Family's anger after Irish labs missed cancer that was found by doctor in Northern Ireland
A Belfast doctor diagnosed a young mother with cancer - nine months after she was given the all-clear in the Republic.
Miriam O'Brien had regular smear tests as part of the CervicalCheck screening programme, which is at the centre of the Irish cervical cancer scandal.
The 34-year-old, a single mother-of-one from Buncrana, Co Donegal, died on August 25, 2013, having been given a terminal prognosis six months earlier.
In the weeks before she died, she told her family: "If anything happens to me, tell the world what they did."
Her family have grave concerns over the care she received until the time she transferred her care to Northern Ireland, and are asking Irish health authorities to clarify if Miriam is included in the official figures of the 18 women who died after smear tests were misread.
Miriam's sisters, Danielle Miley and Susan O'Brien, together with Miriam's daughter, Rachael O'Brien (19), are taking legal action against the Republic's Health Service Executive (HSE) and labs used by CervicalCheck.
One of the defendants is Letterkenny General Hospital and its laboratories, as providers of the CervicalCheck programme, with other defendants being outsourced labs in the US.
The case was initiated by Miriam herself, after the Belfast doctor made her aware of alleged failures in her treatment in the Republic.
"She knew she was wronged and we are now carrying on her wish that her story be told," said Danielle.
"She felt it shouldn't be happening to her because she'd done everything right. She had all of the tests, they all came back clear and she never missed an appointment - how was it missed?
"We don't even know if she is part of the CervicalCheck review or is it because she was diagnosed and died in the North, they may be discounting her and if so, that's not right, because all her smears were done here."
The family described how Miriam had a smear that came back as giving no cause for alarm in June 2011 but in November/December, presented with symptoms to her GP and was referred to the cancer specialist.
"She was extremely unwell," said Susan, explaining that her sister's symptoms included such severe pain that she was unable to stand, and heavy bleeding.
In March 2012 she switched to cancer care in Northern Ireland because she worked across the border in Londonderry, and within three to four weeks of being treated in Northern Ireland's health system, was diagnosed with stage 2B cervical cancer.
She was treated in Belfast, with chemotherapy, radium, brachytherapy, and a hysterectomy was carried out that October.
"They threw the kitchen sink at it," said Susan. "Miriam had good days and bad days - she didn't want to be too reliant on pain relief and she was very hopeful at that point."
But after the hysterectomy, she was still in pain and in January 2013, doctors took her back in for more tests after finding a mass that they initially thought was an abscess. Miriam was then told her cancer was terminal.
"The pain was unbearable," explained Susan, describing how they would stay holding her at home as she cried with the severity of it.
"It was horrendous to watch," she said.
"We feel that Miriam's death was completely avoidable," added Susan.
Rachael, who was 14 at that time, described how she went away to the Gaeltacht in June that year and everything was "fine". But when she returned three weeks later, there had been a "complete flip around".
"Everything changed," she said. "You never expect to go away for three weeks and come back to that."
She described Miriam as a wonderful, supportive mother and a great friend. "It was just me and her and if I ever have a child that's the relationship I want to have," said Rachael, who is now going down the same caring career path as her mother, with one year left to complete in her childcare course.
After six weeks in hospital, Miriam passed away on August 25, 2013.
The defendants in the legal action being taken by her family are the HSE and Letterkenny General Hospital, Clinical Pathology Laboratories, MedLab Pathology Ltd (a sister company of CPL), Sonic Healthcare (which owns CPL and MedLab) and Quest Diagnostics.
The family have been trying to get answers but have been hampered in their search for information - including which lab carried out the smear tests - and so have included all the possible facilities used by the CervicalCheck programme.
Danielle has contacted the CervicalCheck helpline on four separate occasions in the past two weeks, but has not had a satisfactory response.
On the first occasion, she received assurances that someone would call her but that did not happen and two days later, she rang again to say that her 77-year-old mother was anxious to know if Miriam's name was going to come out amid the CervicalCancer scandal.
She was told she would be prioritised but after receiving two subsequent text messages saying that her call had been logged, she rang again on May 11 to be told they were dealing with "priority cases" first. Since then, the family have had no contact with the service.
"We want to know if she is part of this at all - is she one of the 209 women who were subject to CervicalCheck reviews, or is she one of the 18 women who passed away, or is she one of the six women who still have not been contacted?" Danielle said.
"Miriam knew in her heart and soul that she was wronged," she said. "She started the legal process because she wanted to know what they had done to her."
When a query was put to the HSE about whether Miriam is in the official statistics, it responded that it would encourage "all individuals to make direct contact with CervicalCheck on 1800 45 45 55 as they have all data regarding every individual registered".
The statement finished: "We are making every effort to ensure every person who rings is answered and where appropriate and necessary receives a subsequent call back."
MedLab said it could not comment on whether it had any involvement in Miriam's case.