Annex A > Chapter 11 - Referrals > Referrals to other centres by Bristol cardiologists and surgeons > Evidence of referrals from Bristol to other centres

Evidence of referrals from Bristol to other centres

Parents' request for a referral to another centre

220 As has been noted above, the Inquiry heard that some parents were not offered a choice of referral to another centre.

221 Amanda Boyland, whose son James was referred to Bristol from the Royal Gwent Hospital, Newport, said of her discussions with the Bristol team:

`We were not told that there were other centres where the operation could be carried out. We were not given the choice for the operation to be performed anywhere else. No comparison of success rates at Bristol with anywhere else was provided to us.' [233]

222 Helen Johnson, mother of Jessica, told the Inquiry that she lived in the Bristol/Bath area and took Jessica to the BRHSC herself due to concerns about her health. She said:

`I can remember asking someone when Jessica would go to Great Ormond Street Hospital, because I assumed that that was where she would have her operation. The reply was that she would not have to go because Mr Dhasmana was an excellent surgeon and he was in Bristol. They also said that Jessica was too ill to move, anyway.' [234]

223 Although clinicians told the Inquiry that a request by parents could be a reason for a referral to another centre, there is evidence from parents to suggest that such a request was sometimes discouraged by the clinicians caring for the child.

224 Nigel Dymond, father of Naomi, said:

`I specifically recall during one of our meetings with Dr Martin at the North Devon District Hospital [Barnstaple] that my wife asked him if it might be better to take Naomi to somewhere like Southampton or London as opposed to going to Bristol. The reason my wife asked this question was at that time she was the secretary and I was the treasurer of the North Devon branch of the Bristol & South West Children's Heart Circle. At that time there were about five children that went up to Bristol for heart operations and only one survived. We were therefore concerned to ensure that Naomi received the best treatment possible. Dr Martin told us that Bristol was equal to the other hospitals and was a centre of excellence. He told us that the figures for Bristol were comparable to anywhere else and that there was no advantage to going elsewhere.' [235]

225 Marie Hill, whose daughter Kate was referred to Bristol from the Princess Margaret Hospital, Swindon, said:

`I cannot comment on the medical correctness of what was done and what was not done, but the very operation that Bristol was against, Brompton did and with success ... As I left Bristol on the removal of Kate to Brompton Dr Jordan said to me, "If you go to Brompton, don't you ever put your foot back in Bristol again"'. [236]

Dr Jordan was given the opportunity to respond to this statement by way of a written comment, but did not do so.

226 Colin and Gaynor Griffiths, parents of Zara, told the Inquiry of their attempts to have her treated at Great Ormond Street rather than Bristol. Prior to her first operation they discussed their options with a nurse who had previously worked there:

`He told us that GOS was one of the best centres in the world and that Marc de Leval was one of the best surgeons ... When we came home Colin went straight to our GP and told him that we were not happy with Bristol. He said to him "If it was your child would you send her to Bristol or to Great Ormond Street". Dr Lupini said he would send her to Great Ormond Street so we decided to move her. While Colin was there Dr Lupini called Bristol. When he told the person on the phone that he wanted Zara transferred, they said no and he fell into an argument with them.'

Zara was transferred and had her operation at Great Ormond Street. [237]

227 Jennifer Manfield, whose son Brad was referred to Bristol from Southmead Hospital, Westbury on Trym, explained that she and her husband became increasingly concerned about Mr Dhasmana carrying out Brad's operation in April 1995, after seeing two BBC television reports critical of Bristol. They raised this with Mr Dhasmana shortly before the operation. She said:

`My husband and I saw Mr Dhasmana ... and we talked to him about the television reports ... and he was clearly unhappy about the media coverage. He said we could take Brad home now if we wanted, but he did not offer us the possibility of a referral to another hospital.' [238]

A second opinion

228 Parents confirmed that children were sometimes referred to other centres for a second opinion, whether at their request or at the instigation of the Bristol clinicians.

229 Cynthia Baker, whose daughter Sarah was referred to Bristol from Exeter, said:

`I remember Mr Wisheart took the precaution of seeking a second opinion and he contacted Great Ormond Street Hospital in London to ask whether they considered he was doing the right thing in considering a Fontan operation.' [239]

230 However, Susan Perry, whose son Martin was operated on at the BRI, told the Inquiry about Martin's post-operative care. She said:

`My husband was pretty uptight and he asked [Helen Vegoda [240]] where we could get a 2nd opinion about Martin's condition and treatment. She obviously told Mr Dhasmana about this request and he was quite aggressive with us. He told us that there was no one else as good as he and Mr Wisheart.' [241]

Previous death of another child

231 The Inquiry heard from Diana Hill, mother of Jessica and James. Jessica had died following surgery at the BRI. Of James' operation, Diana Hill said:

`I did not want the operation to be performed at Bristol, and I put this request through the GP, who had to contact Dr Martin ... Dr Martin was reluctant to refer us elsewhere, and wrote to our GP stating that this course of action was not necessary. In the end, my husband wrote to our GP, making it clear that ... we wished to be referred to another hospital. We also asked Hugh Ross, the Chief Executive of UBHT, to intervene. James was subsequently referred to a cardiologist at the Birmingham Children's Hospital.' [242]

Previous operation at another hospital

232 Robert Joyce, father of Thomas, explained that when his family lived in London, Thomas had been treated at Guy's Hospital. On their move to Exeter, Thomas was first treated at the Royal Devon and Exeter Hospital, and was then transferred to Bristol. He said:

`Mr Wisheart explained that Thomas required major surgery and said that he could have it in Bristol or be referred back to Guy's - whichever we chose.' [243]

233 William Hine, father of Thomas, explained that although Thomas was born in Bristol and was under the care of Dr Jordan, he had a number of cardiac catheterisations at Great Ormond Street in 1982 because, as Mr Hine was told, `they were unable to carry out this procedure in Bristol'. Thomas then had surgery at Great Ormond Street in 1983. Mr Hine told the Inquiry of discussions before Thomas' second operation:

`Dr Jordan told me that the operation could now be carried out at the BRI and gave Philippa and me the choice of having the operation carried out there or back at Great Ormond Street. We assumed that the treatment Thomas would receive at the BRI would be exactly the same as at Great Ormond Street and did not realise that the risks would be any different at Bristol.' [244]

Waiting list

234 A number of parents told the Inquiry that they had considered paying for their child's operation to be carried out privately elsewhere.

235 Aubrey Lewis, whose daughter Kirsty was referred to Bristol from the Royal Gwent Hospital, Newport, spoke of having been told of a waiting list, but not of being offered the option of going elsewhere. He said:

`Mr Wisheart explained there was a waiting list of about 2 months, although he told us he could sort out the problem on the Monday if we were able to pay privately. ... If we had been able to have the operation done privately, Mr Wisheart would have done it - there was no question of going elsewhere.' [245]

236 Mr Wisheart commented on this evidence:

`There is no record and I have no recollection of this part of the conversation. The possibility of private treatment occasionally arose in these conversations but only because the family raised the matter. I never did so. I never sought to recruit a private patient from my National Health Service practice: indeed I discouraged virtually everyone who raised this possibility ... I believe that [Mr Lewis' remarks] show clearly that I was discouraging him from proceeding in this way.' [246]

237 Robert Langston, whose son Oliver was referred to Bristol from Bath, said that Mr Dhasmana had explained that if Oliver was to have an Arterial Switch operation it:

`... would have to be performed before he was fourteen days old. Because of circumstances at the BRI, Mr Dhasmana said that he could not guarantee that Oliver would be operated upon within this time frame, and that he would have to beg for bed space, and time in the operating theatre. ... When we saw Mr Dhasmana the next day, my father (who was present at the meeting) told him of his intention to arrange for the operation to be done privately. Mr Dhasmana stated that there was no way that he was going to let us take Oliver out of the BCH to have his operation performed elsewhere. The reason he gave for this was that Oliver needed the operation as soon as possible ...' [247]

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Footnotes

[233] WIT 0232 0008 Amanda Boyland

[234] WIT 0259 0002 and 0006 Helen Johnson

[235] WIT 0310 0006 - 0007 Nigel Dymond

[236] WIT 0554 0005 Marie Hill

[237] WIT 0393 0003 - 0004 Colin and Gaynor Griffiths

[238] WIT 0007 0005 - 0007 Jennifer Manfield

[239] WIT 0524 0004 Cynthia Baker

[240] Counsellor in Paediatric Cardiology

[241] WIT 0462 0005 Susan Perry

[242] WIT 0263 0015 Diana Hill

[243] WIT 0528 0002 Robert Joyce

[244] WIT 0333 0002 William Hine

[245] WIT 0185 0005 Aubrey Lewis

[246] WIT 0185 0013 Mr Wisheart (emphasis in original)

[247] WIT 0184 0006 - 0007 Robert Langston