Harefield launches death rates inquiry

Harefield hospital launched an immediate inquiry yesterday after a league table measuring poor performance in cardiac surgery said it had a higher than average death rate. The majority of the operations at the Middlesex hospital are believed to have been carried out by the pioneering surgeon Sir Magdi Yacoub.

The scandal-hit Bristol Royal infirmary came bottom of the nationwide survey whose findings are part of a public inquiry into the death of 29 babies at the hospital. It had twice the death rate for children having open heart surgery than other specialist centres.

It is the first survey of its kind to highlight poor performance and compared mortality rates between 1991 and 1995 at 12 centres across the country, measuring each of the hospitals in terms of "excess death rates".

Bristol had the worst results, with figures suggesting that if 34 children had been operated on elsewhere they might well have survived. Overall mortality rates at Bristol were double the national average.

Harefield came second bottom, with a higher than average mortality rate for children aged more than one year. The hospital was, however, better than average for babies under 12 months.

The intensive investigation found that Bristol was followed by Harefield, then Radcliffe infirmary, Oxford, and the Freeman hospital, Newcastle upon Tyne.

The Royal Brompton and Harefield trust chief executive, Mark Taylor, said: "We are undertaking this review because we feel it is important both to clear the air and put the minds of parents and families of children who have been treated at Harefield at rest.

"If the figures are correct, the higher mortality rate at Harefield during this time was almost certainly partly due to the fact that the Harefield team accepted children for treatment who were more profoundly sick, some of whom had been turned down by other hospitals."

The vast majority of Harefield's surgery is carried out by Dr Yacoub, who developed the heart transplant field.

The hospital with the best record was Birmingham's children's hospital.

The senior counsel for the inquiry, Brian Langstaff QC, warned that the statistics - often limited and not validated - were only part of the jigsaw of evidence before the investigation. They covered an age range from newborn to 15 and involved open heart procedures from 1991 to 1995 recorded in department of health statistics. Other sources include the surgical cardiac register, surgeons' personal logs and local hospital records.

The results were given to the Bristol hearing into the care and treatment of babies undergoing complex heart surgery at the BRI over 12 years to 1995. The four-member inquiry panel has heard allegations of poor performance by the Bristol surgeons.

The key members of the surgical team were surgeons James Wisheart and Janardan Dhasmana. The inquiry was told yesterday that they had similar death rates of 13% in operations carried out in the review period. Mr Wisheart, the unit's medical director, had 81 deaths in 606 operations and his colleague, 69 deaths in 526 operations.

The two and the former chief executive, John Roylance, were found guilty of serious professional misconduct by the General Medical Council.

Mr Wisheart and Dr Roylance - now both retired - were struck off. Mr Dhasmana was banned from operating on children for three years. The GMC investigation was limited to 59 BRI operations involving the two surgeons, in which 29 children died and four were left brain injured. The public inquiry is considering nearly 2,000 heart operations overall.

Campaigner Maria Shortis, whose nine-week-old daughter, Jacinta, died after surgery by Dr Dhasmana, said if hospital trusts had been forced to publish surgical results many children's lives would have been saved. "If anything is to come out of the inquiry, it must be that specialist centres of paediatric cardiac surgery publish their results on a yearly basis," she said.