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Surgeons cleared of serious professional misconduct by GMC

BMJ 2002; 325 doi: (Published 24 August 2002) Cite this as: BMJ 2002;325:408
  1. Owen Dyer
  1. London

    Two surgeons who argued over their operation notes after destroying a patient's liver in an unnecessary operation have been cleared of serious professional misconduct by the General Medical Council.

    Locum consultant surgeon Adel Zaki Demian, 59, and Vijay Vardhini, 37, were found guilty of several charges, but the council's professional conduct committee chose not to sanction them after hearing expert testimony that the patient's condition was unusual enough to confuse any doctor.

    Mother of three Elif Aksu, 34, appeared at the accident and emergency ward of the Homerton Hospital, east London, on 1 December 1997, complaining of abdominal pain. Mr Demian ordered an ultrasound scan of the biliary tree, which showed two gallstones. He suggested that Ms Vardhini, then a second year surgical registrar, perform an emergency open cholecystectomy that evening without supervision, and she agreed. Mr Demian left for home before the surgery began, leaving a contact number. Fiona Neale, representing the GMC, said Mrs Aksu was generally improving” and should have been given treatment for her symptoms and kept under observation.

    During surgery Ms Vardhini divided the hepatic artery, having mistaken it for the cystic artery. She also divided the common bile duct instead of the cystic duct. She then inadvertently cut the portal vein, at which point she clamped the bleeding and called for assistance from Mr Demian.

    At this stage Mrs Aksu had lost slightly more than a litre of blood. Ms Neale said Mr Demian became impatient with Ms Vardhini's hesitant explanations on his arrival half an hour later, and he removed all the clamps and packs at once, causing uncontrolled bleeding. Mrs Aksu lost a further 5.5 litres of blood after his intervention. Mr Demian was able to remove the gallstones but did not verify blood supply to the liver. The portal vein was left unrepaired. Mrs Aksu's liver never regained function, and she died three days later. Police investigated the two surgeons for possible manslaughter, but no charges were brought.

    A practice nurse told the hearing that the two surgeons argued over their notes after the operation. The anaesthetist said he noticed that parts of the report had been altered. Mr Demian initially denied that the operation was uncalled for but later conceded that he had made “insufficient inquiry” before choosing surgery.

    Ms Vardhini acknowledged that the surgery was needless and that she should never have attempted it. She also admitted the charge of writing an account that she did not believe to be correct, having omitted to mention the cutting of the portal vein.

    Summing up, committee chairman Dr Andrew Ferguson said Mrs Aksu's death was an isolated failure in two otherwise unblemished careers. He told Ms Vardhini: “The pathology which you encountered during the operation on Mrs Aksu rendered recognition of the anatomy difficult and would have caused serious difficulties even for a much more experienced surgeon.” He added that Mr Demian had found himself in “extraordinary clinical situation” on taking over.

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