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Consultant surgeon Robert Smith
"These were very desperate patients"
 real 28k

David Nisbet reports
"Operations were 'for the good of the patients'"
 real 28k

BBC Scotland's Kate Fawcett reports
"Body Dismorphic Disorder - an 'ugly duckling syndrome'"
 real 28k

Falkirk Royal Infirmary surgeon Robert Smith
"It took me a year and a half before I did the first operation"
 real 28k

Monday, 31 January, 2000, 19:39 GMT
Surgeon defends amputations

amputations graphic The amputations cost an estimated 3,000 each

The surgeon who amputated healthy limbs from private patients suffering from a psychiatric disorder has defended his decision to carry out the procedures.

Dr Robert Smith spoke out in the debate over the ethics of the operations at Falkirk and District Royal Infirmary.

The trust which runs the hospital has confirmed that no action will be taken against Dr Smith but the chairman has described as inappropriate this type of surgery in an NHS hospital.

I became increasingly convinced that the patients had had very little success from their treatments by psychiatrists and psychologists over the years
Dr Robert Smith, surgeon
Both patients were suffering from Body Dysmorphic Disorder, which convinces people that some part of their body is defective and the obsession takes over their lives.

In the first case, an English patient said to be close to suicide had the lower part of a limb removed in September 1997.

Dr Smith took advice from his professional organisation and consulted the hospital's then medical director Douglas Harper. Written permission was received from the chief executive Margaret Duffy.

'Considerable thought'

The second case involved a man from Germany who had heard that the hospital was willing to carry out the procedure. This went ahead in April 1999.

The operations are understood to have been carried out in National Health Service theatres and involved NHS staff but the men were private patients. Each paid an estimated 3,000 each for their treatment.

Dr Robert Smith Dr Robert Smith: "Surgery was the only redress"
Dr Smith was asked by BBC Scotland why he chose to go ahead when other doctors had refused.

"It gave me considerable pause for thought and it took me a year and a half of investigation before I agreed to do the first patient," he replied.

"I became increasingly convinced that the patients had had very little success from their treatments by psychiatrists and psychologists over the years.

"These two patients had been fully assessed by two psychiatrists, one of whom has an interest in gender reassignment disorders, and also by a psychologist."

'No fee received'

Dr Smith said all three were convinced that surgery was "the only possible redress for this quite seriously disabling condition".

"The one concern is that many of these individuals will in fact injure themselves. There are quite a lot of anecdotal reports, largely from the States, of people taking the law into their own hands, lying on a railway line or shooting their legs off with a shotgun."

He also stated: "I did not actually receive any fee whatsoever for either of these procedures. The patients were private patients in the hospital and the hospital charged a fee but I had no financial return from these patients at all."

Ian Mullen Ian Mullen: "Inappropriate for NHS hospital"
The hospital's Ethics Committee was brought in after a request for an amputation was made by a sufferer in America.

The second operation had taken place shortly after the hospital became part of Forth Valley Acute Hospitals NHS Trust and a new management team had been put in place.

The matter was referred to chief executive Jim Currie and permission was later refused.

At a news conference on Monday, trust chairman Ian Mullen said: "I don't belive it's appropriate for this type of operation to go ahead without consideration being given to the potential implications for the local reputation of the hospital and the concerns that might arise among the local population.

'Importing patients'

"I also don't believe it's appropriate for an NHS hospital like the one here in Falkirk to be importing patients and treating them privately where this is clearly an unusual procedure."

Falkirk West MP Dennis Canavan said he found it "incredible" that a surgeon would amputate a healthy limb.

"I would have thought that the General Medical Council would have an ethical code forbidding such a practice," he said.

A spokeswoman for Scottish Health Minister Susan Deacon said there would be no government inquiry into the affair.

She said: "Where the proposed treatment is in such a controversial area and is carried out in an NHS hospital in Scotland for patients coming from elsewhere specifically for such an operation we would expect the NHS Trust Board to be fully involved.

"It is their responsibility to assess, with advice of appropriate experts, whether or not the treatment should be carried out in their hospital."

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See also:
31 Jan 00 |  Medical notes
Body Dysmorphic Disorder Factfile
31 Jan 00 |  UK
Fit and well - yet in hospital

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