Abstract
In June 1998, the Professional Conduct Committee of the General Medical Council of the United Kingdom (the body which regulates British doctors) concluded the longest-running case it has considered this century. Three medical practitioners were accused to serious professional misconduct relating to 29 deaths (and four survivors with brain damage) in 53 paediatric cardiac operations undertaken at the Bristol Royal Infirmary between 1988 and 1995. All three denied the charges but, after 65 days of evidence over eight months (costing 2.2 Pounds million), all were found guilty. The doctors concerned are Mr James Wisheart, a paediatric and adult cardiac surgeon (appointed in 1976, now retired), and the former Medical Director of the United Bristol Healthcare Trust (the hospital group that includes the Bristol Royal Infirmary); Mr Janardan Dhasmana, paediatric and adult cardiac surgeon (appointed in 1986); and Dr John Roylance, a former radiologist, and Chief Executive of the Trust from its creation in 1991 until his retirement in 1995. The central allegations were that the Chief Executive and the Medical Director of the Trust allowed to be carried out, and the two paediatric cardiac surgeons carried out, operations on children knowing that the mortality rates for these operations, in the hands of these surgeons, were high. Furthermore, the surgeons were accused of not communicating to the parents the correct risk of death for these operations in their hands. Stephen Bolsin, a cardiac anaesthetist, "blew the whistle" and then had the courage to follow through until a full investigation was carried out. The process took over six years. Here he tells his story.