An expert on cervical screening has said it was "unacceptable" that a cervical smear taken from Limerick woman, Ruth Morrissey in 2009 was described as "negative" when it was patently clear that it was abnormal.
Dr Michael McKenna, a consultant cytopathologist in charge of one of the North's four cervical screening laboratories, said it was "unbelievable" that those screening the slide at a laboratory in Grand Rapids, Wyoming in the United States, on behalf of Quest Diagnostics did not see any of the "obvious abnormalities".
He said it fell below the standard of care Ms Morrissey should have expected.
Dr McKenna is giving evidence in Ms Morrissey's case against the HSE and two laboratories - Quest Diagnostics and MedLab Pathology - over the alleged misreading of cervical smears, and the failure to tell her about it sooner.
Ms Morrissey's lawyers also told the court that the laboratory in Wyoming in which the 2009 slide was screened, was not referred to in the contract between the HSE and Quest Diagnostics and was unsupervised by the HSE and not subject to any quality assurance by it.
The court has heard that if the slide had been reported correctly as showing abnormalities, Ms Morrissey would have been called back for a repeat smear test after six months.
Dr McKenna told the court it took him one minute to detect an abnormality in the slide.
He said his conclusion was that it was impossible not to have seen the abnormal group of cells.
There were very obvious abnormalities he said, which breached the fundamental tenets of what is interpreted as benign.
He said he would expect any of the screeners who work for him to have identified the abnormality.
Dr McKenna said people talked about cytology as being subjective. He said it was the judgment of one person, but he said, there were criteria under which you make that judgment.
Yesterday, he identified eight critieria which have to be applied when deciding that a sample is not benign and he outlined the aspects of Ms Morrissey's smear test that breached those criteria.
He told Mr Justice Kevin Cross that he would not expect perfection from screeners, but when something was as "clearly abnormal" as this, it must be identified.
He said in this case, there must and should have been doubt.
Dr McKenna said any screener exercising reasonable care could not have failed to see what was on the slide and no reasonably competent screener could have treated it as normal.
He said he did not believe the way Quest Diagnostics read the slide was in accordance with good laboratory practice.
Dr McKenna said he also thought the fact that at the time, US women were called back for repeat smears annually could have lulled screeners into a false sense of security.
The court heard Quest Diagnostics has submitted a report showing that in a "blind review" carried out by a separate Wisconsin laboratory, six out of eight screeners had also identified Ms Morrissey's smear test as being negative.
He said the sample of ten slides used was too small and he said this type of review often led screeners to undercall or overcall things.
The court also heard the screeners undertook the blind review under guidelines issued by the American society for Cytopathology in the context of possible litigation.
These guidelines encouraged screeners not to consider categories that would be borderline.
Ms Morrissey's Senior Counsel, Patrick Treacy, also raised the contract agreed between the HSE and Quest Diagnostics.
He said the laboratory in Grand Rapids, was not referenced in the contract as a laboratory where it was agreed screening would take place.
He said Quest sent this smear off to Grand rapids to be read by a laboratory unknown by the HSE, unsupervised by the HSE and not subject to any quality assurance by the HSE.
The case will continue this afternoon.