele University, England, receiving a BA with First Class Honours; Smith College, Massachusetts, USA, receiving a MA; and St Anne's College, Oxford...
, had already heard rumours about this paper while they had been researching material about another matter
Dalkon Shield
The Dalkon Shield was a contraceptive intrauterine device developed by the Dalkon Corporation and marketed by the A.H. Robins Company. The Dalkon Shield was found to cause severe injury to a disproportionately large percentage of its users, which eventually led to numerous lawsuits in which...
. Coney and Bunkle published an expose in Metro
Metro (magazine, NZ)
Metro is a glossy monthly lifestyle magazine published in New Zealand by ACP Media. It has a strong focus on the city of Auckland, with reportage of issues and society...
Magazine in June 1987, titling it after a 1986 letter in the New Zealand Medical Journal by Professor David Skegg
David Skegg
Sir David Christopher Graham Skegg, KNZM, OBE, FRSNZ is a New Zealand epidemiologist and university administrator. He is a former Vice-Chancellor of the University of Otago and Professor of Preventive and Social Medicine. His primary research interest is cancer epidemiology.- Biography :Skegg was...
, a Public Health expert with a strong interest in screening condemning what he called the "Unfortunate Experiment". This led to widespread public outcry and the then Minister of Health
Minister of Health (New Zealand)
The Minister of Health is a minister in the government of New Zealand with responsibility for the New Zealand Ministry of Health and the District Health Boards.The present Minister is Tony Ryall, a member of the National Party.-History:...
, Michael Bassett
Michael Bassett
Michael Edward Rainton Bassett, QSO is a former Labour Party member of the New Zealand House of Representatives and cabinet minister in the reformist fourth Labour government...
calling an inquiry.
Green experiments
The inquiry was set up to examine whether Herb GreenHerb Green
George Herbert "Herb" Green was the doctor at the centre of the Cartwright Inquiry, a commission set up to examine claims that he had been illegally experimenting on patients without their consent between 1966 and 1987...
had been intentionally undertreating women with cervical cancer and experimenting on his patients without their consent or proper approval.
Following the development of the Pap smear
Pap smear
The Papanicolaou test is a screening test used in to detect pre-cancerous and cancerous processes in the endocervical canal of the female reproductive system. Changes can be treated, thus preventing cervical cancer...
by Georgios Papanikolaou
Georgios Papanikolaou
Georgios Nicholas Papanikolaou was a Greek pioneer in cytology and early cancer detection, and inventor of the "Pap smear".-Life:...
in 1928, there had been worldwide interest in developing screening programmes for cervical cancer, such as that begun in British Colombia, Canada in 1949 http://www.ccpcn.ca/en/about-ccpcn/what-is-ccpcn/history.php. Although Herb Green was an early proponent of cervical screening, by the mid-1960s he had formed a minority view that cervical dysplasia does not always progress to cervical cancer.
In 1966 he submitted a proposal to the Hospital's Medical Committee to:
- 'withhold conventional treatment of cone biopsy or hysterectomyHysterectomyA hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total or partial...
in women under thirty-five years old'.
Inquiry
District Court Judge Sylvia Cartwright was appointed by warrant dated 10 June 1987 as a Committee of Inquiry to inquire into the treatment of cervical cancer at the National Women's Hospital and other matters. The terms of reference (below) contained many matters that were of general interest regarding patient care and research , in addition to being of particular importance at the National Women's Hospital.Terms of Reference
The Terms of Reference for the Inquiry were to investigate whether (as alleged in the Metro Article):- If there was a failure to adequately to treat cervical cancer and the reasons for this
- If a Research programme into the natural history of CIS was established
- Whether this had been approved
- Whether patients were aware they were in a research programme
- Whether any concerns were expressed at the time
- Whether there was need to contact women involved
- Whether the National Women's Hospital's procedures for research were adequate, especially regarding rights of patients
- Whether the protection of patients undergoing research needs to be improved
- Whether the patients at the National Women's Hospital were properly informed of the treatment and options available to them
- What training is given to doctors regarding cervical cancer
- What is the relationship between the academic and clinical units at the hospital
- Any other matter which is relevant.
Parties to the Inquiry
The first preliminary hearing was held on the 18th June 1987. Three medical advisers were appointed, Professor E V MacKay, Professor of Obstetrics and Gynaecology at the University of QueenslandUniversity of Queensland
The University of Queensland, also known as UQ, is a public university located in state of Queensland, Australia. Founded in 1909, it is the oldest and largest university in Queensland and the fifth oldest in the nation...
, Dr Charlotte Paul, Epidemiologist, University of Otago
University of Otago
The University of Otago in Dunedin is New Zealand's oldest university with over 22,000 students enrolled during 2010.The university has New Zealand's highest average research quality and in New Zealand is second only to the University of Auckland in the number of A rated academic researchers it...
Medical School
University of Otago Dunedin School of Medicine
The Dunedin School of Medicine is one of three medical schools that make up the Faculty of Medicine at the University of Otago. All Otago University medical students who gain entry after a first year "Health Sciences" program, or who gain graduate entry spend their second and third years studying...
and Dr Linda Holloway, Pathologist, University of Otago
University of Otago
The University of Otago in Dunedin is New Zealand's oldest university with over 22,000 students enrolled during 2010.The university has New Zealand's highest average research quality and in New Zealand is second only to the University of Auckland in the number of A rated academic researchers it...
Wellington School of Medicine.
Overall 1200 patient files were reviewed.
The Inquiry ran for seven months and experts were brought from around New Zealand as well as from Australia, United States and Norway, to comment on Green's work. They testified that Green's work varied significantly from what was considered good practice and put his patients at risk.
Results
The Inquiry confirmed the claims made by Coney and Bunkle and the ensuing report - The Report of the Cervical Cancer Inquiry (1988) - led to sweeping changes in law and practice around health consumers' rights. The Office of Health And Disability CommissionerHealth and Disability Commissioner
The Health And Disability Commissioner is a New Zealand crown entity responsible for promoting and protecting the rights of health and disability consumers, and facilitating the fair, simple, speedy, and efficient resolution of complaints.-External links:*...
was established, with a Code of Health Consumers' Rights which enshrined informed consent. Teaching practice was changed at National Women's Hospital and Auckland Medical School
University of Auckland, Faculty of Medical and Health Sciences
The University of Auckland's Faculty of Medical and Health Sciences was established in 1968 at its present site in Grafton, Auckland...
to conform to international practice, independent health ethics committees were set up throughout New Zealand, and a national cervical screening programme was established.
Other related findings
Other unethical practices exposed at the Inquiry were Green's 'baby smears' experiment in which cervical smears were taken from newborn baby girls without their parents' consent, all part of Green's theory that some women were born with abnormal cervical cells and that these were not linked to cervical cancer. Also exposed was the hospital's practice of teaching vaginal examinations and IUDIntrauterine device
A copper IUD is a type of intrauterine device. Most IUDs have a plastic T- or U-shaped frame which is wrapped in copper wire, with the exception of Gynefix, which is a plastic string with several copper beads, affixed to the fundus of the uterus...
insertions on unconsenting women anaesthetised for operations.
Public interest in the process
There was widespread public interest in and condemnation of both Green's actions, and the ethos of the hospital itself which allowed these practices to continue. The Inquiry revealed that several doctors in the hospital had tried to stop Green's studies but the hospital and hospital board hierarchy had declined to take action.Feminist perspectives
There can be no doubt that the Inquiry marks one of the most major leaps forwards in Women's rights in New Zealand. In her book, Coney says "There was a danger that this significant event would go down as something to do with doctors and lawyers and that the women who initiated it and saw it through would be, like so many of their foremothers, written out of history."- The events surrounding the Committee of Inquiry into Allegations Concerning the Treatment of Cervical Cancer at National Women's Hospital and into Other Related Matters in Auckland, New Zealand between August 1987 and March 1988 have international importance as an example of a feminist challenge to patriachal medical structures
Medical perspectives
Although Coney and Bunkle rightly deserve credit for the popular groundswell of opinion that led to the Inquiry, medically the introduction of the cervical screening programme marks the end of long-standing work by large numbers of researchers and campaigners over decades. The medical schools now emphasize ethical training, research and evidence as fundamentals in medical training.Patient perspectives
The reforms started by the changes in ethics committees recommended by the Inquiry and cemented in the role of the Health and Disability CommissionerNew looks at the Inquiry
There have been many articles over time in the lay and academic press over the last twenty years, some are accused of taking a 'revisionist' view of the Unfortunate Experiment. Some (such as Heslop), have claimed that lack of ethical and research training left GreenHerb Green
George Herbert "Herb" Green was the doctor at the centre of the Cartwright Inquiry, a commission set up to examine claims that he had been illegally experimenting on patients without their consent between 1966 and 1987...
ill-equipped to design or carry out a better experiment. Others such as Bryder repeat Green's claims to the Inquiry that there was no experiment.
Numbers harmed
Sandra Coney claimed in her book that "His way was too slow for the twenty-six women who died". In the 1996 Listener Article written by Coney she referred to '26 lives wasted'. Tony Baird wrote to the Director-General of Health, George Salmond, to inquire where this figure had come from; he was told that it was a 'commonly used figure' rather than an 'official figure'. There was no 'official figure'. Sixteen years later, the director of the Women's Health Council, Lynda Williams, published an article in the New Zealand Medical Journal stating that 'we must not forget that over 30 women died as a result'. Baird responded that claiming that the figure 'cannot be substantiated; he referred to appendix 12 of the Cartwright Report listing 24 women who died between 1973 and 1987, pointing out that in only eight of them was cancer of the cervix recorded as the cause of death and there is no way of knowing whether or not those women were part of the study of Associate Professor Green'.Outcomes
Green was never brought before medical disciplinary authorities because he was deemed to be too frail to be charged. His superior and head of the hospital, Professor Denis Bonham, was found to have engaged in disgraceful conduct by the Medical Council. Eventually 19 women who took legal action received compensation in an out-of-court settlement.Further reading
- Coney, Sandra (Ed.) 1993 Unfinished Business: What happened to the Cartwright Report? Women's Health Action Trust, ISBN 0-473-02018-1