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Bristol surgeon regrets not consulting with colleagues over poor results

Clare Dyer legal correspondent, BMJ

James Wisheart, the senior surgeon struck off the medical register for his role in the deaths of children undergoing heart surgery at Bristol, told the public inquiry into Bristol paediatric cardiac surgery services this week that he had stopped operating on children because of stress and anxiety from seeing so many of his patients die.

Although he believed there were "true and proper" factors accounting for the deaths, the "anxiety and emotional investment or drain weighed very heavily." The one thing he could clearly say he regretted was not consulting colleagues earlier over his disappointing results.

But he was not sure this would have led him to stop sooner.

Mr Wisheart, former medical director of United Bristol Healthcare NHS Trust, said that he stopped doing operations to correct atrioventricular septal defects in September 1994. The 1995 report of an independent inquiry by cardiologist Stewart Hunter and surgeon Marc de Leval found that he had an 87% mortality for the operation. The report described him as "among the high-risk surgeons."

Asked by the inquiry’s counsel, Brian Langstaff QC, whether he was "proud" of his long surgical career, he said he was "very disappointed at the manner in which my professional career had finished" when he retired in 1998. He went on: "I felt that my surgical skills had achieved a great deal, but clearly some aspects of those skills were under criticism. Proud would not be a term I would use.

"My own view is that I had done my best. But on what appeared to be the figures and judgments at that time, there was at least a question mark whether my skills were what I would have hoped."

Mr Wisheart was struck off the register for serious professional misconduct by the General Medical Council last year, along with John Roylance, former chief executive of the trust. Another consultant surgeon, Janardan Dhasmana, was banned from operating on children for three years and lost his job.

Asked if he accepted the GMC’s finding against him, Mr Wisheart said he had wanted to appeal but was advised he had no chance of success.

The public inquiry, set up by the then health secretary, Frank Dobson, after the GMC investigation, is looking at nearly 2000 heart operations on children in Bristol over 12 years to 1995.

Mr Wisheart was asked about a letter which Gianni Angelini, professor of cardiac surgery at Bristol, proposed to send to Peter Doyle, a senior medical officer at the Department of Health. The letter was in response to a letter from Dr Doyle, which had said that if preventable deaths were occurring that would be an "unacceptable tragedy."

Mr Wisheart, who was sent a copy of the proposed reply for his comments by Dr Roylance, had written that Dr Angelini’s letter "rightly emphasises that the problem is with one procedure only. The rest of the work is entirely acceptable or better."

Mr Wisheart said that the procedure to which he was referring was the arterial switch operation performed by Mr Dhasmana. He admitted to the inquiry that this was only a month after he had given up doing atrioventricular septal defects, and that seven of the previous eight such operations he performed had been unsuccessful. He accepted that he should have written that there was a problem with this operation.

Mr Wisheart was questioned about the decision, taken by a meeting of cardiologists, surgeons, and anaesthetists, that Mr Dhasmana should operate on 18 month old Joshua Loveday in January 1995. Mr Wisheart said that he was aware at the time that the trust was considering a full review of paediatric cardiac surgery, but he did not tell Mr Dhasmana.

The latter has told the inquiry that he would not have gone ahead had he known the review was planned. Mr Wisheart said: "I felt that that would be to add further to the pressure on Mr Dhasmana. I do not know if that is the right answer or the wrong answer but that was my judgment at the time."  
 

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