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The Investigation of Events that followed the death of Cyril Mark Isaacs
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CHAPTER 15

Warrington General Hospital
Application to Warrington Hospital Ethics Committee

Introduction

This chapter describes discussions in 1988 that preceded consideration of the research protocol submitted by Dr Deakin to the Warrington Ethics Committee. The findings in this chapter are based on contemporaneous documents and the recollections of staff involved.

Background
Winwick Hospital, Warrington, was a psychiatric hospital with long-stay wards but without facilities for post mortems on site. All post mortems, including 'brain only' removals, were carried out at Warrington General Hospital.
Warrington General Hospital also served as a public mortuary and, like Prestwich mortuary, received the bodies of those who had died suddenly in the community.

Correspondence preceding the application to Warrington General Hospital Ethics Committee

1988
Dr Deakin wrote to Dr John, chairman of the Division of Psychiatry at Winwick Hospital, Warrington, on 6 June 1988 to ask if the Division would provide brains for the joint programme: 'I am writing to ask whether you think it may be possible to arrange for the collection of post-mortem material from patients who die in Winwick Hospital or its neighbourhood.'
Dr John replied on 28 June to Dr Deakin: (Your request) 'was discussed at the last meeting of the Psychiatric Services Committee … and in principle we are agreeable to the doctors here co-operating with you in this project by asking relatives permission for academic post-mortems. However, the Committee also agreed that we should seek the permission of the Ethical Committee in the District and to this end, I will be contacting them.'
The Ethics Committee considered and approved the application. It appears that the application considered by the Ethics Committee was the protocol dated 17 July 1986 on the South Manchester Ethics Committee form. This does not refer to the collection of brains from Coroners' cases. The news the application had been approved was not transmitted to Dr Deakin.
1990
Dr Deakin wrote again to Dr John on 14 February 1990 to follow up the 1988 correspondence. Dr Deakin noted: 'We have Ethical Committee permission to collect post-mortem brain material from Prestwich, Manchester and Salford', and enclosed a copy of the protocol dated 17 July 1986 that had been submitted to the North and South Manchester Ethics Committees.
Dr John replied on 3 May 1990 that the Warrington Ethics Committee had considered and approved the application in July 1988. Dr John also apologised for not informing Dr Deakin of the Ethics Committee's decision in 1988.

Chronology and analysis of brains from Warrington General Hospital
Twenty-three brains were obtained from Warrington General Hospital between 1988 and 1992(1). A separate Mortuary Register was maintained for bodies referred to the mortuary by the police, so Coroner's cases can be readily identified.
Twenty-two brains were obtained from patients who were, or had been, in-patients at Winwick Hospital. Two patients were on weekend leave from Winwick Hospital when they died.
The solitary 'control' brain was from an in-patient at Warrington General hospital who had no previous history of neuropsychiatric illness.
The first brain was received from a hospital post mortem in June 1988.
The next 11 brains were obtained from Coroner's cases. All had been patients in Winwick Hospital. The post mortem reports show that all these deaths had been appropriately reported to the Coroner(2). For example, one in-patient died following a fall in which she broke her leg shortly before death.
From June 1990 the next seven brains were all from hospital post mortems or 'brain only' examinations. The reports of these post mortems are no longer available.
After October 1991 four further brains were obtained from Coroner's post mortems. The post mortem reports record two cases died at home from suicide and the others were sudden deaths in Winwick Hospital(2).
The last brain from a Coroner's post mortem was obtained in May 1992.

Uncertainty in the Coroner's office
In 1989, Mr Stephenson took up his duties as Coroner's Officer at Warrington. When he discovered that a brain was being retained, he questioned the legality of brains from Coroner's cases being retained for research. Mr Stephenson telephoned the Coroner's office to check. He was told that retention was allowed as the brain was going to the University. It is possible that the Coroner's office assumed the brain was destined for research that had the consent of the relatives.
Mr Stephenson did not question subsequent brain retentions, but remained uneasy as the relatives appeared to be unaware that the brain had been retained.

Summary
In 1988 the Division of Psychiatry at Winwick Hospital supported, in principle, the proposal for academic post mortems in suitable cases, but asked for Ethics Committee permission.
The protocol sent to the Warrington Ethics Committee appears to have been the protocol dated 17 July 1986. This protocol contains no reference to Coroner's cases.
Ethics Committee approval was given in July 1988 but not conveyed to the team until May 1990.
Eleven brains from Coroner's cases were obtained prior to June 1990. In all cases the referral to the Coroner was appropriate.
Between June 1990 and February 1991, seven brains were obtained from hospital or brain only examinations. No details of these cases are available.
Between October 1991 and May 1992, four further brains were obtained from Coroner's cases. All these cases were appropriately referred to the Coroner.
In three of the 15 cases referred to the Coroner a verdict of suicide was recorded. All other deaths were recorded as natural causes.
In 1989 Mr Stephenson, when newly appointed as Coroner's Officer, questioned the retention of brains from Coroner's cases. He was reassured that brain retention was in order. This could have been the result of a misunderstanding in the Coroner's office that the relatives had given consent.

References
1 Entries in the joint programme brain books.
2 Post mortem reports sent to the Coroner.


 
       
 

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