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– I quickly had to do a lot of operations independently.
The doctor writes about this when he was transferred from Flekkefjord to Kristiansand in early 2019.
Sørlandet Hospital and the doctor are being investigated in ten ongoing supervision cases.
NRK has obtained information about what the 54-year-old Kazakh wrote about his role.
Just over 450 patients have required a new assessment after having been operated on by him in recent years.
Finn Åge Olsen from Lyngdal finally had his leg amputated after surgery.
Photograph: Per-Kåre Sandbakk / NRK
This week, the Norwegian Board of Health took the unusual step of revoking his license while the investigation is ongoing.
They believe the cases are so serious that they cannot wait until they are decided.
The doctor writes to the Norwegian Board of Health that he only had a few short orthopedic courses in Flekkefjord.
– They push me in front of them
About the time in Flekkefjord, the doctor writes:
– Always at SSF I had the impression that it was important to “maintain production” and there was less attention to work with quality assurance and patient safety.
The doctor does not recognize any error in any of the cases.
You think it has been effective and useful for the hospital:
– The management has “encouraged me to keep going”, but now they are pushing me in front of them.
The doctor states that the hospital management is not responsible for the safety of the patient.
But CEO Nina Mevold says she takes responsibility:
– Patient safety is my responsibility. Every day since I started almost two years ago, I have been working towards quality assurance systems.
Executive Director Nina Mevold says she takes patient safety seriously.
Photograph: Per-Kåre Sandbakk / NRK
– Fix this alone
The doctor was educated in Kazakhstan and worked in Germany before entering Flekkefjord Hospital in 2008.
There he started right in the position of orthopedic doctor.
Even though he was not an orthopedist. Management knew he did not have the six-year specialization.
The patients were injured for life.
Several died.
After several cases in the media, the doctor was transferred to Kristiansand last year to begin his education.
He had to operate alone from the beginning.
– My rearguard used to say: “Fix this just as we agreed …”
He claims he was described there as “super competent” to be in education.
Five of the supervision cases currently being processed are from Kristiansand.
– The doctor operated alone from the beginning. Should I have done that, Mevold?
– I asked Helse Sør-Øst RHF for a review of, among other things, this question, precisely to clarify the transition between Flekkefjord and Kristiansand.
Vegard Øksendal Haaland helped move the doctor.
– He knew about the patient’s injuries. Was it healthy?
– Yes, I think it was justifiable. It started with a five-year educational course.
He was completely disabled
One of the patients who underwent surgery at Kristiansand is Margret Annie Gudbergsdottir.
What was an uncomplicated fracture to her wrist has led to her being completely disabled.
He has developed the rare and chronic pain syndrome CRPS. Experts believe it is due to the treatment he received.
Margret Annie Gudbergsdottir fractured her wrist and was operated on by the doctor. She was completely disabled.
Photograph: Per-Kåre Sandbakk / NRK
The pain is so severe that it is called a “suicidal illness.”
– I have the feeling of being in a nightmare, he tells NRK.
NPE (Norwegian Patient Injury Compensation) writes:
“Both surgeries likely led to significant soft tissue dissection and additional trauma to the wrist.”
– Competent for all tasks
Another case concerns a 62-year-old man from Agder.
He had his heavy coat on a saw. The thumb just held.
The doctor took the operation only in Kristiansand.
Norwegian Board of Health Expert Assessment states: Treatment deviates in Big degree of good practice.
The doctor writes to the Norwegian Board of Health:
– I have always perceived that I was perceived as competent for all the tasks assigned to me.
– It is important to increase the number of operations
Sørlandet Hospital consists of Kristiansand, Arendal and Flekkefjord. For years, the Flekkefjord hospital has been threatened with closure.
The professional management of Sørlandet Hospital thought that there were too few patients. Very few operations.
The city was in procession with torches.
The hospital fought for its existence.
The doctor writes:
– I have received comments that it is important to maintain the number of operations and that I was important in that regard.
Several patients have been operated on without any surgical reason. It is established in various cases of supervision.
One of them concerned Åse Løkken Vegge. She was healthy, but had had a complete hip replacement. She was permanently injured.
Åse Løkken Vegge in Lyngdal underwent surgery to insert a full hip replacement for no reason. She ended up with a foot drop and lives in severe pain.
Photograph: Per-Kåre Sandbakk / NRK
Another was a woman who had ten screws inserted into her toe. She had no ailments beforehand.
The doctor had also offered him several “on the table” operations.
360 patients who have been operated on by the doctor in Flekkefjord have demanded a new evaluation.
So far, only 120 per hour have been set up, according to the latest NRK figures.
Kept activity high
There were reports of non-compliance from colleagues who reacted to the doctor operating quickly. The supervision cases also show this.
He says that Flekkefjord management was very satisfied with the efficiency:
– And above all because it had a great capacity and contributed enormously to keeping activity high in the surgery department.
He says it was quantity above quality:
– The emphasis was increasingly on production and less on quality and patient safety.
Vegard Øksendal Haaland was director of the clinic in Flekkefjord since autumn 2017. He does not recognize himself in this:
– My main goal was to further develop patient safety. I put structures in place and during this short period we got off to a good start on this job.
Haaland is now director of quality work throughout Sørlandet hospital after 18 months in Flekkefjord.
Senior executives will not respond
Jan Roger OIsen was director of the Sørlandet Hospital from 2003 to 2018. He was responsible for quality in both Flekkefjord and Kristiansand.
He will not comment on the case.
Per Engstrand was a subject director for many years.
A year ago, he moved to a new position at Health South-East.
He has received the accusations from the doctor. NRK has also asked two questions:
- You were a professional director during these years and you knew that the doctor had repeatedly operated on you incorrectly. Why did you let him continue?
- As a subject director, you were responsible for quality. What should you do?
Engstrand will not respond to this. Write in an SMS:
“Now I work for Helse Sør-Øst and it does not seem natural to me to answer the two questions that NRK has sent.”
The doctor will not comment on the case.
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Director of the Vegard Øksendal Haaland Clinic
- The doctor clearly writes that it was important to maintain the number of operations and that the emphasis was on production rather than patient safety. Do you recognize yourself in it? It is true? ANSWER: I cannot recognize myself in that. I took over shortly after the decision was made to continue emergency functions at Flekkefjord. During the 18 months that I worked as the clinic director, my main focus was to further develop the work with patient safety and find sustainable solutions for the continuation of emergency functions. During this short period, we got off to a good start.
- The doctor states that the hospital management is not responsible for the safety of the patient. What responsibility do you take for what happened in Flekkefjord?ANSWER: I was responsible for patient safety for the 18 months that I served as the clinic director since Fall 2017.
- Why did you let the doctor continue, even after several cases of supervision? ANSWER: During that period, two incidents were reported, in which the doctor in question was central. These cases were taken very seriously and followed up.
- Do you take any self-criticism now in hindsight? ANSWER: During my time as clinic director in Flekkefjord, there was structured work on how we learn from and follow up on unwanted incidents. We are also working to strengthen the collaboration between Flekkefjord and Kristiansand. This was a large and complex restructuring job that I did not come to terms with during the period, and one can always wish they had gone further. The work has been continued by the department head and the new director of the clinic.
- They transferred the doctor to Kristiansand and knew of the patient’s injuries. It’s good? ANSWER: Yes, I think it was good. It started with a five-year educational course.
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CEO Nina Mevold
- There are five cases of Kristiansand supervision. The doctor operated alone from the beginning. Should I have done that? ANSWER: In a dialogue between Helse Sør-Øst RHF and SSHF, in February it was decided to use the Group Audit for a patient treatment review of the LIS doctor’s work at Kristiansand and Flekkefjord hospitals. The audit has had both a patient perspective and a system perspective, also to gain clarity on matters related to the physician’s specialization.
- The doctor believes that the hospital management is pushing him in front of him and is fleeing responsibility for patient safety. What is your answer to that?ANSWER: Patient safety is my responsibility, which I have taken very seriously since I started almost two years ago. Helse Sør Øst has informed that the Group’s Audit report will be published today. Both he and eventually the Norwegian Board of Health report will be an important help in prioritizing further improvement work.
- After all the patient injuries in Flekkefjord, how could he let me operate on patients only in Kristiansand?ANSWER: Specialized education involves assessment of competence and an increasing degree of independence until you have completed a specialist. The person in question participated in a LIS training course. A thorough evaluation was conducted when she began her educational career.
- The Norwegian Board of Health believes the cases are so serious that they take away his license before the investigation is complete. How can you, as a leader, stay put after this?ANSWER: The Norwegian Board of Health must itself be responsible for the reason why you were temporarily deprived of your license. It is the board that evaluates the results of the CEO.
- Should you have done something different? Do you accept any self-criticism?ANSWER: I take the question of the quality of treatment for our patients very seriously. We have identified important areas for improvement and I look forward to receiving the Group Audit report, which will provide more information. We will follow up on these.
