5 August 2010
The publication of an independent report , commissioned by the South Central Strategic Health Authority (SHA) into child heart surgery at the John Radcliffe Hospital in Oxford has led to the suspension of all child heart surgery at the hospital. Four babies died between December 2009 and February 2010 shortly after the appointment of a new consultant surgeon. The children’s heart unit is one of the smallest in the UK, undertaking some 120 operations each year.
The report found that there were problems in Caner Salih's induction and mentoring when he began work at the hospital. It found that the deaths were not due to errors of judgement but that Mr Salih was not given appropriate supervision. In particular the report found:
“ the risks conveyed to the families by both surgeons and cardiologists were broadly in line with national averages which do not relate directly to the unit, the team, the individual surgeon, or take in to account the added risk posed by the individual case. The risks conveyed to parents tended to be underestimates..."
Dr Geoffrey Harris, chairman of the SHA has apologised to the families of the babies who died. He said:
"We offer our sincere condolences and we apologise that, in the cases, the standards of care were not what was expected."
The reports It recommended an overhaul of the way the hospital deals with serious incidents, better clinical and managerial leadership and to develop ways to identify adverse trends in surgical outcomes earlier. It also recommended an adequate caseload for surgeons so that they can ‘maintain their expertise’.
The hospital has to report back to the SHA by September 17th 2010 with an action plan for improvement.
Clinical negligence partner Sarah Campbell commented:
"We see in our own cases the problems that can develop in hospitals when inadequate communication, training and supervision systems are allowed to persist. It is vitally important that medical professionals are committed to transparent methods of working so that any errors or inadequacies can be picked up quickly and not allowed to lead to situations where patients are put at risk."
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