FIFO surgeons & indemnity - CBS’ Nigel Mercer interview on BBC Radio 4

25 September 2019

A surgeon with a long list of allegations that he’d injured patients was allowed to carry out more cosmetic surgery procedures for years without holding any, let alone sufficient insurance to cover claims, according to an ongoing case before the medical tribunal. Surgeons, like Confederation of British Surgeons co-founder and current FSSA President and Consultant Plastic Surgeon Nigel Mercer, are amongst many who say this particular case has put a spotlight on just how little some patients may know about their surgeons, or their past records.

Mr Mercer was interviewed as a CBS spokesperson for BBC Radio 4’s You and Yours where journalist Melanie Abbot, who has been covering the case for several years, explained that some of patients who’d been treated by the surgeon had developed serious complications - in one instance, a woman developed lagophthalmos - and that the Italian surgeon “employed” by a chain of private hospitals was routinely having a tithe applied to his wages to pay the cost of damages, all while continuing to operate on new patients provided by the clinic in full knowledge of his claims rate. Although the surgeon denied doing harm, former patients successfully brought claims against him - many in excess of tens of thousands of pounds - however, no patients saw any recompense as a result of his declaring bankruptcy in 2013, and his Italian insurer refused to pay out.

At the Tribunal, it emerged that the hospital chain had been making payments to patients who’d complained, although it was not established which of the patients received either full or partial payments in their judgements. Additionally, the tribunal heard that the surgeon was having £6,500/month deducted from his pay, which increased to £10,000/month - whether this had any connection to the volume of surgeries being performed or an increase in claims was unclear. The surgeon himself admitted to being inadequately insured, but claimed he did not know this to be the case at the time - however, a former Director of the hospital chain told the hearing that the surgeon had said he did not want his insurance to be used, and whilst they felt he had appropriate indemnity insurance in place, they opted not to disclose the name of the insurer to patients. Despite multiple complaints about his results, the chain felt these weren’t red flags, and that his complications fell within an acceptable range. Until 2015, the chain itself was not insured, which changed just prior to the business going into liquidation and re-establishing itself as a new company with new directors - a process many have criticised as “phoenixing,” and which typically leaves former patients with invalidated terms and conditions in place of aftercare promises, but in this case it is believed the company have agreed to honour their responsibilities to previous patients.

The controversial topic of FIFO - or Fly-In-Fly-Out - surgeons was brought before the House of Commons most recently by Labour MP Kevan Jones, who criticised cost-cutting measures used to employ lower-cost surgeons without appropriate insurance and called for tougher regulations. In a statement to the BBC, the new hospital chain said that they now ensure all surgeons have appropriate U.K. indemnity cover, and that they would extend their duty of care to patients who were adversely affected by treatment with the previous company.

According to Mr Mercer, who spoke on behalf of the Confederation of British Surgeons;

“The problem is that we have absolutely no idea how many FIFO surgeons are operating within the U.K., as there is no register - and although they are meant to be registered with the GMC, it is thought that many aren’t.

If a surgeon applies for admitting rights at a bona fide hospital in any city in the U.K. they would be required to provide evidence of their insurance - for a U.K. based surgeon, it would be coverage to a level of £10M in order to perform Cosmetic Surgery; we know that some surgeons, however, are woefully un- or under-insured. If a surgeon’s practice is increasing to the point that they have performed more surgeries than anticipated when taking out coverage, they must go back to the insurer to disclose this and adjust payment accordingly to sustain their indemnity insurance to the correct level - there is no excuse for not doing so.

If he or she is registered through the Royal College of Surgeons’ Cosmetic Surgery certification scheme, then their level of insurance will have been vetted, and should any questions arise, they would be required to submit additional documentation proving their indemnity cover is adequate. It is important to note, however, that various countries may offer medical indemnity at vastly different costs: for example, surgeons in the U.K. would likely pay £20-30K/year or more, whilst coverage may cost €6,000 elsewhere. That said, it is practically impossible for patients to assess the level of coverage held by a FIFO surgeon.

The Confederation of British Surgeons believe it is a danger to the public that surgeons could be allowed to practice without adequate coverage - we ourselves would certainly not wish to be treated by a surgeon who was not registered with the GMC or who held inadequate insurance - but it is extremely difficult, and almost impossible to police. We can only hope that this story helps to illustrate to the public that they must remain vigilant, and that we must demand tougher regulations to keep Britons safe - which will be one way to keep private hospitals accountable.”

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