Patients sue over claims of botched knee operations at BMI hospital was originally published by The Bureau of Investigative Journalism
A Kent surgeon accused of performing unnecessary operations on NHS patients is now facing legal action from people who say he physically damaged them with substandard surgery. One lawyer told the Bureau that hundreds of former patients might have a case.
A number of people treated by senior orthopaedic surgeon Mohammed Suhaib Sait – who is now suspended from Fawkham Manor private hospital in Kent but continues to work at the nearby Darent Valley NHS hospital – say poor quality knee surgery performed by the doctor left them in extreme pain.
The Bureau revealed last month that Sait is under investigation by police, insurers and health authorities for allegedly performing unnecessary surgery on NHS and private patients at Fawkham Manor, which he benefited from financially. Fawkham Manor is run by the UK’s largest private hospital chain BMI Healthcare.
Sait was suspended by Fawkham Manor in July 2016 and at least three major health insurers – AXA PPP, Bupa and Aviva – have now crossed him off their lists of approved doctors. However he still works as a consultant for the NHS.
A lawyer representing a number of patients said they only learned about the concerns over Sait’s practices through the media, rather than through the hospital.
One of the women taking legal action says she now has difficulty walking after Mr Sait carried out a knee replacement that may not have been necessary.
After having her knee replaced by Sait at Fawkham Manor in 2013, Dorothy Whitehead, 69, says she was left in pain and unable to walk far.
“I was assured by Mr Sait that it was nerve and tissue damage and would settle down,” she said. But her difficulties continued. After her GP noticed a lump in her knee she was referred to a different surgeon at Fawkham Manor who saw her in November 2016.
A letter from this surgeon to Mrs Whitehead’s GP, seen by the Bureau, notes “she has a very limited walking distance now and has a gait which her partner described as ‘walking like a penguin’.”
In contrast to Sait’s assessment that her pain was due to nerve damage, the new surgeon found a major problem with her knee implant.
X-rays taken immediately after the procedure was performed showed “significant mal-alignment of the implant” which was “probably putting stress across the soft tissues and causing her pain”, the surgeon’s letter said.
Mrs Whitehead told the Bureau: “I’m now facing a revision or even a complete replacement”.
She says she was later advised by a third surgeon that the knee replacement carried out by Sait may not have been necessary at that time.
“I was devastated … I’ve had three years of hell over this,” she said.
She has asked law firm Penningtons Manches to look into legal action against Sait.
Her solicitor Nick Haley told the Bureau Mrs Whitehead was one of two of clients of the firm with potential claims against the surgeon. “We will be looking at whether the surgery was necessary, as well as the standard of the surgery itself,” he said.
‘Hundreds’ may be affected
A lawyer acting for a different client in relation to unnecessary treatment said if the allegations against the surgeon prove correct the implications would be “immense”. Ruth Hewitt, a solicitor at Access Legal, an arm of the law firm Shoosmiths, said: “The implications of Mr Sait’s allegedly fraudulent and potentially negligent practice are immense. If the accusations against him are proved, hundreds of patients in Kent and beyond may be affected.”
Hewitt’s client and a number of other patients treated by Sait were alerted to potential concerns through the media, not by the hospital, which she said was surprising. The Bureau’s initial investigation was published at the end of last month and was followed up by local newspapers.
“In our previous experience with cases like this the hospital has done a systematic review of patients over a period and people have been recalled,” said Hewitt.
The Bureau has seen paperwork showing that one of the people taking legal action against Mr Sait is a 74-year old private patient who had a knee replacement. The patient is one of around 50 people who had appointments with Sait in August and September 2016 and were reviewed by other surgeons following Sait’s suspension.
In a document seen by the Bureau the reviewing surgeon said he had to revise the elderly man’s knee as he was “in agony” and that Sait’s surgery was “way below standards”. The fact that the knee “has been revised such a short period after having the initial operation speaks for itself,” the reviewer concluded.
The case has raised questions about the extent of oversight of NHS contracts with private hospitals. More than one third of the UK’s hip and knee replacements are now carried out in the independent sector.
BMI Healthcare, which runs Fawkham Manor, only suspended the surgeon after Kent police informed health authorities of their investigation.
Staff at the hospital told the Bureau they had raised concerns about Sait’s practice with managers to no avail.
And a new witness has now come forward to say hospital staff prioritised Sait over other orthopaedic surgeons when allocating patients and allowed his operating lists to run late into the night.
Healthcare regulator the Care Quality Commission is understood to have serious concerns about the hospital following inspections last July and November, but has so far failed to publish its findings.
Unnecessary or unsuitable surgery
Sait is still working at Darent Valley Hospital, which is run by Dartford and Gravesham NHS Trust. There are no restrictions on his practice there except for a requirement that he be chaperoned while seeing female patients – a condition imposed by the General Medical Council following complaints of inappropriate behaviour towards women. The Bureau understands no problems have been identified with Sait’s clinical work at Darent Valley.
The central allegation against Sait, which is still being investigated, is that he carried out procedures at Fawkham Manor that were unnecessary or unsuitable to treat his patients’ conditions. Many of these involved keyhole surgery, known as arthroscopy, on the knee or other joints.
The Bureau has spoken to several patients who said they were given arthroscopies by Sait and later told by other surgeons that the procedure would not have helped their condition.
Case reviews seen by the Bureau by colleagues who took over Sait’s patients refer to unnecessary treatment, people being “pressured” into surgery and clinic letters written by Sait that conflicted with patients’ versions of events.
Sait was paid on a case-by-case basis by Fawkham Manor, meaning he received more money the more patients he treated. Darent Valley Hospital paid him a set salary.
One woman, who asked to remain anonymous, told the Bureau Sait offered her daughter spinal surgery during a consultation at Fawkham Manor but said she was too young for an operation when he saw her at Darent Valley Hospital.
The woman had accompanied her daughter, who was suffering from back pain, to Fawkham Manor in June 2011 for a private MRI scan, followed by a consultation with Sait.
“He offered my daughter surgery on her back that week, however we told him we could not afford surgery as we were not insured, we just wanted to hurry things along,” the woman said.
“We saw him three months later at Darent Valley as an NHS patient and he told her she was far too young for the surgery and offered her pain relief and referral to the pain management clinic. When I confronted him about this, he denied offering surgery privately,” she said.
Late night operations
Meanwhile further evidence has emerged to suggest managers at Fawkham Manor may have turned a blind eye to risky clinical practice at the hospital.
BMI has failed to answer detailed questions about its handling of staff concerns about the surgeon, pointing out he was not employed by Fawkham Manor and only had “practising privileges” as a self-employed consultant.
But Sait did not work as an entirely independent entity within the hospital: NHS patients sent to Fawkham Manor were allocated to Sait by hospital employees, his operating lists were scheduled by the hospital and BMI also provided the theatre staff who worked with him.
A new whistleblower who contacted the Bureau after reading the initial story said: “Sait’s operating lists were dangerously long. Patients were going into theatre late at night.”
Meanwhile the hospitals’ other surgeons sometimes struggled to schedule their own lists, despite them being much shorter.
“His lists always seemed to get priority. And if someone came into the hospital asking for a consultant they would usually be sent to Sait. Nobody understood why.”
None of this was a secret, the whistleblower said. “It’s been going on for years. The whole hospital knew. The other consultants did complain but Sait would say that they were jealous of his success and it never seemed to go anywhere.”
A nurse at the hospital confirmed Sait’s patients sometimes came back from theatre as late as midnight. There were insufficient staff to cope if something went wrong at that time, the nurse added. “We’re an hour away from help.”
Late night operating was not confined to Sait, the nurse said. “He was allowed to get away with it. He set the precedent.”
A spokesman for Fawkham Manor, which has hired a consultancy firm, Verita, to investigate Sait’s practice, said: “We cannot comment on individual staff matters.
“We took positive action in our decision to suspend practising privileges for a consultant last summer following concerns which had been raised with us. We are following our standard process for dealing with any issues brought to our attention, which may include internal or externally-conducted investigations, and we take whatever action is needed at their conclusion.
The CQC health watchdog visited Fawkham Manor in July and November 2016. According to a letter sent by BMI to staff that month, the inspectors raised “serious concerns” about the hospital’s theatres and clinical leadership.
The CQC’s report of its inspections, which is expected to be damning, is yet to be published. NHS and private patients are still being referred to the hospital.
The Fawkham Manor spokesman said: “While we cannot provide meaningful comment until the CQC publishes its conclusions, we know that the inspectors were complimentary about the care delivered by our dedicated staff.
“We have already made changes at the hospital, included spending £250,000 upgrading areas of the Grade II listed building and its facilities, supporting the staff and strengthening the management team.”
Dartford, Gravesham and Swanley Clinical Commissioning Group said: “We are currently working with the hospital to support them through the regulatory process … It is important that the hospital team are supported to achieve sustainable, long term improvements for the patients in their care.”
A spokesman for AXA PPP, which initially alerted the police to Sait, said: “We continue to recognise the BMI Fawkham Manor in our directory of hospitals.” This will be reviewed if “relevant information comes to light about the performance of the hospital”, he added.
Sait did not respond to requests for comment. The legal claims against him are ongoing and he will be given the opportunity to contest the allegations made.