• Top heart surgeon seeks High Court injunction to overturn recent suspension
  • Says she had reported concerns internally about safety and management at St George’s unit
  • St George’s says surgeon inappropriately tried to influence an independent review, and should remain suspended
  • Surgeon says she has been bullied, including being posted a dead animal and a decapitated doll
  • CQC carried out unannounced inspection of unit on eve of case

A major London teaching trust has had its suspension of a senior cardiac surgeon challenged in the High Court.

Among the case made by Marjan Jahangiri, who was suspended from the troubled cardiac surgery unit at St George’s hospital, is that she has faced harassment and bullying in recent years, including receiving an anonymous package containing a dead animal and a decapitated doll.

St George’s suspended Professor Jahangiri for two weeks on 9 August. Managers believed she tried to imperil an ongoing external review into the team, defying express instructions from the management.

This external review was commissioned by the trust in response to an external report completed last month – as previously revealed by HSJ - which said the department was seriously dysfunctional, laid bare poor relationships, and recommended it be substantially reconfigured.

It also follows several years’ of concerns about culture and about safety, including alerts about high mortality after surgery, at the unit.

St George’s Hospitals Foundation Trust extended Professor Jahangiri’s suspension for another two weeks on 23 August, the day before the legal hearing. On top of that came a second order to exclude her from work, issued on 24 August – one hour before the hearing was due to begin.

Professor Jahangiri’s legal team argued this was a clear attempt to upend their effort to obtain a remedy for their client. They argued the judge should injunct the orders to exclude her so that she could return to work.

The professor believes she has been victimised because she is a successful woman, because she is “Persian”, and because of serious concerns she has raised in recent years about the unit and trust.

She disputes the charge that she risked the probity of the ongoing enquiry, known as the Hollywood review after the firm of external consultants tasked with leading the investigation.

The trust argued the suspension must be maintained, in part to protect the continuation of the Hollywood review, and refuted that it was related to whistleblowing or discrimination.

It was an interim report from the Hollywood review that led the second exclusion notice being issued on the day of the hearing. The interim report was passed up to the judge in an unredacted form, marked private and confidential, so few details were revealed in court.

Part of the review concerns questions over patient safety, however the judge observed that it was “not patient safety in the usual sense”, adding that it is “once removed”.

Mr Justice Morris heard the case in the Royal Courts of Justice today. He reserved judgement on the case until Tuesday afternoon.

‘Poisonous situation’

Professor Jahangiri believes she has been subjected to harassment and bullying, including being the subject of malicious and unfounded allegations. She said the trust had “failed to protect her from such allegations and has allowed this poisonous situation to continue.”

She said her suspension was “the latest in a long line of detriments” she has suffered over the past four years from the trust in general, and, over the preceding 18 months, the acting medical director, Professor Andrew Rhodes, in particular.

The trust and Professor Rhodes both vigorously denied this accusation in their own written submissions. They also pointed to two external reviews that have criticised the attitudes of surgeons in the team, citing their individualism or tribalism as the cause of trouble.

Among the evidence given to the court by Professor Jahangiri was an incident in April 2017 when she received an anonymous package at her home address. It contained “a dead animal and decapitated doll”. She “strongly suspects” this package was sent to her in retaliation for raising safety concerns with the trust through a “protected disclosure” using whistleblower protection policies.

Her evidence statement to the court said: “This was incredibly distressing for me and my family and I still feel traumatised whenever I receive a package to my home address. I feared that we may be at risk of further harm. The next day I alerted the [trust’s] HR department… Two weeks earlier, I had made a protected disclosure to the [trust]…”

Professor Rhodes said it was “not practicable for the trust to seek to establish who had sent” the package, but that he had sought to stop such behaviour, including by writing to the staff of the cardiac service to make clear it was not acceptable.

The trust refuted the assertion that she was receiving “unfavourable treatment by the trust, including on the grounds of discrimination and whistleblowing”. It said professor Jahangiri “is an integral part of a unit that is not functioning effectively and she cannot separate herself from its problems”.

Bewick review

It is the latest development in a series of problems that have dogged St George’s cardiac surgical unit since at least 2010. This includes a surprise inspection of the unit by the Care Quality Commission on 23 August, following concerns being raised with the regulator about developments in recent weeks.

Last year the trust, which is in CQC special measures, was placed in “alert” by the National Institute for Cardiovascular Outcomes Research, based on rates of mortality in hospital after surgery.

It was the first trust in four years to be in alert status. In April this year, the trust received its second NICOR alert. It commissioned an external review of the heart surgery team, led by Professor Mike Bewick, former deputy medical director at NHS England.

As HSJ revealed last month, the Bewick review found there had been some progress since the mediation process but that the change was superficial. It found there was still considerable dysfunction in the surgery team and that little had changed since a similar external review of the surgery unit in 2010.

The reviewers produced several recommendations, first among them that “the current consultant cardiac surgical team membership is incompatible and requires restructuring with some urgency”. It suggests the trust consider unspecified “radical solutions to breaking up the current surgical team”. 

If it could not be resolves the trust faced losing the unit, the review said.