Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change our server in April Editor's Choice | This Week in BMJ | Press releases BMJ No 7132 Volume 316 News Saturday 28 February 1998 Wisheart begins to give evidence at GMC Parents of babies who died or were left brain damaged after heart operations at Bristol Royal Infirmary held a candlelight vigil outside the General Medical Council last week, as James Wisheart, one of three doctors charged with serious professional misconduct, arrived to begin his evidence. They set out 50 shoeboxes painted black, each with a white cross, to represent tiny coffins. A banner proclaimed: "GMC: Great Massacre Cover-up." The parents are angry that the GMC investigation is focusing on only 53 operations of two types - arterial switch operations and open heart surgery to correct atrioventricular septal defects. Twenty nine of the 53 babies died, and four were left brain damaged. Parents are calling for a public inquiry into the deaths Photo: MICHAEL STEPHENS/PRESS ASSOCIATION The Department of Health is to hold an inquiry after the GMC case finishes, but the parents delivered a petition to the prime minister's home in Downing Street demanding a full public inquiry. Mr Wisheart is the first of the three doctors facing charges over the operations to give evidence. He and another consultant surgeon, Janardan Dhasmana, are accused of operating beyond their technical competence when they were aware of concerns over high death rates. Mr Wisheart, who was also the United Bristol Healthcare Trust's medical director, is also charged with misleading parents about the risks associated with him operating. John Roylance, the trust's former chief executive, is accused of failing to use his authority to stop the operations. The case, the most important to come before the council for many years, breaks new ground in focusing attention on the overlap between issues of competence and those of conduct. The GMC case and the inquiry that will follow are likely to lead to changes in the way surgeons are audited and regulated. The government's promised act on the freedom of information may also allow public access to surgical success rates. Mr Wisheart was asked about a letter written by Stephen Bolsin, an anaesthetist, to Dr Roylance in 1990, raising concerns about mortality in children aged under 1 year. The surgeon said that he had not seen the letter until 1995. Dr Bolsin had told the GMC that Mr Wisheart had summoned him to his office for an angry confrontation and warned him that this was not the way to carry on if he wanted to continue his career at Bristol. Mr Wisheart said: "I have no recollection of that, and I may say that I do not often become extremely angry and, when I do, it usually leaves a greater scar on me than on any other party." He added: "I cannot conceive that I would have spoken in such a way to a relatively young consultant." He said that he had been "extremely supportive of Dr Bolsin" over the next five years. Mr Wisheart said that a high proportion of children on whom he performed open heart surgery for atrioventricular septal defects had unusual risk factors, which in several cases were not apparent at the time of the operation. Nine out of 15 babies died. In 13 switch operations carried out by Mr Dhasmana on babies under 28 days old between January 1992 and January 1995, nine babies died, and one was left brain damaged. He stopped doing the operation on neonates, but continued with older children. Mr Wisheart said that the final switch operation performed by Mr Dhasmana, on 18 month old Joshua Loveday, who subsequently died, had gone ahead only after surgeons, cardiologists, and anaesthetists had held a meeting and concluded that there was no medical reason for it not to. Dr Bolsin was the only one who thought that the operation should not be done at Bristol, and he had said he was against it "for political reasons." Mr Wisheart said that at the time that he was proposing to carry out surgery for atrioventricular septal defects on Matthew Rundle, he had operated on nine infants, with four deaths. This was a mortality of 45%, against an national average of 14-15%. But the risks had been very substantially higher than average in his series of patients. Mr Wisheart said: "Based on the actual risk that the facts show were present in these patients, the discrepancy was relatively small and well within any notion of variations and confidence limits that we would accept." But he added: "Because I did not feel that in my hands the outcomes were quite as good as I would have hoped for, I therefore said to the Rundles a risk, I believe, of 20 or 25%." Sandy Rundle, the baby's mother, earlier told the GMC that Mr Wisheart had quoted a 90% chance of success. The baby died. Mr Wisheart, who received an A merit award in 1994, stopped operating voluntarily in December 1996. He announced his retirement from the NHS just before the publication of a report (by independent experts commissioned by the trust) that found his performance to be "significantly poorer" than that of his colleagues and his "operative mortality figures" too high. Clare Dyer, legal correspondent BMJ Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline