1 Monday, 20 February 2012
2 (10.00 am)
3 MR MACAULAY: Good morning, my Lord. The next witness is
4 Dr Stephanie Dancer.
5 DR STEPHANIE JANE DANCER (sworn)
6 Examination by MR MACAULAY
7 MR MACAULAY: Are you Stephanie Jane Dancer?
8 A. Yes, I am.
9 Q. Could you tell the Inquiry what position you hold at the
10 moment, Dr Dancer?
11 A. I'm a consultant microbiologist in NHS Lanarkshire.
12 Q. I think you are based at Hairmyres Hospital; is that
13 right?
14 A. That's correct.
15 Q. If I can put your CV onto the screen, that's at
16 INQ03350001. Perhaps I can take you to page 3 of
17 the document. Can we note that your first degree was
18 a BSc in Medical Physiology from the University of
19 London; do we see that?
20 A. That's correct.
21 Q. If we go to page 2 of the document, did you acquire your
22 medical degree from the same university in June 1983?
23 A. That's correct.
24 Q. You set out on that same page that you have an MSC in
25 Clinical Microbiology, an MD thesis from London and you
1
1 are also a Fellow of the Royal College of Pathologists;
2 is that right?
3 A. That's right.
4 Q. Just looking to your present post, and if we go back to
5 page 3 of the CV, you give us some information about
6 that particular post towards the bottom of the page; is
7 that right? In particular, do we see that this is
8 a post you took up in December 2007?
9 A. That's right.
10 Q. What is the nature of the post?
11 A. It is a consultant microbiologist. I'm single-handed.
12 I look after the laboratory and I interpret the results
13 of the laboratory for the benefit of clinicians, both in
14 the hospital and surrounding community.
15 Q. If we track back, then, and turn to page 4 of the CV,
16 can we note that from April 2005 to December 2007 you
17 held the position of consultant microbiologist at the
18 Southern General Hospital in Glasgow?
19 A. That's correct.
20 Q. Before that, you were attached to Health Protection
21 Scotland, from 2002 to 2005; is that right?
22 A. That's right.
23 Q. What was the nature of that particular post?
24 A. This was an inaugural post for NHS Scotland, in that
25 Health Protection Scotland -- it was called at that
2
1 stage the Scottish Centre for Infection and
2 Environmental Health. This, if you like, was a public
3 health consortium responsible for surveillance and
4 epidemiological analysis of key organisms across
5 Scotland.
6 This was run by a group of public health
7 consultants, but they required microbiological
8 expertise, firstly, to help interpret what goes on in
9 laboratories, and also to build a bridge between the
10 various hospital laboratories in Scotland and a national
11 surveillance centre. Communication and liaison between
12 microbiologists in separate hospitals and a national
13 surveillance centre is not always good, and they wanted
14 somebody to draw in the hospitals to help, in
15 particular, pinpoint surveillance of key organisms
16 causing trouble at the time.
17 Q. That was a post I think you took after you had been
18 a consultant microbiologist at the Vale of Leven
19 Hospital; is that right?
20 A. That's right. It was the first post I moved to from
21 leaving the Vale.
22 Q. If we go back to your CV, then, do you tell us there
23 that from January 1996 to February 2002 you were
24 a consultant microbiologist and infection control
25 officer for Argyll, Vale of Leven District General
3
1 Hospital?
2 A. That's right.
3 Q. You do give us some general information about what the
4 nature of your job entailed, and that is perhaps of some
5 relevance to us. Focusing, first of all, on the
6 laboratory side of things, can you tell us what your job
7 was?
8 A. I was based in the microbiology laboratory, which was on
9 the first floor of a designated laboratory block at the
10 back of the hospital. So it was separate from the
11 hospital, but it didn't take very long to walk across
12 the courtyard and a road to get into the hospital.
13 Again, the hospital was in separate bits as well.
14 My post was very, very similar to what I do now, and
15 that is interpreting the results that the microbiology
16 scientists do on patient specimens and authorising
17 those, deciding on which tests should be done and
18 presenting the results to the clinicians, whether it is
19 paper format or by telephone or verbally, depending on
20 what the nature of it is, to allow the clinicians to
21 choose the best possible treatment for their patients.
22 Q. Just to stop you there for a moment, in this Inquiry we
23 are particularly interested in C. diff.
24 A. Yes.
25 Q. At the time when you were there as a consultant
4
1 microbiologist at the Vale of Leven, if you had
2 a positive C. diff result, would you personally contact
3 the clinician in connection with that or would you leave
4 it to the lab technician?
5 A. Oh, no, no. One would always contact the clinician
6 about a case of Clostridium difficile, because at that
7 stage, it was unusual. Now, I don't think -- I don't do
8 that now at Hairmyres. Now the results do come through
9 to me on the day that they are found positive, but we
10 have a team of infection control nurses who leap upon
11 the day's results and deal with it, and sometimes, of
12 course, I get a phone call later on, if there's problems
13 with treatment, but, then, every single case was phoned
14 through to the clinician responsible.
15 DAME ELISH: My Lord, I wonder, before my friend moves on
16 further in the CV, whether or not Dr Dancer could
17 confirm whether her responsibilities for Vale of Leven
18 were exclusively in respect of that hospital or is it
19 the case that she also had responsibility for Oban, the
20 hospital in Oban at that time.
21 LORD MACLEAN: It is noticeable that it was for Argyll that
22 she was appointed.
23 DAME ELISH: I see that, but just in relation to any other
24 hospitals.
25 MR MACAULAY: I am going to look at this, in any event, so
5
1 I will come to this.
2 Sorry, I think you had been telling us what the
3 position was then, as against the position now, in
4 relation to C. diff.
5 Were you responsible for the reaccreditation of
6 the laboratory?
7 A. Not wholly, no. That was a complete universal
8 laboratory effort, and I would say that the senior chief
9 at the time, Mr Drummond McNair, I think was probably
10 more responsible for the amount of work that went into
11 that reaccreditation for CPA. I just assisted.
12 Q. You then give us some information about your clinical
13 duties. Can you just tell us about that?
14 A. Clinical duties were responding generally to phone calls
15 from consultants and junior staff in hospital about
16 treatment of infection or prophylaxis of infection when
17 applicable. Clinical duties also meant visiting
18 specific patients, either patients who weren't
19 responding to treatment or patients who were suspected
20 of having a particular infection. It really depended
21 where I went as to what was happening in the laboratory.
22 The biomedical scientists, before they would
23 authorise a particular report, which would come through
24 to me, they would let me know, they would alert me, if
25 there was something that they suspected. Sometimes it
6
1 takes 24, 48 hours to confirm the nature of a particular
2 pathogen, but experience by medical scientists will have
3 clues, and if you put those together with the signs and
4 symptoms of patient, you have a pretty good idea what is
5 going on, and you can intervene before the final results
6 are known.
7 Q. Before we move on to the next chapter of your CV, you
8 heard the question that was posed a moment ago. I think
9 you were based in the Vale of Leven Hospital; is that
10 right? That is where your base was. What other
11 hospitals did you have responsibility for?
12 A. I was also responsible for the microbiology service at
13 Oban Hospital, as well as covering or available for the
14 many district, smaller hospitals across Argyll,
15 including the Islands.
16 In Oban, there was one biomedical scientist
17 responsible for microbiology. There were four all
18 together who really covered all the disciplines --
19 biochemistry, haematology, microbiology, three
20 disciplines. I was responsible for looking after the
21 microbiology side of things.
22 This was always an ongoing concern because there
23 wasn't my presence there in the hospital all the time.
24 I could only go up to Oban once every three, four, five
25 weeks, depending on duties, but I did see all the
7
1 results coming through on the computer system and I was
2 also very lucky in having extremely conscientious
3 single-handed microbiology BMS based in the small
4 laboratory in Oban.
5 Q. If we go back to your CV, then, I think you also give us
6 information there about the infection control structure
7 that was in place at the time that you were in the
8 Vale of Leven; is that right?
9 A. Well, there wasn't any before I arrived at the
10 Vale of Leven. There was one experienced senior nurse,
11 Sister Anne Crawford, who had just been appointed fairly
12 recently as an infection control nurse for the Vale, but
13 before, prior to my appointment, there had been
14 a consultant microbiologist who had become unwell, and
15 the hospital had been left without microbiology cover
16 for maybe up to two years before I took up my
17 appointment.
18 So I came in as a full-time consultant
19 microbiologist and Sister Crawford and I almost
20 immediately decided we would form an infection control
21 committee for the hospital, which we promptly did.
22 Q. What you say here is that you initiated and advised
23 three infection control committees. Does that include
24 the one you informed?
25 A. Yes, we felt that the hospital was the first one to
8
1 establish -- to decide who should come, how often we
2 should have meetings and what were the burning issues
3 that I found coming into the hospital. But, of course,
4 on the back of that is the community and, of course,
5 Oban. Both of those required an infection control
6 committee, so I duty set those up as well.
7 Q. Did you chair these committees?
8 A. I started off chairing the infection control committee
9 at the Vale and quickly discovered that I was not
10 a talented chair, so I stepped aside and I found
11 somebody who was: a senior consultant in the hospital,
12 a consultant pathologist, who had had many years of
13 chairing committees and who knew exactly how to keep me
14 in my place.
15 Q. I think you tell us also that you were responsible for
16 writing prescribing policies for the hospital and the
17 community?
18 A. Yes, I did. It is extremely important to have an
19 antibiotic policy. I was a new consultant, so I had
20 been privy to all, if you like, the most recent
21 innovation in microbiology and infection control.
22 Infection control, of course, is still a very young
23 science, and the most important thing to do, if you want
24 to gauge your patients receiving correct antibiotics, or
25 at least a stab in the right direction, is to write
9
1 a policy which covers all the main systems and gives out
2 some basic antimicrobial advice, which is, don't give an
3 antibiotic to a patient unless they really need it. The
4 one proviso to that, of course, is prophylaxis.
5 So because I had had a locum appointment previous to
6 this particular permanent appointment with a consultant
7 called Dr Dugald Baird, I asked Dr Baird to help me
8 formulate the first antibiotic policy, and he very
9 generously gave me the template for his own hospital's
10 antibiotic policy, which I then rewrote and adapted for
11 the Vale of Leven, and I have a copy of that. That is
12 1997.
13 LORD MACLEAN: Where was his appointment, Dugald Baird?
14 A. Dugald was at Monklands Hospital in NHS Lanarkshire.
15 LORD MACLEAN: Is it Dougal or Dugald?
16 A. Dugald, D-U-G-A-L-D. He has a famous father.
17 LORD MACLEAN: Yes, I know.
18 MR MACAULAY: The other thing I think you tell us in this
19 section of your CV is that you also co-wrote the
20 infection control manual that was available at that
21 time?
22 A. I think the accolade for that must go to
23 Sister Crawford. She put it together and I edited it
24 and we discussed it and we had several drafts. We were
25 hampered by the fact that there was no infection control
10