Earlier this year the Secretary of NSW Health - under the Health Services Act 1997 (NSW) s 122 - appointed Gail Furness SC to conduct an inquiry. The NSW Medical Council separately appointed Ms Furness to undertake a review of the management by the Council of complaints about Gayed.
The Tribunal's decision is
1. The respondent practitioner is guilty of professional misconduct.
2. If the respondent practitioner were registered as a medical practitioner the Tribunal would have cancelled his registration.
3. The respondent practitioner is disqualified from being registered as a health practitioner for three years from today.
4. The National Board is required to record the fact that the Tribunal has cancelled the practitioner’s registration in the National Registry kept by the Board.
5. Publication or broadcast without the leave of the Tribunal of the name or other identifying information in respect of any patient referred to in the proceedings is prohibited.
6. The respondent practitioner must pay the applicant’s costs of or incidental to these proceedings as agreed, or as assessed.The Tribunal states (at paras 37 to 73) that
The practitioner graduated with a Bachelor of Medicine and a Bachelor of Surgery in Egypt in 1976.
In 1993 he became a Fellow of the Royal Australia and New Zealand College of Obstetricians and Gynaecologists. He was first registered in New South Wales as a medical practitioner in 1994. He was registered as a “conditional specialist”.
In July 1997 the Health Care Complaints Commission received a complaint by a patient alleging that she had consented for a laparoscopy but the practitioner had performed a laparotomy.
In October 1997 there was a further complaint to the Health Care Complaints Commission that the patient’s bowel, ilium and uterus were perforated by the practitioner in a number of places ranging from 1cm to 5cm perforations. The complaint was dealt with by a Professional Standards Committee. He was reprimanded and ordered to undergo a performance assessment. It recommended informal counselling about some aspects of his practice.
In December 1998 there was another complaint from a patient of the practitioner who after surgery had needed to have further surgery to stop bleeding from an unknown source.
On 8 October 1998 the Health Care Complaints Commission received a complaint from Southern Area Health Service advising that a number of incidents had given rise to concerns about the practitioner’s practice and led to his suspension from the Area Health Service. The allegations made were breaches of protocols for infection control and universal precautions, adequacy of patient’s consents, alteration of a medical record, clinical competence, possible visual impairment and communication issues. These were all investigated and the matter was referred to a Professional Standards Committee. The Southern Area Health Service suspended the practitioner’s visiting rights. The issues that gave rise to that suspension were about breaches of protocols including inadequacy of a patient consent.
On 15 December 1998 the Health Care Complaints Commission received a complaint from Cooma Health Service concerning care provided by the practitioner to two patients. One of those patients alleged that after the practitioner had performed a hysterectomy, she needed further surgery to stop the bleeding from an unknown source. There was an investigation and ultimately no further action.
On 23 December 1998 a patient complained to the Health Care Complaints Commission that she had suffered from incontinence since the practitioner had performed a D&C on her in August 1997. It was referred to the Professional Standards Committee.
The other patient to whom the Cooma complaint applied lodged a complaint in February 1999 saying that she had suffered ongoing problems with her health after she developed “bleeding in my stomach” requiring a laparoscopy, hysteroscopy and D andC performed by the practitioner. This was investigated but ultimately no further action was taken. In April 2000 there was a complaint received from a patient alleging that she had required further surgery because she developed internal bleeding after surgery performed by the practitioner and also alleged that during a third operation later, it was found that the practitioner had stitched a section of her bowel to one of her ovaries. That complaint was investigated but no further action was taken.
A patient made a complaint to the Commission in May 2000 alleging that intercourse became painful after the practitioner performed a vaginal prolapse repair, that further surgery he performed failed to fix the problem, and subsequent surgery performed by another gynaecologist did. This complaint was referred to the Professional Standards Committee. There was a Professional Standards enquiry on 20 - 28 August 2001. The Committee considered nine complaints to the Health Care Complaints Commission. He was found to be guilty of unsatisfactory professional conduct and to be an impaired practitioner owing to his vision problems. Conditions were imposed on his registration including limiting the types of surgical procedures he could undertake.
A Performance Assessment was conducted on 13 September 2004.
Among the orders made by the Professional Standards Committee was that the practitioner not undertake microsurgery and be periodically assessed by an ophthalmologist. It was also recommended that performance assessment be undertaken.
On 30 September 2003 North Sydney Area Health Service temporarily suspended the practitioner’s VMO appointment because of a “cluster of seemingly adverse patient events”. It was then decided there be a performance assessment.
On 4 March 2004 there was a complaint to the HCCC by a patient alleging that when it appeared that she had gone into labour at 22 weeks pregnant with twins, the practitioner refused to transfer her from the regional hospital to another hospital with facilities to care for very premature babies, and that the babies were left to die when they were born at 23 weeks. There was an investigation and ultimately no further action.
On 13 September 2004 there was a performance assessment of the practitioner and his professional performance was found to be “at the standard reasonably expected of a practitioner of an equivalent level of training or experience”. The assessors recommended informal counselling of the practitioner about aspects of his practice which could be improved. That formal counselling occurred on 1 November 2005.
The Medical Tribunal conducted a review of the conditions of the practitioner’s registration on 30 March 2006 and the conditions imposed in 2001 were removed. The NSW Medical Board received notice on 16 March 2007 concerning a number of clinical incidents involving the practitioner and also notice that, by mutual agreement, the practitioner had resigned his appointment at Mona Vale Hospital. A further performance assessment was planned.
The Chair of the Medical Advisory Committee at Delmar Private Hospital notified the Health Care Complaints Commission on 26 March 2007 that the practitioner’s clinical privileges had been temporarily suspended because of concerns about the care provided to three patients. The Board requested that the practitioner be assessed for impairment. The matter was referred to a performance committee.
The practitioner in 2007 resigned from his appointment at Mona Vale Hospital because of clinical incidents and complaints.
On 28 May 2007 the Medical Board received a complaint from a patient alleging that the practitioner perforated her bowel during a laparoscopy and then failed to recognise the complication. This was referred for performance assessment.
On 25 October 2007 there was another performance assessment. The practitioner’s professional performance was found to be unsatisfactory in the areas of basic clinical skills (interviewing/examination), clinical judgment, patient management skills (treatment advice) and practical/technical skills.
On 23 April 2008 there was a Performance Review Panel hearing. The practitioner’s professional performance was found to be unsatisfactory. Conditions were imposed in limiting the surgery that he could perform and requiring him to have a mentor. Re-assessment no sooner than six months’ time was ordered.
On 6 July 2009 Patient G, who was one of the patients to whom the complaints in these proceedings relate complained to the Medical Board about a laparoscopy performed by the practitioner on her for endometriosis. She noted that he was not permitted to perform laparoscopies for moderate to severe endometriosis and queried why he was permitted to perform the surgery when he did not know what degree of endometriosis she had ahead of the surgery. The matter was referred to the Medical Board but no action was taken.
The Performance Committee of the Medical Board on 25 August 2009 decided that the mentorship condition on the practitioner’s registration be removed.
On 24 May 2010 there was a complaint to the HCCC by a patient alleging that the practitioner failed to give her appropriate information about after-care following surgery he performed and that a large swab was left in her vagina, possibly causing an infection. It appears that the patient discontinued dealing with the Commission.
On 8 July 2011 there was a complaint to the Health Care Complaints Commission by a patient alleging that the practitioner did not obtain an informed consent from her before removing three-quarters of her cervix. She had consented to a laparoscopy and the practitioner had performed a laparotomy. There was also an issue that she required further surgery to remove an incorrectly placed stitch around the urethra. The matter was later referred to the Professional Standards Committee.
On 10 October 2013 the practitioner underwent a Performance Re-Assessment Review and his performance was found to be unsatisfactory in the areas of basic clinical skills (interview/examination), clinical judgment, practical/technical skills and interaction/communication with patients. The recommendation was that there be a Performance Review Panel hearing and regular ophthalmological assessment.
On 12 November 2013 there was a complaint to the Health Care Complaints Commission from a patient alleging that the practitioner had used non-dissolvable stitches following her Caesarean section but did not tell her of this, with the result that she required surgery one year later to remove the stitches.
On 16 October 2014 there was a second Performance Review Panel hearing. The finding of the hearing was that the practitioner’s professional performance was of the standard reasonably expected of a practitioner of an equivalent level of training or experience. The Panel considered that continuation of his existing conditions would be prudent, with variation to one condition.
On 27 January 2015 the Performance Committee considered the Panel’s report and resolved to vary Condition 2 on the practitioner’s registration to clarify the nature of the surgery that he is not permitted to perform.
On 5 March 2015 the HCCC received a complaint from a patient alleging that she developed a hernia at the site at which the practitioner performed a laparotomy, requiring further surgery. On 18 November 2015 there was a complaint by the patient who had made a complaint to the Medical Board on 6 July 2009 alleging that she suffered serious complications after the practitioner did not recognise that he had severed a ureter during surgery performed to treat her endometriosis.
On 3 December 2015 the HCCC received a complaint from a patient alleging that the practitioner had provided inappropriate treatment for retained placenta following the birth of her child. On 26 February 2016 there was a complaint received by the HCCC alleging that the practitioner performed a laparotomy on her in breach of his conditions.
On 4 March 2016 there was a notification from the Hunter New England Local Health District that the practitioner had been suspended from his duties at the regional hospital owing to concerns about the care he had provided to six patients. Those matters were being investigated by the HCCC.
