Medical Ethics: Heart surgeons face misconduct charges

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The Independent Online
On Monday three doctors are to appear before the General Medical Council in what is being billed as the most important medical disciplinary case of the decade. The outcome of the case, and the Government inquiry which is to follow it, could change the way surgical practice is regulated in Britain.

Two surgeons, James Wisheart (now retired) and Janardan Dhasmana, and Dr John Roylance, former chief executive of the United Bristol Healthcare NHS Trust, will appear before the council's professional conduct committee on charges relating to heart surgery in children. The council has cleared four months to hear the case compared with the two to three days for routine professional conduct cases.

Between 1988 and 1995, children operated on for congenital heart defects at Bristol Royal Infirmary's paediatric cardiology department had a higher than expected death rate. Some were left brain damaged and four are now suing the hospital trust for damages.

The article on this page tells the story of those years. The GMC case is being described as the biggest since the kidneys-for-sale scandal in the mid-1980s, although the issues are very different. In that case two doctors were struck off the medical register for paying young Turkish men to donate their kidneys to rich private patients. The donors were flown to Britain for the operation and claimed they did not know what was happening to them.

The detailed charges against the three doctors in the present case will not be known until it begins on Monday. The GMC's professional conduct committee has no power to investigate the clinical competence of the doctors, but must confine itself to ethical issues such as what the parents were told about the risks of the proposed surgery. The doctors deny misconduct.

Last March, Stephen Dorrell, then secretary of state for health, ordered an inquiry into the heart surgery service for children at the infirmary after an independent review criticised Mr Wisheart's "poor" surgical performance. Mr Dorrell said that the inquiry should run after the GMC had concluded its investigation.

Mr Wisheart, who announced his retirement from the NHS 24 hours before the review was published, said then: "I have served patients in the South- west for 22 years and given my all to them. No surgeon has been subjected to the scrutiny I have endured. This review has been breaking new ground and the whole issue of standards .... is a difficult one."

The British Medical Journal says in an editorial on the case that a punitive approach to quality may occasionally be necessary to protect public safety but "big sticks" alone are not enough to improve health care. It believes a more systematic, incremental approach led by doctors is needed. It is well known that the performance of individual surgeons varies widely. Many surgeons will watch the unfolding events at the GMC over the next four months and wonder "There, but for the grace of God