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The Bristol heart babies Monday, 8 June, 1998, 17:24 GMT 18:24 UK
'Our rights were ignored'
Three doctors at a Bristol hospital could be struck off in connection with the deaths of 29 children following heart surgery. In the biggest case of its kind, the General Medical Council found the three doctors - James Wisheart, Janardan Dhasmana and John Roylance - could face charges of serious professional misconduct.

Mr Wisheart and Dr Dhasmana were accused of continuing to operate despite very low success rates and inadequate knowledge of clinical procedures. Dr Roylance was accused of failing to intervene to stop the operations. Panorama's Sarah Barclay reports on the case of one of the children who died.

When Joshua Loveday's parents relive the day of his operation, as they do every day, a question haunts them: "How could people walk past us, the nurses and doctors, knowing what they knew and they said nothing to us at all?" says Mandy Evans, Joshua's mother.

Joshua was one and a half when he was admitted to the Bristol Royal Infirmary for open-heart surgery. He had been born with the main arteries to his heart the wrong way round. The operation to reverse them was called an arterial switch. It was a complex operation in which Joshua's heart had to be stopped. He would be kept alive on a by-pass machine.

One in two

His surgeon was Janardan Dhasmana, who had tried and failed for seven years to perfect the switch operation. In other hospitals, the death rate was as low as one in 10. In Mr Dhasmana's hands, it was one in two.

Joshua Loveday
The operation on Joshua Loveday could have been stopped
It was not the first time Mr Dhasmana had operated on Joshua. In June 1993, when he was just 10 days old, he had been taken to hospital in Gloucester with a suspected heart problem. Within a few hours, he was on his way to Bristol for an emergency operation to close a hole in the main artery to his heart.

For the next 24 hours, Joshua's life was in the balance. He was christened by the hospital chaplain. After that, his father, Robert Loveday, remembers Joshua improved, and within a month he was home. The operation had been successful and his parents were grateful to Mr Dhasmana.

"He was a nice man, very open," said Mandy. "He was very confident and we trusted him." Mr Dhasmana told them Joshua would need a switch operation within the next few years, but they were not unduly worried. He seemed to thrive. Occasionally he would be slightly blue, a sign that not enough oxygen was reaching his heart but at the monthly check-ups Joshua had at his local hospital in Gloucester, his parents were reassured there was no immediate cause for alarm.

In June 1994, when Joshua was one, Mr Dhasmana saw him in Bristol and promised he would operate within four to six months. By November, Joshua's heart specialist was worried. Joshua was deteriorating and there had been no word from Mr Dhasmana.


He telephoned him to ask what the problem was and was shocked to be told that because of concerns about the high number of deaths after switch operations, Mr Dhasmana had been banned from doing any more without permission from his colleagues. Yet just one month later, they gave him the go-ahead to operate on Joshua.

Janardan Dhasmana
Janardan Dhasmana's death rates were very high
Three days after Christmas, a letter arrived saying Joshua's operation would be on Jan 12. The memories of that Christmas are precious. "It was Joshua's first real Christmas and he was so well and so full of life, we all thoroughly enjoyed it," Mandy said.

On Jan 10, Joshua was admitted to the Bristol Royal Infirmary for tests to ensure he was fit for the operation. It was the next day that the extraordinary events which led to Joshua's death began to unfold. Throughout the day there had been a series of hurried conversations in hospital corridors as it began to emerge that there were now serious doubts being expressed by other people in the hospital about whether Mr Dhasmana should be allowed to operate. An emergency meeting was called.

At 5.30pm, nine doctors, including Mr Dhasmana, gathered in a small room in the children's heart unit to decide whether Joshua's operation - due to begin early next morning - should take place in Bristol.


In another part of the hospital, Joshua's parents had just given him a bath in a special antiseptic liquid to prepare him for surgery. They were feeling optimistic. Joshua seemed well, not like a child whose time was running out.

"There were no doubts. If there had been any doubts then I would have been up and gone," said Mandy. But nobody had told them about the meeting.

By now the atmosphere was tense, the stakes extraordinarily high. Mr Dhasmana's operating records for the switch operations were being reviewed. They seemed to show an improvement. It was agreed he should be allowed to operate on Joshua, despite the objections of Stephen Bolsin, the anaesthetist who had been concerned about the high number of deaths since he arrived in Bristol in 1988.


He was horrified by the decision. "Everybody was aware of the risks, everybody knew it was not going to be an easy operation, there was no reason why it had to be done in Bristol," he said.

Joshua's family relive the nightmare every day
Dr Bolsin went home, wondering if he should have said something to Joshua's parents. To this day, he wishes he had. At 11pm, as Joshua's parents were getting ready for bed, there was a knock on the door of the room they had been given in the hospital. They were told Mr Dhasmana needed to see them urgently. They had not signed the consent form for Joshua's operation.

"We went into a little room where Mr Dhasmana was waiting for us. He said, 'sorry I'm late but I've been on my rounds'," Mandy said. They discussed the risks of the operation. Mr Dhasmana said Joshua had an 80% chance of survival. They were reassured, signed the consent form and went to bed.


Not only did they know nothing about the meeting, they were also unaware that, while it was taking place, a senior Department of Health official had telephoned Dr John Roylance, the chief executive of the Bristol Royal Infirmary, asking him to stop the operation. But Dr Roylance believed this was a clinical matter in which he had no right to intervene. The Department of Health had no legal power to stop the operation either.

At 8am the next day, Joshua's parents went back to the ward where he had spent the night, expecting to see him before he was given his pre-operation sedative. But when they arrived, Joshua was already sedated. They walked beside the hospital trolley until it reached the anaesthetic room. Then they left the hospital.

Operation redone

By early evening Joshua had not come back from the operating theatre. His parents were told there were complications. In fact, it emerged during the GMC inquiry, Mr Dhasmana had had to re-do the operation, prolonging the critical time Joshua's heart was stopped. And one of his coronary arteries was severed. At 7.30pm, Joshua's parents were told that he had died on the operating table.

"The thing we did not realise was that the longer the operation took, the worse it would be," said Robert Loveday. "I was thinking the longer it took, the more chance of him coming out of it."

Three years on, neither of Joshua's parents has begun to come to terms with what happened and the way they were left so completely in the dark. They say every day remains a struggle.

"You give your children the best chances you can, but now we realise that chances were taken away. We should have been informed and we should have been allowed at least the option of going to that meeting. We had more rights than anybody to be there," said Mandy.

James Wisheart
James Wisheart could also be struck off

When asked what he thinks of Mr Dhasmana, Mr Loveday gives no answer. For several moments he stares at the floor, lost in thought before responding with a look so utterly bereft and yet full of anger that no words are needed.

The tragedy of Joshua's case is that one of the questions raised in the meeting was whether he should be referred to another hospital where death rates were lower. But it was decided this was no necessary.

You can watch a webcast of Sarah Barclay's investigation for Panorama by clicking here.

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