The Royal College of Surgeons in Ireland (RCSI) has begun an investigation into a consultant following an external examination of a number of his cases, including two in which patients died.
The external inquiry which led to the RCSI investigation concluded that one of the deaths "need not have happened" and that the other followed poor decision-making. The external inquiry report was written by a consultant based in Britain and was commissioned by the health board in whose area the hospital in question is based.
The Irish Times has established that the surgeon was investigated on two previous occasions by other surgeons working in the Republic, and their recommendations fell short of placing restrictions on the surgeon's practice. The surgeon is now on paid leave.
The RCSI inquiry into the surgeon is separate from the inquiry into the obstetrician who is under investigation following his performance of a large number of Caesarean hysterectomies in the past three years. The RCSI inquiry also concerns a different hospital.
In the case of the surgeon, one of the fatalities involved a cancer patient who contracted peritonitis, an inflammation of the membrane lining the abdominal cavity. It is understood that the external report found that the possibility of infection within the abdomen was ignored until it was too late.
In a further case, a patient admitted with severe burns was not transferred to the burns unit at St James's Hospital, Dublin, although the nursing notes record a recommendation that this be done. The degree of burns exceeded the criteria set by the American Burns Association for transfer to a specialist unit. The patient subsequently died.
The external inquiry said one of the cases examined involved "gross negligence shared with the anaesthetist".
One case involved a patient who developed serious pneumonia, malnutrition and other serious complications. The seriousness of the case should have become obvious from a chest Xray, says the report, adding that the eventual recovery of this patient was "a lucky escape".
In another case, the surgeon stitched a patient after an operation in a manner not identified in medical literature, according to the report. In other cases, the surgeon allegedly showed lack of judgment and analysis, a lack of knowledge of modern illness management concepts and delay in management of post-operative bleeding, according to the report.
The surgeon has co-operated fully with the external review and is also believed to be co-operating with the RCSI investigation.
The external review by the consultant based in Britain was commissioned by the health board after senior hospital management and nursing management expressed concern in September about the handling of about 12 cases. This came just months after a review by Irish practitioners apparently recommended no restriction on the surgeon's practice.
The health board in whose area the surgeon had been working declined to comment last night.