‘Incomprehensible’: Sydney hospital boss backs disgraced surgeon Al Muderis amid staff concerns

The chief executive of a Medibank-owned private hospital in Sydney’s inner city has backed disgraced surgeon Munjed Al Muderis to continue operating, despite recent reports from staff raising concerns about his practices.

The Federal Court last month ruled Al Muderis had acted unethically towards a significant cohort of his patients and used high-pressure sales tactics and secret cash commissions to recruit vulnerable patients for invasive surgery. He has since appealed against the findings and is also suing the Australian Orthopaedic Association after the board tried to expel him from membership.

Al Muderis continues to operate at several hospitals, including East Sydney Private Hospital in Woolloomooloo, a short-stay clinic owned by ASX-listed Medibank and doctor-shareholders, including Al Muderis, who invested $250,000.

One doctor at the hospital, speaking on the condition of anonymity to discuss internal matters, said they were concerned Al Muderis was still practising without restriction. Others have also raised concerns about his use of multiple operating theatres on the same day, including on a recent Saturday shift at the East Sydney facility.

“His lack of care for the patients is incomprehensible,” the doctor said. “He hasn’t changed. The guys in his group are very loyal. They’re all indoctrinated with the same philosophy.”

The doctor described a recent incident that was reported to the hospital’s senior management, where Al Muderis performed a knee replacement after which the wound became swollen, burst open and was restitched in the recovery ward, an unsterile environment.

“A burst wound after a knee replacement is an orthopaedic emergency. You don’t do it on the ward,” the doctor claimed. “You take it into the operating theatre. This is not best practice.”

East Sydney Private Hospital chief executive and registered nurse Dane Browne confirmed the incident and defended the conduct, saying: “The wound incident you reference was managed in line with clinical protocols, and I can confirm it didn’t warrant a return to theatre.”

Medibank owns 49 per cent of the hospital and promoted its expansion last June with a ribbon-cutting celebration. It did not answer questions about the handling of the burst wound, but a spokesperson said “clinical operations and administration are independently managed by East Sydney Private Hospital”.

“Medibank strongly believe that the highest clinical standards must be upheld across all areas of healthcare,” the spokesperson said. “Medibank won’t be commenting further on the operations or clinical matters at East Sydney Private Hospital.”

East Sydney Private is the second joint venture Al Muderis has with Medibank, alongside the short-stay hospital at Macquarie University Hospital in Sydney’s north-west. These hospitals are designed to reduce the time patients spend in the facility, but have been criticised by some experts, including surgeon Ian Harris, who says the structure creates conflicts of interest and increases profit motives for surgeons to perform unnecessary surgeries.

Medibank has defended its quality of care in these hospitals and previously said it was “very concerned” about the court decision against Al Muderis and was “taking this extremely seriously”. It said it had asked Macquarie University Hospital to investigate and take “all necessary steps” to ensure standards were met.

Macquarie University Hospital announced last month that Al Muderis had taken indefinite leave. Meeting minutes revealed by this masthead this week show surgeons have raised concerns about Al Muderis at Macquarie for years and have either been ignored or threatened with legal action for defamation.

Corporate governance expert Helen Bird has said hospitals and companies financially entangled with Al Muderis cannot be responsible for investigating misconduct due to clear conflicts of interest, and has called for regulatory intervention.

Several sources across various hospitals where Al Muderis practises have also raised concerns about his use of multiple operating theatres on the same day, a practice to maximise the number of surgeries that can be performed.

“Parallel lists are not a patient-led care initiative,” one source said. “They are purely and solely a way for surgeons to double the money they make for a given amount of time.”

Browne confirmed Al Muderis used two theatres to operate on 11 patients during a recent Saturday shift at East Sydney Private, and defended the “two-theatre approach” as a “safe and well-established practice in orthopaedic surgery”.

“Dr Munjed Al Muderis did not operate on more than one patient at the same time. Patient safety is always the highest priority,” Browne said. “Dr Munjed Al Muderis completed the entire operation.”

Royal Australasian College of Surgeons president Owen Ung said concurrent theatres are used by only a minority of surgeons in Australia, and the college had recently released guidelines to promote safe practice.

Ung said surgeons using multiple theatres must take extra steps to ensure the patient is fully informed, and enlist skilled assistants to perform non-essential duties, such as sewing up and dressing the wound. He said he personally avoids the practice as a general surgeon, but said it was more common in other specialties.

“If I’m operating, I feel like I need that break between cases to get my head straight, prepare for the next case,” he said. “If you’re pretty much going non-stop the whole time, it’s taxing.

“I’m not saying surgeons can’t make it work, but we have guidelines for those who are going to do it, how to do it safely.”

Browne and Al Muderis failed to respond to questions about whether patients are informed of the use of multiple theatres.

Browne has provided several statements about Al Muderis’ position at the hospital. The week after the judgment was delivered, Browne said in an email the hospital was “investigating the matter” and “committed to ensuring safe, high quality, patient-centred care”.

In another email on August 29, Browne said: “Dr Al Muderis is currently on a leave of absence with a return date yet to be confirmed,” but declined to comment on whether this was related to the judgment.

Responding to further questions this week, Browne said: “He is returning for a two-day operating list, before returning to his leave. The decision to proceed with surgery was made where clinically appropriate and supporting patient choice.”

Through lawyers, Al Muderis said Browne’s statements were “incorrect”.

“Dr Al Muderis is not ‘currently on a leave of absence with a return date yet to be confirmed’ with East Sydney Private Hospital. He has been currently operating elsewhere. In fact, he is due to return to the hospital very shortly to perform further procedures.”

Al Muderis also denied wrongdoing and defended the use of concurrent theatres as a “well-established practice for busy surgeons at hospitals throughout Australia”.

“The wound you refer to concerning a knee operation was not a medical emergency and did not warrant returning to an operating theatre. A consultant was present at all times and the matter was handled with all due care and best [practice].”

The Australian Orthopaedic Association announced last month Al Muderis had been expelled from the professional association, after the court ruled he had prioritised fame, money and numbers over patient care. Al Muderis then requested a meeting to appeal against the AOA board’s decision, where members would vote on his future. That meeting was scheduled for next week.

However, Al Muderis has since withdrawn his request for a meeting and sued the AOA for alleged breach of its constitution. The court issued orders on Monday restraining the AOA from enforcing the expulsion or holding meetings to consider the “purported expulsion”.

Al Muderis’ solicitor in this matter, Torq Murray, confirmed Al Muderis had withdrawn his request for the meeting and cancelled the vote and said there was “currently an injunction restraining the AOA from expelling him”. The AOA will now file a defence, and the matter will be heard next Wednesday.

“Further communication on this matter will be forthcoming in due course,” the AOA told members on Tuesday night.

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