Derek McMinn: Patients ‘put in danger so scandal-hit surgeon could perform two operations at same time’

The surgeon at the centre of a body parts scandal operated on patients who were dangerously sedated so that their procedures could be carried out simultaneously, according to a leaked investigation seen by The Independent.

Renowned hip surgeon Derek McMinn and two anaesthetists at Edgbaston Hospital, Birmingham, were accused of putting “income before patient safety” in the internal investigation for BMI Healthcare, which runs the hospital.

It comes after a separate review found that McMinn had hoarded more than 5,000 bone samples from his patients without a licence or proper permission to do so over a period of 25 years, breaching legal and ethical guidelines. Police are investigating a possible breach of the Human Tissue Act.

Since The Independent highlighted the allegations surrounding McMinn this week, calls have grown for an independent inquiry into the surgeon, who pioneered hip resurfacing treatment and operated on politicians, sports stars and celebrities.  BMI Healthcare, which initially did not contact anyone who may have been affected, set up a helpline for McMinn’s former patients on Wednesday.

According to the report on sedation by an expert from another hospital, the two anaesthetists, Imran Ahmed and Gauhar Sharih, sedated patients for so long that their blood pressure fell to dangerous levels in order to allow McMinn to carry out near-simultaneous surgery.

It found this meant long delays in the operations starting, with one sedated patient being subjected to prolonged anaesthesia for longer than one hour and 40 minutes – recommended best practice is 30 minutes.

Another patient was apparently "abandoned" for an hour and 26 minutes after their surgery was only partially completed while McMinn began operating on another patient.

The report’s author, expert anaesthetist Dr Dhushyanthan Kumar of Coventry’s University Hospital, said this was unsafe practice by all three doctors and urged BMI Healthcare to carry out a review of patients to see if any had suffered lasting brain damage. Both anaesthetists work for the NHS – Ahmed at Dudley Group of Hospitals, Sharih at University Hospitals Birmingham – without restrictions on their ability to practise.

In his report, dated last November, Dr Kumar reviewed the charts for patients who were operated on at BMI Healthcare’s Edgbaston Hospital.

He said he had “significant concerns” over the “prolonged” time between patients’ sedation and the start of surgery, which ranged from 50 minutes to an hour and 42 minutes. "This is not acceptable practice in my view and caused prolonged exposure to the risks of anaesthesia without benefit to the patient,” he wrote.

In one case he said: “The patient appears to have been anaesthetised before surgery has started on the patient in the other theatre. I can think of no reason why this could be considered safe or acceptable practice.

“It can be argued as self-evident that starting an anaesthetic when the surgeon has not yet started surgery on the previous case is not in the patient’s best interest. Again, whilst not written in a national protocol, expected practice in most hospitals requires the anaesthetist to time induction such as to give the patient the minimum of time exposed to the risks of anaesthesia.”

Dr Kumar said that for these to delays to happen repeatedly over time suggested it was part of the anaesthetic and surgical plan.

In one case that he said was a “serious concern”, he described how, after one part of the patient’s surgery was completed, they were “kept asleep and moved into the anaesthetic room. He added: “At this point the surgeon appears to leave and undertakes an operation on another patient. [The first patient] is abandoned by the surgeon for one hour and 26 minutes before the surgeon returns to complete the surgery.”

Dr Kumar said: “I find this activity unprofessional… In my view this action by the surgeon and anaesthetists warrants referring all three to the GMC for review of their practice. It appears to be putting income before patient safety or the best interests of the individual patient.”

The report also suggests that a patient’s organs, especially their brains, could be starved of oxygen if their blood pressure was dropped too low. Dr Kumar said the extended sedation had been done intentionally without evidence the patients had consented.

He said: “Drs Ahmed and Sharih were exposing their patients to lower blood pressures than 55mmHg meaning that all of their hypotensive patients were exposed to moderately or highly elevated risks.

“The technique of Drs Ahmed and Sharih were outside even the most extreme examples used as evidence in the literature with significant periods in a number of patients below a systolic blood pressure of 55mmHg. I view this as a high risk of harm to those patients.”

He said a review of patients should be carried out by BMI to identify any brain injury or organ damage and he recommended a wider review of their doctors practice should be done “to identify all of those patients who may have been put at risk”. 

He added: “Assuming that this practice is the same as in the NHS, any NHS trusts where these practitioners worked should be informed of the risk to their patients. If this practice was not undertaken in NHS hospitals but only in private ones, the question of why and how needs to be raised and answered.

“Overall the practice of these three doctors, I believe, appears to be outside that expected by NHS practice and GMC good medical practice guidance and has put patients at a risk far outweighing any benefit to those individual patients who expect doctors to work in their individual best interest at all times.”

The General Medical Council declined to answer any questions about the surgical actions of McMinn, Ahmed and Sharih. McMinn, who declined to comment, is under investigation by the watchdog but remains licensed to practise.

The Care Quality Commission said it received Dr Kumar’s report only last Friday – the same day it received the report concerning alleged storage of bone. A spokesperson said: "Now that we have received BMI’s internal investigation report we will be reviewing the detail in full in order to determine what further action is required. This will include consideration of any failure to ensure duty of candour has been complied with.”

Circle Health Group, which took over BMI Healthcare earlier this year, told The Independent: “The NHS organisations where the two anaesthetists worked were informed about our concerns by writing in October 2019 to Heart of England NHS Trust and to the Dudley Group NHS Trust.

“Circle are expanding the breadth and depth of this investigation. Where patients need to be contacted we will do so promptly.”

A Circle spokesperson said: “BMI Healthcare is now under new management and we take these issues incredibly seriously. We only acquired the hospital in June, but will leave no stone unturned in investigating these historic issues relating to Derek McMinn. We have commissioned an independent expert to review the issues raised on anaesthetic practice: they have all been reported to the appropriate authorities and we will cooperate closely with regulators to resolve them.”

The NHS trusts where Ahmed and Sharih work did not respond to requests for comment.

Patients who may be affected by McMinn’s surgery can contact BMI Healthcare’s patient support team on 0800 096 2254