Surgeons may refuse high-risk cases

THE CHIEF executive of a London teaching hospital has warned that surgeons could refuse to operate on high-risk patients if the emphasis on success rates for individual doctors increased.

Nigel Heaton, the head of King's College Hospital, made his remarks yesterday as he defended two heart surgeons at the centre of an inquiry into the high death rates of their patients. He said he had "every confidence" in the surgeons and in the hospital's heart unit.

The Royal College of Surgeons is investigating why death rates for Michael Marriman and Andrew Forsyth were higher than their colleagues' figures. An internal audit of the hospital's heart surgery unit, covering 4,000 patients operated on since 1992, found death rates for the six surgeons ranged from zero to 8 per cent. The average for the unit was 2.5 per cent, compared with a national average of 3 per cent.

Mr Forsyth, who now works at the Royal Sussex County Hospital in Brighton, has agreed to stop operating until the inquiry is complete; Mr Marriman has agreed not to take sole responsibility for operations.

Mr Heaton said: "It is very difficult to compare the outcomes of procedures like heart surgery because the risk factors for each patient differ and surgeons may be seeing people with the same condition but different risks and problems."

In Mr Marriman's case there had been a change in the kind of patients he treated, while Mr Forsyth was known for operating on high-risk patients.

"There are no grounds for suspicion with either surgeon and they have my confidence, but obviously it would be extremely difficult for either of them to continue operating under the pressure of these reports," Mr Heaton said.

There has been a spate of inquiries into heart surgeons since the high death rate among some children treated for heart problems at Bristol Royal Infirmary came to public notice in 1997. In June, anonymous allegations were made about the high death rate and poor attitude of some surgeons at the Royal Brompton Hospital, London's specialist heart centre. The hospital called in outside experts to investigate.

One in 10 children's heart surgeons has been suspended while allegations about their practice have been investigated and there are signs that young doctors are being put off entering the speciality.

At the resumed inquiry into the Bristol cases yesterday, parents of children who had surgery made further allegations that they were misled about the risks and treated insensitively when surgery ended in failure and their children died.

Erica Pottage, from Teignmouth, Devon, said she was not told her son would have had a better chance of survival at another hospital. "We assumed we had left him in the best possible hands," she said.

The inquiry, which began public hearings in March and is expected to report next year, is examining the circumstances in which two heart surgeons continued to operate despite warnings from colleagues that their death rate was too high. The General Medical Council found the surgeons, James Wisheart and Janardan Dhasmana, and the former chief executive, John Roylance, guilty of serious professional misconduct last year.