Heart surgery carried out on a 14-month-old boy at a Leeds unit just days before operations were suspended over controversial claims about safety was performed “competently and appropriately”, a coroner has ruled.
Dr Yvette Oade said: “After hearing the evidence the coroner confirmed that the operation undertaken on Max was performed competently and appropriately and post-operative care was also good.
“We note the coroner’s ruling about the note-taking being insufficient and fully accept these comments. Over the past two years, work has been undertaken to address this issue. On behalf of everyone at the hospital I’d like to express my sincere condolences to Max’s parents and family.”
Max Haigh, from Scarborough, was operated on at Leeds General Infirmary 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 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 later decided an operation was appropriate 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 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.
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.
Max’s mother, Emma Melton, said after the inquest: “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.”
“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.”
She added: “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.”
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.