After a hearing lasting over seven months, the longest in its history, the General Medical Council concluded that James Wisheart, 60, and Janardan Dhasmana, 58, continued to perform complex heart surgery on babies at Bristol Royal Infirmary long after they should have stopped following warnings from colleagues about their high death rates.
A third doctor, John Roylance, former chief executive of the Bristol Royal Infirmary, failed to respond to the warnings about the two doctors by preventing the operations from going ahead, the GMC found.
The original charges related to 53 infants operated on by the two surgeons between 1988 and 1995, of whom 29 died. All had congenital heart problems. The GMC contended that Mr Wisheart who had performed 15 of the operations, should have stopped after the 11th, when five children had died, because of his poor record and the warnings from colleagues. It said Mr Dhasmana, who performed 38 of the operations should have stopped after the first 19.
Yesterday, the council concluded that there was sufficient evidence to prove that they had continued to operate beyond the point when they should have stopped in three cases for each surgeon. Five of the six babies died - two operated on by Mr Wisheart and three by Mr Dhasmana.
Afterwards Malcolm Curnow, spokesman for the Bristol Parents Support Group, said at least 91 children had died or been brain-damaged following surgery at the infirmary and between 40 and 50 families were considering legal action. "We want the truth about these deaths to come out," he said.
The three doctors, who all deny serious professional misconduct, left the hearing without commenting.
Mr Wisheart and his wife were escorted from the building by police, as reporters and photographers ran after them. Helen Rickard, whose 11-month- old daughter Samantha died after a heart operation performed by Mr Wisheart, walked alongside his taxi banging on the window.
Mrs Rickard, whose husband committed suicide two years after their daughter's death, said: "There is still a lot more to be investigated in this case. This is just the tip of the iceberg."
The case is the first to highlight doctors' duty to monitor their performance and compare it with colleagues to protect the safety of patients. Having delivered its "finding of fact" in the case, the seven-member professional conduct committee of the council, including five doctors and two lay people, will next consider whether the charges proved against the three doctors amount to serious professional misconduct and whether they should be struck off the medical register. Mr Wisheart and Dr Roylance, are retired. Removal from the register does not affect pension rights.
The final verdict, which is not expected before mid-June, is likely to trigger an epidemic of soul-searching by the surgical fraternity and could lead to new regulations governing performance. The case has exposed the absence of clear standards against which doctors can be judged and has provoked a flurry of activity by medical organisations which are now seeking ways to introduce them. The Government has promised an inquiry when the GMC case is concluded.
Parents of children who died or were brain-damaged following surgery at the infirmarycrowded into the public gallery of the GMC's headquarters to hear Sir Donald Irvine, the president, read out the committee's findings. The high emotion generated by the case was reflected by the father of Ian Stewart, who was brain-damaged but excluded from the case, who briefly interrupted the proceedings calling them a "sham" and a "charade".
Much of the argument during the case focused on the final operation on Joshua Loveday, aged 18 months, carried out on 12 January 1995. All three doctors were found to have allowed it to go ahead when they should have known it was unsafe.
Mr Dhasmana, who performed the surgery, did so without considering referring Joshua to another hospital and without "sufficient regard" to his safety. Mr Wisheart, who was medical director of the hospital, and Dr Roylance, as chief executive, did not act on repeated warnings they received from colleagues and prevent Mr Dhasmana operating. Joshua died on the day of his operation.
The parents are demanding a public inquiry but the health department said no decision on the type of inquiry had yet been taken. After the final GMC verdict, the doctors are expected to appeal to the Privy Council and officials are concerned that a public inquiry might have to be unreasonably delayed.
The parents are due to meet Sir Cecil Clothier, former NHS ombudsman and chairman of the inquiry into the Nottingham nurse Beverley Allitt who was convicted of murdering children on her hospital ward. He is expected to try to persuade them that an internal investigation modelled on the Allitt inquiry could meet their concerns.
The GMC hearing has taken evidence from 67 witnesses and cost pounds 2.2m.
Why did no one stop these doctors? pages 4, 5
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