FAMILIES of two cancer patients who died with rare fungal infections normally linked to pigeons are still waiting for answers as it emerged that an expert report due three months ago has not yet been written.

It comes after an Independent Review into the Queen Elizabeth University Hospital (QEUH) where they were treated concluded that there is “not a sound evidential basis” that pigeons at the site were the source of the Cryptococcus infections.

Those findings are based on unpublished internal reports commissioned by NHS Greater Glasgow and Clyde, however, and a confidential witness statement to the review chairs.

A separate report by NHS GGC’s own Cryptoccus Expert Advisory Group - which previously said it was “not technically possible” that fungal spores could have reached the patients via hospital ventilation - was due to submit its final report in March, outlining its alternative hypothesis.

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The Herald requested a copy on Tuesday, but was finally told by NHS GGC yesterday that it is "not yet complete".

Monica Lennon MSP, Labour’s health spokeswoman, said: “Families continue to be failed by secrecy and the selective sharing of reports and evidence.

“While questions about the QEUH Cryptococcus infections remain unanswered, it’s impossible to rebuild trust and public confidence and it’s hurtful for the families directly affected.”

She added: “If it wasn’t for the courage of staff whistleblowers, the tenacity of families and investigative journalism, NHSGGC and the Scottish Government would have continued to behave like there was nothing wrong at the QEUH campus.

"We are yet to see the open and transparent approach that was promised.”

Investigations began after Gail Armstrong, a 73-year-old grandmother who was being treated for blood cancer at the QEUH in November 2018, tested positive for Cryptococcus neoformans - a fungus most often associated with pigeons and their droppings.

Ms Armstrong was discharged for palliative care and died in January 2019. Although the infection was initially ruled out as a factor in her death, the case is being investigated by the Crown Office.

In December 2018, a 10-year-old leukaemia patient, who has never been named, also tested positive for the fungus in a post-mortem.

The infection - which can cause a form of meningitis - was said to have contributed to the boy’s death.

The cases led Health Secretary Jeane Freeman to order an Independent Review into the £842 million hospital amid concern that design flaws could have increased the risk of hospital-acquired infections.

The Review, published on Monday, said non-compliant water and ventilation systems had increased the risk to cancer patients but said there was “no clear evidence” this had led to avoidable deaths.

In relation to the Cryptococcus infections, the Review said there “is not a sound evidential basis on which to make a link between their infection, subsequent deaths, and the presence or proximity of pigeons or their excrement”.

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In particular, the Review referenced a study commissioned by the QEUH Estates team and carried out by specialists at Quesada Solutions Ltd which used computer simulations to analyse airflow around the rooftop helipad, beneath which pigeons had roosted.

This was said to have debunked a theory that air contaminated by microorganisms from pigeon droppings could have been drawn into the ducts that supply ventilation to various parts of the adult and children’s hospitals.

The Review said: “The CFD [Computational Fluid Dynamics] simulations demonstrate that the air arriving at these AHU intake locations does not originate in the region beneath the helipad for any of the scenarios.

“It is therefore unlikely that debris or particles from the helipad area was or is being carried into the hospital ventilation system.

“This means birds congregating at or around the helipad, are unlikely to be contaminating the hospital ventilation system.”

The Herald was provided with the helipad report after 5pm yesterday, having asked for it on Tuesday.

However, NHS GGC said this was on the basis of legal advice that it was a "controlled release", meaning that the Herald "cannot share the report or publish its content" ahead of the forthcoming joint public inquiry into the QEUH and Edinburgh children's hospital.

The Independent Review also noted that there had been accounts of pigeons nesting above air intake vents. Pigeon feathers and excrement were also found in a plant room on the top floor.

However, the Review referenced “early evidence” from NHS GGC’s own expert working group which “suggests that the possibility of air from plant rooms, via the AHUs, as being the likely source of fungal spores, which were then breathed in by patients, has been reviewed and found to be improbable”.

It added: “This is because the locations of bird sightings and infection sites are too far apart with too many physical barriers between them to realistically link the two”.

Pigeon remains and excrement “found in the hospital near an air inlet” were also dismissed in the review, which stated that this inlet had not been supplying ventilation to the part of the hospital where the cancer patients “spent much of their inpatient care”.

This was based on a witness statement which a spokesman for the review said could not be released, even if redacted to protect the individual’s identity.

He said: “All statements were taken in the course of private hearings and are subject to a duty of confidentiality.”

There are 37 known species of Cryptococcus. The neoformans strain detected in both cancer patients is the most common cause of human disease.

It is widely present in the environment, but can be lethal to patients with compromised immune systems.

Although it is not stated in the review report, a further puzzle is that neoformans has never been isolated during environmental testing at QEUH - but two other, rarer, forms of Cryptococcus have.

A spokesman for the review said: “This [neoformans] species is associated with pigeons and their guano but it is considered environmental and is found in other sources including soil, decaying wood and other organic matter.

"It is usually inhaled.

“Despite intensive environmental sampling Cryptococcus neoformans has never been isolated from air samples in QEUH.

"Two other species Cryptococcus albidus and Cryptococcus diffluens have been isolated.”

A senior source at the health board told the Herald that it was "notoriously difficult" to isolate neoformans from air samples, or even from pigeon guts.

A spokeswoman for NHS Greater Glasgow and Clyde said: “This has been a very difficult period for our patients, their families and our staff for which we apologise.

"The findings of the Independent Review highlight several areas of learning for NHSGGC. We are fully committed to applying the learning from this experience.

“It is not for NHSGGC to comment on how judgements and findings of the Independent Review were reached.”