The job of Mersey ambulance chief David Todhunter is hanging in the balance after his trust was forced to apologise to the family of a woman who died when her helicopter transfer was delayed because he became embroiled in a personal row.

A highly critical report has been published by North West regional office into the actions of the Mersey Regional Ambulance Service (MRAS) following the death of liver transplant patient Julie Donaldson in May 1999.

Mrs Donaldson was due to be flown from Warrington Hospital to St James University Hospital in Leeds for her operation.

A helicopter from private company North West Aero Medical Services (NWAMS) was ordered from Warrington.

But the MRAS decided to block the transfer because of what the report described as a 'deep personal antipathy' between MRAS chief executive David Todhunter and another key staff member at NWAMS.

Although the block was eventually lifted, the incident meant a three-hour delay before Mrs Donaldson reached Leeds. She died three days later.

The report said her death could not have been prevented but it was 'impossible to say with certainty whether the delay in transferring the patient may have had a bearing on the outcome of treatment'.

It ordered the trust to apologise to her family for making 'misleading omissions and incorrect assertions' in letters and statements to them following her death.

Last week the trust's board agreed to adopt the inquiry's recommendations to improve air transfer protocol.

Mr Todhunter has been on sick leave since the start of this month, but is expected back at his desk next month.

Trust board chair Basil Jeuda told HSJ: 'No decision has been made on Mr Todhunter's future.

He is ill, and it is a question of waiting until he returns to work and speaking with him about the report and the recommendations first before we consider any possible disciplinary action. '

Professor John Ashton, director of public health for North West region, which originally commissioned the inquiry, was critical of the trust's actions.

He said: 'It is unacceptable, it is a disgrace and it is certainly not the NHS at its best. It is a combination of bad personal behaviour with a systems failure. '

Professor Ashton said the fact that responsibility for any possible disciplinary action lay solely with the trust's board created a 'democratic deficit' and he promised to have a 'robust conversation' with the board. 'There are not the powers necessary to take disciplinary action against a chief executive in cases like this unless it comes from the trust itself. '

It is not the first time that Mr Todhunter has hit the headlines in recent months.

In February this year a senior manager with the trust, Anthony Cowley, was awarded a£105,000 compensation pay-out after suffering two nervous breakdowns.

Mr Justice Douglas Brown said the trust had been in breach of duty of care and described Mr Todhunter as 'confrontational'.

Meanwhile MRAS staff are threatening strike action over allegations that senior managers are failing to respond to their grievances and appeals.

The Ambulance Service Union is balloting 600 members, but a spokesperson said the action was not linked to Mr Todhunter's situation.