Surgeons accused over high child death rate for child cases `too high'

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A senior consultant is alleged to have continued to perform complex heart surgery on babies although the death rate for his patients was nearly four times the national average. Kathy Marks reports on one of the most significant General Medical Council cases of recent years.

Between 1990 and 1994, nine of the fifteen babies who underwent "hole in the heart" operations at the hands of James Wisheart died. The mortality rate, according to Roger Henderson, QC, counsel for the GMC, was "unacceptably high."

The charge was made at the start of a marathon disciplinary hearing against three doctors accused of serious professional misconduct relating to babies operated on four congenital heart defects at the Bristol Royal Infirmary between 1988 and 1995.

The case against Mr Wisheart and Janardan Dhasmana, both paediatric cardiac surgeons, and Dr John Roylance, former chief executive of the United Bristol Healthcare NHS Trust, is expected to last well into next year and to hear evidence from up to 40 families. It will be followed by a Government inquiry that could lead to changes in the way that surgical practice is regulated.

Mr Henderson said that Mr Wisheart should have realised by 1993 that his death rate was up to 54 per cent, compared with a national level of 13.9 per cent. His rate was "comparatively disastrous," Mr Henderson said.

Mr Wisheart and Mr Dhasmana, the latter of whom specialised in "switching" operations to unscramble major arteries, are alleged to have continued with their work despite concerns expressed to them by colleagues. Mr Wisheart, who was also the hospital's medical director and is now retired, is also said to have misled parents about the risks of their children dying or suffering brain damage. Dr Roylance is accused of failing to heed the concerns of other consultants and prevent further operations going ahead.

Mr Henderson said lessons had been learned in Bristol and the provision of paediatric heart services had radically improved in the past two years. "I appreciate that these words may be of little solace to parents of children who have died or suffered brain damage," he added. "It is clear that emotions run high in many quarters."

Of Mr Dhasmana's infant patients, 20 out of 38 died between 1988 and 1995. Mr Henderson said that no one doubted the dedication of either doctor, but they should have been aware of how poorly their results compared with the national picture. "They had to stop operating if too many babies were dying," he said.

Mr Henderson said that Dr Stephen Bolsin, a consultant anaesthetist, had played a key role in raising the alert about the two surgeons. "He may be portrayed by others as an rather unattractive whistle-blower," he said. "The fact remains that is was and is the overriding duty of a doctor to safeguard the interests of patients, even if that means shopping a colleague or blowing the whistle on a colleague's performance or conduct."

Mr Henderson said experts would tell the GMC that a number of children "would be alive today" if a more experienced surgeon had operated on Mr Dhasmana's patients. At one time, two babies out of three were dying after being operated on by him, more than six times the accepted level.

All three doctors deny misconduct.

The case continues tomorrow.