10 May 2022: Rejman - A

Dr Rejman went through the typical MRC Path course. This almost universal entry-point has surely been instrumental to shaping the thinking and practice of most of our clinicians. Hopefully, someone has reviewed the course content, the underlying rationale, and the changes over the crucial period involved. Was the under-pinning science inadequate or the ethical foundation flawed such that it created a corporate or systemic problem?

He said, “The Haemophilia thing was very low in the priority list.” Perhaps taken out of context (or not), this could be a haunting comment to make.

Dr Rajman received a warning letter from the Penrose Inquiry as part of Maxwellisation. It was to let him know he was likely to be criticised in the final report. He had not been involved in giving evidence to Penrose. The person criticising him was Prof Lycola (?) from Finland. Dr Rejman took advice from TSOL, now the GLD, who advised him on how to respond. Getting to see the Penrose warning letters and the responses was sought by victim-survivors at the time, but these were not forthcoming. It would have been useful. Dr Rejman was very disappointed with the response by Penrose to his submission. The wording in the final report appeared as if he had not written back at all. Clearly, he was worried about future potential litigation. He felt he was ignored by Penrose. Karma’s gonna get you, maybe not instantly but eventually.

At some point later, Dr Rejman spent a period of time on “gardening leave”. He was not asked why this euphemism was used or what caused it to be necessary.

In explaining his Senior Medical Officer (SMO-Grade 5) role in the Department of Health with respect to haematology, he let slip that most of the leaders he worked under were just not interested in this area. He received zero induction or training into his government role. They just got on with it. The grading system was “a bit of a mess”, since some others on his pay grade could sign documents for a minister, while some like Dr Rejman, could not. There was a set of parallel hierarchies, but the roles could become blurred. Actually, it was often the Administrators who managed key communications and links, including what went to the Minster. It seems like a cosy and informal matter of popping in and out of each other’s offices with no culture of “ back-stabbing”. Upon merging the parallelism, it became “pot luck” if a boss knew as much about a subject as the person reporting. Some were not medically trained at all so knew nothing about the work they were supervising. So, we can’t see anything that could go wrong there then.

Dr Rejman assesses himself as having been a busy, hard-working civil servant. He certainly produced lots of stuff, he says.

The merging of the divisions into one big group seems to have been a big deal at the time. It was seen by its advocates as helpfully efficient, but that was not the view of everyone.

He described the situation of pre-devolution health departments. The “territorials” would have much smaller teams of staff, so their individual remits would necessarily cover much wider topics and specialisms. The greater numbers in London meant there was a reliance on the DH (Department of Health) in London from the likes of the SHHD (Scottish Home and Health Department) in Scotland. There was not much medical information sharing, but there was an underlying concern about one or other of the territories potentially going off and doing their own thing. Often things were automatically coordinated, for example, the quality assurance oversight body for laboratories was a UK body.

When AIDS appeared, Dr Rejman was too busy with his own research to pay much attention at the time. But when he went to Guys in late 1983, it was raised as an issue, but he was again too busy, this time with “acute leukemics” who were dying in front of them. The haemophiliacs got a quick, “How are you?”

Any viral hepatitis attention was initially a response to Hep B due to situations like the Edinburgh outbreak. Non-A-non-B was not a big deal. When it occurred that a patient turned yellow, they contacted Jeff Savidge who gave advice about focussing on batch numbers, but Dr Rejman says, again, he was not really involved in dealing with this incident.

The increasing number of Lowe-type bearded smiles, along with the occasional sigh of “Well, it was like this …” kind of slightly exasperated answer introduction, are beginning to become a bit irritating. He is also relying more and more on the “… you know …” insertion to try to get Counsel on his side. It isn’t working. He finally admits to knowing about the seriousness of what became Hep C, however, he is still working on the effort to re-direct the line of questioning by introducing his answer, “Yes, but …”.