A state medical watchdog placed the privacy of a negligent doctor before the right of his employers to know of his history of harming patients and also before public safety, a damning report has found.

Barrister Gail Furness recommended sweeping legislative reforms and changes to the way the Medical Council of New South Wales handles complaints as part of her independent inquiry into the disgraced gynaecologist Emil Shawky Gayed.

The Furness inquiry was ordered following a Guardian Australia investigation that found dozens of Gayed’s patients had been left with serious infections, and their reproductive organs needlessly removed, after he failed to order and properly analyse diagnostic tests or to get the informed consent of his patients. One of his patients died following his inadequate treatment.

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While the full Furness report is due on 31 January, she has released the findings from the part of her inquiry into the Medical Council of NSW. Furness is still investigating five health districts where Gayed was known to have worked as well as how complaints were handled by other regulatory bodies and managers.

Furness found that after Gayed came to Australia from Egypt, and via working in the UK, the Medical Council of NSW, then known as the Medical Board of NSW, registered him in the specialties of obstetrics and gynaecology in 1994. He was only to practise in positions approved by the board. Gayed ignored that requirement.

“Although the Medical Board sent him letters annually from 1994 to 1999 seeking details of positions held, there is no evidence that Dr Gayed sought the Medical Board’s approval, or that the board ever expressly granted approval, for the appointments Gayed came to hold,” the Furness report found.

“In those years, he worked in public and private hospitals in Grafton, Canberra, Cooma, Taree and Kempsey.”

By 2001, the Health Care Complaints Commission had begun disciplinary proceedings against Gayed in relation to 11 complaints involving nine patients. Ten of those complaints related to surgery Gayed had performed. His nursing and doctor colleagues had lost confidence in him, Furness found.

It was recommended to the board that Gayed be barred from performing microsurgery, undergo regular eye-testing and undergo a performance assessment. But the board only told Gayed’s employers of the decision about microsurgery, and other findings were not communicated. The board also rejected a recommendation for Gayed to undergo a performance assessment, finding that would only be necessary if further complaints were made.

“That decision is difficult to justify,” Furness found.

Gayed continued to harm patients and botch their surgeries for a further 15 years. An ophthalmologist also recommended to the board on multiple occasions that Gayed’s skills in laparoscopy, also known as keyhole surgery, be reviewed and assessed. This never occurred.

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When Gayed went on to work for Mona Vale hospital in 2002, the hospital was not aware of his chequered history, and Gayed did not inform them. Once again Gayed failed to notify the board of where he was working. By 2003, after numerous complaints about Gayed, Mona Vale hospital sought information from the board about Gayed’s history. The board refused to hand it over, saying Gayed needed to consent.

“No legislation prohibited the Medical Board from giving an employer information about a doctor’s compliance,” Furness found. “In my view… any privacy considerations should have yielded to considerations of public safety. Such information is relevant to enable proper supervision of a medical practitioner whose registration is conditional.”

Mona Vale hospital decided to suspend Gayed regardless, and the board’s performance committee decided in 2003 that Gayed needed an urgent performance review. Despite the urgency, that assessment wasn’t conducted until almost one year later. When that assessment was finally conducted, assessors did not assess Gayed’s visual impairment or observe him conducting any major gynaecological surgery. Assessors decided restrictions on his registration “served no useful purpose” and that Gayed was delivering care to the standard reasonably expected of practitioners.

Furness found a more thorough assessment should have occurred, and much earlier. In 2006 Gayed applied to have restrictions on his performing microsurgery removed and this was approved by the Medical Tribunal of NSW unopposed by the board. Gayed continued working and, by 2007, a raft of new complaints had been made. Again Mona Vale hospital suspended him but this time Gayed resigned and went on to work elsewhere.

By this time complaints had also been made about his work at Dee Why hospital, which removed his clinical privileges in 2007. Despite the health service responsible for Dee Why and Mona Vale hospitals providing the board with a report from its investigation into Gayed, the board did not pass this report on to its conduct committee, even though serious areas of clinical concern being raised.

Gayed then moved on to Manning Base hospital in Taree. Again, neither the board nor Gayed told the hospital about his numerous suspensions and the concerns raised by other hospitals. He also continued to treat women in private practises separate to public hospitals. Hospitals where Gayed previously worked continued to raise issues about his work with the board, including his poor record-keeping, errors in the surgical theatre and poor follow-up of patients. All of this was detailed in a report by the Northern Sydney Central Coast Area Health Service in 2007. The board allowed Gayed to continue to practise unrestricted for another 12 months, when a performance review panel found Gayed did not understand his responsibilities and needed mentoring from specialists. The board did not inform the health district where Gayed was by then working, the Hunter New England area health district, of the findings.

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For another decade further complaints were made, some of them “deeply disturbing”, but the board repeatedly failed to inform Gayed’s employers of performance assessment panel findings and repeatedly found Gayed’s performance was satisfactory.

Furness recommended that in future performance assessors should be given the full history of complaints and disciplinary action relating to a doctor.

“Finally, and perhaps most significantly, the assessors must observe the procedures the doctor had performed poorly in the past or specifically address the concerns raised,” the report said. Laws needed to be changed to expressly allow the medical board to share findings with a doctor’s employers, Furness added, to avoid any confusion. Information sharing between regulatory bodies, investigators and employers would be essential to identify a pattern of misconduct and to avoid patient harm going forward, the report found.

A Medical Council of New South Wales spokesperson said: “The recommendations in Ms Furness’s report are currently being considered and an appropriate Council action plan will be developed”.

Furness also uncovered damning reports from delegates tasked with investigating bundles of complaints against Gayed. One such report described how Gayed described himself as “emotionally pressured” and “trapped” when his patients merely asked about conservative treatment options available rather than major or invasive surgeries. Gayed also refused to change his mind.

“He appeared unable to say no after exercising his judgment,” one delegates report found. “At times, he appeared not to have exercised judgement at all.”

Dr Marie Bismark, a lawyer and doctor with the University of Melbourne, said the Furness report revealed that past behaviour was the best predictor of future behaviour. While she said complaints commissioners had been given greater powers in recent years to look at a history of complaints, it was essential that this informaton was shared between employers and regulators.

“We see time and time again concerns raised in one workplace that would be relevant to other workplaces not communicated and as a result, patients are harmed,” she said.