Heart surgery on boy, one, was performed 'appropriately' coroner rules
Heart surgery carried out on a one-year-old boy at a unit just days before operations were suspended over controversial claims about safety was performed "competently and appropriately", a coroner has ruled.
Max Haigh, from Scarborough, North Yorkshire, was operated on at Leeds General Infirmary (LGI) in March 2013, 10 days before paediatric cardiac surgery was suspended at the hospital on the orders of NHS England.
Max died three months later, a three-day inquest in Wakefield, West Yorkshire, has heard.
Children's heart operations at the LGI were stopped for almost a fortnight at Easter 2013 as a row erupted over the unit's safety.
But they resumed in a move which restarted a national debate about how child heart surgery centres should be organised.
The inquest heard how Max was born with a hole in the heart and other congenital cardiac problems, but doctors and his family initially chose to postpone any attempt at surgical correction until he was older.
Doctors decided an operation was appropriate at a later stage and surgeon Stefano Congiu tried to repair the hole on March 18 2013 - a procedure that was unsuccessful.
Max was discharged from hospital on April 11 but, a month later, his condition deteriorated and he was readmitted to the LGI. He died on June 12, 2013, from multi-organ failure brought on by a range of factors linked to his heart problems, the inquest heard.
On Friday, West Yorkshire assistant coroner Philip Holden said: "The decision to operate on Max in the first place was, I find, a reasonable one, taken in an effort to improve his life expectancy and quality of life."
The coroner said: "The surgery was performed competently and appropriately."
But he criticised Mr Congiu's record-keeping following the operation said he would be writing to the hospital trust to recommend improvements in this area.
Speaking after the hearing, Max's mother, Emma Melton, said: "We still have unanswered questions about the circumstances surrounding his surgery."
Supported by Max's father, James Haigh, Ms Melton said: "The procedure underwent was extremely complex and yet we were not warned beforehand of the nature of the surgery, the risks involved, or any alternatives such as delaying the operation until he was stronger."
She said: "We know that care for children born with a heart defect can be safer and, in spite of everything, we only want to see Leeds General Infirmary improve."
Ms Melton thanked the coroner, saying he had done "all within his power" to investigate what happened to Max.
She said: "Max was a bright and happy little boy who meant the world to us and, over the years that have passed since his death, we have never given up hope that we would find the truth behind what happened to him."
In her witness statement, which she read during the inquest, Ms Melton questioned the experience of Mr Congiu and whether the operation should have been performed at all at that stage in Max's life.
She also questioned whether, on the day of his death, staff were fully focused on his care as a number of journalists were on the ward that day conducting interviews.
The temporary suspension of operations in 2013 provoked huge anger and debate, especially as some people linked it to the ongoing controversy about which children's heart surgery units were to be closed as part of a nationwide rationalisation of the service.
A subsequent review found children's heart surgery at the centre was safe but a group of parents has continued to question the safety of the unit, which was originally scheduled to shut as part of the national reorganisation of paediatric care.
After the temporary closure and review of the LGI unit, the Government announced it would look again at the national reorganisation and has yet to decide on how it will proceed.
Dr Yvette Oade, chief medical officer for Leeds Teaching Hospitals, said the trust has co-operated fully with the coroner and fully accepted his comments about insufficient note-taking.
Dr Oade said: " Over the past two years work has been undertaken to address this issue."
She said: " On behalf of everyone at the hospital I'd like to express my sincere condolences to Max's parents and family. I fully understand that they had questions and hope this hearing has given them the answers they needed."