Medical Ethics: Routine Operations Brought Tragic Results
Winkler, Elisabeth, The Independent (London, England)
Heart surgery on children at Bristol Royal Infirmary now has one of the best outcomes in the country. But, as Elisabeth Winkler reports, just five years ago it had one of the worst, according to a report by the then President of the Royal College of Surgeons.
In 1988, when Dr Steve Bolsin became consultant anaesthetist at Bristol Royal Infirmary (BRI) he soon noticed that major heart operations on children were lasting up to three times longer than similar operations he had attended at the Royal Brompton in London - the longer the operation, the higher the risks - and that children undergoing relatively routine operations were dying. Statistics for 1988-89 appeared to suggest that the mortality of Bristol children's heart surgery was twice the national average.
Dr Bolsin was asked by the hospital's Professor of Anaesthesia, Professor Cedric Prys-Roberts, to produce a detailed audit of children's heart surgery over the next two years. The results, made available in 1993, showed the disturbingly high mortality rate for surgery to correct heart defects (A-V Canal procedure). In 1991, Helen Rickard and her partner, Andy, handed over their 11-month-old daughter Samantha to the care of James Wisheart, the hospital's most senior paediatric cardiac surgeon. He was also medical director of one of the NHS's largest trusts and chairman of the hospital management committee - in other words, his own boss. Samantha was about to become the first of six A-V Canal operations (out of a series of seven) to end fatally. "Mr Wisheart drew us a diagram explaining the operation," said Ms Rickard, now 30. He was very quietly spoken and non-threatening. I felt drawn in by him - I thought he was wonderful." Samantha went down to the operating theatre at 8am on 3 February 1991. At 2pm, her parents were told by a liaison nurse that they were having difficulty getting her off the by-pass machine and that the patches (used to repair the holes in her heart) needed to be removed and put back on again. "At 4.00pm we were told that the surgeon couldn't get Samantha's heart to beat by itself. I said, `how long will they keep trying? When will they know when to stop?' The liaison nurse answered, `oh, the surgeons are very good, they know what to do'. I replied, `they might as well take her off the by-pass machine - she's gone.' I knew instinctively that she had died. Samantha died at 6.10pm. In the meantime Andy and I were going frantic. Wisheart came up and began talking but I broke in saying `she's dead', and he nodded. I screamed `no, no'. Even as I was screaming there was a voice in my head saying, `Helen, be quiet, this poor guy is trying to speak to you'. But I couldn't stop. "The next two years were a nightmare and my relationship with Andy was destroyed. We were both leaning on someone bent double with their own pain. We had another child, Ben, but Andy never came to terms with Samantha's death. Just before the second anniversary of her death, Andy committed suicide. If I knew then what I know now both my daughter and husband might still be alive." In 1992, Mr Janardan Dhasmana started doing switch operations, a procedure for unscrambling the major arteries. Of the 13 babies having switch operations, nine died. The mortality rates at Bristol for switch was 67 per cent. The GMC is investigating Mr Dhasmana's switch operations. In July 1993, six cardiac anaesthetists wrote to ask for …
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Publication information: Article title: Medical Ethics: Routine Operations Brought Tragic Results. Contributors: Winkler, Elisabeth - Author. Newspaper title: The Independent (London, England). Publication date: October 1, 1997. Page number: 18. © 2009 The Independent - London. Provided by ProQuest LLC. All Rights Reserved.
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