Consultant surgeon to be sanctioned for ‘risky’ operation without specialist support

A consultant surgeon who carried out a “risky” operation on a patient at University Hospital Galway (UHG) without the availability of specialist support staff over a bank holiday weekend is to be sanctioned by the Irish Medical Council.

The council’s Fitness to Practise committee found eight allegations of poor professional performance to be proven against consultant orthopaedic, trauma and spine surgeon Elias Rahall in relation to operations he carried out on four patients at the hospital nine years ago. It found he had failed to provide appropriate care to all four patients.

The committee said Dr Rahall had carried out complex surgery on a patient on March 15th, 2014, the Saturday of a bank holiday weekend, at a time when it was inappropriate because of reduced support levels.

In relation to another patient, the inquiry concluded that Dr Rahall had carried out unnecessary, complex corrective surgery on a man with a spinal deformity which had the potential for significant complications.

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However, Dr Rahall was cleared of several other allegations that he had failed to document in medical records the nature of discussions he had with three patients and if he had obtained their informed consent.

Separate allegations in relation to the same three patients that he had failed to adequately consult with them about the risk of their surgery were not proceeded with by the council.

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Dr Rahall, who worked at UHG between January 2013 and February 2015, is currently based in Dubai. He did not attend a virtual hearing of the committee on Wednesday at which the inquiry’s findings were announced.

Committee chair Jill Long said the committee agreed with an expert witness, David Moore, that it was inappropriate for Dr Rahall to have carried out “extremely complex” surgery on a person known as Patient A on a bank holiday weekend due to the reduced level of support services available.

Standards of competence

She said the committee was satisfied that such serious conduct represented a failure to meet the standards of competence, in terms of skill and knowledge, expected of a consultant surgeon. It also ruled that Dr Rahall had used an inappropriate approach for treating a spinal condition in a woman known as Patient B on March 5th, 2014.

“There was a risk that the surgical aim or goal would not be achieved and that the procedure to stabilise the spine might have to be abandoned or not completed,” said Ms Long.

Dr Rahall was also found guilty of poor professional performance over his treatment of a male known as Patient C on whom he carried out spinal surgery on February 10th, 2014, without identifying any source of pain.

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Ms Long remarked that the aim of the surgery was “unclear” while the decision to perform it was “hasty”. She noted there was also a risk that metalwork in the patient’s spine could break because of the procedure.

In relation to a female known as Patient D, the committee found Dr Rahall had inserted screws in her spine on May 8th, 2014, which were too long, with one of them protruding into the woman’s bowel.

The committee did not disclose its recommended sanction as any disciplinary action against Dr Rahall must be formally ratified by the full Irish Medical Council and approved by the High Court.