The suspended Leeds cardiac surgeon, Nihal Weerasena, has had a further condition attached to his registration status with the General Medical Council (GMC).
Child heart surgery at Leeds General Infirmary
Weerasena has not been practicing at Leeds General Infirmary since March 2013. Around the time that the child cardiac unit at Leeds was temporarily closed on the orders of Professor Sir Bruce Keogh, medical director of NHS England, it emerged that Weerasena had ceased carrying out surgery, in what the hospital Trust has claimed was a voluntary cessation of his duties. He was subsequently referred to the GMC, and an investigation into his fitness to practice is awaited.
The timing of the suspension, coinciding as it did with the controversial and bitterly opposed NHS England intervention at Leeds, was unfortunate, as speculation has inevitably arisen over the links between the two events.
The Trust made emphatic denials that his suspension had anything to do with mortality rates, despite information later revealed in Freedom of Information requests suggesting that a Leeds surgeon's mortality data had been drawn to the attention of Professor Keogh.
We recently wrote an article, What is Really Happening at Leeds General Infirmary? detailing the concerns and unanswered questions besetting the unit. We now have some further insight, from the GMC website, as to the conditions placed on Weerasena.
The GMC Specialist Register
The GMC Specialist Register for Weerasena states that he must not accept certain medical posts without notifying the regulatory body, and cannot undertake any private practice.
A recently-added condition is that 'he must be supervised in all of his clinical work by a clinical supervisor'.
This is a significant restriction for a senior cardiac surgeon of many years' standing. The reasons behind the condition remain unclear; in addition, we still do not know who initiated the complaint process with the GMC, and whether the referral was from a source at the Trust. He remains listed as part of Leeds' cardiac team on the Trust's website and the National Institute for Cardiac Outcomes Research (NICOR) site.
Questions over Mr Weerasena
This was in fact the second occasion on which concerns had been raised over Weerasena's competence; in 2005, the Trust called in the Royal College of Surgeons to review his surgical practices. However, the report arising from this investigation has never, to our knowledge, been made published.
The 2013 suspension is believed to have been connected to excess mortality figures relating to the performance of a particular kind of surgery or the use of a particular heart valve. We act for a number of families whose children were operated on by Weerasena prior to his suspension and suffered fatal and other adverse outcomes. None of these parents have subsequently been told the reason for the suspension, leaving them with nagging doubts as to his competence and what effect this may have had on their children's outcomes.
If this really was a voluntary cessation of his duties, in recognition of any technical shortcomings, this may be to Weerasena's credit. So little is known about the context of his suspension, however, that it is difficult to see a way to exonerate him. The conditions now imposed by the GMC, including the requirement for close supervision, suggest that serious concerns must be addressed.
If Weerasena is to resume his surgical duties at some point, whether at Leeds or any other centre, serious questions will emerge about what we know about our cardiac surgeons. In this era of transparency and accountability, and with the statutory duty of candour entering its second year, the duty to disclose concerns of this kind seems to be conspicuous in its absence.
What if parents of children operated on by Weerasena had known that there were concerns over his fitness to practice? If any lack of competence or experience on his part had affected the outcomes for his patients, and it is hard to accept that it would not have, this, arguably, might have affected parents' understanding of the risks to which they were agreeing to expose their children.
They may, with access to all the facts, have considered taking their children elsewhere for surgery, particularly if the execution of a particular operation had been flagged as a point of concern for Weerasena. There is an argument, therefore, that parents were not given the opportunity to give valid consent for their children's surgery at Leeds.
Should parents have been made aware of the hospital's concerns over Weerasena, dating back to the Royal College of Surgeons investigation of 2005? Shouldn't this kind of information, relating to a surgeon's experience and competence, perhaps in a particular, complex operation or procedure, form part of the duty to inform patients when consenting to treatment? From a duty of candour perspective, this kind of information should certainly form part of a hospital's duty to give a meaningful explanation to families when a patient has suffered harm.