December 19, 2025 • 63 mins
A newborn’s first breaths should be a promise. For too many families in Bristol during the 1980s and 1990s, that promise was broken by a system that mistook confidence for competence. We walk through how a respected pediatric cardiac unit drifted into preventable tragedy—where prolonged surgeries, poor post-op pathways, and a “club culture” sidelined data, silenced concerns, and cost lives. Then we connect the dots to the reforms that followed: centralizing complex surgery, raising volume thresholds, validating outcomes, and demanding transparency that patients can trust.
If you care about patient safety, surgical outcomes, and how real change happens, you’ll find both caution and hope here. Subscribe, share this episode with someone who trusts medicine to get it right, and leave a review telling us: what should be public by default—surgical volumes, complication rates, or both?
Resources:
https://pmc.ncbi.nlm.nih.gov/articles/PMC1120824/
https://www.ahajournals.org/doi/10.1161/hc3201.097067
https://www.bristol-inquiry.org.uk/final_report/Summary.pdf
http://pmc.ncbi.nlm.nih.gov/articles/PMC1174641/
http://news.bbc.co.uk/2/hi/health/547035.stm
https://www.bmj.com/rapid-response/2011/10/27/mr-james-wisheart
https://www.theguardian.com/uk/2001/jul/23/jamesmeikle2
http://news.bbc.co.uk/1/hi/health/558959.stm
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:48):
Hey girly, how are you?
I was just like, oh, I wasn'tholding my microphone, but I see
it still picked up my Jenna.
So that's good.
SPEAKER_02 (00:57):
I'm glad you picked me up.
I always pick you up.
SPEAKER_00 (01:02):
Oh, how are you doing?
Um good.
I had a surprise baby showertoday at work.
What?
SPEAKER_02 (01:11):
That's awesome.
SPEAKER_00 (01:12):
Yeah, I know.
So sweet.
Our DHH teachers through a babyshower.
SPEAKER_02 (01:20):
Aww.
To get some good stuff.
Get some good stuff, some cuteouties, some onesies.
Oh my god, I love this.
SPEAKER_00 (01:28):
Well, no, no outfits, but just you know, more
things we need.
This kid has so many books.
It's gonna be Smarty Pants kid.
Never have too many books.
And like a lot of cool, likesensory books and sensory toys,
and that's awesome.
Yeah.
I just was like not expectingthat at all.
So I was like, oh, hi.
(01:50):
I love that.
SPEAKER_02 (01:51):
I love that they did that for you.
Well done.
I and I know those ladies, theydid.
SPEAKER_00 (01:56):
I know Miss Balazzati listens to the mod.
SPEAKER_02 (02:01):
Hey, oh Lori.
You're awesome.
We love you.
I miss you.
Yeah, so we had this like, and Ithink you had this too.
It's not just we like way upnorth.
We had this polar vortex comingthrough where it was like
negative, you know, when youwalk outside and your nose
sections together with a littledegrees.
(02:21):
I'm doing bleeding.
Yeah.
And it's so cold, and that's howit was.
And then today it just decidedto flip 50 degrees, 50 degrees
to like 40 degrees Fahrenheit,which is like it's gorgeous out.
A lot of degrees.
Yeah.
So I just a lot of degrees,yeah.
(02:44):
And I sure is.
I had gotten my so I have thiscoat that's like this.
And my shout out to Nicole.
Nicole gave me this coat becauseshe lost all the weight and
didn't fit her anymore, and itwas perfect for me.
But it's like all feather, likesuper long, like your whole
body, like can take you tonegative 40, whatever, and
(03:06):
you'll be fine.
And I just dug that out and worethat, and it was like, I'm
sweating.
What the hell's happening here?
Now I just want to walk out in40 degrees in shorts because
that's that's how it feels.
It's like such a disparity, butI know you know that's the
nature of Minnesota.
SPEAKER_00 (03:26):
I started my Jeep from my phone because I didn't
know what the weather reallywas, and then I walked outside
and things were dripping andmelting, and I was like, oh,
it's warm.
SPEAKER_02 (03:38):
I also say very nice.
Um, so we have our workChristmas party, which is like
this big old potluck, and allthe providers are assigned
domains, and I'm really nervousbecause I'm new and I need to be
loved.
I need to buy people's love, andmy love language is food.
So I made um You're going to winthem over your fabulous cook.
(04:03):
I don't know.
So I made butter chicken curry.
Oh, my gosh, so jealous.
So much.
And then there's like thisbutter, garlic, rice to go with
it.
And oh my god, what am I gonnado if they don't like it,
Amanda?
SPEAKER_00 (04:17):
Are your fingers colored from the tumor?
Yes.
SPEAKER_02 (04:20):
I have orange.
I knew it.
How did you know?
SPEAKER_00 (04:22):
And my whole house smells like garlic, and it's
been a three-day production.
I know because I've had yourcurry and I'm so jealous that
other people get to enjoy it andI don't.
SPEAKER_02 (04:33):
Well, there may be leftovers because I don't know.
You're like, well, four hoursyou could be here.
Oh, I mean, I'm coming down, andI I I don't know.
I don't know.
We'll see if people up north canhandle because I I put less
chili than I normally would, butit's still got a little heat.
It's still got a bit of heat.
(04:54):
We're still gonna need to besmoking a little bit, so
nervous.
It's tomorrow, so we'll let youknow how it grows next week.
SPEAKER_00 (05:02):
You know, I've got pretty Norwegian taste buds, and
I like it, so I think they'll beokay.
Well, oh okay, y'all.
It's my case today, but we'redoing an Adam medical mishap.
So you'll hear from Jennifer,our sponsors, and then I'll
(05:26):
deliver this gripping case andthen the medical mishap.
SPEAKER_02 (05:33):
Bless your little cotton socks.
You've given us the best storiesmishap of all time.
So I can't wait.
SPEAKER_00 (05:43):
But meanwhile, I did, I did, if you saw this,
post a teaser on the socialmedia.
I saw that, and that's thebloody, the bloody parts, some
bloody parts, and I didn't knowwhat what that meant.
SPEAKER_02 (05:56):
It looked horrific, and I can't wait to learn it
goes with our story behind it.
There's like a little half moonshape of some kind of blessed
poor Adam Man.
It's a wonder he's stillsurviving.
SPEAKER_00 (06:12):
I know, I know.
Maybe thanks to you.
Yeah, he's uh thriving today,upright, walking forward.
We're doing okay.
Oh, I love what he said.
SPEAKER_02 (06:22):
So he he does he didn't want to come on, but he
gave his permission for you toread it.
SPEAKER_00 (06:27):
Yeah, yeah, I said as same as last time.
I said, you know, do you want tocome on and and we can tell?
Because like I have a part ofthe story too, right?
Because I get the phone call.
And so I was like, you know,what if we did it together and
that would be so cool, and likeI'll tell my part and then you
can tell your part.
And he was like, nah, no, I'mnot doing that.
And I was like, okay, well, sameas last time, then you have to
(06:50):
sit here and like I'm gonna typefrom the horse's mouth like what
you're saying to retell thestory.
Cause his he also has just likea wildly impeccable memory.
SPEAKER_02 (07:00):
What I wouldn't give for one of those.
SPEAKER_00 (07:02):
And I was like, Oh, when did that happen?
He's like February 3rd, 2020.
I was like, Oh, okay.
I mean, obviously the date ofthe incident would be more
memorable to him, but I waslike, oh, okay.
And so then wasn't, and he waslike, no, no, no, no.
Then and I'm like, okay, justtell me the story.
SPEAKER_02 (07:21):
I can't wait.
Oh my goodness.
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SPEAKER_00 (09:41):
Yay, Kincho cocktails.
As always, the resources will bein the show notes.
Pre-apologies, I have somewicked hot bun today.
So there's been a lot ofhiccuping, and probably that's
gonna be with us forever on thistrack.
(10:01):
So sorry, it's the baby.
Yeah.
And so, yep.
I had Chipotle for lunch today,and I feel like that's what did
it.
I don't know.
SPEAKER_02 (10:23):
Bring it, girl.
It's all nature.
It's nature.
SPEAKER_00 (10:27):
Yeah.
So uh no trigger warnings forthis case.
It's just it's just, we're justgonna have to get right into it.
SPEAKER_02 (10:40):
Okay, you go with it.
Okay, I'm ready.
SPEAKER_00 (10:43):
Bring it.
So imagine this.
It's early morning.
You're cradling your perfectnewborn baby who's swaddled in a
little blanket, and you'vewaited months, perhaps years for
this exact moment.
You marvel at their soft skinand their tiny little hands that
instinctively curl around yourfingers.
(11:04):
God, I love that.
Your baby's chest rises andfalls in a perfect rhythm, and
for a fleeting moment you letyour guard down.
You made it a successfulpregnancy.
You allow yourself to believethat this was the last hurdle to
cross, and you believe thatnothing could go wrong.
And then the words arrive like aphysical blow.
(11:27):
Your baby has a heart defect,will need to perform open heart
surgery immediately.
Shock immobilizes you.
The joy of finally holding thistiny little life in your arms
turns to fear.
Your mind races, your throattightens, and your tears sting
your eyes.
How could this be?
What does this mean?
What will happen?
(11:48):
But you have no time to dwellbecause there is a path forward.
The Bristol Heart Center, one ofthe most reputable pediatric
cardiac units in the UnitedKingdom.
This is where children go whenother hospitals cannot save
them, where miracles are said tohappen.
You arrive at the hospital, itswalls gleam sterile white, the
(12:10):
corridors are long, echoingevery hurried footstep.
Nurses and doctors rush past,their expressions tight,
professional, but hurried andalert.
You catch a glimpse of otherparents clutching blankets that
hold their own fragile infants.
Their eyes are wide withexhaustion, fear, and hope in
equal measure.
(12:31):
Monitors beep, and the baby'stiny hearts are displayed in
green light, each flutter a lifehanging by a thread.
Your baby's diagnosis istransposition of the great
arteries, which is a congenitaldefect where the heart's major
arteries are switched, meaningblood flows in the wrong
direction.
So oxygen poor blood is sent tothe body and oxygen-rich blood
(12:56):
loops back to the lungs.
Without correction, your child'slife expectancy is measured in
months.
The only option is a procedurecalled an arterial switch.
The operation involves detachingand reattaching arteries that
are no wider than spaghettistrands, reconnecting coronary
(13:17):
arteries, and using a heart-lungmachine called Bypass to
circulate blood while the heartis stopped.
One slip or one second ofhesitation could mean life or
death for the patient on thetable.
And now it's your turn.
You're about to hand over yourbaby to complete strangers.
(13:38):
For most people, our childrenare the most important people in
our lives.
Parents typically exhibitextraordinary levels of
protection for their children,shielding them from the dangers
of the world.
Things like crossing the street,talking to strangers, avoiding
animals that could snap, etc.,etc.
Parents extinctively take on therole of protectors for their
(14:02):
children because that's theirjob, to look after them and
nurture them into adult life.
When you bring your baby intothat hospital, you'd have
certain expectations.
You'd expect to be confident inthe knowledge that you are in a
place that is expert, which isspecialized, and in which the
people that work there arehighly trained and are good at
(14:24):
their jobs.
Those that work there work inhigh-quality teams that you can
trust and believe in, and thatthey're also people who work in
appropriate conditions and haveaccess to everything that they
need if things were to go wrong.
That somewhere in that hospital,your precious little baby is
going to become the center oftheir universe too.
(14:46):
This is a story of when thattrust in others was misplaced
and the sense of protection wasundermined.
As Professor Martin Elliott,British surgeon and professor of
cardiothoracic surgery atGresham College London,
paraphrased Sir Ian Kennedy.
(15:12):
In fact, this is a story ofpeople who cared greatly about
human suffering, were dedicatedand well motivated.
But some lacked insight, hadflawed behavior, communicated
badly, and failed to worktogether in the interest of the
patients.
This is a story of a breakdownof trust and letting others down
(15:33):
and of terrible harm to lovelychildren.
In the 1980s and 1990s, theBristol Royal Infirmary became
the stage for one of the mostdevastating healthcare failures
in modern British history.
Children, some just a few monthsold, died not by chance but due
to systemic weaknesses,professional error, and
(15:56):
insufficient oversight.
Many of these children mighthave survived had they been
operated on at different centersor by other surgical teams.
The tragedy did not emergethrough routine auditing or
internal controls.
It was brought to light by therelentless efforts of grieving
parents, courageouswhistleblowers, and a vigilant
(16:18):
press willing to challengeofficial reassurances.
The story of Bristol is acautionary tale and a lens
through which we can examinestructural weakness in the
broader National Health Service,as well as human costs when
ambition, power, and inadequateoversight collide.
For a little further insightinto that, people kept referring
(16:39):
to how this hospital, orspecifically the heart unit, was
around cardiac unit, was a clubculture.
SPEAKER_03 (16:47):
Oh no.
Yeah.
SPEAKER_00 (16:51):
To understand the failures at Bristol, it's
necessary to consider thebroader context of pediatric
cardiac surgery in the UK duringthe 1970s.
At that time, most heart surgeryfocused on adult patients,
primarily addressing valvedisease and coronary artery
disease.
Children were often treated bysurgeons who split their
(17:12):
practice between adult andpediatric patients.
Dedicated pediatric cardiacunits were rare, and hospitals
retained adult-focusedstructures, staffing, and
postoperative care pathways.
These arrangements, whilefunctioning reasonably well for
adult cardiac disease, wereill-suited to congenital heart
(17:32):
conditions in infants.
Open heart surgery was still arelatively young field, barely
two decades into itsdevelopment.
Diagnosis relied heavily onclinical assessment,
auscultation,electrocardiography, and x-rays,
while echocardiography justbeginning to improve anatomical
understanding.
(17:53):
In Bristol, children wereinitially assessed by the
pediatric cardiologists at thechildren's hospital.
Minor procedures could beperformed there, but all open
heart surgery took place atBristol Royal Infirmary, which
was the adult hospital, becauseit had the surgical rooms,
staff, and the ICU capacitynecessary for complex cases.
(18:15):
Post-operative care was largelymanaged by surgeons themselves,
as specialist pediatricintensivists had not yet been
established.
In the early 1970s, Bristol'spediatric cardiac service was
small, performing around 100operations annually, primarily
straightforward cases.
(18:36):
International outcomes wereimproving, and so expectations
rose and demand increased.
To expand the service, thehospital appointed James
Weishart, a cardiac surgeontasked with growing the program.
Under his leadership, the unitgrew rapidly, and by 1985, they
were performing over 430 cases ayear.
(18:59):
That's only 15 years.
That's a big increase.
Yeah.
That same year, the Departmentof Health officially designated
Bristol as a specialistchildren's heart center, and
Janarden Desmana was appointedas a junior surgeon.
Across the UK, pediatric cardiacsurgery was also strengthening,
(19:20):
highlighting how Bristol'sexpansion coincided with a
broader transformation of thespecialty.
And I don't know if I mentionedthis in here, but I think at the
time this story takes place,there were 13 centers that were
providing pediatric cardiacsurgery, open heart surgery.
So for them to grow by 150 casesa year in no math, Amanda.
(19:46):
330 cases a year in 15 years.
Well, there's 13 places forpeople to go to?
That's a lot.
Yeah.
Like, how many people need heartsurgery?
I know.
Sad.
Crazy.
The 1980s marked atransformative decade for
pediatric cardiac surgery.
(20:06):
Surgical practice shifted towardoperating on babies earlier in
life, often aiming for a singledefinitive procedure before a
prolonged strain could causedamage to the heart or lungs.
Pioneers such as Aldo Castanedain Boston and Roger Mee in
Melbourne led these approaches,significantly improving outcomes
(20:27):
for conditions likeatrioventricular septal defect
and transposition of the greatarteries, T G A.
Surgical culture was inherentlycompetitive and ambitious,
pressuring units to adopt theAdvanced procedures, and Bristol
was no exception.
In 1988, Desmana introduced thearterial switch operation for
(20:52):
TGA.
Over the next several years, heperformed 38 operations, but
tragically, 20 of those 38children died.
This mortality rate far exceededreports from centers in Boston,
Melbourne, Birmingham, orLondon's Great Ormond Street
Hospital.
(21:12):
That same year, Stephen Bolson,a newly appointed
anesthesiologist with a specialinterest in congenital heart
disease, joined the Bristolteam.
He immediately noticedoperations were unusually
prolonged and the outcomeshighly concerning.
Determined to understand thesituation, he began collecting
data on surgical outcomes.
(21:34):
Meanwhile, Wiseheart reviewedoutcomes only intermittently
with the cardiology colleagues,and these discussions were
informal and sporadic.
Systematic reporting of surgicalresults were neither standard
nor expected.
A voluntary UK cardiac surgeryregistry existed, but
participation was inconsistent,data validation was weak, and
(21:57):
publications were limited.
Between 1990 and 1994, theunit's outcomes became
increasingly troubling.
Of 15 babies undergoing AVSDrepair by WiseHeart, nine of
them died, a mortality rate farhigher than the sub-5% seen at
comparable centers.
Bolson, alarmed and frustrated,raised the issue with the
(22:20):
hospital's chief executive, Dr.
John Roylins, but his concernswere not met with urgency.
Tensions grew as he facedhostility from colleagues
resistant to scrutiny.
By 1991, Bristol's problemsbegan attracting attention
beyond the hospital.
A senior hospital consultant wasinvited to consider a position
(22:40):
at Bristol, potentially chairingcardiac surgery.
Upon visiting, they quicklydeclined after assessing the
split site arrangement, outdatedfacilities, and inadequate
post-operative care structure.
So this post-operative carestructure, the operating rooms
and the ICU were on differentfloors.
And so the children had to betransported by a lift that could
(23:02):
be called upon by anyone else atany given time.
So, like obviously, if you needto get somewhere quickly because
your heart is failing andsomeone else called this lift,
then it's like, how the heck areyou supposed to get there?
So that was problematic.
Children were being cared forpostoperatively by rotating
adult cardiac surgeons, whilepediatric cardiologists were
physically distant because theywere at the children's hospital,
(23:25):
which further complicated theecho monitoring.
Despite these structuralshortcomings, Wisehart was
promoted to medical director,consolidating power at the same
time that Desmana's arterialswitch outcomes remained poor.
For Bolson, witnessing this musthave been absolutely
infuriating.
Ambition and hierarchy trumpedpatient safety.
(23:48):
And I think we've all probably,well, hopefully not all of us,
but I've certainly workedsomewhere where I've seen the
wrong person keep tripping upthe ladder.
And wow, is that frustrating?
Yep.
SPEAKER_02 (23:58):
Absolutely.
SPEAKER_00 (24:00):
Media exposure further escalated concerns.
Phil Hammond, a local GP andcontributor to Private Eye,
highlighted the poor reputationof Bristol's ICU, grimly
nicknamed the Killing Fields.
SPEAKER_01 (24:15):
Oh God.
SPEAKER_00 (24:16):
Bolson.
Yeah, right.
Not good.
Bolson, whose audit was stillincomplete, alerted the
Department of Health, butactionable steps were limited.
The Royal College of Surgeonsconsidered revoking Bristol's
status as a specialty center in1988 and again in 1990, but
ultimately they didn't.
(24:37):
Weird.
Desmana voluntarily stoppedperforming arterial switch
operations, but the systemicproblems persisted.
In 1994, the Royal Collegeconducted an inspection, issuing
a report that reflectedweaknesses in oversight
reporting and the postoperativecare.
But before we get more intothat, it's time for a chart out.
(25:01):
That's all I've got to do.
SPEAKER_01 (25:06):
No.
No, no, no.
SPEAKER_00 (25:14):
I feel like I need a little like handbell.
I like I'm still so full fromlunch, was which was like over
five hours ago that your baby'ssitting on your chipotle.
Like every time I feel like ahiccup, I I feel like I'm gonna
like puke.
So if it sounds like I'm out ofbreath, I am because I'm wearing
(25:35):
hard pants, as Kylie Kelseywould call them.
Not good.
And if you've ever wornmaternity pants, I mean over
like the seam of where it belike stops being hard pants and
goes on to like the belly band.
Like that is just likesqueezing.
I'm sitting Indian style, whichis probably not the best.
It's like, look at this newtrampoline instead of mom's
(25:56):
bladder.
We've got her Chibole.
Oh.
Okay.
Enough about me.
So I guess this is kind of aboutme still, but I wanted to know
how many cases a year aspecialty service would need to
complete in order to beconsidered or recognized as
specialists or have the facilityrecognized as a center of
(26:17):
excellence.
Yeah.
Unfortunately, I don't know thatI have the best answer, but
we'll go through it.
Based on accreditation standardsand professional guidelines.
So what I found was that in manyhealth systems, specialist
status isn't set by law exceptfor some regulated procedures,
but accreditation programs arecommonly used by hospitals to
demonstrate expertise.
(26:40):
These volume thresholds comefrom accreditation bodies like
the Surgical Review Corporation,SRC, Center of Excellence
programs.
These programs set a minimumnumber of procedures per year to
qualify facilities asspecialists in a surgical area,
and they vary by procedure typeand program.
(27:01):
So I just I have like a fewsurgical areas that I'll
mention, and then theapproximate annual volume of
cases that they would have tosee a year.
And again, if you want to lookall this up, sources are in the
show notes.
SPEAKER_02 (27:18):
So super interesting.
Yeah.
SPEAKER_00 (27:21):
So in the area of colorectal surgery, 100 cases a
year.
Minimally invasive surgeries,150 to 175 cases a year.
Various robotic surgeries, 50 to200 cases a year.
It says it varies by program.
Orthopedic surgeries, 200 ayear, joint replacements, 175 to
(27:46):
200 a year, neurosurgery, 150 to200, thoracic surgery, 125 to
150 cases per year, bariatricsurgery, 80 to 100 cases a year,
cosmetic surgery, and they notedhigh volume.
So that was 300 to 400 cases ayear, and then breast treatment
(28:08):
slash cancer care, 125 to 150cases a year.
SPEAKER_02 (28:14):
So what this tells me is that basically two to four
cases a week.
Yeah.
For most of these specialties.
SPEAKER_00 (28:25):
And then I'm thinking like isn't a lot.
No.
And then I'm like, is that persurgeon then also?
Or right?
Because they need to maintaintheir So let's say you and I are
the surgeons.
SPEAKER_02 (28:43):
Yeah.
SPEAKER_00 (28:44):
If we're if we're doing two a week, but each of us
is only then doing one a week.
SPEAKER_02 (28:52):
Unless you're both doing each case together, it
doesn't, I shouldn't I shouldn'tthink it should count because
you need your hands on for thatexperience and that project and
to keep up your skill set.
So I would say most of these arelike four cases of eight a week.
And most of these surgeons haveat least one surgery day where
(29:14):
I'm sure they do more than fourcases a day.
So yeah, if you're not meetingthis threshold, you're barely
touching the surface.
SPEAKER_00 (29:25):
Yeah.
Because it's like you don't wantjust the center to be called a
center for excellence, but thenhope you didn't get the surgeon
that didn't do that many cases.
Yeah.
So big picture of what Ilearned, or what this tells us,
is there aren't universal laws.
The thresholds are not universallegal requirements.
They are examples from voluntaryaccreditation standards used by
(29:47):
hospitals to show expertise inquality.
Different accrediting bodies,such as national health
authorities or specialtysocieties, may set different
thresholds depending onprocedure complexity and local
healthcare systems.
Research shows that the highersurgical volumes often correlate
with better patient outcomes.
Duh.
This is why many accreditationsystems use volume thresholds.
(30:10):
Makes sense.
These numbers can vary bycompany and organization.
Of course, if you're in a morerural area versus an urban
setting, your numbers are goingto be much different.
And then different countries andspecialty societies have their
own guidelines.
So in short, a specialistsurgical unit needs to
(30:31):
demonstrate that it performs asubstantial number of given
procedures annually.
Often I'd say that 100 to 200case mark per year, depending on
the complexity and specialty, tomeet the accreditation criteria.
So I guess if you're goingsomewhere and they say they're a
center for excellence, probablywill I I feel confident is.
(31:38):
Yeah.
Yeah.
Like a necessary life-savingprocedure versus like uh plastic
elective surgery.
SPEAKER_02 (31:47):
Are you gonna Botox me?
Are you gonna move my nosebridge?
I don't know.
Even so, I would feel like if Iwant plastic surgery, I want to
know that you at least do acouple of these a week.
Like I was gonna say, I stilldon't want my Botox botched.
Right, maybe even less than myheart.
(32:08):
I don't know.
SPEAKER_00 (32:09):
Yeah.
Okay, back to the story.
The crisis reached its tragicclimax in 1995 with Joshua
Loveday, an 18-month-old boywith TGA.
Despite advice from Dr.
Peter Doyle of the Department ofHealth cautioning against
(32:30):
surgery, the cardiology teampersuaded Desmana to operate.
And remember, he voluntarily satout at this point.
His outcomes were not good.
The operation unfortunatelyfailed, and Joshua sadly died on
the operating table.
SPEAKER_03 (32:46):
Oh.
SPEAKER_00 (32:47):
I guess a trigger warning for this episode could
have been children dying.
Yeah.
And maybe.
Yeah.
Coming from the print, maybe.
SPEAKER_02 (32:59):
No.
Okay.
SPEAKER_00 (33:03):
This tragedy prompted an external review by
Professor Mark DeLaval fromGreat Ornburn Street Hospital
and Dr.
Stuart Hunter at Newcastle, whofound disorganization, poor
communication, and weak datasystems.
It was estimated that 35 babiesunder a year old died
unnecessarily, and a third ofall heart babies referred to
(33:26):
Bristol Royal Infirmary receivedless than adequate care.
About 160 of them probablysuffered long-term as a result.
Their recommendations led to theappointment of an experienced
pediatric cardiac surgeon.
The secession of pediatricsurgery at Bristol, and the
(33:47):
transfer of all of the otherchildren there to go to other
centers.
Public and professional reactionwas immediate and intense.
Obviously, if we have childrendying from inadequate care.
Parents formed the Bristol HeartBabies Action Group.
Bolson resigned and moved toAustralia, and Wisehart stepped
(34:07):
down as the medical director,and the General Medical Council
initiated investigations.
A BBC panorama programcriticized both the Department
of Health and the Royal Collegeof Surgeons for ignoring
repeated warnings.
Because remember, Bolson turnedthese people in multiple times.
(34:28):
He tried to say somethingmultiple times.
By 1998, the hearings hadconcluded.
Wiseheart and Roylance werestruck off and Desmana
suspended.
And since we're not in the UK,others in the US may not know
what that means to be struckoff, but they lost their license
and they can't practice.
And they were removed from thesurgical registry.
SPEAKER_03 (34:51):
Yeah.
SPEAKER_00 (34:52):
So Desmana was found guilty of serious professional
misconduct.
When speaking publicly for thefirst time since being found
guilty, he said, quote, wheneveryou start any new operation, you
are bound to have,unfortunately, high mortality.
Unfortunately, at that time,there were no clear guidelines.
Every surgeon was doing the bestavailable practice, end quote.
(35:16):
Desmana had admitted that therehad been a five-year gap between
his assisting an arterial switchoperation and performing the
first one himself.
That is insane.
Five years.
SPEAKER_02 (35:28):
Right.
unknown (35:32):
Okay.
SPEAKER_00 (35:32):
The first nine patients he performed the
surgery on had died.
SPEAKER_02 (35:36):
Okay.
Well, that's I mean, at whatpoint do you go, well, this
doesn't work?
I'm gonna kill my patient.
SPEAKER_00 (35:44):
Yeah.
Like, hey, do you guys have um apractice lab?
And it's like, okay, we're inthe 70s, but yeah.
SPEAKER_02 (35:53):
I mean, after the first one, I would have been
running to the lab, but nine.
Nine.
Yeah.
SPEAKER_00 (36:03):
And knowing that you had that five-year gap, my
friend.
Oh, I hate this guy.
He was banned from operating onchildren for three years and
lost his job at Bristol RoyalInfirmary, which didn't want to
work there anyway.
Is that it?
SPEAKER_02 (36:17):
Is that all that happened to him?
SPEAKER_00 (36:20):
To him, yeah.
But, you know, he did apologizeto the families whose children
had died at the Heart Center.
And this whole scandal has beencalled the Bristol Heart baby
scandal.
He had broken down in tears whenaddressing the family, saying
that he wished he could turn theclock back.
(36:40):
He said, quote, whateversuffering I have gone through is
no match to the suffering oflosing a child.
I'm not a cavalier surgeon.
I did not, and I do not risk anypatient's life unless I believe
fully I can benefit them.
Unfortunately, it didn't work.
I wish I had not operated onthose children.
I never believed in usingpatients as guinea pigs.
(37:01):
I followed the practice at thetime as I saw my elders and
seniors doing.
I do not consider myself anincompetent doctor, and I hope
the inquiry finds that out.
End quote.
SPEAKER_02 (37:12):
But I mean, nine.
You try this technique a coupleof times, but nine times and it
results in death.
Why are you still trusting thesystem at this point?
Like the common sense goes, Oh,a couple of times, something's
not working out.
(37:32):
Like I don't I don't understand.
No, I d I don't give him anycredence for that.
Yeah.
He should have checked in afterthe first, the second, the
third, the fourth, the fifth.
Come on.
SPEAKER_00 (37:46):
Yeah.
Well, you know, he who he wouldhave been checking into is
Wiseheart, who was getting allthis money for growing this
program.
So WiseHart was also foundguilty of serious professional
misconduct for continuing to dothe two types of complex
operations despite the highdeath rates.
Wiseheart and hospital managerJohn Roylance were struck off.
(38:07):
Oh, and I wrote meaning theylost their license, blah blah
blah.
I already said that.
So we know that now.
He said that he wanted to appealagainst the GMC verdict, but you
know, he had been advised thathe would just lose.
No kidding, sor.
I mean, with the reason, right?
Yeah.
He said, quote, I felt mysurgical skills had achieved a
(38:30):
great deal, but it was clearsome aspects of those skills
were under criticism.
I think my own view was that Ihad done my best, but on what
had appeared to be the figuresand judgment at that time, there
was at least a question markover whether my skills had been
what I had hoped they would be.
SPEAKER_02 (38:47):
I mean, do you hope all your patients die?
Because that's what the what thehell happened.
SPEAKER_00 (38:52):
So Yeah, stats were not good.
Okay.
Not good.
During the inquiry, he brokedown in tears as he expressed
his regrets to bereaved parentssitting just a few yards away.
While you'd expect most parentswould be thrilled that the
scandal ended with Weisheartlosing his license, there were
parents that made publicstatements in support of him.
Michelle Cummings shared herexperience as the parent of
(39:15):
Charlotte, who was born in 1987with complex congenital heart
defects, who later diedfollowing surgery performed by
Weishart.
She emphasized his exceptionaldedication, compassion, and
meticulous planning in thetreating of Charlotte,
highlighting that he thoroughlyinformed her and her husband
about the surgical risk,long-term survival changes, I
(39:39):
think that's supposed to bechances, and potential
complications.
Charlotte had underwent surgeryin June of 1988 at a time when
children were moved between thetwo Bristol hospitals due to
limited resources.
Despite a full recovery, shesadly passed away in March of
1989.
(40:00):
Michelle stressed that herdaughter's death was not due to
surgical incompetence.
She also noted her family's longhistory with Wiseheart,
including her husband having hadsuccessful heart surgeries
completed by him in the past,further reflecting his
consistent dedication topatients and families over
decades.
But other bereaved mothers, suchas Helen Rickard, did not agree.
(40:23):
To add insult to injury, she hadfound out that her daughter's
heart was retained by Bristolwithout her knowledge.
She later learned that Wiseharthad continued to receive NHS
merit payments topping hispension, for which she described
as even further insult.
That's right.
The government found That thesebonuses had not stopped after he
(40:46):
was no longer working there.
So they have since put in newrules in place for doctors who
failed to maintain standardsthat they would be unable to
keep such payments.
SPEAKER_02 (40:56):
He got bonuses.
Yeah.
Wait, he got bonuses for keepingthis patient alive that died?
SPEAKER_00 (41:04):
He got bonuses for when he was growing the program.
Okay.
Yeah.
So with that, when that news hadsurfaced, the public learned
that he was well first awardednearly$40,000 a year on top of
his salary by senior doctors in1994.
So years after these poorsurgical outcomes, still getting
(41:27):
that money, honey.
SPEAKER_02 (41:29):
Wow.
SPEAKER_00 (41:30):
Yeah.
Not good.
And I'm also like, I didn't seeanything about this, but no jail
time?
SPEAKER_02 (41:38):
Right.
SPEAKER_00 (41:39):
Like we're punishment.
Just you lost your job and youcan't be a surgeon anymore.
Okay.
And you're still getting 40,000on top of your pension.
Like that's more than a lot ofpeople make in a year.
Yeah.
So in 1999, the Bristol RoyalInfirmary Inquiry, led by
Professor Sir Ian Kennedy withEleanor Gray, produced a
(42:01):
comprehensive investigation, andthe inquiry issued 198
recommendations, emphasizingsystemic failures rather than
focusing solely on individualblame.
Clinicians had beenoverextended, ambition exceeded
capacity, and power wasconcentrated in too few hands.
Kennedy stressed that complexsurgery should be concentrated
(42:24):
in high-volume centers, withpatient safety taking precedence
over convenience.
Stephen Bolson, who was ourwhistleblower in this case,
faced scrutiny from those who hehad blown the whistle on.
He received what he thought wasa quite chilling threat from Dr.
Roylins.
Dr.
Bolson was facing a manslaughterinvestigation after an adult
(42:45):
patient received the wrong bloodand died.
The conclusion of the case wasthat the death was found to have
been caused by coronary arterydisease, and the coroner's court
returned a verdict of death bynatural causes.
Dr.
Bolson then moved on fromBristol and became the director
of anesthesia at GeelongHospital in Victoria, Australia.
He perceived the threats fromRoylands as a serious threat to
(43:08):
his future as a cardiacanesthesiologist and wanted out.
Jim, like these guys that gotfired and were like basically
running this club culturecardiac unit.
Like, who are you to bethreatening Dr.
Bolson?
SPEAKER_03 (43:24):
Uh-huh.
SPEAKER_00 (43:26):
Get out of town, sir.
Subsequent professional reviewsconcluded that part pediatric
cardiac units should perform atleast 300 cases annually to
maintain expertise.
Implementation, however, wasslow, hindered by local
loyalties, political caution,and procedural concerns.
The legacy of Bristol eventuallyinfluenced broader NHS reform.
(43:50):
Safe and Sustainable, launchedin 2008 under Bruce Keogh,
sought to centralize pediatriccardiac services from 11 to 7
centers.
A joint committee of PCTschaired by Sir Neil McKay
oversaw the process.
Advisory and standards groups,including parents and
(44:10):
clinicians, established nationalbenchmarks, and public
consultation brought in tens ofthousands of responses.
Expert assessments reinforcedthe need for centralization.
Implementation faced opposition,minor procedural flaws and legal
challenges, but the reformsaimed to ensure that high-volume
(44:31):
regional centers deliveredsuperior outcomes, had robust
training, and sustainableservices.
International comparisonconfirmed this.
Concentrating the expertise,collecting the robust data, and
ensuring effective oversightwould ultimately save lives.
The story of Bristol underscoresthe complexity of healthcare
(44:51):
reform where clinical,managerial, political, and
societal pressures intersect.
Ambition, inadequate oversight,structural weaknesses, and
cultural factors led topreventable loss of life.
Subsequent inquiries, audits,and reforms demonstrated the
capacity for improvement, thoughobstacles like localism,
(45:14):
procedural obsession, and mediasimplification persist.
Rest assured.
Speaking of this being a longtime ago, because maybe it
doesn't seem like that long ago,but I saw this video online the
(45:35):
other day, and people were likeasking young people like, what
age does someone have to be bornto be considered old?
And the the oldest or likelongest ago year that they said
was 1990.
And I was like, oh, some of themwere saying like the 2000s.
I was like, oh, okay, I'm old, Imade it.
(45:57):
Okay.
Oh yeah.
Oh, I know.
Yeah, yeah, yeah.
Yeah.
So yeah, we can, you know, wecan rest assured it's it's safer
there now.
Safeguards have been put inplace.
But yeah, this was a really bigtragic story for the times and a
(46:17):
lot of unnecessary infant deathsjust because A, they were not
skilled enough to be doing it,but B, you were motivated by
like kickback money and justkeep doing it.
So I did feel a little bad forDesmana when he did bow out
himself, like voluntarily didthat, and then got pressured
(46:38):
into doing another one.
Like, yeah, at least he tried todo, I will recognize that.
I mean, I think it took too manyto finally get to that point,
but I don't know.
SPEAKER_02 (46:50):
Well, thankfully, cardiac surgery currently is
safer, centralized, and bettermonitored thanks to this
combination of rigorous data,concentrated expertise,
effective governance, and publicaccountability that serves as a
safeguard to prevent tragedieslike this that you mentioned in
(47:12):
Bristol.
So we can't tolerate mediocrity.
Patients need to be safe.
There needs to beaccountability, and transparency
must remain the benchmark.
So I love that you brought thisup.
It's super important.
So excellence in healthcare, andyou know, we can say we're
(47:34):
excellent in healthcare, but wehave to be accountable.
And when stuff goes wrong, wehave to have the courage to
report it.
SPEAKER_00 (47:43):
Especially like when when things are going wrong, are
people losing their lives?
This isn't like, oh, we lost thepaperwork and now we have to
spend more money.
I mean, the stakes are neverhigher, right?
Like that's not a patient safetyconcern.
SPEAKER_02 (48:01):
Like Yeah, exactly.
It's too late at that point.
So definitely, while this is atragic story, it shows that
tragedy can emerge.
Lasting reform is we need tolearn from our mistakes, and
hopefully we have.
SPEAKER_00 (48:18):
When I was researching this, I found a
separate little rabbit hole thatI did not even go down.
But that mother Helen, who hadfound out that her daughter's
heart was like kept at thecenter, it sounded like perhaps
that was happening also atBristol and other hospitals in
the UK were like hoarding heartsafter people died.
(48:41):
I was like, What in the fuck areyou guys doing with that?
I was like, I can't even gothere right now.
Oh no.
SPEAKER_02 (48:49):
So yep.
Well, I appreciate you bringingup that fascination.
SPEAKER_00 (48:55):
It definitely was different than usual and not the
like gripping, like, oh my god,who's the murderer?
But still important, I think, tobring up and definitely a big
thing in UK history forhealthcare.
SPEAKER_02 (49:08):
Absolutely.
Absolutely.
And we need to understand tothink about, you know, what are
these implications inhealthcare?
What's you know, betweenmorality and you know what's
actually happening.
So I appreciate you bringingthat up and you know it's giving
us all listeners something tothink about.
You're welcome.
(49:28):
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(49:51):
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SPEAKER_00 (50:25):
Okay.
Are we ready for another Adamstory?
I can't.
It's not as intense as the firstone.
I mean, it's it's medically isintense, but yeah.
SPEAKER_02 (50:36):
But this poor Adam.
I mean, how many medical mishapshas this one got too many?
SPEAKER_00 (50:41):
He's got too many.
Oh, bless his heart.
Oh.
I know.
I was like, beep, I accidentallythought of that one story from
this other story.
Can we tell it?
Thank you.
Okay, so this story starts outwith me.
So here I am.
(51:02):
I'm sitting in grand rounds, andI'm in Bellingham, Washington.
SPEAKER_02 (51:08):
Which but what is what do you mean, grand rounds?
Talk to the listeners about whatthat means.
SPEAKER_00 (51:14):
Okay, so grand rounds are where a speaker will
take a clinical case, and solike let's say I had a really
interesting patient, I wouldtake that patient's clinical
case and kind of break down whatthat looked like from start to
finish.
And like, where do we go fromhere with that patient?
(51:35):
So that's an example of a grandrounds presentation um for a
clinical case.
I mean, you can do grand roundson like specific medical things
or like research.
But for the purpose of thisstory, it was grand grounds with
patient stories.
So I'm in grand rounds, I'm inBellingham, Washington.
(51:55):
So I'm 2,000 miles away fromwhere Adam is.
He's in Minnesota back home.
And I get a notification on mywatch that he's calling me.
And I'm like, okay, well,obviously this is a butt dial
because he knows I'm in grandrounds because we share a
calendar, which also was highlynecessary at the time because I
(52:16):
was two time zones behind himand he worked overnights.
So yeah, bad.
What a time we've lived through.
So anyway, I focus back on grandrounds and then I get another
notification on my watch, avoicemail.
Highly suspicious because peopledon't leave voicemails, really.
(52:39):
Excuse me.
Heartburn hiccup and a gon.
Trifecta.
So you know when you look atyour watch or like on your
phone, um, and you can catch aglimpse of like the preview of
what the message is saying.
So I see that on my watch, andthe message starts out, Hi
Amanda, this is so and so.
(53:03):
And I'm and I see from theemergency department at Mayo
Clinic.
And I was like, So I got up inthe middle of grand rounds, went
out to the hallway, listened tothis voicemail, which I do still
have.
We confirmed last night, but Idon't think there's a way for me
to play it while I'm on the myphone.
(53:24):
So basically, the voicemail waslike, hi, this is so-and-so,
like an emergency department.
Adam is here.
Um, I'm just calling to tell youwhat happened, if you can give
me a call back.
Like, there was not a lot ofinformation.
So now we're gonna like flip theswitch to Adam, what happened in
(53:44):
Minnesota?
So Adam was walking out into theliving room when he went to take
a step.
Our puppy at the time, Raven,she was only four months old
when this happened.
And she was right there.
So he tried to do this likeawkward step off to the side so
that he wouldn't bump into her.
And he lost his footing and hefell backwards into and through
(54:08):
our glass coffee table.
Oh shit.
Oh no.
Um, so then he quotes as he'sretelling a story.
My butt was stuck in the coffeetable.
I couldn't get out because Ilearned there was a shard of
glass sticking out of my backthat was no shit, six inches
long.
So anytime I tried to get up,the glass piece would catch on
(54:30):
the frame of the table.
I pulled the glass out and madea pressure bandage out of a
towel, took a shower to wash theglass off of me, let the dog out
to go potty, put her in herkennel, and drove myself to the
emergency room.
I was nearly passed out by thetime I got to the front desk.
After imaging, I learned thatthe glass piece missed my spine
(54:52):
by about two inches and luckilydidn't make it into my abdominal
cavity.
I was admitted for three daysand then went back home.
While there, we had some lovelyfriends go and clean up all of
the glass.
And I remember this, theyreported that it looked like a
glitter bomb went off in theliving room from all of the
glass everywhere.
And we had other friends thatwatched Raven while he was
(55:14):
admitted in the hospital.
So he goes on to say he willnever own a glass coffee table
or any glass table of any sortever again.
So that's your fair warning tonot own a glass table.
SPEAKER_01 (55:27):
Oh my god.
SPEAKER_02 (55:29):
Oh my gosh.
He just stuck himself off with alittle glass shard stabbing his
back.
Oh my gosh.
SPEAKER_00 (55:38):
We have a picture of the shard.
Because of course we would.
Why wouldn't we?
SPEAKER_02 (55:42):
Oh my gosh.
Oh, you're like a cat with ninelives.
SPEAKER_00 (55:48):
I'm like, wow, most people would call the ambulance.
He's like, oh no, I'm not gonnapay for an ambulance.
I'm like, of course, you're alsoshowering and like cleaning up
and letting the dog up beforeyou go.
SPEAKER_01 (55:58):
He was like, I did X, Y, and Z.
We're all good.
And I'm like, oh my God.
Yeah, he did.
Oh my god.
SPEAKER_00 (56:07):
So also he worked in the emergency department at the
time.
So he knew everyone there very,very, very well.
And so the social worker thatcalled me, he had told her, he
said, you tell Amanda, do notget on a fucking plane and come
(56:28):
here.
I will be fine.
Because he's like, I knew youwould buy a ticket and fly home
right away.
Yeah, and so when I was talkingto her, I called back and she
was like, He told me to tell younot to buy a fucking plane
ticket.
I was like, Yeah, that soundslike him.
SPEAKER_02 (56:48):
Okay, umestly, because what what wife wouldn't
want to fly back?
SPEAKER_00 (56:55):
I know, and I wanted to so bad.
SPEAKER_02 (56:59):
He was he knew what his injury was, but like
honestly, you make sureeverything else is okay and
cleaned up, and then okay, we'llgo.
SPEAKER_00 (57:10):
Yeah, he's like, I'm just sitting in the hospital
anyway, no, no point in flyinghome.
Which Seattle to Minneapolis,surprisingly, always very
expensive flights.
Why always right?
SPEAKER_02 (57:24):
Well, bless his heart.
Adam, you've delivered again.
When we need a medical mishap,almost sad to say you're the
one.
SPEAKER_00 (57:34):
I do have another one for him, actually.
Now that I'm thinking of it, Icould tell he almost lost part
of his foot.
SPEAKER_02 (57:44):
I don't, he's a cat.
He's got nine lives.
Like, I think he's about 42.
unknown (57:50):
Oh my god.
SPEAKER_00 (57:52):
Yeah.
Oh, well.
So anyway, we'll give thelisteners some more chances to
do, but I do, yeah, we do havemore if we ever run out of uh
material.
SPEAKER_02 (58:03):
Oh my goodness.
Yes.
Well, thank you, Adam, forsharing.
So yeah, uh, what can we expectto hear next week then?
Well, I mean, it's the holidayseason, so it's like, what could
be like lighthearted medicalcrime?
And and so I landed on somethingthat isn't necessarily crime,
(58:24):
but it's like healthcare andmedically interesting.
This guy named Brian Johnsonthinks he's never gonna die, and
he's got a formula, and I wantto talk about how Brian Johnson,
this multimillionaire who looksa lot like other multi-billion
dollar entrepreneurs, like ElonMusk.
SPEAKER_00 (58:50):
I'm like trying to draw up in my mind, like, what
does this mean?
SPEAKER_02 (58:53):
No, he looks like Elon, but he's not Elon.
But like, what science whatscience is behind this?
What medical mysteries does hethink he's conquered?
Because he thinks that he's gothe's like the ultimate medical
experiment for how thisgeneration can live forever.
So he's just basically, andthere's a whole documentary
(59:16):
about him called Don't Die.
But he thinks he's not gonnadie.
So we're gonna learn more aboutBrian Johnson.
Okay, cool.
I can't wait.
I can't wait to learn how to notdie.
Exactly.
Well, and and honestly, as Ilearn what he's doing with his
life, I'm like, I don't know ifI want to do that.
(59:38):
Okay.
Anyway, y'all can be the judgenext week.
But meanwhile, don't miss abeat.
Subscribe or follow Doctor andthe Truth wherever you enjoy
your podcast for stories thatshock, intrigue, and educate.
Trust, after all, is a delicatething.
You can text us directly on ourwebsite at Doctoringtruth at
(01:00:01):
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(01:00:22):
Don't forget to download, rate,and review because those reviews
are really, really helpful.
So leave a review.
And then we can be sure to bringyou more content next week.
Until then.
Stay safe and stay suspicious.
SPEAKER_00 (01:00:42):
I was just thinking like, yeah, review, you're gonna
learn how not to die next week.
That's a five-star baby.
So until then.
Bye.
Goodbye.
Goodbye, Toodaloo Adios.
Boop.
Hey girly, how are you?
I was just like, oh, I wasn'tholding my microphone, but I see
it still picked up my Jenna.
So that's good.
SPEAKER_02 (00:57):
I'm glad you picked me up.
I always pick you up.
SPEAKER_00 (01:02):
Oh, how are you doing?
Um good.
I had a surprise baby showertoday at work.
What?
SPEAKER_02 (01:11):
That's awesome.
SPEAKER_00 (01:12):
Yeah, I know.
So sweet.
Our DHH teachers through a babyshower.
SPEAKER_02 (01:20):
Aww.
To get some good stuff.
Get some good stuff, some cuteouties, some onesies.
Oh my god, I love this.
SPEAKER_00 (01:28):
Well, no, no outfits, but just you know, more
things we need.
This kid has so many books.
It's gonna be Smarty Pants kid.
Never have too many books.
And like a lot of cool, likesensory books and sensory toys,
and that's awesome.
Yeah.
I just was like not expectingthat at all.
So I was like, oh, hi.
(01:50):
I love that.
SPEAKER_02 (01:51):
I love that they did that for you.
Well done.
I and I know those ladies, theydid.
SPEAKER_00 (01:56):
I know Miss Balazzati listens to the mod.
SPEAKER_02 (02:01):
Hey, oh Lori.
You're awesome.
We love you.
I miss you.
Yeah, so we had this like, and Ithink you had this too.
It's not just we like way upnorth.
We had this polar vortex comingthrough where it was like
negative, you know, when youwalk outside and your nose
sections together with a littledegrees.
(02:21):
I'm doing bleeding.
Yeah.
And it's so cold, and that's howit was.
And then today it just decidedto flip 50 degrees, 50 degrees
to like 40 degrees Fahrenheit,which is like it's gorgeous out.
A lot of degrees.
Yeah.
So I just a lot of degrees,yeah.
(02:44):
And I sure is.
I had gotten my so I have thiscoat that's like this.
And my shout out to Nicole.
Nicole gave me this coat becauseshe lost all the weight and
didn't fit her anymore, and itwas perfect for me.
But it's like all feather, likesuper long, like your whole
body, like can take you tonegative 40, whatever, and
(03:06):
you'll be fine.
And I just dug that out and worethat, and it was like, I'm
sweating.
What the hell's happening here?
Now I just want to walk out in40 degrees in shorts because
that's that's how it feels.
It's like such a disparity, butI know you know that's the
nature of Minnesota.
SPEAKER_00 (03:26):
I started my Jeep from my phone because I didn't
know what the weather reallywas, and then I walked outside
and things were dripping andmelting, and I was like, oh,
it's warm.
SPEAKER_02 (03:38):
I also say very nice.
Um, so we have our workChristmas party, which is like
this big old potluck, and allthe providers are assigned
domains, and I'm really nervousbecause I'm new and I need to be
loved.
I need to buy people's love, andmy love language is food.
So I made um You're going to winthem over your fabulous cook.
(04:03):
I don't know.
So I made butter chicken curry.
Oh, my gosh, so jealous.
So much.
And then there's like thisbutter, garlic, rice to go with
it.
And oh my god, what am I gonnado if they don't like it,
Amanda?
SPEAKER_00 (04:17):
Are your fingers colored from the tumor?
Yes.
SPEAKER_02 (04:20):
I have orange.
I knew it.
How did you know?
SPEAKER_00 (04:22):
And my whole house smells like garlic, and it's
been a three-day production.
I know because I've had yourcurry and I'm so jealous that
other people get to enjoy it andI don't.
SPEAKER_02 (04:33):
Well, there may be leftovers because I don't know.
You're like, well, four hoursyou could be here.
Oh, I mean, I'm coming down, andI I I don't know.
I don't know.
We'll see if people up north canhandle because I I put less
chili than I normally would, butit's still got a little heat.
It's still got a bit of heat.
(04:54):
We're still gonna need to besmoking a little bit, so
nervous.
It's tomorrow, so we'll let youknow how it grows next week.
SPEAKER_00 (05:02):
You know, I've got pretty Norwegian taste buds, and
I like it, so I think they'll beokay.
Well, oh okay, y'all.
It's my case today, but we'redoing an Adam medical mishap.
So you'll hear from Jennifer,our sponsors, and then I'll
(05:26):
deliver this gripping case andthen the medical mishap.
SPEAKER_02 (05:33):
Bless your little cotton socks.
You've given us the best storiesmishap of all time.
So I can't wait.
SPEAKER_00 (05:43):
But meanwhile, I did, I did, if you saw this,
post a teaser on the socialmedia.
I saw that, and that's thebloody, the bloody parts, some
bloody parts, and I didn't knowwhat what that meant.
SPEAKER_02 (05:56):
It looked horrific, and I can't wait to learn it
goes with our story behind it.
There's like a little half moonshape of some kind of blessed
poor Adam Man.
It's a wonder he's stillsurviving.
SPEAKER_00 (06:12):
I know, I know.
Maybe thanks to you.
Yeah, he's uh thriving today,upright, walking forward.
We're doing okay.
Oh, I love what he said.
SPEAKER_02 (06:22):
So he he does he didn't want to come on, but he
gave his permission for you toread it.
SPEAKER_00 (06:27):
Yeah, yeah, I said as same as last time.
I said, you know, do you want tocome on and and we can tell?
Because like I have a part ofthe story too, right?
Because I get the phone call.
And so I was like, you know,what if we did it together and
that would be so cool, and likeI'll tell my part and then you
can tell your part.
And he was like, nah, no, I'mnot doing that.
And I was like, okay, well, sameas last time, then you have to
(06:50):
sit here and like I'm gonna typefrom the horse's mouth like what
you're saying to retell thestory.
Cause his he also has just likea wildly impeccable memory.
SPEAKER_02 (07:00):
What I wouldn't give for one of those.
SPEAKER_00 (07:02):
And I was like, Oh, when did that happen?
He's like February 3rd, 2020.
I was like, Oh, okay.
I mean, obviously the date ofthe incident would be more
memorable to him, but I waslike, oh, okay.
And so then wasn't, and he waslike, no, no, no, no.
Then and I'm like, okay, justtell me the story.
SPEAKER_02 (07:21):
I can't wait.
Oh my goodness.
Well, meanwhile, I hope to besipping a Kencho cocktail
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(07:42):
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SPEAKER_00 (09:41):
Yay, Kincho cocktails.
As always, the resources will bein the show notes.
Pre-apologies, I have somewicked hot bun today.
So there's been a lot ofhiccuping, and probably that's
gonna be with us forever on thistrack.
(10:01):
So sorry, it's the baby.
Yeah.
And so, yep.
I had Chipotle for lunch today,and I feel like that's what did
it.
I don't know.
SPEAKER_02 (10:23):
Bring it, girl.
It's all nature.
It's nature.
SPEAKER_00 (10:27):
Yeah.
So uh no trigger warnings forthis case.
It's just it's just, we're justgonna have to get right into it.
SPEAKER_02 (10:40):
Okay, you go with it.
Okay, I'm ready.
SPEAKER_00 (10:43):
Bring it.
So imagine this.
It's early morning.
You're cradling your perfectnewborn baby who's swaddled in a
little blanket, and you'vewaited months, perhaps years for
this exact moment.
You marvel at their soft skinand their tiny little hands that
instinctively curl around yourfingers.
(11:04):
God, I love that.
Your baby's chest rises andfalls in a perfect rhythm, and
for a fleeting moment you letyour guard down.
You made it a successfulpregnancy.
You allow yourself to believethat this was the last hurdle to
cross, and you believe thatnothing could go wrong.
And then the words arrive like aphysical blow.
(11:27):
Your baby has a heart defect,will need to perform open heart
surgery immediately.
Shock immobilizes you.
The joy of finally holding thistiny little life in your arms
turns to fear.
Your mind races, your throattightens, and your tears sting
your eyes.
How could this be?
What does this mean?
What will happen?
(11:48):
But you have no time to dwellbecause there is a path forward.
The Bristol Heart Center, one ofthe most reputable pediatric
cardiac units in the UnitedKingdom.
This is where children go whenother hospitals cannot save
them, where miracles are said tohappen.
You arrive at the hospital, itswalls gleam sterile white, the
(12:10):
corridors are long, echoingevery hurried footstep.
Nurses and doctors rush past,their expressions tight,
professional, but hurried andalert.
You catch a glimpse of otherparents clutching blankets that
hold their own fragile infants.
Their eyes are wide withexhaustion, fear, and hope in
equal measure.
(12:31):
Monitors beep, and the baby'stiny hearts are displayed in
green light, each flutter a lifehanging by a thread.
Your baby's diagnosis istransposition of the great
arteries, which is a congenitaldefect where the heart's major
arteries are switched, meaningblood flows in the wrong
direction.
So oxygen poor blood is sent tothe body and oxygen-rich blood
(12:56):
loops back to the lungs.
Without correction, your child'slife expectancy is measured in
months.
The only option is a procedurecalled an arterial switch.
The operation involves detachingand reattaching arteries that
are no wider than spaghettistrands, reconnecting coronary
(13:17):
arteries, and using a heart-lungmachine called Bypass to
circulate blood while the heartis stopped.
One slip or one second ofhesitation could mean life or
death for the patient on thetable.
And now it's your turn.
You're about to hand over yourbaby to complete strangers.
(13:38):
For most people, our childrenare the most important people in
our lives.
Parents typically exhibitextraordinary levels of
protection for their children,shielding them from the dangers
of the world.
Things like crossing the street,talking to strangers, avoiding
animals that could snap, etc.,etc.
Parents extinctively take on therole of protectors for their
(14:02):
children because that's theirjob, to look after them and
nurture them into adult life.
When you bring your baby intothat hospital, you'd have
certain expectations.
You'd expect to be confident inthe knowledge that you are in a
place that is expert, which isspecialized, and in which the
people that work there arehighly trained and are good at
(14:24):
their jobs.
Those that work there work inhigh-quality teams that you can
trust and believe in, and thatthey're also people who work in
appropriate conditions and haveaccess to everything that they
need if things were to go wrong.
That somewhere in that hospital,your precious little baby is
going to become the center oftheir universe too.
(14:46):
This is a story of when thattrust in others was misplaced
and the sense of protection wasundermined.
As Professor Martin Elliott,British surgeon and professor of
cardiothoracic surgery atGresham College London,
paraphrased Sir Ian Kennedy.
(15:12):
In fact, this is a story ofpeople who cared greatly about
human suffering, were dedicatedand well motivated.
But some lacked insight, hadflawed behavior, communicated
badly, and failed to worktogether in the interest of the
patients.
This is a story of a breakdownof trust and letting others down
(15:33):
and of terrible harm to lovelychildren.
In the 1980s and 1990s, theBristol Royal Infirmary became
the stage for one of the mostdevastating healthcare failures
in modern British history.
Children, some just a few monthsold, died not by chance but due
to systemic weaknesses,professional error, and
(15:56):
insufficient oversight.
Many of these children mighthave survived had they been
operated on at different centersor by other surgical teams.
The tragedy did not emergethrough routine auditing or
internal controls.
It was brought to light by therelentless efforts of grieving
parents, courageouswhistleblowers, and a vigilant
(16:18):
press willing to challengeofficial reassurances.
The story of Bristol is acautionary tale and a lens
through which we can examinestructural weakness in the
broader National Health Service,as well as human costs when
ambition, power, and inadequateoversight collide.
For a little further insightinto that, people kept referring
(16:39):
to how this hospital, orspecifically the heart unit, was
around cardiac unit, was a clubculture.
SPEAKER_03 (16:47):
Oh no.
Yeah.
SPEAKER_00 (16:51):
To understand the failures at Bristol, it's
necessary to consider thebroader context of pediatric
cardiac surgery in the UK duringthe 1970s.
At that time, most heart surgeryfocused on adult patients,
primarily addressing valvedisease and coronary artery
disease.
Children were often treated bysurgeons who split their
(17:12):
practice between adult andpediatric patients.
Dedicated pediatric cardiacunits were rare, and hospitals
retained adult-focusedstructures, staffing, and
postoperative care pathways.
These arrangements, whilefunctioning reasonably well for
adult cardiac disease, wereill-suited to congenital heart
(17:32):
conditions in infants.
Open heart surgery was still arelatively young field, barely
two decades into itsdevelopment.
Diagnosis relied heavily onclinical assessment,
auscultation,electrocardiography, and x-rays,
while echocardiography justbeginning to improve anatomical
understanding.
(17:53):
In Bristol, children wereinitially assessed by the
pediatric cardiologists at thechildren's hospital.
Minor procedures could beperformed there, but all open
heart surgery took place atBristol Royal Infirmary, which
was the adult hospital, becauseit had the surgical rooms,
staff, and the ICU capacitynecessary for complex cases.
(18:15):
Post-operative care was largelymanaged by surgeons themselves,
as specialist pediatricintensivists had not yet been
established.
In the early 1970s, Bristol'spediatric cardiac service was
small, performing around 100operations annually, primarily
straightforward cases.
(18:36):
International outcomes wereimproving, and so expectations
rose and demand increased.
To expand the service, thehospital appointed James
Weishart, a cardiac surgeontasked with growing the program.
Under his leadership, the unitgrew rapidly, and by 1985, they
were performing over 430 cases ayear.
(18:59):
That's only 15 years.
That's a big increase.
Yeah.
That same year, the Departmentof Health officially designated
Bristol as a specialistchildren's heart center, and
Janarden Desmana was appointedas a junior surgeon.
Across the UK, pediatric cardiacsurgery was also strengthening,
(19:20):
highlighting how Bristol'sexpansion coincided with a
broader transformation of thespecialty.
And I don't know if I mentionedthis in here, but I think at the
time this story takes place,there were 13 centers that were
providing pediatric cardiacsurgery, open heart surgery.
So for them to grow by 150 casesa year in no math, Amanda.
(19:46):
330 cases a year in 15 years.
Well, there's 13 places forpeople to go to?
That's a lot.
Yeah.
Like, how many people need heartsurgery?
I know.
Sad.
Crazy.
The 1980s marked atransformative decade for
pediatric cardiac surgery.
(20:06):
Surgical practice shifted towardoperating on babies earlier in
life, often aiming for a singledefinitive procedure before a
prolonged strain could causedamage to the heart or lungs.
Pioneers such as Aldo Castanedain Boston and Roger Mee in
Melbourne led these approaches,significantly improving outcomes
(20:27):
for conditions likeatrioventricular septal defect
and transposition of the greatarteries, T G A.
Surgical culture was inherentlycompetitive and ambitious,
pressuring units to adopt theAdvanced procedures, and Bristol
was no exception.
In 1988, Desmana introduced thearterial switch operation for
(20:52):
TGA.
Over the next several years, heperformed 38 operations, but
tragically, 20 of those 38children died.
This mortality rate far exceededreports from centers in Boston,
Melbourne, Birmingham, orLondon's Great Ormond Street
Hospital.
(21:12):
That same year, Stephen Bolson,a newly appointed
anesthesiologist with a specialinterest in congenital heart
disease, joined the Bristolteam.
He immediately noticedoperations were unusually
prolonged and the outcomeshighly concerning.
Determined to understand thesituation, he began collecting
data on surgical outcomes.
(21:34):
Meanwhile, Wiseheart reviewedoutcomes only intermittently
with the cardiology colleagues,and these discussions were
informal and sporadic.
Systematic reporting of surgicalresults were neither standard
nor expected.
A voluntary UK cardiac surgeryregistry existed, but
participation was inconsistent,data validation was weak, and
(21:57):
publications were limited.
Between 1990 and 1994, theunit's outcomes became
increasingly troubling.
Of 15 babies undergoing AVSDrepair by WiseHeart, nine of
them died, a mortality rate farhigher than the sub-5% seen at
comparable centers.
Bolson, alarmed and frustrated,raised the issue with the
(22:20):
hospital's chief executive, Dr.
John Roylins, but his concernswere not met with urgency.
Tensions grew as he facedhostility from colleagues
resistant to scrutiny.
By 1991, Bristol's problemsbegan attracting attention
beyond the hospital.
A senior hospital consultant wasinvited to consider a position
(22:40):
at Bristol, potentially chairingcardiac surgery.
Upon visiting, they quicklydeclined after assessing the
split site arrangement, outdatedfacilities, and inadequate
post-operative care structure.
So this post-operative carestructure, the operating rooms
and the ICU were on differentfloors.
And so the children had to betransported by a lift that could
(23:02):
be called upon by anyone else atany given time.
So, like obviously, if you needto get somewhere quickly because
your heart is failing andsomeone else called this lift,
then it's like, how the heck areyou supposed to get there?
So that was problematic.
Children were being cared forpostoperatively by rotating
adult cardiac surgeons, whilepediatric cardiologists were
physically distant because theywere at the children's hospital,
(23:25):
which further complicated theecho monitoring.
Despite these structuralshortcomings, Wisehart was
promoted to medical director,consolidating power at the same
time that Desmana's arterialswitch outcomes remained poor.
For Bolson, witnessing this musthave been absolutely
infuriating.
Ambition and hierarchy trumpedpatient safety.
(23:48):
And I think we've all probably,well, hopefully not all of us,
but I've certainly workedsomewhere where I've seen the
wrong person keep tripping upthe ladder.
And wow, is that frustrating?
Yep.
SPEAKER_02 (23:58):
Absolutely.
SPEAKER_00 (24:00):
Media exposure further escalated concerns.
Phil Hammond, a local GP andcontributor to Private Eye,
highlighted the poor reputationof Bristol's ICU, grimly
nicknamed the Killing Fields.
SPEAKER_01 (24:15):
Oh God.
SPEAKER_00 (24:16):
Bolson.
Yeah, right.
Not good.
Bolson, whose audit was stillincomplete, alerted the
Department of Health, butactionable steps were limited.
The Royal College of Surgeonsconsidered revoking Bristol's
status as a specialty center in1988 and again in 1990, but
ultimately they didn't.
(24:37):
Weird.
Desmana voluntarily stoppedperforming arterial switch
operations, but the systemicproblems persisted.
In 1994, the Royal Collegeconducted an inspection, issuing
a report that reflectedweaknesses in oversight
reporting and the postoperativecare.
But before we get more intothat, it's time for a chart out.
(25:01):
That's all I've got to do.
SPEAKER_01 (25:06):
No.
No, no, no.
SPEAKER_00 (25:14):
I feel like I need a little like handbell.
I like I'm still so full fromlunch, was which was like over
five hours ago that your baby'ssitting on your chipotle.
Like every time I feel like ahiccup, I I feel like I'm gonna
like puke.
So if it sounds like I'm out ofbreath, I am because I'm wearing
(25:35):
hard pants, as Kylie Kelseywould call them.
Not good.
And if you've ever wornmaternity pants, I mean over
like the seam of where it belike stops being hard pants and
goes on to like the belly band.
Like that is just likesqueezing.
I'm sitting Indian style, whichis probably not the best.
It's like, look at this newtrampoline instead of mom's
(25:56):
bladder.
We've got her Chibole.
Oh.
Okay.
Enough about me.
So I guess this is kind of aboutme still, but I wanted to know
how many cases a year aspecialty service would need to
complete in order to beconsidered or recognized as
specialists or have the facilityrecognized as a center of
(26:17):
excellence.
Yeah.
Unfortunately, I don't know thatI have the best answer, but
we'll go through it.
Based on accreditation standardsand professional guidelines.
So what I found was that in manyhealth systems, specialist
status isn't set by law exceptfor some regulated procedures,
but accreditation programs arecommonly used by hospitals to
demonstrate expertise.
(26:40):
These volume thresholds comefrom accreditation bodies like
the Surgical Review Corporation,SRC, Center of Excellence
programs.
These programs set a minimumnumber of procedures per year to
qualify facilities asspecialists in a surgical area,
and they vary by procedure typeand program.
(27:01):
So I just I have like a fewsurgical areas that I'll
mention, and then theapproximate annual volume of
cases that they would have tosee a year.
And again, if you want to lookall this up, sources are in the
show notes.
SPEAKER_02 (27:18):
So super interesting.
Yeah.
SPEAKER_00 (27:21):
So in the area of colorectal surgery, 100 cases a
year.
Minimally invasive surgeries,150 to 175 cases a year.
Various robotic surgeries, 50 to200 cases a year.
It says it varies by program.
Orthopedic surgeries, 200 ayear, joint replacements, 175 to
(27:46):
200 a year, neurosurgery, 150 to200, thoracic surgery, 125 to
150 cases per year, bariatricsurgery, 80 to 100 cases a year,
cosmetic surgery, and they notedhigh volume.
So that was 300 to 400 cases ayear, and then breast treatment
(28:08):
slash cancer care, 125 to 150cases a year.
SPEAKER_02 (28:14):
So what this tells me is that basically two to four
cases a week.
Yeah.
For most of these specialties.
SPEAKER_00 (28:25):
And then I'm thinking like isn't a lot.
No.
And then I'm like, is that persurgeon then also?
Or right?
Because they need to maintaintheir So let's say you and I are
the surgeons.
SPEAKER_02 (28:43):
Yeah.
SPEAKER_00 (28:44):
If we're if we're doing two a week, but each of us
is only then doing one a week.
SPEAKER_02 (28:52):
Unless you're both doing each case together, it
doesn't, I shouldn't I shouldn'tthink it should count because
you need your hands on for thatexperience and that project and
to keep up your skill set.
So I would say most of these arelike four cases of eight a week.
And most of these surgeons haveat least one surgery day where
(29:14):
I'm sure they do more than fourcases a day.
So yeah, if you're not meetingthis threshold, you're barely
touching the surface.
SPEAKER_00 (29:25):
Yeah.
Because it's like you don't wantjust the center to be called a
center for excellence, but thenhope you didn't get the surgeon
that didn't do that many cases.
Yeah.
So big picture of what Ilearned, or what this tells us,
is there aren't universal laws.
The thresholds are not universallegal requirements.
They are examples from voluntaryaccreditation standards used by
(29:47):
hospitals to show expertise inquality.
Different accrediting bodies,such as national health
authorities or specialtysocieties, may set different
thresholds depending onprocedure complexity and local
healthcare systems.
Research shows that the highersurgical volumes often correlate
with better patient outcomes.
Duh.
This is why many accreditationsystems use volume thresholds.
(30:10):
Makes sense.
These numbers can vary bycompany and organization.
Of course, if you're in a morerural area versus an urban
setting, your numbers are goingto be much different.
And then different countries andspecialty societies have their
own guidelines.
So in short, a specialistsurgical unit needs to
(30:31):
demonstrate that it performs asubstantial number of given
procedures annually.
Often I'd say that 100 to 200case mark per year, depending on
the complexity and specialty, tomeet the accreditation criteria.
So I guess if you're goingsomewhere and they say they're a
center for excellence, probablywill I I feel confident is.
(31:38):
Yeah.
Yeah.
Like a necessary life-savingprocedure versus like uh plastic
elective surgery.
SPEAKER_02 (31:47):
Are you gonna Botox me?
Are you gonna move my nosebridge?
I don't know.
Even so, I would feel like if Iwant plastic surgery, I want to
know that you at least do acouple of these a week.
Like I was gonna say, I stilldon't want my Botox botched.
Right, maybe even less than myheart.
(32:08):
I don't know.
SPEAKER_00 (32:09):
Yeah.
Okay, back to the story.
The crisis reached its tragicclimax in 1995 with Joshua
Loveday, an 18-month-old boywith TGA.
Despite advice from Dr.
Peter Doyle of the Department ofHealth cautioning against
(32:30):
surgery, the cardiology teampersuaded Desmana to operate.
And remember, he voluntarily satout at this point.
His outcomes were not good.
The operation unfortunatelyfailed, and Joshua sadly died on
the operating table.
SPEAKER_03 (32:46):
Oh.
SPEAKER_00 (32:47):
I guess a trigger warning for this episode could
have been children dying.
Yeah.
And maybe.
Yeah.
Coming from the print, maybe.
SPEAKER_02 (32:59):
No.
Okay.
SPEAKER_00 (33:03):
This tragedy prompted an external review by
Professor Mark DeLaval fromGreat Ornburn Street Hospital
and Dr.
Stuart Hunter at Newcastle, whofound disorganization, poor
communication, and weak datasystems.
It was estimated that 35 babiesunder a year old died
unnecessarily, and a third ofall heart babies referred to
(33:26):
Bristol Royal Infirmary receivedless than adequate care.
About 160 of them probablysuffered long-term as a result.
Their recommendations led to theappointment of an experienced
pediatric cardiac surgeon.
The secession of pediatricsurgery at Bristol, and the
(33:47):
transfer of all of the otherchildren there to go to other
centers.
Public and professional reactionwas immediate and intense.
Obviously, if we have childrendying from inadequate care.
Parents formed the Bristol HeartBabies Action Group.
Bolson resigned and moved toAustralia, and Wisehart stepped
(34:07):
down as the medical director,and the General Medical Council
initiated investigations.
A BBC panorama programcriticized both the Department
of Health and the Royal Collegeof Surgeons for ignoring
repeated warnings.
Because remember, Bolson turnedthese people in multiple times.
(34:28):
He tried to say somethingmultiple times.
By 1998, the hearings hadconcluded.
Wiseheart and Roylance werestruck off and Desmana
suspended.
And since we're not in the UK,others in the US may not know
what that means to be struckoff, but they lost their license
and they can't practice.
And they were removed from thesurgical registry.
SPEAKER_03 (34:51):
Yeah.
SPEAKER_00 (34:52):
So Desmana was found guilty of serious professional
misconduct.
When speaking publicly for thefirst time since being found
guilty, he said, quote, wheneveryou start any new operation, you
are bound to have,unfortunately, high mortality.
Unfortunately, at that time,there were no clear guidelines.
Every surgeon was doing the bestavailable practice, end quote.
(35:16):
Desmana had admitted that therehad been a five-year gap between
his assisting an arterial switchoperation and performing the
first one himself.
That is insane.
Five years.
SPEAKER_02 (35:28):
Right.
unknown (35:32):
Okay.
SPEAKER_00 (35:32):
The first nine patients he performed the
surgery on had died.
SPEAKER_02 (35:36):
Okay.
Well, that's I mean, at whatpoint do you go, well, this
doesn't work?
I'm gonna kill my patient.
SPEAKER_00 (35:44):
Yeah.
Like, hey, do you guys have um apractice lab?
And it's like, okay, we're inthe 70s, but yeah.
SPEAKER_02 (35:53):
I mean, after the first one, I would have been
running to the lab, but nine.
Nine.
Yeah.
SPEAKER_00 (36:03):
And knowing that you had that five-year gap, my
friend.
Oh, I hate this guy.
He was banned from operating onchildren for three years and
lost his job at Bristol RoyalInfirmary, which didn't want to
work there anyway.
Is that it?
SPEAKER_02 (36:17):
Is that all that happened to him?
SPEAKER_00 (36:20):
To him, yeah.
But, you know, he did apologizeto the families whose children
had died at the Heart Center.
And this whole scandal has beencalled the Bristol Heart baby
scandal.
He had broken down in tears whenaddressing the family, saying
that he wished he could turn theclock back.
(36:40):
He said, quote, whateversuffering I have gone through is
no match to the suffering oflosing a child.
I'm not a cavalier surgeon.
I did not, and I do not risk anypatient's life unless I believe
fully I can benefit them.
Unfortunately, it didn't work.
I wish I had not operated onthose children.
I never believed in usingpatients as guinea pigs.
(37:01):
I followed the practice at thetime as I saw my elders and
seniors doing.
I do not consider myself anincompetent doctor, and I hope
the inquiry finds that out.
End quote.
SPEAKER_02 (37:12):
But I mean, nine.
You try this technique a coupleof times, but nine times and it
results in death.
Why are you still trusting thesystem at this point?
Like the common sense goes, Oh,a couple of times, something's
not working out.
(37:32):
Like I don't I don't understand.
No, I d I don't give him anycredence for that.
Yeah.
He should have checked in afterthe first, the second, the
third, the fourth, the fifth.
Come on.
SPEAKER_00 (37:46):
Yeah.
Well, you know, he who he wouldhave been checking into is
Wiseheart, who was getting allthis money for growing this
program.
So WiseHart was also foundguilty of serious professional
misconduct for continuing to dothe two types of complex
operations despite the highdeath rates.
Wiseheart and hospital managerJohn Roylance were struck off.
(38:07):
Oh, and I wrote meaning theylost their license, blah blah
blah.
I already said that.
So we know that now.
He said that he wanted to appealagainst the GMC verdict, but you
know, he had been advised thathe would just lose.
No kidding, sor.
I mean, with the reason, right?
Yeah.
He said, quote, I felt mysurgical skills had achieved a
(38:30):
great deal, but it was clearsome aspects of those skills
were under criticism.
I think my own view was that Ihad done my best, but on what
had appeared to be the figuresand judgment at that time, there
was at least a question markover whether my skills had been
what I had hoped they would be.
SPEAKER_02 (38:47):
I mean, do you hope all your patients die?
Because that's what the what thehell happened.
SPEAKER_00 (38:52):
So Yeah, stats were not good.
Okay.
Not good.
During the inquiry, he brokedown in tears as he expressed
his regrets to bereaved parentssitting just a few yards away.
While you'd expect most parentswould be thrilled that the
scandal ended with Weisheartlosing his license, there were
parents that made publicstatements in support of him.
Michelle Cummings shared herexperience as the parent of
(39:15):
Charlotte, who was born in 1987with complex congenital heart
defects, who later diedfollowing surgery performed by
Weishart.
She emphasized his exceptionaldedication, compassion, and
meticulous planning in thetreating of Charlotte,
highlighting that he thoroughlyinformed her and her husband
about the surgical risk,long-term survival changes, I
(39:39):
think that's supposed to bechances, and potential
complications.
Charlotte had underwent surgeryin June of 1988 at a time when
children were moved between thetwo Bristol hospitals due to
limited resources.
Despite a full recovery, shesadly passed away in March of
1989.
(40:00):
Michelle stressed that herdaughter's death was not due to
surgical incompetence.
She also noted her family's longhistory with Wiseheart,
including her husband having hadsuccessful heart surgeries
completed by him in the past,further reflecting his
consistent dedication topatients and families over
decades.
But other bereaved mothers, suchas Helen Rickard, did not agree.
(40:23):
To add insult to injury, she hadfound out that her daughter's
heart was retained by Bristolwithout her knowledge.
She later learned that Wiseharthad continued to receive NHS
merit payments topping hispension, for which she described
as even further insult.
That's right.
The government found That thesebonuses had not stopped after he
(40:46):
was no longer working there.
So they have since put in newrules in place for doctors who
failed to maintain standardsthat they would be unable to
keep such payments.
SPEAKER_02 (40:56):
He got bonuses.
Yeah.
Wait, he got bonuses for keepingthis patient alive that died?
SPEAKER_00 (41:04):
He got bonuses for when he was growing the program.
Okay.
Yeah.
So with that, when that news hadsurfaced, the public learned
that he was well first awardednearly$40,000 a year on top of
his salary by senior doctors in1994.
So years after these poorsurgical outcomes, still getting
(41:27):
that money, honey.
SPEAKER_02 (41:29):
Wow.
SPEAKER_00 (41:30):
Yeah.
Not good.
And I'm also like, I didn't seeanything about this, but no jail
time?
SPEAKER_02 (41:38):
Right.
SPEAKER_00 (41:39):
Like we're punishment.
Just you lost your job and youcan't be a surgeon anymore.
Okay.
And you're still getting 40,000on top of your pension.
Like that's more than a lot ofpeople make in a year.
Yeah.
So in 1999, the Bristol RoyalInfirmary Inquiry, led by
Professor Sir Ian Kennedy withEleanor Gray, produced a
(42:01):
comprehensive investigation, andthe inquiry issued 198
recommendations, emphasizingsystemic failures rather than
focusing solely on individualblame.
Clinicians had beenoverextended, ambition exceeded
capacity, and power wasconcentrated in too few hands.
Kennedy stressed that complexsurgery should be concentrated
(42:24):
in high-volume centers, withpatient safety taking precedence
over convenience.
Stephen Bolson, who was ourwhistleblower in this case,
faced scrutiny from those who hehad blown the whistle on.
He received what he thought wasa quite chilling threat from Dr.
Roylins.
Dr.
Bolson was facing a manslaughterinvestigation after an adult
(42:45):
patient received the wrong bloodand died.
The conclusion of the case wasthat the death was found to have
been caused by coronary arterydisease, and the coroner's court
returned a verdict of death bynatural causes.
Dr.
Bolson then moved on fromBristol and became the director
of anesthesia at GeelongHospital in Victoria, Australia.
He perceived the threats fromRoylands as a serious threat to
(43:08):
his future as a cardiacanesthesiologist and wanted out.
Jim, like these guys that gotfired and were like basically
running this club culturecardiac unit.
Like, who are you to bethreatening Dr.
Bolson?
SPEAKER_03 (43:24):
Uh-huh.
SPEAKER_00 (43:26):
Get out of town, sir.
Subsequent professional reviewsconcluded that part pediatric
cardiac units should perform atleast 300 cases annually to
maintain expertise.
Implementation, however, wasslow, hindered by local
loyalties, political caution,and procedural concerns.
The legacy of Bristol eventuallyinfluenced broader NHS reform.
(43:50):
Safe and Sustainable, launchedin 2008 under Bruce Keogh,
sought to centralize pediatriccardiac services from 11 to 7
centers.
A joint committee of PCTschaired by Sir Neil McKay
oversaw the process.
Advisory and standards groups,including parents and
(44:10):
clinicians, established nationalbenchmarks, and public
consultation brought in tens ofthousands of responses.
Expert assessments reinforcedthe need for centralization.
Implementation faced opposition,minor procedural flaws and legal
challenges, but the reformsaimed to ensure that high-volume
(44:31):
regional centers deliveredsuperior outcomes, had robust
training, and sustainableservices.
International comparisonconfirmed this.
Concentrating the expertise,collecting the robust data, and
ensuring effective oversightwould ultimately save lives.
The story of Bristol underscoresthe complexity of healthcare
(44:51):
reform where clinical,managerial, political, and
societal pressures intersect.
Ambition, inadequate oversight,structural weaknesses, and
cultural factors led topreventable loss of life.
Subsequent inquiries, audits,and reforms demonstrated the
capacity for improvement, thoughobstacles like localism,
(45:14):
procedural obsession, and mediasimplification persist.
Rest assured.
Speaking of this being a longtime ago, because maybe it
doesn't seem like that long ago,but I saw this video online the
(45:35):
other day, and people were likeasking young people like, what
age does someone have to be bornto be considered old?
And the the oldest or likelongest ago year that they said
was 1990.
And I was like, oh, some of themwere saying like the 2000s.
I was like, oh, okay, I'm old, Imade it.
(45:57):
Okay.
Oh yeah.
Oh, I know.
Yeah, yeah, yeah.
Yeah.
So yeah, we can, you know, wecan rest assured it's it's safer
there now.
Safeguards have been put inplace.
But yeah, this was a really bigtragic story for the times and a
(46:17):
lot of unnecessary infant deathsjust because A, they were not
skilled enough to be doing it,but B, you were motivated by
like kickback money and justkeep doing it.
So I did feel a little bad forDesmana when he did bow out
himself, like voluntarily didthat, and then got pressured
(46:38):
into doing another one.
Like, yeah, at least he tried todo, I will recognize that.
I mean, I think it took too manyto finally get to that point,
but I don't know.
SPEAKER_02 (46:50):
Well, thankfully, cardiac surgery currently is
safer, centralized, and bettermonitored thanks to this
combination of rigorous data,concentrated expertise,
effective governance, and publicaccountability that serves as a
safeguard to prevent tragedieslike this that you mentioned in
(47:12):
Bristol.
So we can't tolerate mediocrity.
Patients need to be safe.
There needs to beaccountability, and transparency
must remain the benchmark.
So I love that you brought thisup.
It's super important.
So excellence in healthcare, andyou know, we can say we're
(47:34):
excellent in healthcare, but wehave to be accountable.
And when stuff goes wrong, wehave to have the courage to
report it.
SPEAKER_00 (47:43):
Especially like when when things are going wrong, are
people losing their lives?
This isn't like, oh, we lost thepaperwork and now we have to
spend more money.
I mean, the stakes are neverhigher, right?
Like that's not a patient safetyconcern.
SPEAKER_02 (48:01):
Like Yeah, exactly.
It's too late at that point.
So definitely, while this is atragic story, it shows that
tragedy can emerge.
Lasting reform is we need tolearn from our mistakes, and
hopefully we have.
SPEAKER_00 (48:18):
When I was researching this, I found a
separate little rabbit hole thatI did not even go down.
But that mother Helen, who hadfound out that her daughter's
heart was like kept at thecenter, it sounded like perhaps
that was happening also atBristol and other hospitals in
the UK were like hoarding heartsafter people died.
(48:41):
I was like, What in the fuck areyou guys doing with that?
I was like, I can't even gothere right now.
Oh no.
SPEAKER_02 (48:49):
So yep.
Well, I appreciate you bringingup that fascination.
SPEAKER_00 (48:55):
It definitely was different than usual and not the
like gripping, like, oh my god,who's the murderer?
But still important, I think, tobring up and definitely a big
thing in UK history forhealthcare.
SPEAKER_02 (49:08):
Absolutely.
Absolutely.
And we need to understand tothink about, you know, what are
these implications inhealthcare?
What's you know, betweenmorality and you know what's
actually happening.
So I appreciate you bringingthat up and you know it's giving
us all listeners something tothink about.
You're welcome.
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SPEAKER_00 (50:25):
Okay.
Are we ready for another Adamstory?
I can't.
It's not as intense as the firstone.
I mean, it's it's medically isintense, but yeah.
SPEAKER_02 (50:36):
But this poor Adam.
I mean, how many medical mishapshas this one got too many?
SPEAKER_00 (50:41):
He's got too many.
Oh, bless his heart.
Oh.
I know.
I was like, beep, I accidentallythought of that one story from
this other story.
Can we tell it?
Thank you.
Okay, so this story starts outwith me.
So here I am.
(51:02):
I'm sitting in grand rounds, andI'm in Bellingham, Washington.
SPEAKER_02 (51:08):
Which but what is what do you mean, grand rounds?
Talk to the listeners about whatthat means.
SPEAKER_00 (51:14):
Okay, so grand rounds are where a speaker will
take a clinical case, and solike let's say I had a really
interesting patient, I wouldtake that patient's clinical
case and kind of break down whatthat looked like from start to
finish.
And like, where do we go fromhere with that patient?
(51:35):
So that's an example of a grandrounds presentation um for a
clinical case.
I mean, you can do grand roundson like specific medical things
or like research.
But for the purpose of thisstory, it was grand grounds with
patient stories.
So I'm in grand rounds, I'm inBellingham, Washington.
(51:55):
So I'm 2,000 miles away fromwhere Adam is.
He's in Minnesota back home.
And I get a notification on mywatch that he's calling me.
And I'm like, okay, well,obviously this is a butt dial
because he knows I'm in grandrounds because we share a
calendar, which also was highlynecessary at the time because I
(52:16):
was two time zones behind himand he worked overnights.
So yeah, bad.
What a time we've lived through.
So anyway, I focus back on grandrounds and then I get another
notification on my watch, avoicemail.
Highly suspicious because peopledon't leave voicemails, really.
(52:39):
Excuse me.
Heartburn hiccup and a gon.
Trifecta.
So you know when you look atyour watch or like on your
phone, um, and you can catch aglimpse of like the preview of
what the message is saying.
So I see that on my watch, andthe message starts out, Hi
Amanda, this is so and so.
(53:03):
And I'm and I see from theemergency department at Mayo
Clinic.
And I was like, So I got up inthe middle of grand rounds, went
out to the hallway, listened tothis voicemail, which I do still
have.
We confirmed last night, but Idon't think there's a way for me
to play it while I'm on the myphone.
(53:24):
So basically, the voicemail waslike, hi, this is so-and-so,
like an emergency department.
Adam is here.
Um, I'm just calling to tell youwhat happened, if you can give
me a call back.
Like, there was not a lot ofinformation.
So now we're gonna like flip theswitch to Adam, what happened in
(53:44):
Minnesota?
So Adam was walking out into theliving room when he went to take
a step.
Our puppy at the time, Raven,she was only four months old
when this happened.
And she was right there.
So he tried to do this likeawkward step off to the side so
that he wouldn't bump into her.
And he lost his footing and hefell backwards into and through
(54:08):
our glass coffee table.
Oh shit.
Oh no.
Um, so then he quotes as he'sretelling a story.
My butt was stuck in the coffeetable.
I couldn't get out because Ilearned there was a shard of
glass sticking out of my backthat was no shit, six inches
long.
So anytime I tried to get up,the glass piece would catch on
(54:30):
the frame of the table.
I pulled the glass out and madea pressure bandage out of a
towel, took a shower to wash theglass off of me, let the dog out
to go potty, put her in herkennel, and drove myself to the
emergency room.
I was nearly passed out by thetime I got to the front desk.
After imaging, I learned thatthe glass piece missed my spine
(54:52):
by about two inches and luckilydidn't make it into my abdominal
cavity.
I was admitted for three daysand then went back home.
While there, we had some lovelyfriends go and clean up all of
the glass.
And I remember this, theyreported that it looked like a
glitter bomb went off in theliving room from all of the
glass everywhere.
And we had other friends thatwatched Raven while he was
(55:14):
admitted in the hospital.
So he goes on to say he willnever own a glass coffee table
or any glass table of any sortever again.
So that's your fair warning tonot own a glass table.
SPEAKER_01 (55:27):
Oh my god.
SPEAKER_02 (55:29):
Oh my gosh.
He just stuck himself off with alittle glass shard stabbing his
back.
Oh my gosh.
SPEAKER_00 (55:38):
We have a picture of the shard.
Because of course we would.
Why wouldn't we?
SPEAKER_02 (55:42):
Oh my gosh.
Oh, you're like a cat with ninelives.
SPEAKER_00 (55:48):
I'm like, wow, most people would call the ambulance.
He's like, oh no, I'm not gonnapay for an ambulance.
I'm like, of course, you're alsoshowering and like cleaning up
and letting the dog up beforeyou go.
SPEAKER_01 (55:58):
He was like, I did X, Y, and Z.
We're all good.
And I'm like, oh my God.
Yeah, he did.
Oh my god.
SPEAKER_00 (56:07):
So also he worked in the emergency department at the
time.
So he knew everyone there very,very, very well.
And so the social worker thatcalled me, he had told her, he
said, you tell Amanda, do notget on a fucking plane and come
(56:28):
here.
I will be fine.
Because he's like, I knew youwould buy a ticket and fly home
right away.
Yeah, and so when I was talkingto her, I called back and she
was like, He told me to tell younot to buy a fucking plane
ticket.
I was like, Yeah, that soundslike him.
SPEAKER_02 (56:48):
Okay, umestly, because what what wife wouldn't
want to fly back?
SPEAKER_00 (56:55):
I know, and I wanted to so bad.
SPEAKER_02 (56:59):
He was he knew what his injury was, but like
honestly, you make sureeverything else is okay and
cleaned up, and then okay, we'llgo.
SPEAKER_00 (57:10):
Yeah, he's like, I'm just sitting in the hospital
anyway, no, no point in flyinghome.
Which Seattle to Minneapolis,surprisingly, always very
expensive flights.
Why always right?
SPEAKER_02 (57:24):
Well, bless his heart.
Adam, you've delivered again.
When we need a medical mishap,almost sad to say you're the
one.
SPEAKER_00 (57:34):
I do have another one for him, actually.
Now that I'm thinking of it, Icould tell he almost lost part
of his foot.
SPEAKER_02 (57:44):
I don't, he's a cat.
He's got nine lives.
Like, I think he's about 42.
unknown (57:50):
Oh my god.
SPEAKER_00 (57:52):
Yeah.
Oh, well.
So anyway, we'll give thelisteners some more chances to
do, but I do, yeah, we do havemore if we ever run out of uh
material.
SPEAKER_02 (58:03):
Oh my goodness.
Yes.
Well, thank you, Adam, forsharing.
So yeah, uh, what can we expectto hear next week then?
Well, I mean, it's the holidayseason, so it's like, what could
be like lighthearted medicalcrime?
And and so I landed on somethingthat isn't necessarily crime,
(58:24):
but it's like healthcare andmedically interesting.
This guy named Brian Johnsonthinks he's never gonna die, and
he's got a formula, and I wantto talk about how Brian Johnson,
this multimillionaire who looksa lot like other multi-billion
dollar entrepreneurs, like ElonMusk.
SPEAKER_00 (58:50):
I'm like trying to draw up in my mind, like, what
does this mean?
SPEAKER_02 (58:53):
No, he looks like Elon, but he's not Elon.
But like, what science whatscience is behind this?
What medical mysteries does hethink he's conquered?
Because he thinks that he's gothe's like the ultimate medical
experiment for how thisgeneration can live forever.
So he's just basically, andthere's a whole documentary
(59:16):
about him called Don't Die.
But he thinks he's not gonnadie.
So we're gonna learn more aboutBrian Johnson.
Okay, cool.
I can't wait.
I can't wait to learn how to notdie.
Exactly.
Well, and and honestly, as Ilearn what he's doing with his
life, I'm like, I don't know ifI want to do that.
(59:38):
Okay.
Anyway, y'all can be the judgenext week.
But meanwhile, don't miss abeat.
Subscribe or follow Doctor andthe Truth wherever you enjoy
your podcast for stories thatshock, intrigue, and educate.
Trust, after all, is a delicatething.
You can text us directly on ourwebsite at Doctoringtruth at
(01:00:01):
Buzzbrot.com.
Email us your own story ideasand comments at Doctorinthe
Truth at Gmail.
And be sure to follow us onInstagram at Doctoring the Truth
Podcast and on Facebook atDoctoring the Truth.
We're on TikTok at Doctor in theTruth and at oddpod e d aud.
(01:00:22):
Don't forget to download, rate,and review because those reviews
are really, really helpful.
So leave a review.
And then we can be sure to bringyou more content next week.
Until then.
Stay safe and stay suspicious.
SPEAKER_00 (01:00:42):
I was just thinking like, yeah, review, you're gonna
learn how not to die next week.
That's a five-star baby.
So until then.
Bye.
Goodbye.
Goodbye, Toodaloo Adios.
Boop.
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