Scotland's independent prosecution and fatalities investigation service has significantly broadened its scope at Glasgow's premier medical facility, with seven patient deaths now under formal review for potential connections to environmental hazards within the hospital infrastructure. The Crown Office and Procurator Fiscal Service (COPFS) has escalated its inquiry into the Queen Elizabeth University Hospital (QEUH) campus, marking a critical development in one of the nation's most complex healthcare safety investigations.
The expanded investigation encompasses both adult and pediatric cases across the sprawling QEUH campus, which includes the Royal Hospital for Children. This unified approach reflects growing concerns that systemic failures in essential building systems may have created deadly conditions for vulnerable patients over several years. The prosecution service has established two distinct tracks within its investigation, reflecting varying stages of evidence review and legal analysis.
In the more advanced phase, COPFS has received formal police prosecution reports for four fatalities. These cases include Milly Main, who was just ten years old when she died, along with two other children whose identities remain protected and 73-year-old Gail Armstrong. Law enforcement submitted these comprehensive reports in May after exhaustive evidence gathering, indicating investigators believe sufficient grounds exist to suspect criminal wrongdoing. The submission of these "standard prosecution reports" represents a crucial threshold in Scottish criminal procedure, signaling that police have moved beyond preliminary inquiry to formal accusation.
For these four cases, prosecutors must now determine whether to pursue corporate homicide charges against NHS Greater Glasgow and Clyde, the health board responsible for hospital operations. This rare and serious charge would require demonstrating that organizational failures at the highest level constituted gross negligence leading to unlawful killing. Alternatively, prosecutors may opt for charges under health and safety legislation, which could result in substantial fines and mandated operational changes but would not carry the same criminal stigma as homicide convictions.
The remaining three cases—involving Andrew Slorance, Tony Dynes, and Molly Cuddihy—remain in the evidence compilation stage. Investigators continue to gather medical documentation, interview healthcare staff, and consult with independent medical experts to establish causal links between hospital conditions and these patients' deaths. While police have not yet submitted formal prosecution reports for these cases, their inclusion in the COPFS investigation underscores the breadth of concerns about patient safety at QEUH.
The case of Molly Cuddihy has emerged as a particularly poignant example of the investigation's personal impact. In 2018, at age 15, Molly received a diagnosis of metastatic Ewings Sarcoma, a rare and aggressive form of bone cancer. Her treatment journey at the Royal Hospital for Children took a devastating turn when she contracted mycobacterium chelonae, an extremely rare bacterial infection that public health experts associate with contaminated water systems in healthcare facilities.
This secondary infection triggered a cascade of medical complications. The powerful antibiotic cocktail required to treat mycobacterium chelonae placed enormous stress on Molly's already compromised body. Combined with intensive chemotherapy, the dual treatment regimen severely damaged her organ function. After years of declining health and repeated hospitalizations, Molly was readmitted to the QEUH campus in 2023 and passed away in August at age 23.
Her father John, who previously served as a police officer, had raised concerns about safety standards at the hospital long before his daughter's illness. He now views the involvement of COPFS's specialized hospital investigation unit as confirmation that authorities are treating the case with appropriate seriousness. His perspective highlights the intersection of professional expertise and personal tragedy driving many families' pursuit of accountability.
The investigation runs parallel to an ongoing public inquiry examining the QEUH campus's construction and maintenance. That inquiry has focused intensely on whether flaws in water and ventilation systems created pathways for dangerous pathogens to infect immunocompromised patients. The public inquiry was established in 2019 following public outcry over Milly Main's death, which her mother had linked to contaminated water. The investigation has heard testimony from engineers, clinicians, and families over several years, revealing concerns about the hospital's design and maintenance dating back to its opening in 2015.
Earlier this month, NHS Greater Glasgow and Clyde made a watershed admission, acknowledging for the first time that child cancer patients likely acquired infections from the hospital environment "on the balance of probabilities." This admission represents a dramatic reversal from the health board's previous stance and potentially strengthens the legal case against the organization. The phrase "on the balance of probabilities" is significant in legal terms, representing the civil standard of proof rather than the higher criminal standard of "beyond reasonable doubt." However, it provides a foundation for prosecutors to argue that the board knew or should have known about environmental risks.
Previous evidence presented to the inquiry has documented numerous cases of immunocompromised patients contracting unusual infections. Expert witnesses have testified that the hospital's water supply system and ventilation infrastructure failed to meet standards necessary for protecting vulnerable cancer patients and transplant recipients.
A spokesperson for COPFS emphasized the service's commitment to independence and family communication: "A thorough and independent investigation into the deaths is ongoing and the families will continue to be kept updated in relation to any significant developments." This statement reflects the delicate balance between transparent victim support and maintaining prosecutorial integrity.
Bereaved families have formed a advocacy group, meeting regularly with investigators and sharing information. Their persistence has been credited with keeping pressure on authorities to pursue criminal investigation rather than limiting the matter to civil proceedings or internal NHS reviews.
The potential outcomes of this investigation extend far beyond Glasgow. If corporate homicide charges proceed, it would mark one of the first instances of a UK health board facing criminal prosecution for deaths linked to hospital infrastructure failures. Such a precedent could fundamentally alter how healthcare organizations approach building maintenance, infection control, and risk disclosure.
Legal experts note that corporate homicide prosecutions require proving that senior decision-makers' conduct fell far below reasonable standards, creating a substantial and unjustifiable risk of death. This differs from individual negligence, focusing instead on organizational culture, resource allocation, and systemic oversight. The investigation will likely examine whether cost-cutting measures, inadequate maintenance schedules, or failure to act on early warning signs contributed to the fatal outcomes.
The health and safety alternative, while less severe criminally, could still impose significant consequences. Convictions under the Health and Safety at Work Act can result in unlimited fines and court-ordered remedial actions. For a public body like NHS Greater Glasgow and Clyde, such penalties would ultimately impact taxpayer resources and could trigger governance reforms.
As families await decisions, the investigation continues to shape public discourse about healthcare accountability. The progression from internal hospital reviews to independent police investigation, and now potential criminal prosecution, illustrates evolving expectations for transparency and responsibility in patient safety failures. For the bereaved families, the legal process represents both a search for justice and a means to prevent future tragedies.
The QEUH campus investigation serves as a critical test case for how modern healthcare systems balance infrastructure investment with patient safety priorities. With complex building systems becoming increasingly integral to medical care, the Glasgow cases may establish new benchmarks for monitoring, maintenance, and accountability that resonate throughout the UK's National Health Service and potentially influence international healthcare governance standards.