The duty of the coroner is to enquire into who the deceased was, where, when
and by what means they came to their death. A death as a result of medical
treatment involving neglect (not negligence - there is a difference) can
convert what would otherwise be a natural cause of death into accidental
death.  The coroner has the power to state at the end of the inquest that he
will report matters which the inquest has uncovered where the situation
disclosed puts a significant proportion of the public at risk to the
relevant authority. Clearly if someone had died as a result of AZT toxicity
and the lab had received a request to submit a sample for TPMTase that had
turned it down because they thought that to forward the samples to a none
approved laboratory would compromise their CPA accreditation, then that
would be something worthy of such action. I would hope that Mssrs Sue,
Grabbit & Runne would in such a case consider involving CPA in the
subsequent litigation. Arguably, it is reasonably foreseeable that this
situation might arise and measures should have been put in place to deal
with such cases; for example a let out clause so labs can refer samples for
rare assays elsewhere without compromising their status with CPA.

More to the point; I would hope that any medically qualified laboratory
director who declined to refer on a rare assay to a non CPA registered lab
on the grounds that to do so might compromise his laboratory's accreditation
status would be reported to the GMC. The first duty of the doctor is to his
patient, not to CPA. Where there is any conflict between the two there is,
or should be, absolutely no doubt that the welfare of the patient should
take priority.

Robert Forrest

> -----Original Message-----
> From: This list is an open discussion list for the academic community
> working in [mailto:[log in to unmask]]On Behalf Of Dr John
> A Duley
> Sent: 05 March 2002 16:30
> To: [log in to unmask]
> Subject: Re: SAS reports
>
>
> This will be interesting, as every non-A.L.L. Thiopurine
> Methyltransferase and Purine and Pyrimidine metabolic assay
> presently comes from our non-accredited laboratory.
> It remains to be seen how the CPA will explain to coroners
> and patient families, for example, why avoidable
> azathioprine deaths occurred because Chem Path labs could
> not fulfil clinicians' requests for TPMT?
> (we know of 3 azathioprine deaths and several patients
> who ended in ITU in the past year, because their TPMT was
> not assayed).
> Is this a case of the CPA running in front of the UK, when
> it comes to specialist assay services, or is there lack of
> consultation?
>
> ----------------------
> Dr John A Duley
> Purine Research Laboratory
> Guy's Hospital
> London SE1 9RT  (GB)
>
> ----------------------------------------------------
>
> On Tue, 5 Mar 2002 16:05:21 +0000
> [log in to unmask] wrote:
>
> > CPA does now demand that the reference laboratory's name
> is indicated on the report form together with any
> interpretative comment that the ref. lab. might make; this
> latter should be distinguished from any further comment
> that the home lab. might make.
> >
> > And when the new regulations come in (shortly) one will
> be expected to send samples only to accredited laboratories
> - contrary to the view of inspectors who came around our
> lab a couple of years ago this is not currently a CPA
> requirement.
> >
> > David Williams
> >
> >                 -----Original Message-----
> >                 From:   p=NHS NATIONAL
> INT;a=NHS;c=GB;dda:RFC-822=ACB-CLIN-CHEM-GEN(a)JISCMAIL.AC.UK;
> >                 Sent:   Tuesday, March 05, 2002 2:33 PM
> >                 To:     p=NHS NATIONAL
> INT;a=NHS;c=GB;dda:RFC-822=ACB-CLIN-CHEM-GEN(a)JISCMAIL.AC.UK;
> >                 Subject:        SAS reports
> >
> >                 There is a long running discussion here
> regarding reports on work we have referred elsewhere. At
> present we manually enter the results in our system along
> with any comments, and store the original report. (Complex
> assays such as lymphocyte subsets we send a copy of the
> report to the requesting clinician).
> >                 One clinician in particular is anxious
> that as well as doing this, we should send out copies of
> all reports of referred work, to all clinicians.
> >
> >                 I would be interested to hear what other
> centres are currently doing.
> >                 Thanks in advance
> >
> >                 Louise Tilbrook
> >
> >                 Louise Tilbrook
> >                 Principal Clinical Scientist
> >                 Pathology Department
> >                 Princess Alexandra Hospital
> >                 Hamstel Rd
> >                 Harlow
> >                 Essex
> >                 CM20 1QX
> >                 Tel: 01279 827034
> >                 Fax: 01279 416846
> >                 [log in to unmask]
> >
> >                 ------ACB discussion List
> Information--------
> >                 This is an open discussion list for the
> academic and clinical
> >                 community working in clinical
> biochemistry.
> >                 Please note, archived messages are public
> and can be viewed
> >                 via the internet. Views expressed are
> those of the individual and
> >                 they are responsible for all message
> content.
> >
> >                 ACB Web Site
> >                 http://www.acb.org.uk
> >                 List Archives
> >
> http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
> >                 List Instructions (How to leave etc.)
> >                 http://www.jiscmail.ac.uk/
> >
> > ------ACB discussion List Information--------
> > This is an open discussion list for the academic and
> clinical
> > community working in clinical biochemistry.
> > Please note, archived messages are public and can be
> viewed
> > via the internet. Views expressed are those of the
> individual and
> > they are responsible for all message content.
> >
> > ACB Web Site
> > http://www.acb.org.uk
> > List Archives
> > http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
> > List Instructions (How to leave etc.)
> > http://www.jiscmail.ac.uk/
>
> ------ACB discussion List Information--------
> This is an open discussion list for the academic and clinical
> community working in clinical biochemistry.
> Please note, archived messages are public and can be viewed
> via the internet. Views expressed are those of the individual and
> they are responsible for all message content.
>
> ACB Web Site
> http://www.acb.org.uk
> List Archives
> http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
> List Instructions (How to leave etc.)
> http://www.jiscmail.ac.uk/
>

------ACB discussion List Information--------
This is an open discussion list for the academic and clinical
community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
they are responsible for all message content.

ACB Web Site
http://www.acb.org.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/