Britain's botched operations

By John Sweeney BBC reporter, Sweeney Investigates

Foreign surgeons working in private hospitals have helped reduce NHS waiting lists, but a six month BBC investigation has uncovered an alarmingly high number of botched operations. Investigative reporter John Sweeney found some surgeons with failure rates above 50% for routine operations.

Are patients being used as guinea pigs for this government initiative?

Tony Blair boasted of a job well done when maximum hospital waits fell from two years to six months at the end of 2005, thanks to the "fast-track" strategy of outsourcing surgery to doctors, trained abroad, in private hospitals.

But confidential health authority investigations into fast-track botches tell of a chaotic mess, where blundering surgeons have operated on unsuspecting NHS patients with catastrophic results.

And one audit of 70 operations at a private hospital found "serious concerns" about a staggering 67% of them.

Now senior doctors fear that, despite millions of pounds spent on fees for fast-track surgeons mainly from Europe - some were paid up to £2,500 a week, there will be a rash of early failures and repeat operations.

"In 40 years experience, I have never come across quite so many operations needing to be repeated in such a short time," says Mr David Dandy, vice-president of the Royal College of Surgeons.

Routine surgery

Patients who have had their lives ruined by botched "fast-track" operations include policeman Dave Foskew from Clacton, who went to the Nuffield Ipswich for a routine knee operation last summer.

He suddenly found himself being rushed to the local NHS hospital in a desperate bid to save his leg from amputation.

Fast-track surgeon Arpad Illyes from Hungary had severed Foskew's femoral artery, as well as chipping the bone and fitting the new knee joint at the wrong angle.

The NHS managed to save his leg, but PC Foskew still cannot walk without pain.

Illyes had a fine CV, but of the 18 operations that he did, 12 were found by an independent surgeon to be poor.

The surgeon was banned for 18 months by the GMC in March 2005

Another victim is retired dinner lady Phyllis Brown from Cambridge, whose knee tendon was severed by surgeon Roland Istria, head of the orthopaedic department in a large hospital outside Paris, in 2004.

Mrs Brown said: "He didn't kill me but he may as well have because I can't ever, because of him, do the things I used to do."

Out of 15 operations by Istria, nine were found to be poor - a failure rate of 66%.

The average NHS failure rate in this field is 2%.

Both Istria and Illyes have been suspended from practising in the UK by the General Medical Council.

Blocked records

The damning evidence on fast-track botches has been uncovered by a six-month BBC investigation, with little help from the Department of Health.

We put 20 requests under the Freedom of Information Act to find out more.

All 20 were blocked.

The Department of Health said giving us the information would impede their own investigations and conflict with commercial confidentiality.

Health secretary Patricia Hewitt declined to be interviewed.

Her department issued a statement saying that patient safety is a paramount concern.

Corrective surgery

Pensioner Elaine Cowan had a hip replacement operation at the Nuffield Cheltenham in 2004 which left her crippled. It was performed by Dr Matthias Honl from Germany.

A hip replacement operation left Elaine Cowan in unbearable agony

Looking at her X-ray, a screw can clearly be seen protruding from her new thigh cap through the thin wall of her pelvis, into her abdominal cavity.

"It felt like 100 hot pokers going through your leg and up into your hip," said Elaine.

"He shouldn't have operated on a dog, let alone a human being."

NHS hip surgeon Dr Gordon Bannister had to carry out a second operation on Elaine to correct the first.

And alarmingly, it has become apparent that because corrective surgery had been carried out, Elaine's operation was actually considered on overall success.

Ros Gray, the clinical director of the Nuffield Hospitals group, one of four main contractors for the fast-track system, told us: "We have treated some 18,000 patients under that scheme and have had very good results for the majority of them. We've had incidents in fractions of 1%."

I put to her that therefore the fast-track had seen a 99% success rate and she replied: "As far as we're concerned, yes."

Good references

You can't import surgery like you can import goods Dr Matthias Honl

The general manager of the Nuffield Cheltenham, Sheila Richards, wrote to Elaine in November 2004, saying: "Dr Honl did crack your femur during surgery.

"This is a known risk of a hip placement operation. The subsequent rewiring is accepted as the correct procedure to follow."

On paper, Dr Honl is the model surgeon, with good references and a seemingly impeccable track record in Germany.

He now lectures on surgery at Rush University Hospital in Chicago and remains free to operate in Britain.

He appeared to be shocked that his surgery had been criticised and stated he had been cleared by Nuffield Hospitals only two days before he was interviewed.

Regarding Elaine's case he said: "I would say sorry to Elaine Cowan. It was never my goal to make her worse than before my surgery. But all of these things can happen, even to a British surgeon."

'Import' strategy

Confidential health authority investigations into Istria and Honl, at the Nuffield's Cambridge and Cheltenham Hospitals, make for ghastly reading for health secretary Patricia Hewitt.

The investigation into Nuffield Cheltenham and Honl revealed that the Nuffield have undertaken "a gap analysis research project between UK educated and foreign educated consultants", something which, perhaps should have happened before the foreign surgeons began to operate.

But perhaps the most damning verdict on the fast-track success is from Dr Matthias Honl himself.

He said: "You can't import surgery like you can import goods. Just to fly a surgeon in is not the solution."

In a statement to the BBC, the company said: "Nuffield regrets that despite proper recruitment procedures being followed, a very small number of the doctors recruited failed to perform according to Nuffield's standards. As a result, after initial problems were identified, Nuffield applied and developed additional measures for checking potential doctors' qualifications, competence and experience in advance of their beginning work.

"Nuffield Hospitals accepts that the radiologists in Leeds identified a cause for concern in 67% of the 70 X-rays reviewed. Any incident arising from procedures involving these 70 patients is included in Nuffield's overall incident rate of well below 1% of almost 17,000 procedures."

Sweeney Investigates: Botched Operations is on BBC Two at 2050GMT on Thursday 9 March 2006.

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