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Dysfunctional surgeons put patients at risk at heart surgery unit – report

An investigation looked into St George’s Hospital in south London.

A “toxic” feud between two rival camps at a troubled heart-surgery unit left staff feeling a high death rate was inevitable, according to a leaked report.

St George’s Hospital heart unit was consumed by a “dark force” and patients were put at risk by a dysfunctional team of surgeons, an investigation concluded last month.

The damning review was written by former NHS England deputy medical director Mike Bewick in response to higher mortality rates at the hospital.

He found the south London facility had a cardiac surgery death rate of 3.7% – above the national 2% average, reports said.

Internal scrutiny was said to be “inadequate” and the department was riven between “two camps” exhibiting “tribal-like activity”.

Professor Bewick’s review was quoted as saying: “Some felt that there was a persistent toxic atmosphere and stated that there was a ‘dark force’ in the unit.”

It added: “In our view the whole team shares responsibility for the failure to significantly improve professional relationships and to a degree surgical mortality.”

Conversations with 39 staff revealed they were shocked by the death rate, but “most felt that poor performance was inevitable due to the pervading atmosphere”.

The independent reviewer examined “disturbing and often difficult information”, concluding an “existential threat” was posed to the unit because staff and patients would go elsewhere if problems persisted.

“The surgical team is viewed as dysfunctional both internally and externally,” he said.

We would like to stress that the cardiac surgery service we provide for patients is safe. However, it is very clear that major and urgent improvements are required, which we are already taking action to deliver St George's spokesman

Stronger leadership and “new blood” were called for, while the “defensive approach” the unit took to death rate data was criticised, according to reports.

The review was additionally said to have called for “radical solutions to breaking up the current surgical team”.

A spokesman for St George’s Hospital said recommendations from Professor Bewick were being implemented “at pace”, including the immediate relocation of all cardiac surgeons to a single-speciality practice.

The investigation commissioned in June after the National Institute for Cardiovascular Outcomes Research (NICOR) issued an alert over the unit’s lower surgery survival rates.

The hospital spokesman said: “We would like to stress that the cardiac surgery service we provide for patients is safe.

“However, it is very clear that major and urgent improvements are required, which we are already taking action to deliver. ”

St George’s, one of the biggest teaching hospitals in the country, has advertised for an additional consultant cardiologist to join the team.

Fellow London hospital Guy’s and St Thomas’s Foundation Trust will send “on the ground leadership support” in the form of cardiac surgeons, the spokesman said.

Officials are additionally “addressing concerns” about the way surgery data is managed.

A spokesperson for the Royal College of Surgeons and the Society for Cardiothoracic Surgery, said: “The Society for Cardiothoracic Surgery (SCTS) informed St George’s in both March 2017 and March 2018 that analysis of their results showed that early survival after cardiac surgery at the hospital for the periods of activity 2013-2016 and 2014-2017 was lower than the expected level, although still within the UK standard.

“This is called an alert and does not automatically mean there is a cause for concern as there may be clinically valid reasons why the Trust has a worse early-survival rate than other units around the country.

“Cardiac surgery within the UK is amongst the safest in the world and St George’s has always shown that early survival for their patients is within what is regarded as the UK standard.

“It has never been below the required standard for the UK. All the other hospitals in the UK have shown that early survival after cardiac surgery is at the required standard, with only St George’s triggering the early warning alert over the last 4 years of surgery.

“Nevertheless the independent review has highlighted serious concerns so it is still crucial that St George’s address the findings of the report so that patients can be sure they are receiving the best possible care.”

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