An Ebola health screening programme that was put in place at Heathrow airport to protect Britain against the spread of the deadly virus was hampered by poor organisation, lack of training and lack of resources, a tribunal has heard.
The breakdown in the system was so great that the manager of the screening system called the wrong number for the specialist on call at the infectious disease hospital when concerns were raised on 28 December 2014 when the Scottish volunteer nurse Pauline Cafferkey passed through the airport.
Passengers deemed to require further observation or assessment were to be sent to Northwick Park hospital in north-west London. But the screening manager revealed he rang an incorrect switchboard the day Cafferkey arrived, rather than the infectious disease consultant on call.
David Carruthers, the shift manager the day Cafferkey returned from Sierra Leone, admitted in the tribunal that his team had run out of screening kits and monitoring kits, and that half the staff on the screening team were not clinically qualified and were “office workers” previously.
He was giving evidence at a Nursing and Midwifery Council hearing where one of Cafferkey’s volunteer group, the nurse Donna Wood, is facing being struck off for allegedly concealing the Scottish nurse’s high temperature on the day. Wood has denied the charges.
Carruthers described how the screening team was given passenger numbers for the two indirect flights coming in from Sierra Leone where NHS workers had volunteered at the peak of the Ebola outbreak.
However, he was not aware of how many passengers had actually worked on the Ebola frontline and would therefore have been deemed to be “category 3” passengers with a risk profile.
He said the screening team was unable to cope with the high numbers of category 3 passengers arriving on the Royal Air Maroc flight. But he claimed the Scottish nurse only got past the checks put in place by Public Health England to check travellers entering the country from west Africa after a deception.
“Chaotic is a bit of a harsh term, it was busy and it was a little disorganised,” he said.
Carruthers conceded that the screening system was flawed on some fronts, under cross-examination by Wood’s counsel, but said he was not clinically qualified to manage a health risk.
He said he was reliant on border control and PHE managers to provide passenger lists for any given day. “It wasn’t an exact science, I’m afraid,” said Carruthers, who worked as a Metropolitan police officer from 1984 to 2013.
He said they had only four cubicles in Terminal 4 to deal with passengers arriving on the Royal Air Maroc flight. He said passengers from Ebola-hit countries were not isolated at Heathrow.
Those, like Cafferkey, who had come from “high risk” environments were allowed to mingle freely with other passengers in the screening zone, the tribunal heard. Transit passengers were also able to move freely between terminals before being screened.
“We are talking about a highly infectious and dangerous disease,” said Ben Rich, for Wood.
Carruthers described how he had arrived in the screening area in Terminal 4 the day Cafferkey and her volunteer group returned from Freetown, the capital of Sierra Leone. He noticed that some people were agitated and unhappy with what was going on. Staff also complained that some of the forms had not been filled out properly.
However, he said he did not talk to passengers as he felt this would “exacerbate” things. His job was to manage the process, he said.
The former police officer learned that Cafferkey had been allowed through the screening process with a temperature above 38 degrees at about 6.20pm.
It is alleged that Wood recorded her temperature a degree lower in order to escape the “chaos” at the screening area and “sort it out”.
He said he learned of the alleged “deception” after he received a call from an infectious diseases nurse and then had a telephone conversation with Cafferkey directly.
At this point she was in either the arrivals hall or on the train platform to take her to Terminal 5 for a connecting flight to Glasgow.
“Pauline Cafferkey confirmed her temperature had been recorded as lower than it was,” said Carruthers. “I told her she should return to screening and have her temperature recorded. I assured her there was plenty of time for her flight [to Glasgow] and assured here there was nothing to worry about.”
He told the independent panel that he remained calm and courteous with her as he did not want to panic her as he escorted her from arrivals back to the screening area.
“I did summarise to her that the temperature had been taken at 38.3 degrees but recorded as lower than his. She did not disagree with this. I would describe her as tail between the legs or sheepish,” he said.
He later said: “Ms Cafferkey got through the screening area with what I would call as deception.”
He told how the screening team was made up of eight staff on the day, including a communicable disease expert, three clinically qualified professionals and four non-professional screeners.
In addition, an infectious diseases clinician was on call at Northwick Park hospital in the event of a high-risk patient arriving.
When alerted to Cafferkey’s temperature, he took responsibility in place of the PHE clinician on the team, to contact the expert at the hospital. By mistake, he phoned the switchboard and did not get a reply.
“That’s a breakdown in communication and for that I am partly responsible without a shadow for a doubt,” he said.
After Cafferkey was tested positive for Ebola on 28 December, Nick Gent, a doctor and deputy dead of PHE’s emergency response department was drafted in to assess the efficacy of the body’s screening process.
He interviewed volunteers in Cafferkey’s group as part of a fact-finding rather than evidential operation, he told the tribunal. Gent added that along with Cafferkey and Wood, doctors Hannah Ryan and Mark Willcox were referred to their regulatory bodies.
The NMC hearing continues.
Half of Ebola screening staff at Heathrow "were not clinically qualified"
