1 Monday, 16 January 2012
2 (10.00 am)
3 (Proceedings delayed)
4 (10.17 am)
5 MR MACAULAY: Good morning, my Lord. The next witness
6 I would like to call is Professor George Griffin.
7 PROFESSOR GEORGE EDWARD GRIFFIN (sworn)
8 Examination by MR MACAULAY
9 MR MACAULAY: Are you George Edward Griffin?
10 A. I am.
11 Q. Could I ask you, please, to tell the Inquiry what
12 position you hold at present?
13 A. I hold two positions. I am Professor of Infectious
14 Diseases Medicine at St George's University of London
15 and I am a consultant physician in infectious diseases
16 practising medicine at that level in St George's London.
17 Q. Perhaps you could inform the Inquiry what is covered by
18 the expression or the term "infectious diseases"?
19 A. Infectious diseases is a subject and a discipline within
20 medicine in which a pathogen, a microbe, a virus,
21 a parasite, bacterium, gains access to an animal or
22 a human being and then causes disease in that animal or
23 human being. It causes disease by maybe producing
24 toxins, by invading cells and killing cells, and, in my
25 clinical practice in humans, of course, my role is to be
1
1 able to diagnose infection in humans and to treat that
2 infection appropriately.
3 Q. Would you classify C. difficile as an infectious
4 disease?
5 A. C. difficile is most definitely an infectious disease in
6 humans.
7 Q. Perhaps I could ask you to look at your CV, and this
8 will be put on the screen, and we have already, I think,
9 page 1 of the CV on the screen.
10 We have to do this manually, because there has been
11 a technical hitch with the database, but we will still
12 be able to see it.
13 I see from this first page that we have on the
14 screen that your first degree was a Bachelor of Science
15 degree in 1968; you then took a PhD and your medical
16 degree is from the University of London in 1974; is that
17 right?
18 A. That is correct.
19 Q. You then set out your current appointments, and that
20 includes being vice principal for research at
21 St George's University of London?
22 A. Yes -- well, I have just finished that post, actually,
23 since the -- starting that, yes.
24 Q. If we turn to the second page of the document, you set
25 out towards the top your professional qualifications,
2
1 and we can read, for example, that in 1988 you were
2 a Fellow of the Royal College of Physicians of London;
3 is that correct?
4 A. That is correct.
5 Q. We see for ourselves the fellowships that you have taken
6 up since then. Then, looking at your education, you set
7 out some more details about your academic
8 qualifications, including, I think, a period that you
9 spent at the Harvard Medical School from 1974 to 1976;
10 is that right?
11 A. That is correct.
12 Q. You set out some information about distinctions that you
13 have acquired, and then, on page 3, you give us some
14 information about your previous appointments; is that
15 right?
16 A. That is correct.
17 Q. Looking to your teaching experience, if you turn to
18 page 4 of the document, what teaching commitments, if
19 any, do you have at present?
20 A. Teaching is within the medical school and the hospital,
21 and also external lectures. My responsibility within
22 the medical school is teaching and graduate students.
23 I teach them clinical medicine, and specifically I teach
24 them about infection, how to diagnose and treat
25 infection.
3
1 At post-graduate level, I organise the training
2 scheme for what are called SpRs, senior registrars, in
3 infection, and help run the joint infection and
4 microbiology training scheme based at St George's, and
5 then I am invited to give post-graduate lectures
6 nationally and internationally in my areas of expertise.
7 Q. If we turn to page 9 of the CV, you set out there
8 details of your clinical experience, including your
9 present responsibilities -- we see that in the second
10 paragraph on the page -- and you also then go on to give
11 us information about past research, and then, moving on
12 to page 10 and page 11, of research and progress?
13 A. Yes.
14 Q. You appear certainly to have spent some time researching
15 into HIV; is that correct?
16 A. Yes. As part of my training towards infectious
17 diseases, I trained in gastroenterology at the
18 Royal Postgraduate Medical School, and I have had
19 enteric functions since then as one of my principal
20 strategic aims, so I have looked at immunology of
21 the gut, vaccines which may be useful in the gut and HIV
22 and the gut and, in fact, my first research grant was on
23 C. difficile many years ago.
24 Q. We then move on to page 13, where you set out, I think
25 for quite a number of pages, publications that you have
4
1 been involved in; is that right?
2 A. That is correct.
3 Q. Turning to page 28, I think you give us some information
4 on that page, and the following pages, in connection
5 with national and international invited lectures; is
6 that right?
7 A. That's correct.
8 Q. I think the first on the list, in fact, at number 1 is
9 a presentation you gave in Vienna, Austria, in 1985 on
10 C. difficile in the neonate?
11 A. That is correct.
12 Q. In connection with this Inquiry, Professor, were you
13 asked to look at a number of cases of C. difficile in
14 connection with the Vale of Leven Hospital in the period
15 from January 2007 to June 2008?
16 A. Yes, I was. I was invited to look in detail at case
17 reports in that period. The case reports had been
18 assembled in the office in Edinburgh, and I attended the
19 office in Edinburgh and looked at those case reports in
20 great detail and then produced a synopsis of the
21 clinical details, based on my interpretation of those
22 notes.
23 Q. The particular purpose of carrying out this exercise was
24 to see whether or not C. diff may have been implicated
25 in the death of a particular patient?
5
1 A. Yes. I was given a very defined brief, and that is to
2 look at these notes in detail and then to define C. diff
3 infection as part of cause of death or contributing to
4 death, and in each of those categories -- in each of
5 those groups, there were four categories: definitely,
6 probably, possibly and no. Based on my judgment,
7 looking at those notes, looking at the pathology results
8 and looking at the nursing notes as well, which were
9 also provided, I came to that judgment.
10 Q. I think the position is -- and we can see this from your
11 overview report that I will look at in a moment -- that
12 your principal focus was on a cohort of cases that was
13 defined to be within the focus period; is that right?
14 A. That is correct.
15 Q. The focus period was a period from 1 December 2007 to
16 1 June 2008?
17 A. That is correct.
18 Q. If we can perhaps have the overview report on the
19 screen, and that is at EXP02780001, we see the
20 frontispiece of that report. If we turn to table 1 on
21 page 8 of the report, have you set out in this table the
22 list of patients who were covered by your remit who died
23 between 1 December 2007 to 1 June 2008?
24 A. Yes, that is correct. That is a true record.
25 MR KINROY: My Lord, I wonder if it might be convenient at
6
1 this point to clarify -- there are 31 deaths here from
2 a focus group. What was the total number of patients in
3 the focus group from which the statistic of deaths is
4 taken? I don't think it is evident in the report. It
5 might be useful to clarify that.
6 LORD MACLEAN: You heard that question. Is it possible for
7 you to say?
8 A. There were 31 patients in the focus group -- this is
9 annex 1, table 1 -- and there were 28 deaths within that
10 group.
11 MR MACAULAY: I am going to come to this. Can we get the
12 full page on the screen? The heading for table 1 is
13 "Deaths between 1st December 2007 to 1st June 2008:
14 focus period (n = 31)".
15 MR KINROY: My Lord, my concern was to know how many
16 patients had C. diff in the period, so that we know the
17 deaths were 31 from a total number of patients?
18 A. They all had C. diff within that period.
19 MR MACAULAY: Yes, it wasn't within your remit, Professor,
20 to look at patients who did not die?
21 A. Absolutely.
22 Q. You were focusing on patients who died?
23 A. Absolutely. I beg your pardon.
24 Q. Now, we can look elsewhere to see what, in fact, the
25 total number of patients who may have had C. diff were,
7
1 but that was not within your remit?
2 A. Yes. I'm sorry, I misinterpreted the question.
3 I thought you meant how many patients were on this
4 table, and that is clearly shown as 31.
5 Q. I will come back to the table. Can I then look at the
6 body of the report itself and turn to page 2 of
7 the overview report?
8 As you have, I think, already said, and perhaps just
9 to confirm the position, you begin by telling us under
10 the heading "Commission of Report" that you were
11 commissioned by the Vale of Leven Hospital Inquiry to
12 undertake a review of all the case notes of patients
13 reported to the Inquiry board who had died and who had
14 a history of microbiological C. diff infection. So that
15 summarises your remit?
16 A. That summarises it, very briefly.
17 Q. Moving on:
18 "The aim was to assess each case from the records
19 alone, produce a clinical summary of the events leading
20 to death and to make a judgment as to the role of
21 C. diff infection as a cause of death or contributory
22 factor to death."
23 A. Yes, that is correct.
24 Q. The focus, at that point, as you tell us in that
25 paragraph, was simply by your examination of the records
8
1 themselves, and nothing else?
2 A. Absolutely.
3 Q. In particular, at this stage of the analysis, you did
4 not see any other reports that may have looked at the
5 cause of death?
6 A. I did not see any. I was looking at these completely
7 independently, yes.
8 Q. Indeed, you didn't see the death certificates at this
9 stage of your analysis?
10 A. I did not see the death certificate at this stage.
11 Q. The section headed "Material considered and
12 methodology", I think, ultimately, in fact, you looked
13 at a total of 43 case notes in relation to 43 patients
14 who died?
15 A. I did.
16 Q. As you already indicated, you have produced separate
17 reports for each of these patients and given a view as
18 to what role C. diff may have played in the death of
19 the patient?
20 A. That is correct.
21 Q. You then give us some general information about the
22 reasons why you would link C. diff to mortality, and can
23 you just take us through that section of your report and
24 explain your thinking?
25 A. I beg your pardon, C. diff was responsible for
9
1 mortality?
2 Q. Yes. If you look at section 3 of your report, you have
3 a section headed "Reasons for linking C. difficile to
4 mortality". This is on page 2 of the report.
5 A. Yes. C. difficile is an organism which is known as an
6 anaerobe. That means it needs to be in an environment
7 with very, very low oxygen around it, and that is the
8 principal reason that the colon is a very, very -- the
9 lumen of the colon is a very good place for it to grow,
10 divide and, in particular, to produce toxins, and there
11 are at least three toxins which are produced.
12 When they are released by the organism, they bind to
13 receptors, they bind to specific proteins, on the cells
14 that line the colon, and they then cause destruction by
15 a process called apoptosis of these lining cells of
16 the epithelium. That causes a big inflammatory
17 response, it causes fluid secretion, and the colonic
18 function is then completely destroyed.
19 In the most severe cases, the whole of
20 the epithelium is destroyed, leaving the bare surface
21 underneath. There is fluid secretion, there is
22 inflammation.
23 From this organ, chemicals are released into the
24 circulation which give rise to what's called an acute
25 phase response, and these give fever, anorexia, feelings
10
1 of severe malaise, and so on, and they are highly toxic
2 to the individual.
3 The most profound consequence of C. difficile
4 infection is when the whole of the colonic epithelium is
5 destroyed. The colon then becomes very large, called
6 a toxic megacolon, and that can lead to perforation,
7 which is a surgical emergency, because the contents of