serious professional misconduct. The Society of Clinical Psychiatrists study group estimated that NHS inquiries into allegations against suspended doctors cost ten times what they would have done if handled by the GMC through its disciplinary procedures. Removing decisions about clinical competence and fitness to practise from NHS disciplinary procedures might be fairer, quicker, and not amount to

cheaper. Diana Brahams 1. Brahams D. Suspended doctors in the Health Service. Lancet 1988; ii: 1205. 2. Dyer C. Quicker disciplinary decisions for hospital doctors. Br Med J 1990; 300: 767. 3. Suspensions: a blot on the NHS. Report of a study group set up by the Society of Clinical Psychiatrists (chairman, Dr Harry Jacobs). Presented to a meeting of the society (a self-help group) on Sept 7, 1989. 4. Dickinson IS. Summary dissmissal and the consultant. New Law J June

9, 1989: 787-88. 5. Brahams D. Bad professional relations and risks to patients. Lancet 1988; ii: 519.

Noticeboard Chernobyl four years on Though you’ll deny it, take refuge in illusion, Put all the blame on those who have been killedI will still come and stand before you And look into your eyes Irina Ratushinskaya

The suicide of Valerie Legasov, a leading Soviet atomic scientist, two years after Chernobyl, followed his analysis in Pravda of the origins of the disaster. It was, he felt, illustrative of "economic mismanagement" over many years. The safety experiment in reactor IV, conducted on the eve of a scheduled shutdown, was one that should have been performed before commercial launch in 1984. The double explosion at 0123 h on April 26, 1986, was no accident. An accident implies an event without apparent cause. Although some of the engineers were found guilty of criminal negligence, there were multiple contributory factors before 1986. Zhores Medvedev is a scientist who left Russia in 1973 and now lives and works in London. He has carefully pieced together’ the events leading up to and following the uncontrollable power surge that precipitated the explosions, the partial meltdown, and the ten-day graphite fire with resultant plume of radioactive material. The initial reaction of the Soviet authorities was confusion and cover-up. The first report of abnormal radiation levels came from Sweden, two days after the explosion. The impact on the local community was and remains enormous. 31 people died (predominantly unprotected fire crews), over 200 had acute radiation sickness, and 600 000 had a dose of radiation that will necessitate medical follow-up for life. Overall 135 000 people were evacuated from a 30 km exclusion zone around Chernobyl. The subsequent environmental and agricultural damage make

harrowing reading. Despite this, a health care plan did exist for nuclear accidents and the logistics of this operation were successfully implemented-a fact

sufficiently credited in Medvedev’s account. Patients were initially transported to Kiev for specialised care. A radiation team


arrived 10 h after the accident from Moscow, arranging transport of patients back to the capital. A civilian radiation disaster programme was instituted involving assessment of residents by 450 medical brigades. The major international consequence has been an altered perception of nuclear energy post-Chemobyl. Though these events could not be repeated in Western pressurised water reactors, public distrust of the nuclear option has caused governments to acknowledge the commercial failure of nuclear programmes and has

paralysed them from continuing ambitious new developments. Indeed, Sweden will have phased out all nuclear energy installations by 2010. Mysteries remain unsolved. There are persistent accusations that officials ordered the artificial induction of rain, to prevent drift of the radioactive cloud towards Moscow, resulting in radionuclide deposition in Byelorussia. Affected villages continue to be evacuated as radiation increases beyond maximum permissible levels.

Medvedev’s book was published on the fourth anniversary of the worst industrial disaster. The longer-term health-care


implications are beginning to emerge (p 1086). Legacy of Chernobyl Zhores A. Medvedev. Oxford: Blackwell. 1990. Pp 352. £10.95. ISBN 0-631169555.

1. The

Reprieve for AIDS conference Restrictions on the entry of HIV-infected visitors to the USA have been lifted for foreigners who wish to attend the sixth international AIDS conference in San Francisco in June. Conference participants will be able to obtain a 10-day visa without identifying their HIV status. The US Bureau of Consular Affairs, Department of State, has said that "no computer record will be entered and at the applicant’s request, the annotated visa will be placed on a separate form, which can be discarded after the alien completes his travel", The International AIDS Society (IAS), which had threatened to boycott the conference, has announced that it will support the meeting because of the urgent need for international and interdisciplinary coordination of AIDS-related activities and the vital importance of exchange of scientific information. However, the IAS has re-emphasised its view that there is no valid scientific or public-health basis for discriminatory policies towards HIVinfected travellers. The society urges scientists worldwide, and particularly those in the US, to oppose discriminatory policies in all countries. A legislative solution to abolish travel restrictions on HIV-infected people has been introduced into the US House of Representatives, but the final outcome is said to be uncertain.

Management of trauma 12% of injured patients in the UK are likely to receive treatment that is seriously deficient, according to a report from the British Orthopaedic Association.This conclusion is based on the results of a nationwide random survey, which showed that about half the inadequately treated patients would have fared better if treated by a more senior doctor and half should have been transferred to a more specialised centre. In 1988 the Royal College of Surgeons of England suggested, mainly on the basis of a retrospective survey, that a third of all deaths after major injuries were preventable, and one of its recommendations for improving the management of such injuries was to set up regional trauma centres serving populations of 2 million or SO.2 The BOA, too, favours the setting-up of large trauma centres (and the curtailment of the work of smaller units to match their capabilities) but proposes that such units should serve only a 500 000 to 750 000 population. This change, says the association, would improve standards and could be achieved relatively cheaply by the reorganisation of existing units. The BOA points out that trauma centres would have to deal with large numbers of non-life-threatening injuries as well as life-threatening ones, and that such considerations must be taken into account in formulating an operation policy-skeletal injuries, for instance, need long-term management and transfer of patients elsewhere for continuing care would be unsatisfactory. The BOA comments that the present arrangements for treating injured patients are tolerated only because the public is unaware of their shortcomings. 1. The management of trauma

in Great Britain British Orthopaedic Association, 35-43 Lincoln’s Inn Fields, London WC2A 3PN (071-405 6507) 2. Royal College of Surgeons of England. The management of patients with major injuries. London. RCS, 1988.

Reprieve for AIDS conference.

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