Friday 5th June 1992 Morning coffee break 10:39

“Good morning, gentlemen.”
“Good morning, Nathan. How was the holiday?”
“It was fantastic! You really should try Trinidad, Nick.”
“Nesta and I prefer to stick to what we know, Nathan. We both love Mauritius. I don’t think we’ll ever tire of going there.”
“Nerys and I were thinking of going to the Carribean, next year,” said Neil. “It will be our first exotic holiday.”
“I would highly recommend it,” said Nathan.

“Look . . . Nigel has arrived. We can start.”
“Good morning, Nigel.”
“Good morning, gentlemen.”
Nathan Russell shuffled impatiently through his papers while he waited for Nigel to sit down.
“We’ve got a lot to get through this morning and I’ve arranged to meet Natasha for lunch. I had hoped we could start on time today.”
“Listen, I am sorry that I’m late and I apologise for bringing this up again,” Nigel cleared his throat as he spoke, “but, while we are all together . . . I would like to discuss Ebola.”
“Ebola?” Nathan frowned.
“Ebola’s not going to come here, Nigel.” Nick spoke tersely.
“You can’t be sure of that, Nick. Are you aware of how dangerous it is?”
“Of course I am, Nigel! It has a very high mortality.”
“The mortality is at least 50%, Nick and it may be as high as 90%. Depending on the strain. It is highly infectious.”
“It is not contagious in the sense that influenza is.”
“No, it is not, Nick. It is transmitted by contact with body fluids. However, a patient with vomiting and diarrhoea is very infectious and healthcare workers are at particular risk. My concern is that we have not got enough personal protective equipment.”
“That old chestnut! You are always worrying about personal protective equipment, Nigel.”
“If doctors and nurses are dying because they don’t have the proper protection, there will be a public outcry.”
“We discussed this in March, Nigel. We bought a large supply of personal protective equipment last year. It’s in storage in Surrey, not far from where you live!”
“We bought 1000 sets, Nathan. If there is a significant Ebola outbreak, they won’t last longer than a few weeks.”
“The whole kit and caboodle for Ebola is very expensive, Nigel. We can’t afford to waste money on equipment that we’re never going to use.”
“I know it is expensive, Nathan but, we’ve got to have it. We owe it to our staff.”
“We have two warehouses full of personal protective equipment that you insisted on acquiring for the supposed 1989 influenza pandemic. It has been there for 5 years. If we have to, we can use that.”
“You know that personal protective equipment for influenza is not adequate for Ebola, Nathan. It doesn’t satisfy the World Health Organisation recommendations.”
“They tend to be a bit over the top with their recommendations. We’ve got our own Ebola guidance. It’s not quite as stringent.”
“The equipment doesn’t even comply with our own guidance, Nathan.”
“If there is an Ebola outbreak, we’ll just change the guidance.”
“We will completely lose credibility if we do that, Nathan.”
“I don’t think so, Nigel. I will get Peter in the College to endorse the new guidance.”
“Phil Green, in the Institute, will give it his stamp of approval,” Nick added. “and I am sure Arthur in Health and Safety will be happy to oblige. I will speak to him personally.”
“Most other developed countries seem to be following World Health Organisation advice.” Nigel insisted.
Aren’t we now classed as a third World country with regard to health care?” Neil chuckled.
“I am sorry, Neil.” Nigel retorted quickly. “I’m not in the mood for facetious remarks. An Ebola outbreak would be a catastrophe. We . . .”
“Look, Nigel,” Nathan interrupted. “Personally, I am happy to use the equipment that we’ve got for influenza. It will be fine. That, as far as I am concerned, is the end of the matter.”

“Right, let’s get on with this morning’s business.” Nathan looked at his watch. “We haven’t got all day. The first item on the agenda is Dr Desmond Dennis.”
“I thought we had sorted Dr Dennis out in our March meeting.”
“We did fine him quite heavily, Nick, but he is still using the same flimsy aprons for minor surgery.”
“Shouldn’t this be a health authority problem?” Neil sighed impatiently.
“They have asked us to intervene, Neil. They see it as a potential public health problem. If you remember, gentleman, we had a look at one of Dr Dennis’ aprons last time. The plastic is extremely thin. I don’t think they are any more substantial than cling film. Dr Dennis bought a large consignment of these from China. He insists that they are suitable.”
“He did point out that, in over 30 years of minor surgery, he has just had two wound infections,” said Nigel.
“We have only got his word for that.”
“He submitted some convincing figures last time we met.”
“They were his own figures though, Nigel.”
“Look,” Nathan stepped in again. “I have tried as hard as I can to be sympathetic towards Dr Dennis but I have to admit I agree with the Health Authority. I do think we need to intervene. If this is left, it could become a serious public health issue.  Dr Dennis has clearly ignored our previous concerns. My recommendation is that the next step should be suspension from the medical register. I suggest that we refer him to the General Medical Council for consideration of this.”
“I am not sure we need to go as far as that. It seems quite extreme.”
“I am sorry, Nigel. I am going to have to overrule you there as the Chairman of the Committee. Is everybody else in agreement?”
Nick and Neil nodded.
“Right . . . do you want to bring Dr Dennis in, Nick. We can explain our decision to him.”

We’ll just change the guidance.
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