1 Wednesday, 19 October 2011
2 (10.00 am)
3 MR MACAULAY: Good morning, my Lord. I understand that
4 Ms Donald would wish to address your Lordship before
5 I call the next witness.
6 LORD MACLEAN: Ms Donald?
7 MS DONALD: Good morning. My Lord. My Lord, yesterday
8 afternoon there was a discussion between Dame Elish and
9 your Lordship about Dr Clarke.
10 LORD MACLEAN: Yes.
11 MS DONALD: I managed to speak with Dr Clarke yesterday
12 evening, and I have met with her this morning, as
13 instructed by your Lordship. Dr Clarke did indeed
14 receive the letter of 22 September and did telephone
15 your Lordship's Inquiry team.
16 She had misread the letter she had received,
17 thinking that it asked her to keep herself available for
18 the whole of the period from 19 October until 5 and
19 6 December, rather than the three days mentioned in the
20 letter. On telephoning, she was given reassurance she
21 would not be required for the whole period, but to
22 attend on specific days.
23 Her understanding thereafter was that she would be
24 told when she should come, she would be given another
25 telephone call. In any event, Dr Clarke is here today.
1
1 She and I have had an opportunity to discuss the matters
2 that Mr MacAulay has indicated he is going to raise with
3 her in examination-in-chief, those matters being the
4 contents of her statement, the contents of an email
5 exchange referred to in the statement and the treatment
6 of one particular patient.
7 I have had an opportunity to go through those
8 matters with Dr Clarke and I am content that Dr Clarke
9 can proceed to give that evidence with me representing
10 her this morning, and I am very grateful to
11 your Lordship for the time.
12 LORD MACLEAN: I am very grateful to you, actually, for
13 interceding or intervening and making it clear to
14 Dr Clarke what the true meaning of the letter was and
15 the notice. I am delighted that she is here to give
16 evidence. Good.
17 MR MACAULAY: My Lord, can I move on and call
18 Patricia Clarke?
19 DR PATRICIA CLARKE (affirmed)
20 Examination by MR MACAULAY
21 MR MACAULAY: Good morning, Dr Clarke.
22 A. Good morning.
23 Q. Are you Patricia Clarke?
24 A. Yes.
25 Q. Can you tell the Inquiry what position you hold at
2
1 present?
2 A. I am a consultant haematologist at the
3 Vale of Leven Hospital.
4 Q. For how long have you held that particular position?
5 A. Since 1991.
6 Q. If I can just retrace your steps a little bit. When did
7 you qualify?
8 A. I qualified in 1979.
9 Q. Following upon that, where did you go to work?
10 A. I worked variously around London and the south-east. My
11 first job was at Charing Cross, then Frimley Park, then
12 Charing Cross, Balham. I got lost then. Watford.
13 Q. Can I just say, perhaps just slow down a little bit so
14 the transcriber can catch your every word.
15 A. Sorry.
16 Q. Can I ask you this: when did your interest in
17 haematology begin?
18 A. During my first post-registration job, I did an oncology
19 job at Charing Cross, where I was involved partly in
20 haematology. That was where my interest started. So
21 I did medical jobs after that, because one of
22 the qualifications for haematology is the membership of
23 the Royal College of Physicians, so I did that
24 qualification first and then went into haematology.
25 Q. So far, you have been, I think, giving me some
3
1 information as to your work experience south of
2 the border?
3 A. Mmm-hmm.
4 Q. When, then, did you move to Scotland?
5 A. I moved the year before I started at the Vale of Leven:
6 I think October 1989, I think it would have been.
7 Q. Where did you go to work at that time?
8 A. I worked at the Western Infirmary in Glasgow.
9 Q. What position did you hold at that time?
10 A. Senior registrar in haematology.
11 Q. Then, did you move from there to take up the consultancy
12 post in the Vale of Leven?
13 A. Yes.
14 Q. In 1991?
15 A. Mmm-hmm.
16 Q. At the time you took up your position in 1991, which is
17 quite some time ago now, what was the nature of
18 the hospital at that time?
19 A. It was a small district general hospital admitting
20 a full range of medical admissions: a combination of
21 acute, medical and surgical admissions, outpatients.
22 Sort of fairly standard for a district general hospital
23 at that time.
24 Q. Today, has there been a change since then?
25 A. Yes, there has been a huge change since that time. So
4
1 now there is no acute surgical admissions received by
2 the hospital. There will be short-stay surgical
3 patients. The medical patients are different as well.
4 There is only a selected group of acute medical
5 admissions will come through the hospital, with others
6 either coming to the hospital and being transferred to
7 Paisley, which is where they would usually go, or being
8 diverted directly from the ambulance service through to
9 another hospital.
10 Other things that have changed is that there is no
11 longer a paediatric unit; the maternity unit is now
12 a nurse-led unit, a midwife-led unit.
13 Q. Can you just give me a general understanding as to what
14 a haematologist does?
15 A. There are two main parts to the job. The first is the
16 laboratory side of the post, where any samples coming
17 through for haematology blood tests will come through
18 the haematology laboratory. I would be in charge of
19 that. So although the technical staff would be the ones
20 undertaking the work, it would be under my supervision.
21 If there were queries about results, clinicians
22 would phone me; if there were specific tests, I would be
23 involved in doing those, for looking at, for example,
24 blood films, where there was a significant abnormality,
25 bone marrow examinations.
5
1 Q. So that is the first limb?
2 A. That is the laboratory side of it.
3 Q. Just to be clear, then, if samples are sent for blood
4 sampling, the lab staff would carry out the work?
5 A. Mmm-hmm.
6 Q. Would you be supervising that, to some extent?
7 A. I would be in charge of the -- I would be responsible
8 for the process, yes, but I wouldn't be doing a lot of
9 it; only if there were certain abnormalities. There was
10 a specified list of abnormalities and, if it met those
11 criteria, then it would be referred to me to take
12 further action.
13 Q. Would you then liaise with clinicians?
14 A. That would be the usual. So I would usually, if I had
15 a significantly abnormal result, phone through to either
16 the GP or hospital clinician. Other ones would just be
17 a written report. I would add a comment onto a report.
18 But if it was not urgent, it would just go out in
19 written format at that point.
20 Q. Just on looking at this particular aspect of your
21 responsibilities, then, would you be located in the
22 laboratory area?
23 A. Yes.
24 Q. Leaving that aside for the moment, then, the other
25 aspect of your job?
6
1 A. Is clinical haematology, where that's involved in
2 managing patients who have haematological disorders or
3 for investigation of possible haematological disorders.
4 Q. Can you give us some examples of that what might
5 involve?
6 A. Lymphoma, leukemia, anaemias of various types.
7 Q. In relation to that aspect of the job, would you be
8 looking at patients in the different wards in the
9 hospital?
10 A. Most patients would be coming to an area where I worked,
11 and so I'd either be seeing them in an outpatient clinic
12 or on the day ward. So that's where most patients would
13 come to. But I would also be requested by other
14 clinicians to see patients that they might have in under
15 their care who might have a blood problem, in which case
16 I would go to the ward.
17 In addition, I would have some of my own patients in
18 hospital as well at any one time.
19 Q. Would the patients that you would have in the hospital
20 be in different wards or in a particular location?
21 A. They would be in different wards. There was an attempt
22 to try and keep them in a single area as much as
23 possible so that expertise could be built up among
24 a smaller pool of staff, but the reality was that they
25 often were spread around. Often they needed side room
7
1 facilities. So they had to go where there were single
2 rooms.
3 Q. If I can look at a document which I think may be some
4 form of a job description; GGC22090001. We are looking
5 at a document that has your name towards the top, and
6 towards the very bottom, in the bottom left, we can read
7 "P Clarke job plan 2005. doc". Do you see that?
8 A. Yes.
9 Q. Can you tell us what this is?
10 A. This is a job plan. I'm not exactly certain when the
11 process started, but there is -- the current process is
12 an annual review of job plan, to look at what sessions
13 you do, how they are filled, and that is, as part of
14 the appraisal process, what your work is is reviewed and
15 how your time is distributed.
16 Q. So we can see, for example, that under the heading
17 "Day", we get the various days of the week, and there
18 are times allocated to different tasks. Is that how we
19 read this?
20 A. Yes.
21 Q. So, for example, if we look at the first entry for
22 Monday, it would appear that from 9.15 to 9.45,
23 according to this, you would be within the laboratory --
24 A. Yes.
25 Q. -- and so on. Did you also have some commitment to
8
1 another hospital outwith the Vale of Leven?
2 A. I worked at the Lorn and Islands Hospital.
3 Q. We see reference to that on Tuesday?
4 A. Yes, so on alternate Tuesdays, I visit there and do
5 a clinic.
6 Q. Looking to this, you certainly would appear to spend
7 a reasonable amount of your time in the laboratory?
8 A. Yes.
9 Q. On each day, in fact.
10 A. I certainly spend a significant part of every day in the
11 laboratory.
12 LORD MACLEAN: Where is the other hospital?
13 A. In Oban.
14 MR MACAULAY: If we can look at what may be a floor plan for
15 the laboratory, and this is at GGC27620001, and could we
16 also have -- let's look at this, first of all. This is
17 described as being the laboratory ground floor. Do you
18 recognise this ground floor plan of the laboratory?
19 A. I do.
20 Q. I don't need for you to tell me what all the areas are,
21 but looking to the sampling of the blood samples, for
22 example, would that be done on the ground floor or
23 where?
24 A. The samples would come in through the door into the
25 area -- into the reception area, 32, and then the
9
1 laboratory reception is rooms 26 and 27.
2 Q. If we look at where we see number 2, that is the
3 reception area, is it?
4 A. Yes, where you have highlighted now.
5 Q. I'm sorry?
6 A. 26/27.
7 Q. 26/27 is the reception area?
8 A. Yes.
9 Q. Where is the way in?
10 A. Through the doors by number 32.
11 Q. I see, yes. So that is the reception area. Would there
12 be somebody there to deal with people who came into the
13 laboratory?
14 A. Yes.
15 Q. And with samples?
16 A. Yes.
17 Q. What about the sampling itself? Was that done on this
18 floor or in a different area?
19 A. No sampling was taken in the laboratory at this time.
20 Any samples would be taken either on the wards,
21 GP surgeries, outpatients.
22 Q. Yes, indeed, but I meant the analysis of the samples.
23 A. Sorry, the analysis. The samples would be initially
24 processed there, so they would be numbered so that --
25 they would be checked and numbered in the reception
10
1 area. Some specimens would have some initial
2 processing, such as centrifugation done there, although
3 that wouldn't be so for haematology. Then they would be
4 taken down the corridor by a member of the reception
5 staff, usually down to, for haematology, room 19 was the
6 main haematology lab and room 18 was the transfusion
7 laboratory.
8 Q. I see. Now, there you are dealing with, essentially,
9 blood samples. We are interested in samples taken so
10 that C. diff could be tested.
11 Now, I take it -- I understand that is not under
12 your domain, but was the testing for C. diff done on
13 this floor or on a different floor?
14 A. On the floor above in the microbiology department.
15 Q. But would the specimens still come into the reception
16 area?
17 A. All the specimens would come into the reception area.
18 The basic numbering and checking would have been done
19 for all disciplines there.
20 Q. If we look at the plan for the floor above, GGC27610001,
21 that is described as the first floor of the laboratory
22 block. Are you able to identify the microbiology lab,
23 then, on the plan?
24 A. From the stairwell to the left is all part of
25 the microbiology department, or was.
11
1 Q. So we are looking at rooms like 21?
2 A. 21 was the main microbiology laboratory.
3 Q. Are you able to help on this: what days was the
4 laboratory open? By that, I mean, obviously it was open
5 Monday to Friday, but if we are looking at the weekend,
6 what was the position there?
7 A. The laboratories were open for a limited period on
8 Saturday morning, to take semi-routine samples, and then
9 there was an oncall service at all other times.
10 Q. Leaving aside your duties in relation to the laboratory
11 and focusing a bit more on your clinical functions,
12 I think you said you dealt with patients first of all on
13 an outpatient basis; is that correct?
14 A. Sorry, can you --
15 Q. You dealt with patients on an outpatient basis?
16 A. Yes.
17 Q. So the patients would come in, did you say, to the day
18 room?
19 A. Either to the clinic or to the day ward. Depending
20 slightly on the type of patient, we would select -- so
21 day patients would be more for patients who were having
22 procedures done and outpatients more for just
23 consultation.
24 Q. But you also had patients who were in the hospital --
25 A. Yes.
12
1 Q. -- and you would have direct contact with these
2 patients?
3 A. Yes.
4 Q. Looking to your two areas of responsibility, if we look
5 at the laboratory responsibilities, was that under the
6 auspices of a particular directorate?
7 A. Yes, that was under the diagnostics directorate.
8 Q. Did you have a line manager or supervisor that you could
9 report to?
10 A. I would have. It's changed so often. I think, at that
11 time, Mary Martin was the directorate manager.
12 Q. Mary Martin. Perhaps I should make it clear that,
13 unless I make it clear otherwise, I am looking in
14 particular at the period from about January 2007 through
15 to June 2008.
16 A. Yes.
17 Q. What about your clinical area of responsibility? What
18 directorate was that covered by?
19 A. The clinical was in the medical directorate.
20 Q. Who was your line supervisor there?
21 A. I suppose Dr McCruden would have been.
22 Q. So if you had an issue you wanted to raise, would it be
23 with Dr McCruden you would raise that issue?
24 A. If it was a managerial-type issue rather than a clinical
25 issue, yes.
13
1 Q. If you had a clinical issue that you wanted to raise
2 with somebody?
3 A. I wouldn't have a specific line manager. I would phone
4 a colleague and discuss any clinical issue I had, but
5 I would phone a haematologist, rather than a general
6 physician, routinely.
7 Q. I propose to look subsequently at your statement, but
8 there is a point I want to raise with you at this point,
9 if we can have your statement on the screen. It is
10 WTS01600001. If we can turn to page 8 of your
11 statement, where you have a section dealing with staff
12 morale, starting at paragraph 32.
13 Can you just tell me what the morale of the staff
14 was like in the period that we are looking at here?
15 A. In my opinion, it was very low. The hospital had had
16 gradual changes and closures; the future of the hospital
17 was felt to be very uncertain, whether it would continue
18 to exist at all or in a much more limited format.
19 There was -- because of these changes, there were
20 many posts that weren't filled. We had people acting up
21 in posts, there were staff who left with failure to
22 recruit replacements, and I think that was both the
23 effect of the low morale, but also further poor morale
24 among staff.
25 Q. When you talk about "acting up", can you elaborate on
14
1 what you mean by that?
2 A. I mean, probably easiest if I give an example. In the
3 laboratory, when our most senior person left in
4 haematology, because the laboratory was being reviewed
5 and uncertainty as to what the future of the laboratory
6 would be, instead of that post being replaced, the
7 second-most senior person was moved into that role in an
8 acting-up position. So they took on the
9 responsibilities, but weren't actually appointed to the
10 post.
11 Q. You say, I think, also in paragraph 32, that you could
12 not fill a senior post. Is that an example that you
13 have just given?
14 A. That is what I meant, that we weren't allowed to, rather
15 than we failed to.
16 Q. When you say you weren't allowed to, not allowed to by
17 whom?
18 A. By senior management. All posts had to go through what
19 was then the vacancy committee, and while there was
20 uncertainty about the future they were not allowed to be
21 replaced.
22 Q. In paragraph 33, you make some mention of the review of
23 the laboratories that had gone on for some, you say,
24 four or five years; is that correct?
25 A. We have had reviews on and off for decades, but I think
15
1 there was a particular one then which had been going on
2 for some years.
3 Q. In the next paragraph, 34, what you say is this:
4 "It felt like management were trying to sell the
5 unsellable."
6 What do you mean by that?
7 A. We were getting -- the official assurances that we
8 appeared to be getting were that no-one was wanting to
9 shut the Vale, that it would continue to be an important
10 hospital, that services would be retained there, while,
11 at the same time, we weren't allowed to fill posts
12 because there was uncertainty about whether we were
13 going to keep those posts. So the two messages coming
14 across seemed to be inconsistent.
15 Q. Are you able to say, from your perspective, who was in
16 charge of the Vale of Leven during the period we are
17 looking at, from 2007 through to 2008?
18 A. I can't recall who was the manager at that point, no.
19 Q. If you look at paragraph 36 on page 9 of your statement,
20 what you say there is: