Row over who is to blame for CJD scare

The hospital at the centre of the scare that has left 24 patients at theoretical risk of contracting Creutzfeldt-Jakob disease was locked in a row with the Department of Health yesterday over where blame for the blunder lay.

Staff at Middlesbrough General Hospital have now contacted nearly all the patients who had brain surgery with instruments that had been used on a woman later diagnosed with the sporadic or classical form of the disease (not linked with BSE). Solicitors said they could have a claim for compensation against the hospital for emotional distress, even if they do not develop CJD.

But the hospital and the Health Department gave differing accounts of the lapse. The Health Department first described it as an "appalling incident" that highlighted the need to follow strict guidelines on the quarantining of instruments used in suspected cases of CJD. Yesterday it tempered its language in a statement from the chief medical officer, Professor Sir Liam Donaldson, which referred to the "dedicated" staff at Middlesbrough and the "difficult situation" they found themselves in. It added: "No one should rush to judgement on this case."

An inquiry had been set up headed by the regional director of public health, Dr Bill Kirkup, Sir Liam said.

The hospital said CJD had not been suspected in the female patient who was suffering from memory loss and had undergone a brain operation on 19 July. A sample of brain tissue removed in the operation had been sent to the CJD surveillance unit in Edinburgh only because of the "diligence of one of our pathologists" to "rule CJD out rather than confirm it".

Dr Paul Lawler, medical director, protested over the criticism from the Health Department. Until CJD was confirmed there was no reason to follow the strict guidelines on quarantining instruments, he said. "For some reason we have been hung out to dry."

But experts said CJD should have been suspected and once a specimen was sent to the CJD surveillance unit precautions should have been put in place. Henry Marsh, brain surgeon at Atkinson Morley's Hospital, Wimbledon, south London, and a member of the CJD incidents panel set up to monitor cases, said: "If you do a brain biopsy, common sense dictates that you don't use those instruments again until you have a diagnosis."

The hospital was further criticised because the instruments used in the original operation could not be traced and it did not know in what order the patients had surgery after the woman with CJD.

Official advice is that only the first six patients to have surgery with "contaminated" instruments should be told, because after repeated washings the risk to subsequent patients is negligible. But the CJD panel advised that all 24 patients be told, because of uncertainty about the order of surgery. Several sets of instruments, worth £90,000, had to be destroyed.

Only four out of ten neurosurgical units have systems in place to trace which instruments are used on which patients, but new systems are being introduced.

Mr Marsh said the chances of contracting CJD from surgical instruments was "infinitesimally small" and the psychological consequences of living with the threat of an irreversible brain disease could outweigh the benefit of knowing about it.

Peter Hutton, professor of anaesthetics at Queen Elizabeth Hospital, Birmingham, and a member of the CJD panel, said: "What has happened at Middlesbrough could have happened at any neurosurgical centre in the country."

Last night, the hospital said 22 of the 24 patients had been contacted and a helpline had received 150 calls.

Contamination

The risk of transmitting any form of Creutzfeldt-Jakob disease (CJD) through surgical instruments could be eliminated by disposing of them after every operation involving the brain or gut. This would cripple the NHS. Even a simple set of instruments costs £10,000, and endoscopes used to inspect the gut cost up to £30,000. With six million operations annually, discarding each set would cost about £1.2bn. There are two surgical reasons that disposing of costly instruments is unpopular.

"Surgeons typically buy their own kit, and the hospital keeps everything together, ready for that particular person," said Professor Bill Keevil of the University of Southampton.

Second, using disposable plastic instruments has been found to be more dangerous. But reusing instruments means they cannot be truly sterile.

Charles Arthur