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NEWS: Clare Dyer Bristol doctors found guilty of serious professional misconduct BMJ 1998; 316: 1924a [Full text]

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After Bristol

Stephen Bolsin   (25 January 1999)

After Bristol 25 January 1999
Stephen Bolsin Send response to journal: Re: After Bristol	Editor- Professor Stirrat in his letter to the eBMJ emphasises several points from the original Royal College of Surgeons document on Clinical Audit in Surgical Practice (1,2). As the first National Audit Coordinator for the Association of Cardiothoracic Surgeons of Great Britain & Ireland I was well aware of the ground rules governing audit in clinical practice. He fails to include the fact that all of these points are qualified by the phrase "under normal circumstances". What was occurring in the Bristol Paediatric Cardiac Surgery Unit was not normal (in fact it has been judged by the GMC to have been serious professional misconduct) and consequently normal considerations did not apply (3). Professor Stirrat should also know that the "secret audit" he refers to was authorised in 1992 by Professor Prys-Roberts, Head of the University Department of Anaesthetics at the Bristol Royal Infirmary (BRI) and the results were shown to him on completion in early 1993. Professor Prys-Roberts immediately discussed the results with Dr John Roylance, then Chief Executive of the United Bristol Healthcare Trust (which included the BRI). The results were also shown to Professor Gianni Angelini, Head of the University Department of Cardiac Surgery at the BRI, Dr Chris Monk, Director of Anaesthesia at the BRI (and a paediatric cardiac anaesthetist), Dr Sally Masey, senior paediatric cardiac anaesthetist at the BRI and Professor John Vann-Jones when he was the Clinical Director of Cardiac Services, which included paediatric cardiac surgery (4). To describe a survey that was circulated as widely as this at very high levels within the BRI as "secret" indicates a staggering but understandable ignorance on the part of Professor Stirrat, who, it must be remembered, did not work at the BRI. Both Professors Stirrat and Dunn were close friends of Mr Wisheart and they may have allowed this to colour their appreciation of events. The editors of scientific journals may need to bear this in mind when considering publishing future material from these sources (5). I do not deny that the paediatric cardiac surgeons and cardiologists proposed structural changes to the service in 1989 and that they were implemented later. My concern was that the high mortality of some surgeons for several procedures including A-V canals, tetralogy of Fallot, arterial switch and possibly truncus arteriosus and TAPVD exposed children to the risk of excess mortality from these operations at the BRI after changes were proposed for whatever reason. I would like to think that I can take a small amount of the credit for some of the action that has resulted in the improvement in overall mortality rates in the new service at the Royal Bristol Children's Hospital compared to the service that existed in 1995 at the BRI. Yours sincerely Dr Stephen Bolsin Director of Perioperative Medicine, Anaesthesia & Pain Management The Geelong Hospital, Victoria 3220, Australia References 1 Stirrat GM. The Bristol affair: Audit – secret yet not confidential. EBMJ 31st December 1998. 2 Royal College of Surgeons of England. Clinical Audit in Surgical Practice; 1st Edition 1989. 3 Dyer C. Bristol doctors found guilty of serious professional misconduct. BMJ 1998;316:1924. 4 Bolsin SN. Personal Perspective. Professional misconduct: the Bristol case. MJA 1998;169:369-72. 5 Dunn PM. Education and debate. The Wisheart affair: paediatric cardiological services in Bristol 1990-5. BMJ 1998;317:114-5.