Next

CHAPTER 29

Introduction

The retention of the brain of the late Mr Stuart Fayle was brought to my attention by Mr Robert Fayle, Stuart's father, during a meeting of the Retained Organs Commission on 30 May 2002. Mr Robert Fayle described the circumstances by which he had discovered that his son's brain had been retained after the Coroner's post mortem carried out at the Queen's Medical Centre, Nottingham, on 15 May 1991.
Mr Robert Fayle asked me to investigate these circumstances under the third of my Terms of Reference.
Sources of information
This chapter is based on:
-  examination of the contemporary hospital medical records;
-  the post mortem report to the Coroner, Mr Jenkin Jones;
-  correspondence between Mr Fayle and the Queen's Medical Centre;
-  the recollections of:
Dr Robson, Consultant Neuropathologist who carried out the post mortem;
Mrs Lianne Ward, Head Neuropathology Technician at QMC.
The chapter describes what happened, and the reasons why Mr Fayle's brain was retained in line with the post mortem practices and the policies at the Queen's Medical Centre, Nottingham, in 1991.
Mr Stuart Fayle's accident
Mr Fayle was riding his motorcycle when he was involved in a road traffic accident on 14 May 1991(1). He was severely injured and taken to the Queen's Medical Centre where he was found to have suffered major abdominal and pelvic injuries as well as a head injury. An emergency operation to control internal bleeding was undertaken but Stuart died despite all efforts to save his life.
In view of the accident which precipitated Mr Stuart Fayle's death, the Coroner, Mr Jenkin Jones, ordered a post mortem examination. This was carried out by Dr Robson, a consultant neuropathologist at the QMC, on 15 May 1991.
Post mortem findings
Dr Robson's report to the Coroner identifies the cause of death as multiple injuries, adding that: 'This man died as a result of extensive pelvic injuries which caused surgically uncontrollable bleeding, death occurring shortly after admission (to the Queen's Medical Centre). In addition there is a severe head injury which may well have proved fatal had he survived the other injuries. His management has been appropriate, but death was inevitable due to the severity of the injuries. Death is not due to natural causes. The injuries are entirely compatible with a history of a motorcyclist who has been involved in a road traffic accident'.	Annex 90
Dr Robson's report also notes the weight of the brain and its naked eye appearance but does not mention that Mr Fayle's brain was retained for further examination.
The retention of Mr Fayle's brain was not referred to during the inquest and the Coroner did not refer to detailed examination or ask Mr Fayle's relatives about their wishes regarding eventual disposal. As a result, Mr Fayle's family had no reason to believe Stuart's body was not complete when the hospital gave the body to the undertakers.
Had the family been aware that Stuart's brain had been retained, they would have wished to know the results of the histological examination and would have expressed their wishes about disposal.
Mr Fayle's enquiries in February 2001
Mr Fayle senior did not give further thought to the possibility of organ retention until February 2001 when he was prompted to write to the Chief Executive of the Queen's Medical Centre by an article in the Nottingham Evening Post. This article reported that the Centre had 2,700 stored organs. Mr Fayle wanted to be sure that none of his son's organs had been retained after the post mortem carried out ten years previously.	Annex 91
Mr Fayle received a letter dated 3 July 2001 from one of the QMC's specialist pathology nurses to say that the results of the hospital's search of its documentation had been completed and that Mr Fayle should telephone the Help Line. When Mr Fayle did so, he learned for the first time that his son's brain had been retained at the post mortem, but the brain had since been disposed of.	Annex 92
Mr Fayle and his family were greatly distressed, as they had believed they had buried Stuart's body complete. Had they known otherwise at the time, because of their religious beliefs, the funeral would have been delayed until Stuart's brain could be re-united with his body. The family's distress was further increased when they learned that Stuart's brain had been disposed of as clinical waste.
Since learning of the retention of his son's brain, Mr Robert Fayle has endeavoured to obtain answers about why it had been thought necessary for his son's brain to be retained, why he had not been informed and why his son's brain had been disposed of without his knowledge or consent. Mr Fayle has also questioned the timing of the neuropathology investigation in relation to the date of the inquest into his son's death.	Annex 93
Meeting with Dr Robson on 13 August 2002
This meeting was arranged to clarify the reasons why Mr Stuart Fayle's brain had been retained. In discussion with Dr Robson it became clear that Mr Fayle's brain had been retained for the reasons set out in Chapter 28.
The QMC policy of 'full post mortem' was in place for Coroner's cases in 1991, and was carried out in all accident deaths. In all cases of head injury the brain was retained and examined histologically. What happened to Mr Fayle's brain was the routine at that time. The brains from Coroners' cases had been similarly retained at the QMC in the years before 1995. The 'full post mortem policy' and brain retention has been described in the previous chapter.
Was the Coroner aware that Mr Fayle's brain had been retained?
There are no papers or other records that set out the late Mr Jenkin Jones' views on organ retention. What follows is based on the recollections of Dr Robson, who undertook many post mortems for Mr Jenkin Jones, and other pathologists and staff of the Neuropathology Department.
Dr Robson clearly remembers that in 1990, when he started undertaking post mortems for Mr Jenkin Jones, he was informed that he should provide a pathological interpretation of his post mortem findings. Mr Jenkin Jones was content for Dr Robson to retain the brain, or other organ, if he considered detailed histological examination was necessary. Dr Robson believed Mr Jenkin Jones did not wish to be informed about organ retention in each case. However, this would inevitably mean that Mr Jenkin Jones was not in a position to ask the relatives about their wishes for disposal of any brain or other organ retained from a Coroner's post mortem.
These practices had been well established when Dr Robson began working at the QMC.
Why was the retention not mentioned on the post mortem report?
The reasons why retention of the brain was not mentioned on the pathology form were described in the previous chapter. In Mr Fayle's case, Dr Robson did not expect the histological findings would change his opinion about the cause of death. The naked eye findings suggested strongly that the cause of death was 'multiple injuries'.
There was, however, a small possibility that at the time of the accident, or possibly later, there could have been a period of anoxia (deprivation of oxygen), recognisable only by microscopic changes in the brain that were not visible to the naked eye.
Dr Robson did not expect to find such changes but until he had examined the brain histologically he could not be absolutely sure. In deciding to retain Mr Fayle's brain, Dr Robson had been influenced by this possibility as well as the policy that histology should be routinely performed.
Had Dr Robson considered that the microscopic findings were likely to influence the Coroner's verdict, he would have alerted Mr Jenkin Jones and advised that the inquest should be delayed.
Why was there a delay in the histological report on Mr Fayle's brain?
The histological examination was certainly delayed and was not carried out until after the inquest had taken place. The reasons for prioritisation have been discussed already. Mr Fayle's death occurred when there was a major backlog awaiting histology and his brain was not considered an urgent case. Like many other non-urgent cases in 1991, the examination was delayed for some months.
Why was no histological report sent to the Coroner?
No report was sent to Mr Jenkin Jones for the reasons described in the previous chapter.
Has Mr Fayle's brain been disposed of?
The entries in the brain book clearly indicate that Mr Fayle's brain was disposed of after the histological examination was finished, although the date is not recorded.
Why was Mr Robert Fayle not informed when the decision was taken to dispose of his son's brain?
In the early 1990s it was not the policy to inform relatives, for the same reasons that the relatives were not informed that the brains or other organs had been retained after the post mortem.
Was there a possibility that Mr Fayle's brain was retained because of possible further legal proceedings?
There is no record of the time for which Mr Fayle's brain was retained. It is known there was a possibility of legal proceedings. Whether this had any bearing on the length of time for which Mr Fayle's brain was retained can now only be speculation.
Was Mr Fayle's brain retained or transferred elsewhere for research?
Dr Robson is clear that he has never retained a brain for research without the consent of the relatives. The brains he has retained are all from hospital post mortems. Dr Robson assured me he has never retained a brain from a Coroner's case for research, and Mrs Ward independently confirms this.
The previous chapter described the occasions when brains were referred from QMC to other centres for diagnosis or research. The brains referred in this way did not include Mr Fayle's brain.
I am satisfied that there has never been a programme of research into head injury at QMC and that brains from patients who died from head injury have not been transferred to other centres for research.
I am also satisfied Mr Fayle's brain was not used at Nottingham for any other research.
Summary
A full post mortem was carried out on the late Mr Stuart Fayle in accordance with the policy and practice at QMC in 1991.
Mr Fayle's brain was retained for two reasons, as part of the policy to undertake histology in all fatal head injuries and to exclude the possibility of anoxic damage. The relatives were not informed.
In keeping with practice in many other places, the post mortem report did not mention brain retention which the pathologists believed had the late Coroner's agreement.
Similarly, the fact of histology being available at a later date had not been recorded in the report as it was not expected that the histology would alter the diagnosis.
The histology examination was, in fact, carried out after the inquest. There were no unexpected findings and a copy of the report was not sent to the Coroner.
Mr Fayle's brain was disposed of on the instructions of the pathologist on an unrecorded date. The relatives were not informed.
The circumstances in which Mr Fayle's brain had been retained for a limited period of time were no different from those of many other brains that had been held for diagnostic purposes.
Mr Fayle's brain was not referred elsewhere for research, or used in research at Nottingham.
When Mr Robert Fayle began making enquiries of QMC, he did not feel he was being fully informed. It was for this reason that he asked that his experience should be considered under my Terms of Reference.
References
1. Evidence given at the inquest into Mr Fayle's death.

Next