A former hospital manager claimed last week that 'crossing the bridge' from being a doctor to becoming a chief executive meant he could be held to account only as a manager.
Dr John Roylance, former chief executive of the Bristol Royal Infirmary, told the General Medical Council's professional conduct committee that he had to rely on the expertise of medical colleagues over clinical matters.
Dr Roylance, who is charged with serious professional misconduct for allegedly failing to act on warnings about the mortality rates of two children's heart surgeons, emphatically denied having been aware of any concerns before 1995.
He denied that a letter from Dr Stephen Bolsin in 1990 had said that the level of mortality was 'unacceptable'. Dr Roylance said the letter had sought improvements to paediatric cardiac surgery, whose morbidity and mortality levels were 'undesirable', in the context of the hospital's application for trust status.
Dr Roylance said that nothing in the letter, nor in a subsequent conversation with Dr Bolsin, had suggested that there was 'an unacceptable level of care at Bristol or that there were unavoidable deaths in Bristol - nothing. I say that very clearly and with total conviction.'
Articles in Private Eye magazine in May 1992, which allegedly exposed a high death rate among babies during heart surgery, had been dismissed as 'a poor attempt at satire'.
Questioned by Roger Henderson QC, for the GMC, Dr Roylance said he had first become aware of concerns when a conflict of clinical opinion emerged at the hospital in 1995. A case conference was called on whether to proceed with an arterial switch operation on Joshua Loveday, aged 17 months. The operation went ahead and Joshua died.
Dr Roylance said he had acted as soon as he was made aware of anxieties about paediatric cardiac surgery mortalities. He had ordered a 'quick and dirty' inquiry by two outside experts who could not be considered 'soft options called in to do a whitewash'.
He returned from holiday in Australia to find the report had already been written and promised to a BBC television reporter. His main concern at the time was a public relations one: the report had not been intended for publication and was potentially actionable.
'This image of a festering discontent, an anxiety, about paediatric cardiac surgery extending over a period of five years and ignored by everybody is a fiction.
'It did not happen and, therefore, questioning my failure to respond to anxieties that were not felt I find difficult to answer.'
Under persistent questioning by Mr Henderson on his duty as a doctor to protect patient safety, Dr Roylance said that every chief executive had that responsibility. Being a doctor made that responsibility neither greater nor less.
'I do not think if I had taken a part-time job as a bus driver, I would expect to be accountable to the GMC while I was exercising that responsibility, ' he said.
The case continues.