Annex A > Chapter 29 - Concerns 1994 > Concerns > November
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November
102 Mr Alan Bryan, consultant cardiac surgeon, told the Inquiry about a consultants' meeting, attended by Mr Dhasmana, Mr Hutter, Mr Bryan and Professor Angelini, [127] immediately after the monthly audit meeting of 10 November 1994:
`Professor Angelini asked Mr Dhasmana whether the paediatric service could be rationalised prior to the arrival of Mr Pawade ... Mr Dhasmana was very offended by the Professor's apparent interference. ... He accused the Professor of criticising the paediatric cardiac surgery service outside Bristol ... Professor Angelini had sought advice and help ... from [Mr Stark] ... Mr Dhasmana unfortunately appeared to interpret this action as unwelcome and unfair interference from others outside the running of the service. This meeting degenerated into an unpleasant argument ... the Professor asking for the rationalisation of the service and Mr Dhasmana rejecting outside interference in the service. Mr Hutter and I participated very little in the argument which ended in an acrimonious impasse. [128]
` ... I can fully understand why Mr Dhasmana would view this ... action as unsolicited and unfair interference by Professor Angelini ... [129]
`Q. ... Did Mr Dhasmana ... perceive Professor Angelini as being one of the outsiders interfering with the service?
`A. Yes ... I think that is specifically what I mean.' [130]
103 Mr Dhasmana told the Inquiry about the meeting:
`The whole meeting related to raising concerns about my surgical work outside Bristol without first discussing them with me.' [131]
`It started friendly. ... It became ... acrimonious ... It was not - more an argument in the end, it became almost a one-sided, a Latin burst. ... I was angry but I am not very good with my words so I became dumb when I heard somebody [Professor Angelini] really saying "kiss my feet". ... After that I became totally dumb because I thought "if I respond now I am angry I may say something and I will regret it". Obviously he himself felt a bit bad having uttered those words so he was trying to explain and it became ... one-sided. He really said "well, I tried to save your bacon, the Department of Health was going to close the Unit and I really fought your corner, I really told them your results are very good, we do not need to stop the Unit, it is just we really need to look at a few things." But I am sorry at that time I was in no mood to reciprocate or communicate any further and I just kept listening ...
`Q. ... there had been concern expressed to the Department of Health about the results in paediatric cardiac surgery and that he ... had suggested that the Unit was solving the problems by appointing a new cardiac surgeon so that the work would go on taking place ...
`A. At that time I did not understand that that is what he was saying, but when I read further information on that I think it became more clear. I do not think it was that clearly mentioned at that time. What upset me ... we were meeting almost every other day or every week in the Unit, we were working on a common purpose, to get a paediatric cardiac surgeon and he never mentioned that there was this talk with Dr Doyle or the Department of Health ... I was very pleased that he was with me on this one to get [Mr Ash Pawade]. ... He talked to other people, why could not he really just tell me at the same time? ... If you are told by somebody "kiss my feet", would you take any further part in the conversation?
`Q. (The Chairman): Mr Dhasmana, what did you understand was meant by that? ...
`A. Very humiliating.' [132]
104 Mr Dhasmana told the Inquiry about the effects of the meeting:
`I thought I had good relations with all the gentlemen who had been here and saying something totally different than what they said before.
`A. I have changed my mind after the November 1994 meeting.' [133]
105 On 17 November Professor Farndon discussed the concerns being expressed about paediatric cardiac surgery with one of the surgeons involved, Mr Wisheart:
`I met with James Wisheart on 17 November 1994. At that meeting I made a note ... The meeting took place in James' office on Ward 5, which is the cardiac ward. I made the note on the night of the meeting but did not provide a copy to James. The fact that I made a note was a measure of the degree of importance I attached to the meeting. Until that occasion the writing of notes would never have been something I would have done.' [134]
106 Professor Farndon told the Inquiry about his reasons for calling the meeting:
`I think I had heard a volume of continued disquiet, noise, and it was almost an exasperation that no resolution had occurred. It still was not within any of my remit, strictly speaking, to be concerned with the results of cardiac surgery, but people kept talking and no evidence was ever handed to me that everybody had agreed upon, identifying that there is a problem or there is not a problem. So there was a feeling of exasperation that the thing had not been resolved.' [135]
107 Professor Farndon, in his written evidence to the Inquiry, stated that:
` ... as a friend and colleague of James, I could not tolerate hearing oblique criticisms (without objective evidence) of a colleague's work or performance. I felt a duty, first, to be sure that James was aware of these criticisms, and, secondly, to see if I could help in the resolution of any particular problems that might exist.' [136]
108 Professor Farndon went on:
` ... James agreed that the outcomes of some paediatric cardiac procedures were not good but I do not remember discussing any specific procedures. I think I would have made a note if we had. I also remember that we discussed case complexity and risk factors and how these played upon outcome.' [137]
` ... at the end of the meeting we had resolved the issues and we had seen a potential way forward. It was agreed that there would be a tabulation of results, and an agreement between the relevant surgeons as to their authenticity and accuracy. Then, there would be an open meeting with the cardiologists and anaesthetists to discuss that data. This was in respect of all the cases, adult and paediatric ... .' [138]
110 Professor Farndon's note of the meeting recorded the outcome as follows:
` ... That it is resolved that: the 5 cardiac surgeons will tabulate results, agree them as authentic and accurate and that the 5 surgeons will then meet openly with cardiologists and cardiac anaesthetists to discuss results.
`(i) cardiac surgeons will meet & agree figures for all cases
`(ii) hold an open meeting for all to examine results ...
`(iii) that I ring Chris Monk and advise him of these things
`(iv) that JW [Mr Wisheart] recognises that he gets more difficult cases ... .' [139]
111 On the following day, Professor Farndon wrote to Mr Wisheart, with a copy to Dr Monk:
`I really do believe that the best way forward is for an internal discussion to begin initially with the five cardiac surgeons. Work should be done fairly quickly to agree the data and this should then be openly discussed with colleagues from cardiology and cardiac anaesthesiology.' [140]
`I wanted the matter to be resolved quickly. I was getting impatient with colleagues talking in corridors without objective evidence. I wished to see the situation resolved. I indicated to both James and Dr Monk that if the group wished me to play any further part I would be pleased to do so. My aim was to be an objective and honest broker, or chair, if that were to be desired. I hoped that the things we had agreed would happen. [141]
`No one ever returned to me to ask for my further services.' [142]
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Footnotes
[128] WIT 0081 0026 - 0027 Mr Bryan
[131] WIT 0081 0039 Mr Dhasmana
[134] WIT 0087 0009 Professor Farndon (emphasis in original)
[135] T69 p.170 Professor Farndon
[136] WIT 0087 0010 Professor Farndon
[137] WIT 0087 0010 Professor Farndon
[138] WIT 0087 0011 Professor Farndon
[139] WIT 0087 0025 - 0026 ; transcript of Professor Farndon's handwritten note of the meeting on 17 November 1994 (emphasis in original)
[140] WIT 0087 0028; letter from Professor Farndon to Mr Wisheart dated 18 November 1994
[141] WIT 0087 0012 Professor Farndon
[142] WIT 0087 0012 Professor Farndon