Attitudes in Bristol

• The “many senior colleagues” referred to in the article are exhibiting exactly the same behaviour patterns that allowed the Bristol cardiac disaster to occur in the first place. These are lack of insight, failure of critical appraisal, and muddled thinking.

• In the first half of the article Dunn presents the case that there was not a problem but then asks, “Why wasn't the responsibility of the hospital administration recognised?” This leaves unanswered the question “responsibility for what?” For allowing a problem not to develop? Was there or was there not a problem? I and others believe that there was a serious problem.

• If, as Dunn suggests, his three colleagues were treated unjustly, why did they not make use of the GMC's appeals mechanism and appeal not just against the sentences but also against the verdict of the disciplinary committee?

Excess mortality for operations

Dunn asks, “Why were the surgeons judged only on a small selected fraction (4%) of their paediatric surgical workload during 1990-5?” I find his answer less satisfactory than the alternative explanation that the United Bristol Healthcare Trust only provided to the GMC's disciplinary committee the details of the operations that it had requested at such short notice that the GMC was unable to deal with anything other than the operations for atrioventricular canal and arterial switch. Even in these limited cases the excess mortality for these two operations was sufficient for the disciplinary committee to reach its verdict.

However, we now learn that there were other operations with equally bad records for mortality. On 27 …