How would you feel if you moved to a new hospital and discovered that their mortality for the cases you were doing was twice the national average? Would you try to get things changed? And if you succeeded then would you expect to be treated as a saint or a sinner?
Twenty two years ago Dr Steve Bolsin found himself in this position when he took up a post in childrens heart surgery. After many years of struggle he got things changed - but at a huge cost to himself. Now it is time for British medicine to acknowledge the contribution of this unsung hero.
Dr Bolsin was appointed as a consultant anaesthetist in September 1988. Almost immediately he realised that there were problems in Bristol with the conduct of open heart surgery in children. He was particularly concerned about the long duration of surgery and bypass, and the consequent effect on postoperative outcomes. He soon raised this with his professor and his departmental chairman.
The Professor of Anaesthesia in Bristol recalls that Dr Bolsin had: “…expressed his concerns to me about problems in managing small babies following cardiac surgery… He was concerned that the mortality in this group of patients was much higher than he had been accustomed to… I advised him that rather than create waves with little credible evidence, he would be better advised to collect prospective data on babies and children who he anaesthetised for cardiac surgery in Bristol.”
Bolsin carefully audited the process, and continued to draw attention to the problems. In one of his letters he pointed out that the mortality for open-heart surgery in babies was “one of the highest in the country”. He expected that this letter would get a positive response. But instead of a commendation, he received a rebuke, and was sent away to collect more data.
Further data collected over the next three years showed the same patterns. He audited not only the anaesthesia and intensive care, but also at the work of the perfusionists and surgeons. The findings repeatedly demonstrated that there was a high mortality for children having major heart surgery.
At no stage was he told that he was wrong or mistaken in seeking to gather information, and he received assurances that the matter would be looked into. But nothing changed.
Between 1992 and 1995, he became progressively more desperate. He secured the help of senior doctors in other hospitals, the press and the Department of Health. For this he was rebuked, being told that he should not take information to ‘outsiders’ and that he should ‘keep his head down’. As the data he collected become more solid, his working environment became increasingly hostile.
A compounding factor was the uneasy relationship between anaesthetists and surgeons. He found that the surgeons ruled the roost, which made it difficult for any anaesthetist to appear critical of a surgeon.
After many years of adversity his data was finally acted upon. The death rates for children’s heart surgery in Bristol were dramatically reduced as a result of his determined efforts.
He also catalysed the development of a new process in medicine - clinical governance. It’s now used routinely to study and improve medical care across the country. And he was elected as the first national audit coordinator for the Association of Cardiothoracic Anaesthetists of Great Britain.
But here the tale turns sour. His career took a major nose dive, and he found himself unable to work in the UK. He eventually moved to Australia. He’s a forgotten hero of British medicine and, having recently had a quadruple bypass of his own, must wonder whether it was worth it.
The great and the good tell us that we should be impartial and committed, and that Good Medical Practice is based around the concept of integrity. The reality of whistleblowing is that the brave honest and committed doctors who attempt to change things risk professional suicide and spending the rest of their careers in the wilderness. Yet the smiling face of the Professor who Bolsin originally turned to for help is captured forever on an oil painting that hangs in the royal college.
Fortunately the British have a way to recognise and acknowledge the significant contributions that Dr Bolsin made to patient care. The Honours System exists for precisely this purpose. A group of his friends and supporters are now in the process of completing an application for him.
Remedy believes that the awards mechanism of the establishment should be used to bestow honour upon those who truly deserve it. We would wholeheartedly support this application, and invite our supporters to do the same. And there is a Twitter Group to support the campaign.
Tags: Bristol Inquiry, Whistleblowing
Steve’s perseverance was remarkable, but what a price he had to pay. Through it all he never lost sight of the important issue - patient safety - and for that he has my utmost respect.
The website to submit to is http://www.steve-bolsin.com
We need as many supporters by letter [ we are happy to publish or not to publish depending on the supporter's choice]
Many thanks
Bolsin4UKHonour
http://www.steve-bolsin.com
Stephen Bolsin sacrificed his career to establish the truth of what went on in Bristol, knowing that this would be the likely outcome. Those of us who were his UK contemporaries offered scant support and for much of the time he must have felt alone. I had no direct contact with the case yet I feel I must shoulder my portion of the blame. Collectively we should have done more, much more. Therefore I send my own apologies, and support the call for him to be included in the UK honours list as the best way of saying “sorry for not supporting you when you needed it most”
Signed Derek Gray (Professor of experimental surgery, University of Oxford)
http://nhsexposedblog.blogspot.com/2010/09/persecution-of-nhs-whistleblowers.html
Persecution of NHS Whistleblowers
These days, new reports have emerged whereby Managers fabricate malicious vexatious, frivolous, if not minor allegations of sexual assault against whistleblowers and report them to police. The only thing required is a police report and the whistleblower is in the dock and the word of one person becomes a wider investigation with millions spent in court to bring the issue to trial. The spectre of “investigation” begins where attention from the real issues [ eg poor care] is diverted by persecuting and discrediting the whistleblower. The question we ask is this, does the Crown Prosecution Service have any concept of organisational reprisals as applied to whistleblower? It is interesting that a vexatious frivolous allegation will be energetically taken up by the police and the CPS thereby wasting millions of tax payers funds, yet the case of Dr Jane Barton who ended the lives of many was dropped at the first stage.
Simultaneously, the Managers may refer him/her to GMC/other regulatory bodies and the poor person appears before the Interim Order Panel (IOP).If s/he is vigilant and has all the records of complaints, there is 50/50 chance that he may face sanctions until the issue is resolved by police which takes almost a year before the case reaches trial. During that period, the health professional has to disclose this GMC investigation in all his or her job application forms.
Meanwhile, s/he/ may well be suspended by the Trust, has lost his/her good name and if a locum, s/he is unable to work with other agencies as the Enhanced CRB disclosure will contain these charges and even the existing agency may not offer him/her a job. So virtually s/he is jobless with huge gap in his/her C.V, which has to be disclosed . He/She will have no other option except to find job secretly and hide him/herself from Managers who are ‘haunting’ and all out to spread more rumors to colleagues and prospective employers.
So after discovering, the NHS staff is subjected to allegations of sexual assault , the employer will try subtly ask him/her to leave or will not extend his/her locum and will be rigorously watched as a ’suspect’. So he/she has lost his/her friends, confidence, trust and avoids attending conferences fearing he/she may have to face members who had subjected him/her to subtle surveillance and organized mobbing.
Now the case reaches court. The prosecution may deny that it has anything to do with whistleblowing and wants reasons for malicious allegations. The NHS staff defends themselves by saying it’s part of organized mobbing and it takes a huge amount of courage and risk to whistleblow and the allegations are premeditated just to discredit complaints.
Though the defendant says, the complainant might have motive to make allegation and the complaints might have gone to Care Quality Commission (CQC) who could have downgraded star rating leading to job losses affecting the complainant herself, the problem is how to convince the Jury which comprise only 12 ordinary individuals on electoral register who might have relavant prejudices/ bias . Also the defendant might not be articulate and impressive and lose the case altogether. So the consequences are that an innocent has a criminal record and ends up on sex offenders register, has ruined his/her career with no livelihood, out of medical profession and virtually unable to find a job overseas as he/she would be erased from the GMC/Other regulatory bodies’ register.
Another scenario!!! the Jury may not reach a verdict and it could be a hung jury. The CPS may ask for re-trial. Are the consequences easily understandable to the public?. How can s/he prove her/his innocence if he/she is not in the UK and how can he defend without earning. How can s/he seek the services of a solicitor to challenge Enhanced CRB disclosure even if the charges are dropped but appear under ‘other relevant information section’ of the Enhances CRB Disclosure. The scenario is such that even if the charges against a whistleblower are dropped, the very fact there was an “investigation” is held against his or her name. The prejudice and stigma will be a lifelong sentence.
These are a few of endless problems such as Appraisal/Revalidation/CPD being faced by whistleblowers. If they raise concern, they are prosecuted, if not still persecuted.
Is there anyone in the town who dare to speak and help NHS Whistleblowers/????????