One of the two surgeons at the centre of the Bristol heart surgery scandal, in the United Kingdom, told the public inquiry this week that a high death rate was inevitable while surgeons were on a "learning curve" for a new operation.
Janardan Dhasmana, speaking publicly for the first time since the General Medical Council found him guilty of serious professional misconduct last year, said: "Whenever you start any new operation you are bound to have, unfortunately, high mortality." There was always a possibility that a child would die who could have survived if sent elsewhere. "Unfortunately, at that time there were no clear guidelines. Every surgeon was doing the best available practice."
Mr Dhasmana said there had been a five year interval between his assisting at an arterial switch operation and performing the first one himself. The first nine patients on whom he performed the operation died. He and another surgeon, James Wisheart, were found guilty of serious professional misconduct for continuing to do two types of complex operation despite high death rates. Mr Wisheart and the United Bristol healthcare NHS trust's chief executive, John Roylance, were struck off by the GMC. Mr Dhasmana was banned from operating on children for three years and lost his job at Bristol Royal Infirmary.
The public inquiry is looking into children's heart surgery at Bristol between 1984 and 1995. Last week Stephen Bolsin, the consultant anaesthetist who blew the whistle on the high mortality told the inquiry that the events of the past decade had brought a "severe personal and professional penalty" to him and his family. Finishing four days of evidence, he said that he had received what he saw as a "quite chilling" threat from Dr Roylance. Dr Bolsin was facing a manslaughter investigation after an adult patient received the wrong blood and died. In the event, the death was found to have been caused by coronary artery disease and the coroner's court returned a verdict of natural causes. He said Dr Roylance mentioned that the trust's new chairman had come from the aerospace industry. In that industry the standards were such that "if somebody is paid to bolt the blades on helicopters and there is an accident where the blades fall off, he never does that job again."
Dr Bolsin, now director of anaesthesia at Geelong Hospital, Victoria, Australia, said: "I perceived it as a very real threat to my future as a cardiac anaesthetist. It was quite chilling." He said he was phoned that evening by the BMA place-of-work accredited representative for the Bristol Royal Infirmary, who told him he had "just received from Dr Roylance a serious threat to my career in which the same analogy was used."
The anaesthetist said private work had accounted for about half his income but he noticed a reduction from 1995. The cardiac component of his private work dropped off. "I believed that with what had happened in Bristol and the way it had been responded to, my future career in Bristol was going to be very limited." A surgeon, whose name he had undertaken not to reveal, had indicated that he had been asked not to refer private cases to him. He believed from what the surgeon told him that Mr Wisheart was responsible.