HM Inspector of Anatomy: report - August 2018-October 2019

Summary of Outcome of Inspections

Aberdeen

3. Head of Anatomy, recently appointed Regius Professor of Anatomy, University of Aberdeen.

4. There are three licensed teachers, all academic staff with no technical staff licensed. A recommendation was made that the chief technician be considered for a licence.

5. An inspection of all records, which are kept locally in a fireproof cabinet and offsite on a server, found them to meet the requirements of the Anatomy (Scotland) Regulations 2006. However a check of the record keeping system for the tracking of bodies/body parts as they were moved around the department found it to be complicated and difficult to use. Consequently a recommendation was made that a simpler more user-friendly system should be considered.

6. The body donor programme is working well with the number of bodies donated meeting the requirements for all courses run by the department. At the time of the inspection there were 55 embalmed and 10 frozen bodies in storage; the latter being used primarily by the 13 external courses using the facilities offered by the department. Occasionally bodies are relocated to Forresterhill Hospital for surgical training courses when they are always accompanied by a licensed teacher; all bodies are returned to the anatomy department on the day they are used i.e. nothing is ever stored overnight off site.

7. One course, a plastic surgery course, required upper limbs to be imported from the USA due to the lack of local availability. These were subsequently held and then cremated as per the department's procedures.

8. A walk around the department found it to be largely clean and tidy.

Aberdeen statistics

Bequest Forms requested	309
Bequest Forms returned	191
Bodies accepted	38
Bodies rejected	26
Bodies redirected to another department	0
Number of embalmed bodies currently held	55
Number of frozen bodies in storage	10
Number of Licensed Teachers, Academic	3
Number of Licensed Teachers, Technical	0

Dundee

Centre of Anatomy and Human Identification (CAHID), University of Dundee.

9. Head of Anatomy and Director of the Centre.

10. There are 8 licensed teachers this being made up of both academic and technical staff.

11. There was however a discrepancy between those currently named as licensed teachers and the record of licensed teachers held by the Scottish Government. This has now been corrected.

12. A premises licence was available for inspection as was a map of the licensed areas within the department. A new teaching area, which at the time of the inspection was not licensed, was viewed and it was agreed that this area could now be licensed (which it now is).

13. Records and copies of all paperwork, which are kept in a fireproof cabinet and offsite on a server, were found to be in order. All information is stored on a readily accessible spreadsheet which is updated as bodies/body parts are moved around the department. This was checked and found to work very efficiently.

14. CAHID receives all bodies for embalming which are then distributed to other licensed sites (see below) as required. All bodies are embalmed using the Thiel method; there are no frozen bodies on site.

15. At the time of the inspection CAHID were responsible for 197 bodies, 28 of which were offsite. These are used for a variety of medical/dental/medically related undergraduate courses. There is also an extensive use of bodies by external courses for both medical education and research; for the year 2018, 30 external courses had used the CAHID facilities.

16. A walk around the department found it to be in excellent order and very well organised.

17. There was one reported incident of alleged inappropriate behaviour by students which was brought to public attention by the newspapers in March 2019. It followed on from a previous reported incident which had occurred several years earlier and which was dealt with at the time by the then Inspector.

18. I visited CAHID when this was reported and spoke with all staff concerned with the incident. As what was reported in the newspapers referred back to what had happened previously I looked at how that had been dealt with at the time. I am satisfied that the Head of Anatomy and the University authorities took the incident extremely seriously and dealt with it appropriately at the time.

Dundee Institute for Healthcare Simulation Surgical Skills Centre (DIHS), Ninewells Hospital

19. There are 2 personal licence holders responsible for this area.

20. An up-to-date premises licence was available for inspection which covered 2 existing restricted areas. A third area was being considered for licensing which could be accessed by an external locked door. However as no key could be found for this door, it was agreed that licensing of this space could not go ahead until a new lock had been fitted. A request for licensing has yet to be submitted.

21. At the time of the inspection, 7 bodies were on site; these are all under the control of CAHID. Bodies are usually stored at CAHID and transported to the Skills Centre when needed where they may be kept for short periods.

22. All body movements between CAHID and the Skills Centre are tracked on the CAHID database.

23. A comprehensive list of all courses run in the Skills Centre was produced for inspection; as at the time of the inspection, 9 courses had already taken place with a further 20 booked in for the rest of the year (2019).

24. DIHS have to be commended for their meticulous and comprehensive record keeping which was made available for inspection.

25. A walk around the area found it to be clean, tidy and in excellent order overall.

Institute for Medical Sciences and Technology (IMSaT), Ninewells Hospital

26. There are 2 personal licence holders responsible for this area which has just one licensed space.

27. At the time of the inspection there were 5 bodies being kept onsite which were used as and when required for research projects. As for DIHS, all bodies used by IMSaT are under the control of CAHID with all body movements between the two sites being tracked on the CAHID database.

28. The area was clean, tidy and in good order.

ENT Temporal Bone Lab, Ninewells Hospital

29. Three named licence holders are responsible for this single licensed area.

30. Access to the space is via an office which connects to a main outside corridor. There was no door however between the bone lab and the adjacent office where temporal bones were stored which allowed, potentially, unrestricted access to the licensed space. Consequently it was requested that all the temporal bones should be removed from the area and relocated temporarily to CAHID until a secure door was fitted between the office and the bone lab. This has now been done.

31. All material held in the bone lab is under the control of CAHID and is recorded on their database.

Dundee Statistics

Bequest Forms requested	543
Bequest Forms returned	282
Bodies accepted	71
Bodies rejected	54
Bodies redirected to another department	10
Number of embalmed bodies currently held	197
Number of frozen bodies in storage	0
Number of Licensed Teachers, Academic	10
Number of Licensed Teachers, Technical	5

Edinburgh

32. Head of Anatomy.

33. There are 6 personal licence holders, 5 of which are academic staff and 1 technical staff member.

34. A public display licence for public workshops which are run on 6 occasions throughout the year was also seen. (Given that these workshops are restricted to people who have been vetted in advance of them attending the workshop and not open to the general public, I question whether a display licence is actually required for these events).

35. Given the different levels of access to licensed areas a comprehensive list of all those having access to specific areas was provided. I was happy with the way this was controlled by the lab manager.

36. A comprehensive record keeping system is in place which is held as a paper copy locally in the department but also backed up on a server. As the paper copy was only stored in a filing cabinet it was recommended that these be stored in a fireproof cabinet which has now been done.

37. A record check found everything to be in order. The importance of a well organised record keeping system is exemplified here as at the time of the inspection there were 529 retained parts being stored in the department, all of which were used on a regularly basis.

38. Bodies and body parts are transferred between the anatomy department and the Royal College of Surgeons of Edinburgh for courses run by the College. A tracking system is in place to monitor the movement of specimens between the two establishments.

39. At the time of the inspection, there were 39 embalmed and 45 frozen bodies on site. These are used by 9 university courses, 16 non-university courses and 6 public workshops.

40. The anatomy museum is open to the public on the last Saturday of each month and occasionally at other times for special events. It was estimated that upwards of 15,000 people had visited the museum in the past year. A record of all organised events in the museum was available for inspection.

41. A walk around the area found it to be clean, tidy and in good order. The embalming room however is dated and in need of upgrading particularly if the department wishes to meet the increasing demand for the use of its facilities.

Edinburgh statistics

Bequest Forms requested	559
Bequest Forms returned	308
Bodies accepted	34
Bodies rejected	67
Bodies redirected to another department	3
Number of embalmed bodies currently held	39
Number of frozen bodies in storage	45
Number of Licensed Teachers, Academic	5
Number of Licensed Teachers, Technical	1

Royal College of Surgeons of Edinburgh

42. Lab Manager.

43. At the moment there are only 2 licensed teachers one being the lab manager and the other being the remains conservator of the College Museum. The lab manager is the only licensed teacher and the only member of staff looking after the lab facilities. The College however is in the process of appointing 2 new staff members to assist the lab manager as their current position is untenable there being no other licensed teacher cover available in her absence.

44. There were no bodies on the premises at the time of the inspection. All bodies/ body parts for courses are obtained from the anatomy department of the University. Records are kept of all material received from the University which is signed for on receipt; it is also signed for on its return to the University.

45. Access to the licensed area is locked at all times but the door to the area is not alarmed and hence could be left open inadvertently. The lab manager was told that this should be rectified as soon as possible.

46. The area was clean, tidy and orderly.

Glasgow

47. Head of Anatomy.

48. There are 3 licensed teachers, 2 academic and 1 technical staff member.

49. At the moment, the public has access to the anatomy museum which puts limitations on how the licensed space can be used. As a consequence plans are in place to restrict public access by extending the licensed area to include the corridors around the museum. Once appropriate security measures are in place a new premises licence will be required. This has yet to be applied for.

50. A comprehensive record keeping system is in place with all records being kept both locally in a fireproof cabinet and on a server. Additionally they have in place a printed and bound standard operating procedure for the handling of cadavers from the receipt of a body into the department until its final disposal by cremation. This is an excellent document and one which should be considered being put in place by other anatomy departments.

51. Seventeen University run courses use the anatomy facilities. External courses are organised by the Clinical Anatomy Skills Centre (CASC) which is a joint venture between the University and the Royal College of Physicians and Surgeons of Glasgow. A Joint Management Committee which vets all courses before allowing them to go ahead manages these. Approximately 30 - 40/year courses are organised by CASC.

52. At the time of the inspection, there were 117 bodies on the premises, 51 of which were embalmed and 66 frozen. There had been a recent review of all retained parts and as a consequence, it was decided to dispose of all the historic, non-tagged parts and to start a new, up-to-date collection. This is now underway.

53. All areas were clean, tidy and in good order.

Glasgow statistics

Bequest Forms requested	1500
Bequest Forms returned	428
Bodies accepted	87
Bodies rejected	98
Bodies redirected to another department	1
Number of embalmed bodies currently held	51
Number of frozen bodies in storage	66
Number of Licensed Teachers, Academic	3
Number of Licensed Teachers, Technical	1

Royal College of Physicians and Surgeons of Glasgow

54. Director of Clinical Skills.

55. There are 3 licensed teachers, 2 academic and 1 technical member of staff.

56. No bodies on site at the time of the inspection.

57. All requests for cadaveric material from the Anatomy Department, University of Glasgow are emailed to a licensed teacher who then logs the specimens out of the department and logs them back in on their return.

58. The area is clean and tidy with access tightly controlled.

Royal College of Physicians and Surgeons of Glasgow statistics

Number of Licensed Teachers, Academic	2
Number of Licensed Teachers, Technical	1

St Andrews

59. Head of Anatomy.

60. There are 4 licensed teachers - 3 academic, 1 technical staff member.

61. A user friendly, computer based record keeping system is in place which is first class in its operation. Access to the system is by licensed teachers, the bequest co-ordinator and IT staff who maintain the system. If it was possible to do so, I would recommend this system to all anatomy departments due to its comprehensiveness and its ease of use.

62. There were 44 bodies in the department at the time of the inspection all embalmed; no frozen bodies are used although the facility exists to do so. These are used for 5 University organised courses and 5 externally run courses.

63. All areas were clean and tidy.

St Andrews statistics

Bequest Forms requested	150
Bequest Forms returned	86
Bodies accepted	26
Bodies rejected	16
Bodies redirected to another department	1
Number of embalmed bodies currently held	47
Number of frozen bodies in storage	0
Number of Licensed Teachers, Academic	3
Number of Licensed Teachers, Technical	1

General Points from all Inspections

64. Premises licences plus maps of licensed areas were available for inspection from all departments all of which were in date.

65. At every inspection, a random check of the records was made to determine their accuracy and their ease of use. Without exception, all departments met the requirements of the Anatomy (Scotland) Regulations 2006.

66. All departments, unless stated elsewhere in this report, were adequately secure and were maintained in good order.

67. Apart from the one incident in Dundee referred to above and which related to an event which occurred several years previously, there were no reported breaches of security or incidents of inappropriate behaviour at any of the medical schools. All have in place the Scottish Government Code of Practice which everyone is expected to conform to and which states very clearly what behaviour is expected of anyone using anatomy facilities.

Statistics Summary (these are cumulative figures for all anatomy departments)

Bequest Forms requested	3061
Bequest Forms returned	1288
Bodies accepted	256
Bodies rejected	261
Bodies redirected to another department	15
Number of embalmed bodies currently held	386
Number of frozen bodies in storage	121
Number of Licensed Teachers, Academic	31
Number of Licensed Teachers, Technical	5

Other General Points

Memorial Services

68. All medical schools have a memorial service at some point in the year to which relatives and friends of all those who donated their body for medical education and the advancement of medical science, are invited. These are all different in their presentation but all serve the same purpose and all are very well received by those attending.

69. I attended all memorial services with the exception of St Andrews which I could not attend due to an unavoidable prior commitment

Code of Practice

70. A revised draft Code of Practice was produced and has now been circulated around all Heads of Departments for comment. Once these have been received and reviewed, a final version will be produced which will then supersede all previous versions and will become the working copy.

Image Taking

71. A question raised at all inspections was what images could be taken of cadavers and how they could be used. Consequently a meeting was held in July in the Anatomy Department of Glasgow University to discuss the subject specifically. The conclusion reached was that if consent had been given by the donor, so long as nothing could be identified and as long as the images, in whatever form they took, were within the normal bounds of decency then they could be used. At all times, the records required as stated in the Code of Practice, must be adhered to.

Disposal of Plastinated Material

72. Without exception, all departments are starting to accumulate, no longer required, plastinated material. Plastinated material is human tissue that has undergone a process whereby the tissue fluids have been replaced by a silicone resin rendering the material rubber-like in texture. The problem arises when it comes to the disposal of this material as crematoria are not willing to accept it due to the potential toxic fumes that may be given off during the cremation process and it is not clear if burial is an option. To get advice on this, I contacted the Scottish Environment Protection Agency and they are now looking into this. I await a response from them.

Temporary Display License

73. In November 2018 a request for a Temporary Display Licence was received from Arthrex, a bioengineering company, for the purpose of demonstrating an ankle replacement procedure for an international meeting of orthopaedic surgeons in the Edinburgh International Conference Centre. This was duly granted.

Functional Fascia Courses, University of St Andrews

74. Some reservations were expressed about the use of cadavers by individuals who were not medically qualified or who were not associated with professions allied to medicine.

75. Although I was satisfied that St Andrew's University operated on a cost recovery basis only, providing the facilities and the specimens, it was important to explore whether the total income generated by these courses could be justified.

76. I wrote to the Medical School Manager and subsequently visited St Andrews in advance of a course in March to express my concerns about these courses. The School Manager in turn notified the Dean of the Medical School but despite my reservations the University decided that the course would go ahead.

77. I visited the course in March when it was running to speak to the organiser who gave reassurances that the income generated from these courses only covered the expense of running them and that there was no financial gain on their part.

78. Whilst I can question practices that may be deemed to be inconsistent with the Anatomy Code of Practice, the decision to run such courses is ultimately one for the university. The Code states that no financial profit is to be made from donated bodies and it is for the university to satisfy itself that no profit is being made. Until the Code is made statutory, I have limited powers of enforcement.

79. I have recommended that bequest co-ordinators review the information sent out to enquirers about the body donor programme to ensure the information is explicit about the circumstances in which a body may be used. It is crucial that those people making a bequest are fully informed before doing so.

Anatomy Events Using Non-human Parts

80. There has been an increasing occurrence of events in public venues offering the public access to the dissection of non-human material. Although this is outwith my jurisdiction, there is a concern about the way these events are advertised, and that they may be perceived as being the dissection of human material.

81. My suggestion to one organiser of such an event was that it had to be made more clear on any advertising that the material used was non-human and that there should be no link made between the event and a particular medical school i.e. any member of staff of an anatomy department participating in such an event should be there as a private individual and not as a representative of that medical school.