The BMJ recently reported on the efficacy of bariatric surgery. In the paper, a group of bariatric surgeons review their recent work to find that, despite increased obesity, the number of procedures is reducing. They argue that it would be more cost effective to deal with the obesity crisis by means of surgery than to deal with the consequences down the line such as diabetes, and respiratory and mobility problems.

Amongst the smaller print in the article is the emphasis on the need for skilled and appropriate units to perform such surgery. I am reminded of recent cases involving the Whittington Hospital and the surgeon Mr Dugal Heath.

For those who are unaware, Mr Heath was recently struck off the medical register following a series of complaints by patients to the GMC. He was one of the bariatric surgeons at the Whittington. I have recently settled a case involving the care provided by him and the unit. There was no doubt that fault was identified (and agreed) in relation to Mr Heath but there were other aspects of care generally which were subject to criticism. Ultimately the matter was settled and did not go to trial so we will not know whether they would have been found justified. What is apparent is that there were concerns for some time before the disciplinary process commenced.

Bariatric surgery is a relatively new area and there are fewer surgeons who really have expertise in this are though there seems to have been a growth in units claiming to do the work. Although it gets put together with general surgery it is a specialist field in its own right and needs to be treated as such.

Bariatric surgery patients are often treated slightly differently from general surgery patients. Symptoms which may not cause concern in a general surgery patient are often viewed as more potentially of a problem in the bariatric surgery patient. Small changes which would be noted but would not necessarily cause significant concern in an appendectomy patient might be considered much more serious in a patient with a sleeve gastrectomy. A small undetected leak can have significant effects. In one case my client was left so unwell and immobile for so many months that ultimately she lost the ability to use her limbs at all. In another case, numerous corrective operations have made my client’s appearance so distressing for her that the psychological impact is worse now than when she was obese.

Legally these cases can be difficult and need specialist solicitors familiar with the surgery and with access to experts who are sufficiently specialist to comment. There are few of these in this field. Mr Heath was a consultant working in a busy unit in North London. He specialised in this type of surgery and seemed to do a great deal of it. Some surgeons appear to “dabble” which cannot be anything other than a concern.

Whilst everyone would like to see an improvement in the availability of surgery which can, if done well, allow people to live better quality lives, the emphasis has to be on the appropriately funded and staffed unit. It is the quality of the care that makes the difference as the recent examples show. Whilst I continue to do many of these cases it has to be hoped that the units will improve as the number of procedures increases.