Three NHS patients ‘mutilated’ by surgeon in a single week prompts shake-up at NHS trust

Exclusive: Royal College of Surgeons called in to investigate services at NHS trust after devastating injuries from routine surgery

An RAF veteran has been left with life-changing injuries after being “mutilated” by an NHS surgeon during what should have been a routine procedure.

Paul Tooth, 64, has been permanently left with tubes going in and out of his body which he needs to continually recycle bile produced by his liver.

The previously fit and active father-of-two has lost five stone in weight and can barely leave his house after the surgery last year.

It was supposed to be a routine gall bladder removal, but the surgeon inexplicably took out Paul’s bile duct and hepatic duct, which link the liver to the intestines, as well as damaging the liver itself, making a repair impossible.

Although he has won his legal battle against the Norfolk and Norwich University Hospital Foundation Trust, Paul believes what happened to him raises bigger safety questions for the trust after he learned he was one of three patients harmed by the same surgeon just days apart.

The alarm was first raised by Addenbrooke’s Hospital in Cambridge where the three patients were transferred for specialist care after their initial operations.

The Norfolk and Norwich trust has now admitted liability for the errors and standard of care Paul received.

The Royal College of Surgeons (RCS) expressed concerns over the treatment of patients like Paul who need their gall bladder removing after suffering with gall stones.

The RCS found some patients were waiting 18 months or more, with more than half being readmitted as emergencies while they waited.

An expert review has not been made public, nor will the trust share a summary of its key findings following the inquiry.

But in a letter to Mr Tooth, the trust’s medical director Erika Denton, revealed the review had raised concerns about long waits for some patients needing gall bladder surgery and made recommendations about “team working and learning from incidents”.

The Royal College of Surgeons has also refused to say more about the review it carried out.

Mr Tooth, a former aircraft engineer for the RAF, told The Independent: “As soon as I woke up, I knew something was wrong. I was in agony. This was just off the scale in terms of pain. They asked to me to rate it out of 10 and I said 25.”

Mr Tooth has since undergone more surgery to try to repair the damage but may ultimately need a liver transplant.

“The surgeon removed all my plumbing and mutilated my liver. He totally removed the common bile duct, which links the liver to the intestines. He cut off that branch, he took the gall bladder, other branches and parts of the liver.”

Paul Tooth is now forced to live with tubes going in and out of his body to recycle bile produced by his liver ( )

After complaining of pain, the surgeon took Mr Tooth back to surgery, but said “everything appeared normal”. It was more than a week after the surgery when Paul was told he had suffered an injury and was transferred to Addenbrooke’s Hospital where he then remained for six weeks.

He only learnt the full extent of what had happened when he overheard clinicians talking about his injury during a procedure using a camera to explore the liver.

He said: “They hit something solid which shouldn’t have been there and I heard them say it looked like it had been clipped.”

The consequences for him have been devastating.

“My liver is ruined. I have one drain which removes the bile and collects it in a bag. To eat anything, I have to empty that bile into a machine and recycle it back through a tube that goes down the back of my throat, through my stomach and into the intestines.

“I have been doing this constantly since last March, having to drain the bag every four to five hours. It means I can never get a full night’s sleep, and this is how it will be for the foreseeable future, if not for the rest of my life.”

The liver can produce up to a litre of bile every day which it needs to digest food.

Paul said: “I have been virtually housebound, often bedbound, and I have lost a lot of weight to the point where my grandchildren barely recognise me.

“My daughter lives in Australia and cannot visit me due to Covid-19 restrictions. It is a constant worry that I may never see or hold her again.”

Mr Tooth has serious concerns about what happened after his surgery and the way it was handled.

He said: “They tried to whitewash us. Nobody told us there were other patients until nine months after the event. The surgeon never reported the other two cases.

“He should have reported himself and stopped. The only reason he was stopped was because Addenbrooke’s reported it to the trust.

“I know there is nothing I can do to change what I have been through, but I want everyone to know my story to help stop it from happening to anyone else.”

Guy Forster, medical negligence expert at Irwin Mitchell who represented Mr Tooth, said: “Paul has been through a terrible ordeal and he now faces a future of uncertainty and the prospect of a possible liver transplant and further surgery which carries serious risks.”

He added: “We are seeking reassurances that there has been a comprehensive investigation into the circumstances of Paul’s injuries so that everything can be done as soon as possible to improve patient care and prevent anyone else from suffering the way Paul and the other two cases have.”

The Norfolk and Norwich University Hospital Foundation Trust said the surgeon was now operating under supervision (PA)

In October, the trust’s medical director Professor Erika Denton revealed she had asked the Royal College of Surgeons to carry out a review “in light of the knowledge of three cases of potentially serious concern involving the same surgeon”.

She added: “All of the surgeries took place within a five-day period in January 2020.”

She said the RCS had not identified wider concerns about the surgeon’s safety, but added: “They documented that [the surgeon] accepted that his recognition of the complications in your case had not been optimal and could have been quicker. In addition, there was also a failure to recognise that help or an alternative strategy was required.”

Prof Denton said there was nothing that would have alerted the trust to problems with the surgeon’s abilities before the incident, adding in the letter to Mr Tooth: “I appreciate this may be of little comfort to you and does not detract from the devastating and life-changing consequences that you have been left with and for which [the surgeon] offers his sincere regrets and apology.

“With regards to our responsibility to future patients, with the involvement of an external body, the trust has assured itself that there is no ongoing risk to patient safety and that the serious complications that you suffered is an unexpected outcome for this surgeon.”

In a statement, Professor Denton said: “We have fully investigated the surgery Mr Tooth received while under our care and have since changed and strengthened our surgery processes to ensure that this will not happen again.”

The trust said the surgeon was now carrying out similar surgeries under supervision and all actions and learning from the RCS review had been fully implemented.