A Canberra gynaecologist who was under investigation after several of his patients suffered complications has been cleared by the medical watchdog to continue practising.
Omar Adham, who was at the centre of an ABC investigation last year, has worked at several hospitals in the ACT and NSW.
Last year, the Australian Health Practitioner Regulation Agency (AHPRA) confirmed it was investigating a number of his cases.
Several of his former patients had complained to the regulator following surgery with Dr Adham, which required further repair operations.
They were advised by AHPRA in letters, some of which were seen by the ABC, that the Medical Board of Australia had met on March 4 and decided to take no further regulatory action.
It found "Dr Adham provided care to a reasonable standard".
Dr Adham told the ABC through a spokesman that he welcomed the findings.
"The investigation process has been challenging for both my patients and myself," he said. "The Medical Board of Australia has conducted a thorough and exhaustive investigation, which has completely and comprehensively cleared me in these matters."
Several of the complainants told the ABC they were disappointed by the decision.
They said AHPRA did not interview them and they were also unable to obtain a copy of the expert opinion about their case by obstetrician and gynaecologist Michael McEvoy, which the decision to clear Dr Adham was based on.
One of Dr Adham's former patients who complained, Kristy Stanford, said she was "gutted" by the news.
She suffered a perforated bowel, a fistula and other complications after a procedure for endometriosis with Dr Adham and subsequent delay by the Canberra Hospital in treating her post-operative symptoms.
"I told AHPRA I was disgusted," she said.
According to AHPRA, Dr McEvoy assessed Ms Stanford as a "very high risk" of complications, but he considered the complications she suffered were "within recognised professional standards".
She said she was not warned the risks were high.
"The risks are very minimal — it's something he does all the time, easy surgery," Ms Stanford said she was told.
"I feel so worn down by the system.
"It's been so long and drawn out and it's something we are still dealing with on a daily basis."
During AHPRA's investigation, Dr Adham arranged for two colleagues to observe his surgical procedures at Canberra Hospital.
Their opinions, including that Dr Adham was "an extremely competent surgeon" with "acutely developed laparoscopic surgical skills", were instrumental in the Board's finding.
Dr McEvoy told AHPRA he considered Dr Adham's complication rates were "within normal range and the complications experienced by all of the patients are known complications of the surgery being performed".
AHPRA told the patients it had also obtained data from Calvary John James and The Canberra Hospital about Dr Adham's complication rates, which showed they were "comparable to [those] of his peers".
Calvary John James said that, between June 28, 2018, and June 28, 2021, only seven of Dr Adham's 516 patients at the hospital (1.3 per cent) had suffered complications.
The ABC is aware of eight patients at that hospital in that period who say they suffered complications after operations by Dr Adham. While the difference is statistically insignificant, it raises a question about the robustness of record-keeping.
AHPRA declined to comment on the quality of the data, citing legislative restrictions on discussing individual cases.
Several patients told the ABC they were not warned of the risks of complications and, in some cases, were not fully informed about the procedure they were to undergo.
However, the Board found that "Dr Adham did adequately discuss the condition and available treatment options, including their potential benefit and harm and material risks".
Julie Ashcroft disputes this.
She received bladder and ureter injuries after prolapse surgery and the insertion of mesh with Dr Adham at Calvary John James Hospital in 2019.
Ms Ashcroft said that she was not informed that mesh would be used in the procedure before the surgery, and the first she learned it had been inserted was several months after the operation.
Dr Adham had provided her with a brochure outlining numerous types of prolapse operations, which included a reference to some procedures that used mesh and the risk of erosion.
No record about a discussion about mesh could be found on her medical file, which Ms Ashcroft obtained. Mesh was also not mentioned on the consent form she signed.
She said, at the time she lodged her complaint with AHPRA — which did not interview her during its investigation — she had not yet learned she had mesh, nor that it was eroding and causing internal damage.
"How could I have consented when I didn't even know I had it?" she said.
"I would have said no to mesh at the time," she said, adding that she was aware of the widely reported class action over the use of mesh that was then underway.
"We all knew about Johnson & Johnson," she said.
AHPRA informed her that Dr McEvoy had concluded in her case that "[r]isks were discussed, including erosion of mesh, ureteric damage and bowel and bladder damage".
"I don't understand how [AHPRA] haven't come back to me," she said.
"He got to respond. Why don't I?"
AHPRA said it did sometimes interview patients who complained about practitioners, but would not discuss why it had not done so in this investigation.
Dr Adham was previously cautioned by AHPRA over the consent process with another patient, Juanita Connors, who underwent surgery for excision of suspected endometriosis at Calvary John James in late 2018.
She was advised by Dr Adham on the morning of the operation that he wished to add an additional procedure.
Ms Connors signed the consent for that procedure while lying on a gurney on her way into the operating theatre.
In late 2020, the Medical Board found Dr Adham's "performance [in obtaining Ms Connors' consent] was below the standard reasonably expected of a registered medical practitioner".
However, AHPRA's letter this month to patients in the more recent investigation says that Dr McEvoy considered that "Dr Adham's consent process is to standard and that he was compliant with the current standards".
It said that Dr McEvoy had made "comments surrounding [Dr Adham's] process of obtaining informed consent" and that Dr Adham had made some changes to his consenting process.
Dr Adham declined to disclose to the ABC what comments Dr McEvoy made, but he disputed AHPRA's suggestion he had changed his consenting process.
"My process of informing patients about the risks of surgery has always been comprehensive and did not require any change," he said.
"All of my patients are fully informed about the procedures they are considering undergoing, including the risks of those procedures."
Lawyer Sam Tierney, who acts for several of the AHPRA complainants, said his clients were disappointed with the outcome.
"This is particularly so when so many women in the Canberra community came forward to raise concerns with AHPRA," he said.
"As a professional body that claims a focus on patient safety as its number-one priority, it is concerning that AHPRA would not seek to speak directly with any of the women who raised concerns … before [it] proceeded to simply dismiss their concerns."
AHPRA would not say how many cases involving Dr Adham's patients it had investigated.
The ABC is aware of eight stretching across six years, one of which is still ongoing.
