It shows communications in March 2016 between the Health Service Executive, the National Cancer Screening Service and the Chief Medical Officer of the Department regarding the CervicalCheck Audit.
The March 2016 memo, which called for all letters to be paused, was prepared by Majella Byrne, Head of National Screening Service, HSE Health and Wellbeing Division on behalf of Dr Stephanie O'Keeffe, National Director Health & Wellbeing.
The documents also warn there is a risk of negative publicity and reputational impact involved in communicating review outcomes to the clinicians of individual patients.
The documents say that GPs and health professionals should be informed of the audit.
In September 2016, the Chief Medical Officer was given letter templates to consultants and GPs on the smear test audit.
The documents also show that in June 2016, officials in the Department of Health were told that women whose smear tests were subject to a clinical audit should be informed "if the woman herself asks about her screening history".
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A memo provided by CervicalCheck states: "While CervicalCheck supports the principals of open disclosure, it is recognised that there are limitations to its universal implementation particularly for screening services where there is an inherent recognised error rate."
The memo shows that officials in the Department of Health were informed that in cases where women died before the completion of a clinical review "the review outcome is still communicated to the doctor, for inclusion in the woman's medical record".
It advises that "clinicians should use their judgement in selected cases where it is clear that discussion of the outcomes of the review could do more harm than good".
The document states that "where a review outcome suggests that a step may not have been carried out as recommended, the discussion should include the full context and detail obtained from the relevant consultant doctors and pathologists.
"Women should be advised of their right to receive copies of all information, include any review reports and should be given contact details on how to proceed if they wish to do so."
Related documents show officials at the Department of Health were told in March 2016 that some women may not be aware that their cervical smear tests were subject to a clinical audit.
A status report issued by CervicalCheck, which was circulated by the Department of Heath, states that "women may not be aware of the audit process and it may come as a surprise that such an audit was performed".
It states that "clinicians should be informed of the cancer audit process and requested to advise the women when diagnosis of cervical cancer is notified".
The same document states "the outcome of reviews are being communicated by letter to the women's clinician. The clinician is requested to discuss the outcome with the women if this is appropriate".
The documents show discussions about the audit process took place at a meeting between the Department of Health, the National Cancer Control Programme and the National Screening Service on 3 March 2016.
Minutes of the meeting show the Head of the National Screening service raised the matter with officials from the Department of Health and informed the meeting that clinicians involved in individual cases were being written to in relation to the audit.
Further discussions took place in April at a meeting attended by the Chief Medical Officer.
A further memo circulated within the Department of Health in April 2016 shows there was a legal dispute involving the laboratories that carried out the screening.
It states that "one of the contracted cytology laboratory providers" had "alleged a breach of contract to challenge the right of the programme to communicate review outcomes to treating clinicians".
It says the cytology laboratory in question "invoked the Dispute Resolution Procedure" in the contract and "numerous legal letters have been sent by the solicitors retained by the laboratory".
Documents released by the Dept of Health show in Oct 2016 the dept's Chief Medical Officer was told of legal proceedings being taken in relation to the Cervical cancer audit. pic.twitter.com/bpFeeOrDvc— Justin McCarthy (@MrJustinMac) May 15, 2018
In another memo, the Chief Medical Officer at the Department of Health was informed in October 2016 that legal proceedings had been taken by one of the women involved in the cervical cancer audit.
The women who initiated the legal action subsequently died.
The memo circulated to Tony Holohan states that "one legal proceeding has been taken by a woman who has since passed away" and a further "four letters from legal representatives of women seeking copies of all medical records have been received".
Dr Holohan was informed that doctors treating women with cervical cancer were told that the outcome of a clinical audit of smears should be communicated to the woman, but "clinicians should use their judgement in selected cases where it is clear that discussion of the outcomes of the review could do more harm than good".
The memo states that "in cases where the woman has died, simply ensure the result is recorded in the women's notes".
The memo was prepared for the chief medical officer by the National Screening Service.
'No concerns raised' over cervical programme - Taoiseach
Taoiseach Leo Varadkar told the Dáil this afternoon that the documents show that no concerns were raised about the cervical screening programme with the department and the issues were not escalated to advisors, ministers or the secretary general.
The number of women who have died in relation to the CervicalCheck crisis has increased to 18.
The additional case has been identified by the HSE’s Serious Incident Management Team as it continues to try to contact all those affected.
So far, 205 of the 209 women or families in the original group who were subject to CervicalCheck audits have been contacted.
The HSE says that most women have at this stage been contacted and meetings have either been held, or have been arranged, to discuss the audit and the response with them.
In the case where women are deceased, their family or next of kin are being contacted.
Earlier, the Social Democrats said that significantly more women may have developed cancer after getting the all-clear from a smear test.
The party’s co-leader Róisín Shortall said this claim related to the 1,500 or so cases that were not initially audited but had been notified to the National Cancer Registry.
She said a number of women from this group had contacted the party to say they had a smear test but later became ill.
Ms Shortall said the total number of cases that are now being audited must be published soon. She said the number of women affected could potentially be as high as 200.
Her party colleague Catherine Murphy called for the publication of documents that will reveal the HSE's communication plans around the CervicalCheck audits.
The Kildare North TD said the Oireachtas Public Accounts Committee would continue to examine this issue and it would not bring down the shutters on its work just because the Scally inquiry is under way.
Dr Gabriel Scally has been appointed by the Government to conduct a preliminary inquiry into the cervical cancer controversy.
Additional reporting Micheál Lehane, Conor McMorrow, Justin McCarthy