Surgeon who botched three operations 'too arrogant' to ask for help
Joel Adams and Clarissa Place
- Credit: Archant
A report into a surgeon who left patients with life-changing injuries when he botched three gallbladder surgeries in a week found “significant concerns” with his decision-making during the operations and concluded it was “difficult to understand” why he did not call for assistance when the surgeries started to go wrong.
The reviewers from the Royal College of Surgeons (RCS) were also “concerned ... about his understanding of this operation” and concluded he had “failed to recognise that an alternative strategy was required” once complications arose.
But the RCS did not recommend that surgeon Camilo Valero be suspended, and he continues to work at the Norfolk and Norwich hospital despite calls from his injured patients and local MPs to suspend him.
As reported in this newspaper, Paul Tooth and Lucy Wilson were left horrifically injured, suicidally depressed, and barely able to move after Mr Valero removed their common bile ducts in addition to their gallbladders, in January 2020.
Mr Tooth, 64, from Dereham has lost five stone since the operation and now has to spend ten hours a day recycling his own bile through a series of tubes, out of his abdomen and into his stomach via his nose.
Today Mr Tooth said the report showed Mr Valero had left him “butchered” because “he was too arrogant to admit he didn’t know what he was doing”, adding that he had pleaded for months to have a different surgeon after finding Mr Valero “arrogant, hostile and ill-informed” during a preoperative procedure the previous year.
The review by the Royal College of Surgeons (RCS) was completed in July 2020 but the Norfolk and Norwich University Hospital Trust has repeatedly refused to publish its contents citing patient confidentiality.
But after a string of reports in this paper, medical director Erika Denton told yesterday’s meeting of the Trust’s board of trustees she was publishing the report as “part of our openness and transparency to the public we serve.”
The RCS review into Mr Valero concluded that two bile duct injuries out of more than 200 cases over two years was “uncommon” and “not an unacceptably high number” particularly when a large number of those were acute cases.
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Reviewers highlighted that feedback from his colleagues was consistently positive, and found no patient safety concerns regarding his non-gallbladder surgeries.
But in addressing the surgeries on Mr Tooth and Mrs Wilson, the RCS stated: “The review team… had significant concerns regarding [Mr Valero’s] intraoperative decision-making.
It went on: “He had failed to recognise that an alternative strategy was required and the need to consult with a consultant surgeon colleague.”
In relation to one of the two surgeries, “the review team concluded that, given that the audit data indicated that [Mr Valero] was experienced in undertaking acute cholecystectomies, it was difficult to understand why he had not called for assistance when complications arose.”
Both Mr Tooth and Mrs Wilson’s operations were laparoscopic (keyhole) surgery, and it is common practice that if a surgeon is finding it difficult to identify the anatomy he or she should revert to open surgery. Mr Valero did not do this in either case.
Despite Mr Valero telling reviewers he would switch to open surgery if an operation was not progressing as expected, the review team’s impression was that the entire surgical team had a “perceived tendency of higher incidence of problems” with open surgery, and a reluctance to follow this route.
The report states: “The review team were concerned, from [Mr Valero’s] description of sub-total cholecystectomy, about his understanding of this operation and they concluded that this could be in part related to his view of this approach.” They recommended targeted training.
Paul Tooth said: “Six months before my surgery Mr Valero shouted at me to take medication I’d been instructed by an anaesthetist not to take. He was arrogant, hostile and ill-informed and from that moment I feared his attitude could cost me my life.
“I submitted my own damning account to the Norfolk and Norwich but they didn’t pass it on to the RCS.
“Yet despite the N&N withholding this crucial information from the RCS, the review proves Camilo Valero left me butchered, and facing another life-threatening operation next month, simply because he was too arrogant to admit he didn’t know what he was doing.”
Lucy Wilson, 33, from Norwich, who has launched a petition calling on medical professionals to report all such incidents, said: “It may only be two surgeries out of 200 which went wrong, but he’s destroyed my life and there’s no going back from that.
“He could, and should, have paused and asked for help. When you’ve got someone’s life in your hands that’s a moral obligation. I won’t ever be able to forgive him.”
Professor Denton said the hospital had apologised to the patients, and had changed and strengthened its surgery processes to ensure this will not happen again.
Relationships between staff in the gastrointestinal surgical team at the N&N are so bad, and leadership so weak, that the atmosphere might undermine surgeons’ ability to work as a team and even impact patient care, the RCS concluded.
A second report, into the entire upper gastrointestinal and emergency surgical service, found “interpersonal and team working difficulties [were] widely reported by interviewees”.
Unresolved issues which had been the subject of two previous reviews of the team (the findings of which were not passed to the RCS in time to discuss them with interviewees) “had the potential to impact the ability of the upper GI surgeons to function as a cohesive, mutually supportive team underpinned by trust”, the RCS found.
For the sake of patient safety, the report recommends the Trust address issues including difficulties in interpersonal interactions, uncertainty in respect of mutual trust and support, lack of strong leadership, and a perceived lack of opportunity for open discussion.