A surgeon who botched gallbladder operations on two patients causing them "irreversible and life-changing" injuries received only a warning from a medical tribunal.
Dr Camilo Valero was accused of putting the patients at "unwarranted risk of harm" when he carried out two gallbladder removals, just 6 days apart, at Norfolk and Norwich University Hospital in January 2020. Both patients suffered severed bile ducts and complications after undergoing a laparoscopic cholecystectomy and needed reconstructive surgery.
A Medical Practitioners Tribunal Service (MPTS) tribunal in Manchester heard how Dr Valero had committed similar errors during both operations and had "misinterpreted the anatomy", not obtained the critical view of safety, and failed to seek help from colleagues.
The MPTS panel concluded he put the patients at "unwarranted risk of harm", and they sustained "avoidable" injuries when he acted "beyond his level of competence".
The Panel added: "The mistakes in these cases ultimately caused irreversible and life-changing complications for the patients."
Dr Valero admitted various charges relating to his operative failings and the MPTS panel ruled his actions amounted to serious misconduct. But it noted his insight, remorse, and remediation which meant he was "highly unlikely" to repeat the same errors.
It found Dr Valero's fitness to practise was not impaired, meaning no sanction could be imposed, and issued him with a warning instead.
Details of the Cases
The tribunal heard how one 32-year-old female patient, known as Patient A, suffered a "high volume" bile leak after Dr Valero mistakenly severed her bile duct during her gallbladder procedure. The operation left her feeling sick, in constant pain, and drifting in and out of consciousness.
She was later transferred to Addenbrooke’s Hospital, in Cambridge, for almost 11 hours of corrective surgery but has continued to suffer health complications.
Patient A, who attended the tribunal, was told by Charles Foster, counsel for the doctor, that he wished to apologise and had "got in wrong" with her surgery.
"He recognises that you had a terrible time and is very sorry for that," Mr Foster said.
A Patient C, a 63-year-old man, suffered injuries after "similar failings" when Dr Valero performed gallbladder surgery on him, the tribunal heard.
The man, who served with the armed forces, also needed further surgery at Addenbrooke’s Hospital but will need more reconstructive surgery and a possible liver transplant in the future.
The patient, the tribunal heard, believed that Dr Valero’s operation "completely changed his life" because he is no longer able to do things he used to.
Mistakes were 'Catastrophic': GMC
Bob Sastry, counsel for the GMC, said Dr Valero was guilty of "serous misjudgements" and the effects on each patient were "catastrophic, with significant and irreversible long-term complications".
He said the operative failures "fell significantly below" the standard to be expected of a reasonably competent general surgeon and Dr Valero would still pose a risk if he was allowed to work unrestricted.
But Charles Foster, counsel for Dr Valero, described the two procedures as "particularly difficult", putting the tribunal's findings "at the bottom" of the bracket in relation to serious misconduct.
Bile duct injuries were a "recognised complication" that occurs in 0.3% of cases, he said, and Dr Valero recognised what went wrong, namely that he "did not have the critical view of safety".
Dr Valero knew how to avoid making the same mistake in the future, added Mr Foster, and, if in doubt, would consult colleagues.
The tribunal heard that a The Royal College of Surgeons review of Mr Valero's practice had found two cases of bile duct injury in 200 such operations performed over a 2-year period. He has since carried out 30 similar operations, under supervision, of which five were emergencies.
Several charges relating to a third patient, Patient D – who has cerebral palsy, epilepsy, and learning difficulties. Accusations that ehe patient was allegedly wrongly discharged by Dr Valero in March 2021 were found not proved.
Dr Valero has not been allowed to perform gallbladder surgery unsupervised after restrictions were placed on his practice at an interim orders tribunal in July 2021, but that order has now been revoked.
Trust Admitted Liability for Patients A and C
In legal cases brought by Patient A and C, Norfolk & Norwich University Hospitals (NNUH) NHS Foundation Trust has admitted liability for the errors and standard of care provided to them.
Lawyer Marianne Stapleton, of Irwin Mitchell who is representing the two patients, said they had "struggled significantly" over the past 3 years and continued to have concerns over what happened to them and how it would impact their lives going forward.
She said: "While today's outcome doesn't go far enough in terms of what they hoped for, we note the panel’s decision and welcome the training and supervision provided to Mr Valero to help prevent patients being put at risk in the future.
"Nothing will ever change what [Patient A & C] have been through, but we'll continue to support them at this difficult time. It's also vital that lessons are learned, and the highest standards of care are maintained at all times to ensure patient safety."
NNUH Medical Director, Erika Denton, said: "We accept the decision of the Medical Practitioners Tribunal and offer our apologies to the two patients who experienced serious injury and complications during laparoscopic cholecystectomy surgery in 2020.
"We fully investigated the incidents at the time and commissioned the Royal College of Surgeons to review what happened, which resulted in a number of changes to strengthen our surgery processes.
"Mr Valero has expressed his profound sorrow and apologies for the errors that occurred during these two laparoscopic cholecystectomies."