One in 10 heart surgeons investigated

After Bristol: Checks ordered into hospital death rates as concern grows over allegations of incompetence

DEATH RATES for every heart surgeon in the country are to be collected and compared for the first time in order to protect patients from sub- standard operations, it emerged yesterday.

Preliminary studies completed last December show that one in 10 heart surgeons have been subject to internal hospital inquiries after their competence was questioned by colleagues or hospital managers. All hospitals with a heart unit are to be asked to submit individual death rates for each consultant to the Society of Cardiothoracic Surgeons and any found to be significantly worse than average will be investigated.

The audit was disclosed following the landmark decision by the General Medical Council on Friday that two senior heart surgeons continued to operate on babies long after they should have stopped. James Wisheart and Janardan Dhasmana were found to have ignored warnings from colleagues about their high death rates at Bristol Royal Infirmary and Dr John Roylance, former chief executive of the hospital, was found to have failed to prevent the operations going ahead.

Julian Dussek, president of the society and consultant cardiothoracic surgeon at Guy's Hospital, London, said: "It has caused a huge amount of concern. We think a lot more cases may never have come to light."

The society is also to set up a "Rapid Response Force", approved by the Royal College of Surgeons last week, in which senior consultants will be available to act as troubleshooters to sort out heart units having problems.

Last December, two months after the Bristol case had begun, the society called an extraordinary general meeting because of growing concern at the number of heart surgeons facing allegations of incompetence. It disclosed that 18 of the 199 consultant cardiac surgeons in Britain had been investigated after questions about their safety had been raised.

Most were cleared but the 700-member society, which represents all heart surgeons, said the threat of suspension could inhibit surgeons from carrying out high risk procedures.

At a second meeting in March, the society agreed to collect individual surgeons' death rates for four surgical procedures - two in adults and two in children. The adult operations will be coronary bypasses and lobectomies (removal of part of the lung); the paediatric operations will be holes in the heart and coarctations (widening of the aorta - the main artery from the heart).

Mr Dussek said: "We want to try and identify any consultant surgeon whose performance is outside the normal range. The results will be sent in by each heart unit individualised for the first time. The consultants will not be identified but I will write to any unit where a surgeon has unusual results to invite them to contact me. I am sure they will but if they don't we will break the code to identify them."

He said there could be reasons why a surgeon had a high mortality rate - if he was operating on high risk cases for example - but it needed investigating and, if necessary, dealing with. In New York death rates for every cardiac surgeon are published by name each year. The British moves did not go that far but, said Mr Dussek: "The public are entitled to expect that surgeons' performance will be assessed and the Government is demanding that it be done. Performance indicators are going to come. You can't argue against it."