healthmedicinet

“In my experience this culture of denial is a problem across the whole NHS,
but I’ve never seen it as bad as it is at MTW. Rather than owning up to
mistakes and trying to do something to rectify them a blame game takes
place.”

This newspaper revealed
earlier this month how Maidstone and Tunbridge Wells hospitals were
forced to stop carrying out keyhole surgery for upper gastrointestinal
cancer (GI), on the instruction of The Royal College of Surgeons (RCS),
following the unexpected death of five patients who had undergone the
procedure in December 2012 and early 2013.

The RCS ordered that all laparoscopic, or keyhole, upper GI procedures from
Maidstone and Tunbridge Wells should be carried out by St Thomas’s Hospital
in London for at least 12 months and until improvements could be shown.

^{From left: Ahmed Hamouda, Amir Nisar and Haythem Ali}

Three surgeons, Professor Amir Nisar, Haythem Ali and Ahmed Hamouda, were
barred from carrying out the procedure on the recommendation of the RCS, but
have been allowed to continue general surgery at the hospitals.

But the RCS’s report said doctors and nursing staff had warned managers about
the surgeons as far back as 2011.

It gives details of an anonymous letter from member of staffs at Maidstone and
Tunbridge Wells to the General Medical Council in May that year, raising
concerns about “dangerous and unethical practices” in surgery. This letter
was forwarded on to Dr Paul Sigston, medical director for MTW.

The report, which was only published in full for the first time last week
following complaints of a ‘cover-up’ from families of the dead, found that
staff had repeatedly raised their concerns, saying: “Some staff had formally
documented their concerns in correspondence with clinical managers.”

The RCS found a disturbing catalogue of faults at the hospitals, including a
“dysfunctional working relationships” between surgeons, a “lack of personal
responsibility for patient care” displayed by the three surgeons in question
and “secretive” working practices by the three which caused problems in
treating patients effectively.

It concluded of Professor Nisar, Mr Ali and Mr Hamouda, that all three had
showed “poor insight” into the deficiencies in the service.

Lawyers for relatives of the dead are now examining more than 20 deaths and
serious complications which may have been caused by problems during the
keyhole procedure, with the families of those who died preparing to take
legal action against the trust for negligence.

There are fears that the three surgeons may have been too enthusiastic about
using the keyhole procedure as a way of boosting their own prestige. One of
the operations, which resulted in the death of a 51-year-old man, was
broadcast live to a conference of consultants and surgeons who had paid £900
to attend.

The doctor told The Telegraph the problem with the laparoscopic procedure
predated the deaths of the five patients and was not restricted to Mr Ali,
Professor Nisar and Mr Hamouda.

“I’m afraid that from my experience the problems have been going on for
several years and aren’t limited to those three surgeons,” he said.

Among the new cases to emerge is that of Brian Choppen, a classic car dealer
who died after months of agony following complications resulting from
keyhole surgery for stomach cancer carried out by Mr Ali in January 2010.
Despite going back to AE on several occasions it was only when a duty
surgeon examined Mr Choppen in June 2010 that a serious blockage was
discovered. The 70-year-old was immediately rushed into theatre for
exploratory surgery, but died of multiple organ failure a few hours later.

Mr Choppen’s wife Patricia, 70, of Oxted, Surrey, said: “If they had found
that blockage earlier Brian would have had a better chance of survival. But
Mr Ali and his surgical team didn’t examine him at all after the first
operation. It took a duty surgeon in AE to realise something was
seriously wrong.”

The doctor, who is in his early 30s, has asked for his identity to be kept
secret, fearing his job prospects and career in the NHS will suffer if he is
revealed to be a whistleblower.

He told how one woman died in 2010, after a chest drain during keyhole surgery
damaged a major artery. Staff rushed her back into the operating theatre
from intensive care, but she bled to death on the operating table. At the
same time a male patient spent long periods in intensive care after a leak
to his thoracic duct following the procedure.

The doctor joined the trust more than more than three years ago on a training
rotation, after working at another hospital in southern England following
his qualification medical school. He now works at another NHS hospital.

He said: “I noticed very quickly that things weren’t right with the way the
procedure was being carried out at MTW, so much so that I said to my parents
that if they ever needed that kind of procedure they should never have it
done there. I certainly would not. In some cases it was a case of one
surgeon showing off rather than doing what was best for the patient. Another
surgeon was prone to being very slap-dash, going from one theatre to another
without srcubbing in again and so risking cross-contamination.”

The doctor’s fears appeared to be confirmed when a friend pointed out that St
Thomas’s Hospital’s outcomes for the same procedure were far better than
MTW’s.

“It was when I was told about the St Thomas’s figures that I realised
something was really wrong. It seemed to be the case that while our patients
were undergoing prolonged stays in intensive care and were prone to internal
leaks after surgery, those at St Thomas’s were generally able to go home
after a few days fit and well,” he said.

The trust initially suspended operations in December 2012 following the
unexpected deaths of two patients on consecutive days. On investigation it
reported a ‘good track record’ with no deaths in 2011 and the procedure
resumed in January 2013.

However, it was again halted following three deaths in February, April and
July 2013. The Trust did not record these deaths as serious incidents “as
each case had been examined and was not felt to be inappropriate,” the
report states.

Maidstone and Tunbridge Wells NHS Trust rejected claims it ignored staff
warnings. A spokesman for the trust said: “We have a robust ‘Speak out
safely’ policy, which proactively encourages members of staff to report
concerns at the earliest opportunity.

“There is not a ‘culture of denial’ about problems and mistakes and this is
evidenced, for example, by the fact that the Trust commissioned an
assessment, by the Royal College of Surgeons, of its own upper GI cancer
surgery service last year as part of its own review of standards.”

The trust said it could not comment on the outcomes of procedures at other
hospitals, but that its overall mortality rates for upper gastrointestinal
cancer surgery were within national expected levels.

Case Study: ‘If something had been done sooner he might still have
survived.’

^{Brian Choppen with his wife Patricia (Geoff Pugh)}

Patricia Choppen’s husband Brian died after months of agony in 2010, following
complications resulting from keyhole surgery for stomach cancer – a
procedure similar to the one his surgeon at Maidstone and Tunbridge Wells
hospitals was subsequently banned from performing.

At the time, though wracked with grief, Mrs Choppen tried to accept what had
happened as the sad, but perhaps unavoidable, consequence of her husband’s
illness.

But something at the back of her mind pressed her to keep asking questions of
the hospital and it was one answer in particular that made her realise that
all was not right with the treatment Mr Choppen had received.

In fact, when she heard it she began to question everything she had been told
about his condition and subsequent death.

It was when his surgeon, Haythem Ali, denied knowing that Mr Choppen had been
readmitted for emergency treatment in AE several times in the months
that followed his laparoscopic oesophagectomy in January 2010, that made her
lose faith.

In response to an official complaint submitted by Mrs Choppen to Maidstone and
Tunbridge Wells Hospitals Trust, Glenn Douglas, its chief executive, said:
“Had Mr Ali known that Mr Choppen had continued to return to the AE
department he may well have instigated an earlier operation with a camera.”

The answer caused deep distress to Mrs Choppen. “It was unbelievable,” she
said. “Every time my husband went back into AE, because he was in
such pain and not improving at all, I informed Mr Ali’s surgical team. I
always told them he had been admitted. How could Mr Ali not know?”

In fact it was only when a duty surgeon in casualty examined Mr Choppen in
June 2010, during one of his emergency readmissions, that it was realised
how serious his condition had become. The 70-year-old was immediately rushed
into theatre for exploratory surgery.

This found that he had suffered a blockage as a result of the first operation
five months earlier. Mrs Choppen was sent home to rest, but when she
returned to the hospital the next day she was told her husband’s condition
had deteriorated dramatically. He died of multiple organ failure a few hours
later.

She said: “If they had found that blockage earlier Brian would have had a
better chance of survival. But Mr Ali and his surgical team didn’t examine
him at all after the first operation. It took a duty surgeon in AE to
realise something was seriously wrong.

“After the first operation Brian had been in agony a lot of the time. There
were times he’d be writhing around in pain.”

Mrs Choppen, 70, is angry that at a time when she should have been enjoying
retirement with her husband, who loved walking the couple’s dogs and
listening to his collection of classical music, she is instead still having
to ask questions about his death.

She is equally angry that although Mr Ali was barred by the Royal College of
Surgeons from carrying out laparoscopic, or keyhole, surgery for upper
gastrointestinal cancer (GI) that led to the deaths of five people at the
trust in 2012 he is still being allowed to perform general surgery.

“My husband was a fit and well man before he went in for his first operation,
despite the cancer,” she said. “If something had been done sooner top
rectify the mistakes in the first procedure he might still have survived.”

The trust maintains that Mr Choppen was “investigated thoroughly” each time he
attended AE, including CT and ultrasound scans and there was “no
evidence in the records which would have given an early indication of the
final diagnosis”.

However, it did admit that doctors might have taken a decision to operate
again earlier, “had the clinicians known at the time about the sequence of
attendaces at AE”.