Time to investigate Alder Hey?
What has been done to properly investigate allegations of avoidable death, suboptimal care and lack of informed consent at Alder Hey Children’s Hospital? Back in 2007, it was alleged that a baby died hours after surgery despite the explicit advanced warning of a specialist surgeon not to operate at that stage. An excellent outcome would normally be expected in the overwhelming majority of such cases. The whistleblowing surgeon raised his concerns with the then Clinical Director, who did not investigate but instead made his life difficult through withholding on-call work, job plans and travel payments. The whistleblower was then suspended on the trumped up charge of being a ‘self-harm risk’.
In 2010, another baby allegedly suffered avoidable bowel damage during routine surgery at Alder Hey. No incident form was completed. X-ray evidence suggested a leak from the bowel and the child died a few days later. Another surgical whistleblower tried to get both cases properly investigated but thus far without success.
A subsequent Royal College of Surgeons (RCS) visit registered ‘incomprehensible failure’ at the lack of proper investigation, but this was excised from the publicized report along with anonymous cases of suboptimal care. The RCS found medical notes to be confused, or to have disappeared. They did not look at the nursing records. In one case, a senior surgeon struggling with stress and ‘failing eyesight’ was allegedly responsible for a child who was seriously harmed during routine day case surgery. He requested that discussion of this case not be minuted in light of legal action, but vast compensation was apparently paid out. In other cases, parents are allegedly still unaware of the true extent of the harm. In one case an accident in theatre went unreported despite the clear national guidance and the child later died in unusual circumstances yet without post-mortem or adequate investigation.
Prior to 2011, the department was not recording and circulating minuted reviews of children’s deaths such that learning was not shared and errors recurred. This meant in over 60% of surgical deaths, Alder Hey failed to provide notes for review by the National Confidential Enquiry into Perioperative Deaths (At Birmingham Children’s Hospital the figure is less than 2%). Similarly the RCS highlighted problems with consent. It is further alleged that one surgeon did unorthodox anti-reflux surgery on children that had no evidence of benefit in that role and that he repeatedly refused to publish his results or risks of harm. Inexplicably the RCS did not require him to declare his results or inform parents they had consented to riskier non-beneficial, non-standard procedures.
The surgical colleagues of the whistleblowers now refuse to work with them. One of the surgeons allegedly has a severe tremor that worsens with stress. He was criticized in the RCS report over an appendicectomy that took over ten hours. Another surgeon allegedly returned from extended stress-related leave tied off the wrong arteries during a routine surgery and failed to recognize this in time to save the child. In a statement, Alder Hey hospital said: ‘The surgical service referred to in this report was reviewed independently by the Royal College of Surgeons in 2011 and was found to be “safe”. In March 2012, the Care Quality Commission made an unannounced inspection of the Trust and concluded that “patients have safe, appropriate care, treatment and support”. Both reports are in the public domain. Alder Hey has full confidence in its surgical team and is extremely disappointed that they, along with our parents, continue to be targeted in this way.’
The key question is whether the RCS and CQC got to the bottom of these serious allegations, and whether the whistleblowers were given the support and protection they needed. The GMC has apparently been made aware of the allegations but it is unclear whether it will investigate. Meanwhile, patients are left in the dark.