Bristol surgeon claims deaths were `inevitable' columns

A SURGEON at the centre of the Bristol heart babies disaster described yesterday how a high death rate was inevitable when surgeons were learning new operations.

Janardan Dhasmana, former paediatric cardiac surgeon at the Bristol Royal Infirmary, told the public inquiry into the disaster that there was a "surgical learning curve" which meant the death rate was likely to be higher than at units with more experience.

Giving evidence for the first time to the inquiry, he said: "I wish nobody had to operate on someone for the first time. I was just keeping up with the practice."

He added: "Whenever you start any new operation you are bound to have, unfortunately, high mortality."

Mr Dhasmana was found guilty of serious professional misconduct and banned from operating on children for three years following a General Medical Council investigation last year. He was later sacked by the infirmary but is appealing against his dismissal. His senior colleague, James Wisheart, the medical director, was also found guilty and struck off the medical register.

The GMC case focused on 53 cases, in 29 of which the baby died or was brain damaged. The public inquiry is examining almost 1,900 operations involving complex heart surgery carried out at the infirmary between 1984 and 1995.

One of the complex operations, known as an "arterial switch", involved switching the main arteries to the heart in babies born with them transposed in the wrong positions. Mr Dhasmana had a good record on hole-in-the-heart operations, with a death rate better than the national average, but when he began trying the switch operations, he found his skills tested to the limit. He told the inquiry yesterday: "In any complex case, anywhere, there is always a possibility that a child could survive elsewhere. Unfortunately at that time there were no clear guidelines, every surgeon was doing the best available practice."

Mr Dhasmana, who was appointed a consultant on 1 January 1986, also told the inquiry of the primitive facilities at the infirmary compared to other hospitals where he had worked, including London's Great Ormond Street and hospitals in Chicago and Alabama in the United States. There was a shortage of beds, operating time and space in the intensive care unit, and as a result Bristol carried out fewer complex operations than other specialist units. "We were lagging behind in general terms. We were moving but not at the same pace as the others," he said.

The inquiry heard Mr Dhasmana would often be seen in the intensive care unit at 1am, because of his heavy workload. Asked by Brian Langstaff QC, the inquiry counsel, if the pressures on him were great he answered: "Yes. I can see that now but at the time I didn't realise."

As his wife sat in the public gallery, Mr Dhasmana described a working pattern where he would leave the wards at 6.00pm, often returning late at night to check on his patients.

"I didn't feel at that time I was under any extra pressure than my colleagues elsewhere. They were probably doing the same thing everywhere," he said.

The inquiry continues.