DEATH AND THE PROCURATOR FISCAL
Directors of Public Health in Scotland
List of Paediatricians in Scotland
DEATH AND THE PROCURINDEXATOR FISCAL
1. Duty of Procurator Fiscal to Enquire into Deaths
It is the duty of the Procurator Fiscal in the exercise of his function at common law and under statute to enquire into certain categories of death. This is necessary not only in order to minimise the risk of undetected homicide or other crime but also in pursuance of the public interest to eradicate dangers to health and life, to allay public anxiety and to ensure that full and accurate statistics are compiled. It is also necessary to secure and preserve evidence relevant to the rights of interested parties which may vary with the circumstances of the death.
In Scotland no other official has any duty in relation to enquiry into death comparable to that of the Procurator Fiscal.
2. Deaths to be Reported to the Procurator Fiscal
It is the duty of the appropriate Procurator Fiscal to enquire into all sudden, suspicious, accidental, unexpected and unexplained deaths and in particular into all deaths resulting from an accident in the course of employment or occupation, deaths while in legal custody and deaths occurring in circumstances such as to give rise to serious public concern. However, the Procurator Fiscal may enquire into any death brought to his notice if he thinks it necessary to do so. Knowledge of such deaths will usually come to the Procurator Fiscal through reports by the police, hospital doctors, or doctors in general practice or through intimations from registrars or from relatives. Any death which the circumstances or evidence suggest may fall into one or more of the following categories must be reported to the Procurator Fiscal :-
(1) any death due to violent, suspicious or unexplained cause.
(2) any death involving fault or neglect on the part of another.
(3) possible or suspected suicide.
(4) any death resulting from an accident.
(5) any death arising out of the use of a vehicle including an aircraft, ship or train.
(6) any death by drowning.
(7) any death by burning or scalding, or as a result of a fire or explosion.
(8) certain deaths of children - any death of a newborn child whose body is found, any death from sudden infant death syndrome (see Section 5 below), any death due to suffocation including overlaying, any death of a foster child.
(9) any death at work, whether or not as a result of an accident.
(10) any death related to occupation, for example, industrial disease or poisoning. (See Appendix 1).
(11) any death as a result of abortion or attempted abortion.
(12) any death as a result of medical mishap, and any death where a complaint is received which suggests that medical treatment or the absence of treatment may have contributed to the death. (See Section 3 below).
(13) any death due to poisoning or suspected poisoning, including prescription or non-prescription drugs, other substances, gas or solvent fumes.
(14) any death due to notifiable infectious disease, or food poisoning.
(15) any death in legal custody.
(16) any death of a person of residence unknown, who died other than in a house.
(17) any death where a doctor has been unable to certify a cause.
Where the death is a result of food poisoning or an infectious disease the Procurator Fiscal should consult the Director of Public Health for the area concerned before deciding whether there should be further enquiry into the circumstances of the death (see Appendix 2). In the case of death from industrial disease or poisoning the Health and Safety Executive will be consulted.
3. Deaths Under Medical Care/Medical Mishap
(1) Certain deaths associated with the provision of medical care are to be reported to the Procurator Fiscal. Most of these deaths represent an unfortunate outcome where every reasonable care has been taken, but they may result from acts of either negligent commission or omission on the part of medical or para-medical staff, or may be associated with criminality. It is the duty of the Fiscal to enquire into deaths which fall into the following categories, which are not to be regarded as exhaustive, viz:
(i) deaths which occur unexpectedly having regard to the clinical condition of the deceased prior to his receiving medical care;
(ii) deaths which are clinically unexplained;
(iii) deaths seemingly attributable to a therapeutic or diagnostic hazard;
(iv) deaths which are apparently associated with lack of medical care;
(v) deaths which occur during the actual administration of general or local anaesthetic;
(vi) deaths which may be due to an anaesthetic;
(vii) deaths caused by the withdrawal of life sustaining treatment to patients in a persistent vegetative state (see Section 17 below).
(2) "Medical care" includes surgical, anaesthetic, nursing or other kind of health care. These deaths may be the result of diagnostic procedures (investigations or x-ray procedures) or therapeutic procedures (whether surgical or as a result of medication - oral, parenteral or inhalation administration of drug treatment). This includes deaths possibly linked to defects in medicinal products or medical equipment or apparatus.
(3) Instructions have been given to hospitals, nursing homes and general practitioners that where a patient has died in such circumstances the Procurator Fiscal must be informed without delay. The responsibility for notification lies with the doctor concerned in the care of the patient or the doctor called in at the time of death. The Procurator Fiscal should be notified by telephone or otherwise as soon as possible after the occurrence and as soon as practicable thereafter on Form F89 signed by the doctor. Arrangements have been made to distribute supplies of Form F89 to hospitals, nursing homes and general practitioners. Further supplies may be obtained from the Procurator Fiscal.
If the deceased died after surgery and the doctor who is reporting the death to the Procurator Fiscal has no knowledge of the surgery preceding the death, the Form F89 should not be completed by the reporting doctor without consultation with the surgeon who conducted the operation or with a senior member of the surgical team to ascertain if any particular matter should be brought to the attention of the Procurator Fiscal.
(4) On receipt of the Form F89, the Procurator Fiscal will consider whether it is appropriate to request the doctor in charge of the case, and where appropriate other doctors who have been involved in the treatment or investigation of the patient, to provide a full written report detailing the circumstances leading up to and surrounding the death.
(5) On receipt of a report the Procurator Fiscal may take the decision if he considers this appropriate, to make no further enquiry. If he deems other action to be necessary, he will obtain a report from a forensic pathologist and/or a consultant in the speciality concerned (anaesthesia, cardiology, surgery, etc) or an appropriate general practitioner. They should be independent of the medical institution or medical practitioner concerned. The decision as to whether an autopsy is necessary will, as always, be taken by the Procurator Fiscal. In many cases, an autopsy will form an important part of the evidence available for the further enquiries. The forensic pathologist and specialist adviser should have full access to the Form F89, any additional reports obtained by the Procurator Fiscal and to any medical records, and it may be helpful for them to discuss with the physicians concerned any aspect of the case which requires clarification.
(6) The Procurator Fiscal will ask the forensic pathologist and/or the independent specialist adviser to provide a report considering objectively the standards of medical care, the
treatment given and the availability and adequacy of the emergency steps taken. Where appropriate, any deficiencies in the standards should be brought to the attention of the Procurator Fiscal.
(7) In particular the forensic pathologist and/or the independent specialist adviser will be asked to direct his attention to the following points, viz:
(i) whether the patient was properly and sufficiently examined before the procedure;
(ii) whether all due precautions were observed in the performance of the procedure and the selection and administration of any anaesthetic or medication;
(iii) whether there were any factors present which could have been discovered indicating that the procedure would be attended with special risk to life.
(8) The Scottish Office Department of Health has informed Health Boards and Trusts that if a death is not reported to the Procurator Fiscal but the Health Board or Trust subsequently receives a complaint from the next of kin about the medical treatment given to the deceased and the complaint contains a suggestion that the medical treatment may have contributed to the death of the patient, then that death should be reported to the Procurator Fiscal as soon as the complaint is received.
4. Deaths of Persons Receiving Dental Treatment
The death of a person undergoing dental treatment will be reported to the Procurator Fiscal by the dentist and/or anaesthetist concerned. The Procurator Fiscal will obtain a report from a forensic pathologist and/or independent specialist adviser.
5. Sudden Infant Death Syndrome and Post Perinatal Infant Mortality
Procurators Fiscal must enquire into all cases of SIDS or 'Cot Death' but they will not necessarily see the parents in all cases as this can cause additional strain for the family. Should the parents express specific concerns about the circumstances of the death, or should the Procurator Fiscal be of the view that it is appropriate to consider holding a Fatal Accident Inquiry, the parents will be interviewed.
In dealing with such cases Procurators Fiscal will have regard to the following:-
(1) SIDS can be diagnosed only as the result of an autopsy. When a case of SIDS is suspected, an autopsy must be conducted unless there are clear and compelling reasons for not doing so and notwithstanding the views of relatives.
(2) Where practicable, autopsies will be conducted by a paediatric pathologist and, if there is a suspicion of criminality and a two doctor autopsy is thought necessary, by a forensic pathologist in association with a paediatric pathologist.
(3) As it is possible that tissue samples may be of value to the continuing medical research into the cause or causes of cot death, the pathologists should be instructed to obtain samples of lung and liver tissue from cot death victims.
(4) To provide support and assistance to general practitioners in such cases, a paediatrician designated by the British Paediatric Association will be informed by the Procurator Fiscal of any sudden infant death once SIDS has been established as the cause. Procurators Fiscal will intimate to the appropriate paediatrician (listed at Appendix 3).
(5) Where requests for access to the autopsy report are received by Procurators Fiscal from paediatricians or other members of the medical profession involved in counselling parents following a cot death, a copy of the report will be provided. Where the request is received from bereaved parents, it may be appropriate to suggest that a copy be given to their General Practitioner, who could discuss its contents with them. If the parents do not want to involve their GP, Procurators Fiscal may provide parents with a copy direct. However, if there is any uncertainty as to whether the death is suspicious or an instance of SIDS, copies of reports will not be made available until a decision has been reached regarding their possibility of criminal proceedings, or any criminal proceedings are completed.
(6) To prevent unnecessary distress to parents, local procedures should be established in consultation with the police and pathologists to obviate the necessity for formal identification of the body prior to autopsy. Arrangements should be made, however, should the parents wish this as a final opportunity to see their child. This should be done in as sympathetic surroundings as possible.
(7) Procurators Fiscal should continue to cooperate fully with paediatricians and members of the medical profession involved in research into post perinatal infant deaths (ie deaths of children aged 7 - 365 days). Procurators Fiscal should send a copy of all autopsy reports of infants dying between the ages of one week and one year to the Scottish Cot Death Trust.
6. Control of a Dead Body
The Procurator Fiscal has a right and a duty to control the disposal of a dead body while he makes enquiries into the death. Depending upon the circumstances he may decide to leave the body where the death occurred, eg at home or in a hospital. He may decide to have the body removed to a police or hospital mortuary or a specially designated mortuary. He will require to decide in every case whether he will accept a medical certificate as to the cause of death and release the body, or whether an autopsy is necessary. When releasing a body the Procurator Fiscal requires to decide whether cremation may be allowed to take place. There may be circumstances, for example a homicide investigation where the Procurator Fiscal cannot allow cremation to take place as it would lead to the destruction of evidence available from the body. If the Procurator Fiscal has no objections in principle to a cremation, the matter then becomes one for the Medical Referee to decide.
7. Decision to Instruct an Autopsy
An autopsy will not always be necessary. In many cases when the Procurator Fiscal first hears of the death he will be advised that a death certificate has not been granted. If the Procurator Fiscal is satisfied that death is due to natural causes and that there are no elements of criminality or negligence, he will invite the deceased's own doctor or, if the death occurred in hospital, the doctor concerned, to provide a certificate as to the cause of death. If the doctor is unwilling to do so after consultation with the Procurator Fiscal, the Procurator Fiscal will invite the police surgeon (if there is one and he is prepared to act) to view the body and provide a certificate after consultation as he sees fit. The police surgeon may then agree to certify the cause of death or, alternatively, may advise the Procurator Fiscal that an autopsy should be carried out. In such cases a one doctor autopsy will usually be sufficient.
If a deceased has died in hospital and the death does not appear to require any further investigation on the part of the Procurator Fiscal the question of an autopsy to establish the cause of death is a matter for the hospital.
Where a pathologist while conducting a one-doctor autopsy finds unexplained difficulties or grounds for suspicion he should suspend the autopsy and report immediately to the Procurator Fiscal in order that a second pathologist can be instructed.
In deciding whether or not to instruct an autopsy, the Procurator Fiscal will be influenced by considerations of potential hazard, such as the danger of infection, to those who require to be present. Where the deceased is considered to be in a high risk category, as a possible carrier of HIV or Hepatitis viruses, an initial blood screen for the presence of these viruses should be ordered. The test for the need to have a dissection will become much more stringent should a positive result for any of the above viruses be obtained. Where there is no possibility of criminal proceedings it may be sufficient to have an external examination of the body by a pathologist, supplemented by toxicological analysis of blood and/or tissue and of the contents of any relevant containers found at the scene or elsewhere, for example hypodermic syringes.
8. Medical Research - Hospital Autopsy
The Procurator Fiscal is sometimes asked by doctors, especially hospital doctors, to permit an autopsy in the interest of medical research or for some other medical reason, although the cause or primary cause of death is known. In cases where the cause of death has been ascertained without a dissection and the Procurator Fiscal does not otherwise require an autopsy to be held it would not be appropriate for him to instruct one. In such cases Procurators Fiscal may not have any objection to an autopsy, but doctors should approach the next-of-kin to obtain their consent, making it clear the autopsy is not at the instance of the Procurator Fiscal. However, if the autopsy conducted in such circumstances reveals suspicion, it should be halted immediately and the Procurator Fiscal informed. The results of autopsies conducted under an arrangement of this kind must always be reported to Procurators Fiscal.
9. Choice of Medical Experts
It is the Procurator Fiscal who is responsible for deciding which pathologists to instruct in any particular death and the number of specialists required, notwithstanding the arrangements with universities. In some cases, it may be necessary to bring in a pathologist with a particular skill, eg a neuropathologist in cases of head injury. It may be desirable to instruct experts who are not pathologists, eg in cases of sexual assault where an expert in obstetrics or gynaecology could be associated with the autopsy.
The Procurator Fiscal is also responsible for deciding the extent of investigation to be made by way of forensic science. He will choose and instruct the experts whom he wishes to carry out the work, eg members of the police laboratory, staff of a hospital or university department or an Inspector from the Health and Safety Executive. The Procurator Fiscal will have selected and instructed the pathologists who are to perform the autopsy. These pathologists may advise him of the need for further investigation by way of forensic science but the decision as to such investigation will be made by the Procurator Fiscal in the light of all the circumstances of the case which are known to him.
10. Deaths where there is a Possibility of Criminal Proceedings
In every case in which (a) there is a possibility that the death was caused or contributed to by the commission of a criminal act, or (b) there is a possibility of criminal proceedings in which it will be necessary to prove the fact and cause of death, an autopsy must be carried out by two pathologists.
11. Identification of Body
In cases where there is the possibility of criminal proceedings care should be taken that, where the identity of the deceased is know, there is corroborated evidence of identification of the body to the pathologists. When death has occurred in hospital, it is customary for the nurses who prepare and lay out the body to attach a bracelet to the deceased unless he was already an in-patient whereupon it would have been attached at admission.
12. Extent of Examination
In some deaths the Procurator Fiscal will require to give specific instructions as to what steps are to be taken during and after an autopsy depending on the circumstances of the case, eg the taking of blood and urine, hair, nail scraping or fingerprints of the deceased, or the sampling of dirt, dust, etc at the locus, to compare with dirt, etc found on clothing or the body. Photographs of specific wounds and marks of the body, examination of wounds in relation to particular weapons or other objects and in relation to the deceased's clothing, examination for fingerprints on the surface of the body in cases of manual strangulation. It may be necessary to retain organs for additional expert examination, eg the liver in suspected poisoning or drug abuse enquiries. For health reasons body organs, stomach contents, blood and saliva samples and swabs stained with body fluid will be retained by the examiner for a period of 21 days only, following service upon the accused or his solicitor of a letter informing him that they will be destroyed unless the defence indicate they wish to examine them or wish an extension to the 21 day period. Prior to dissection it may be deemed necessary to carry out a full skeletal X-ray. This should always be done if "battered baby syndrome" is suspected. A forensic ododntologist may be called in where bite marks are present.
13. Attendance at Autopsy
It is the Procurator Fiscal who is in charge of the inquiry during the autopsy and either he or one of his deputes should attend the dissection in connection with a death which is a suspected homicide. He will ensure that any medical problem or apparent contradiction in the pathological findings is further investigated to a solution and that all known non-medical facts are properly investigated and explained by the pathologists. He must ensure that the pathologists fully explore the findings to determine whether the non-medical facts can be reconciled with the medical conclusions.
14. Human Tissue Act 1961
The Human Tissue Act 1961 provides inter alia for the use of parts of bodies for therapeutic purposes. Section 1(5) states that no part of a body may be removed if the Procurator Fiscal objects. Where there is reason to believe that the Procurator Fiscal may require an autopsy or a Fatal Accident Inquiry to be held, no parts of a body should be removed without his prior consent.
The Act applies mainly to removal of the kidneys, heart, liver and the cornea from the eye. It is not vital that the cornea be removed immediately upon death and so no special procedure is necessary. Other organs must, however, be removed very soon after death and the medical authorities have been advised to inform the Procurator Fiscal as soon as possible of any proposed transplant before death occurs. Where there is doubt about the appropriate Procurator Fiscal, the initial contact will be made with the Procurator Fiscal for the area in which the hospital is situated. He should then make enquiry to establish who is the appropriate Procurator Fiscal to consent to the removal of parts of the body.
The appropriate Procurator Fiscal will then instruct immediate enquiry by the police into the circumstances so he may decide whether to consent for his interest to the removal when death occurs. Consent would never be given in a case which is likely to result in a charge of murder. Where consent is given it is the responsibility of the Procurator Fiscal to ensure that sufficient evidence is available for any subsequent criminal proceedings or Fatal Accident Inquiry. It is necessary to establish that the death has not been caused or contributed to by the transplant operation. If there is uncertainty as to whether the retrieval operation could affect the evidence, the Procurator Fiscal should ask the transplant coordinator to put him in touch with the senior transplant surgeon to discuss the operation plans and any requirement for pathological investigation.
15. Where the Procurator Fiscal consents to the removal of parts of the body
The following is the procedure adopted in hospitals:-
Transplant surgery will not be commenced until the fact of death of the donor has been established by two doctors independent of the transplant team. These doctors will, if required, give evidence to that effect to prove that the death of the donor was not caused by the transplant operation. The transplant surgeon will detail his operative procedure and any other findings in the hospital records which will be available for the autopsy pathologist should he wish to see them. The transplant surgeon will also be available for court purposes, if required.
The above procedure ensures that if the Procurator Fiscal then decides to instruct an autopsy, evidence will be available to prove that the transplant operation did not contribute to the death of the donor. It is emphasised that the consent of the Procurator Fiscal is not of itself authority for the removal of part of a body. The other requirements of the Human Tissue Act place an onus upon those seeking to implement the transplant procedure but the Procurator Fiscal is not involved in this.
16. Anatomy Act 1984
The 1984 Act makes provision for the examination by dissection of a body for the purposes of teaching or studying, or researching into, morphology. In any case where there is reason to believe that the Procurator Fiscal may require a Fatal Accident Inquiry or a post-mortem examination of the body, an anatomical examination as defined by the 1984 Act should not be carried out except with the Procurator Fiscal's consent. Whilst the hospital or institute require the concurrence of the Procurator Fiscal, that is not tantamount to authorisation. The approval of the next of kin will still be required.
17. Persistent Vegetative State: Withdrawal of Life Support Facilities
In light of the decision of the Inner House of the Court of Session in the case of Law Hospital NHS Trust v Lord Advocate (1996 SLT 848), the Lord Advocate announced the approach that will be adopted by the Crown when life sustaining treatment or medical treatment is withdrawn or discontinued for patients who are incapable of consenting to such withdrawal or discontinuation.
The Lord Advocate will not authorise the prosecution of a qualified medical practitioner (or any person acting upon the instruction of such a practitioner) who, acting in good faith and with the authority of the Court of Session, withdraws or otherwise causes to be discontinued life sustaining treatment or other medical treatment from a patient in a persistent, or permanent vegetative state (PVS), with the result that the patient dies.
In his opinion in the Law case, the Lord President stated that by means of application by petition for the exercise of the parens patriae jurisdiction of the court, an area Health Board or NHS Trust in whose care the patient is, or any relative of the patient, may seek the withdrawal of treatment. The court decided it was not necessary to require such an application in every case; the decision as to whether an application is necessary must rest with those who will be responsible for carrying that intention into effect, having regard in particular to the views of the patient's relatives and statements of policy issued by the Lord Advocate.
It will be noted from the terms of the Lord Advocate's statement that the immunity from prosecution does not automatically extend to medical practitioners who have not sought and received the authority of the Court. The Lord Advocate has expressed the view, however, that if doctors, and those acting on their instructions, were acting in accordance with accepted medical practice, and had exercised the proper degree of care expected of them, it would be very unlikely any prosecution in the public interest would be brought against them.
Procurators Fiscal may require to consider instructing an autopsy when the withdrawal of life sustaining treatment has resulted in the death of a person in a persistent vegetative state. Such deaths should be reported to the Procurator Fiscal as they are deaths under medical care.
Clearly this is a growing area of medico - legal interest and may be subject to further update in light of experience. Any such update will be circulated as required.
18. Asbestosis, Mesothelioma and Asbestos-Related Lung Cancer
Relatives of those who have died as a result of asbestosis, mesothelioma or asbestos-related lung cancer have an interest in ensuring that evidence as to the cause of death is available should they wish to make a claim in respect of the circumstances in which the deceased was exposed to asbestos.
If the deceased's condition was conclusively diagnosed before his death, an autopsy may not be necessary. Unless a lung biopsy has been undertaken prior to death which revealed asbestos bodies, it is unlikely that a conclusive diagnosis will have been reached.
It should not be necessary for next of kin to attend at the mortuary for the purpose of formal identification of the deceased. If the death has occurred in a hospice or hospital, medical staff should be able to provide a link in the chain of identification. The Procurator Fiscal will require to gather evidence about the deceased's employment record which may be available from his medical records.
As in every case where an autopsy is instructed, the pathologist should send to the deceased's GP a letter informing him that a post mortem examination has taken place and giving him details of the cause of death.
1. INDUSTRIAL DISEASES OF THE LUNGS
Extrinsic allergic alveolitis
Any lung disease qualified by an occupational term (eg grinder's phthisis, farmer's lung)
2. ZOONOTIC DISEASES (diseases transmitted from animals to man)
Erysipeloid (of Rosenbach)
Contagious ecthyma (Orf)
3. OTHER INDUSTRIAL DISEASES
(except poisonings covered by item 4)
Compressed air sickness
Malignant disease (cancer or sarcoma), leukaemia, anaemia or blood dyscrasia if attributed on the medical certificate of cause of death to X-rays or radio-active substances or radiation.
Any form of cancer if shown to be of industrial origin or due to specified substance, such as:-
cancer of the skin (epitheliomatous ulceration, epithelioma, squamos-celled carcinoma) due to tar, mineral oil, arsenic pitch, bitumen, soot etc.
Cancer of the nose (nasopharynx, nasal sinuses) or of the lung (bronchus or bronchial) if shown to be due to nickel fumes or vapour or associated with wood or leather working.
Cancer of the bladder or renal pelvis or ureter (papilloma of the bladder) if due to industrial chemical or dye-stuff preparations or processes.
Hepatitis B, viral hepatitis, hepatitis caused by Australia antigen, serum hepatitis and any form of hepatitis where the deceased was a medical or dental worker.
Any other disease qualified by an occupational term (eg wool-sorter's disease).
4. INDUSTRIAL POISONING
Toxic jaundice or toxic anaemia (unless the medical certificate clearly indicates that the condition is due to natural causes.)"
Any condition certified as ... poisoning or poisoning by ...
NOTIFIABLE INFECTIOUS DISEASES
Viral Haemorrhagic Fever,
(including Yellow Fever, Lassa Fever
and Marburg Disease)
Fevers known by any of the following names: typhus, typhoid, enteric relapsing continued or puerperal
DIRECTORS/CAMOS OF PUBLIC HEALTH IN SCOTLAND
Dr Lesley Wilkie
Argyll & Clyde Health Board
Tel: 0141 887 0131
Fax: 0141 848 1414
Dr Drew Walker
Ayrshire & Arran Health Board
10 Arthur Street
Tel: 01292 611040
Tel: 01292 885684 (Direct Line)
Fax: 01292 286762
Dr I A Mcdonald
Borders Health Board
Tel: 01896 825560 (Direct Line)
Fax: 01896 823401
Dr David Breen
Dumfries & Galloway Health Board
Tel: 01387 241864
Fax: 01387 252375
Dr Lesley McDonald
Fife Health Board
Tel: 01334 656200
Fax: 01334 657579
Dr Malcolm McWhinter
Forth Valley Health Board
33 Spittal Street
Tel: 01786 457254
Fax: 01786 451474
Dr Harry Burns
Greater Glasgow Health Board
225 Bath Street
Tel: 0141 201 4602
Fax: 0141 201 4601
Dr G Paterson
Grampian Health Board
2 Eday Road
Tel: 01224 663455
Fax: 01224 404014
Dr Eric Baijal
Highland Health Board
Tel: 01463 704926
Fax: 01463 235189
Dr Dorothy C Moir
Lanarkshire Health Board
14 Beckford Street
Tel: 01698 281313
Fax: 01698 423134
Dr Helen Zealley
Lothian Health Board
11 Drumsheugh Gardens
Tel: 0131 225 1341
Dr W M Hamilton
Orkney Health Board
New Scapa Road
Tel: 01856 885400
Fax: 01856 885411
Dr Derek Cox
Brevik House, South Road
28 Burgh Road
Shetland IE1 0RB
Tel: 01595 743072
Fax: 01595 695200
Dr Sue Ibbotson
POX Box 75
Dundee Technology Park
Tel: 01382 561818
Fax: 01382 424003
Dr Alan Michael George
Western Isles Health Board
37 South Beach Street
Isle of Lewis
Tel: 01851 702997
Fax: 01851 704405
LIST OF PAEDIATRICIANS IN SCOTLAND
ARGYLL AND CLYDE
Dr Graham Stewart
Royal Alexandra Infirmary
Dr J McClure
Dr Adrian Margerison
The Borders General Hospital
DUMFRIES AND GALLOWAY
Dr Ruth Thomson
Dumfries & Galloway Royal Infirmary
Dr C Steer
Dr I. Abu-Arafeh
Falkirk Royal Infirmary
Dr Paul Duffty
Aberdeen Maternity Hospital
Dr J McDonald
Dr R Barclay
Dr A Edmunds
Royal Hospital for Sick Children
Dr Robert Hume
Dr R Mackay
Perth Royal Infirmary