Rhiannon Tull knew one thing when she was pregnant with her first child. She did not want her gynaecologist to be Dr Emil Shawky Gayed. Gayed (pictured below) had a reputation in the regional town of Taree on the mid-north coast of New South Wales, where he worked as a visiting medical officer, consulting in his private rooms as an obstetrician and gynaecologist, and scheduling women in for surgery at the Manning Rural Referral public hospital.
“I know nurses who work at the hospital and they told me, ‘Do not see Gayed,’” Tull said. “I was told he’s OK if you deliver naturally, but not if you need to have surgery. I was told people come back with infections and complications and heaps of bad things happen. From then on I thought, ‘I do not want to encounter that man, ever.’”
But Tull wasn’t so lucky when she was pregnant with her second child three years ago. She was 27 and again needed an emergency caesarean section. Gayed was the obstetrician on duty.
- Rhiannon Tull nearly died on the operating table
“I was petrified,” Tull recalls, her eyes tearing up. “I tried to calm myself down and to tell myself, ‘No, it will be OK.’ But it wasn’t OK.”
Tull nearly died on the operating table. But Gayed never told her that, or why she lost so much blood and needed a transfusion. He didn’t visit her in the days after her surgery to debrief her. Tull found out she nearly died only when she was out for dinner months later with a friend, who is a nurse at the hospital, to ask for her advice about further surgery she needed to repair a tear in her abdominal wall.
- The response letter Rhiannon Tull received from Gayed’s office after the complaint she sent last year
“I told her I was scared of the surgery, because I felt like I was dying on the table during my caesarean. And she said, ‘Well that’s because you nearly did die. It was really close.’”
Tull was sick and exhausted for weeks after the C-section. Her baby’s head was so bruised as a result of forceps Gayed initially used to try to deliver him that his liver began to shut down trying to break down the blood, and he needed to stay in hospital for more than a week. Later, Tull would see that her medical notes contained glaring errors and inaccuracies. She is still too scared to have the surgery she needs to repair her abdominal wall.
“I know for a fact that so many nurses have complained about him numerous times,” Tull said. “I want to know how he wasn’t taken off the medical register a long time ago.”
The Health Care Complaints Commission and dozens of other women who allege they were harmed by Gayed are asking the same question. The HCCC began investigating Gayed only in 2015, which resulted in him being banned in June from practising medicine for three years. But Guardian Australia has revealed that Gayed – who has been contacted multiple times for comment – was making serious medical errors as far back as 15 years ago. On Thursday the HCCC announced it had begun a second investigation, this time also examining the hospital management and staff who may have known about Gayed and the horrific infections, injuries and trauma he was leaving in his wake, but failed to report him.
The stories of his failures are graphic and distressing. There are consistencies in the cases – many women have said their medical notes went missing or what was recorded did not match their experience. Other women had surgeries performed on them that they later found out were unnecessary, such as hysterectomies, fallopian tube removal and the removal of uterine tissue. They would wake up from surgery in agony and suddenly in menopause, their reproductive organs missing.
- Manning Rural Referral hospital in Taree
All the women who spoke to Guardian Australia remain traumatised. Many said they were in excruciating pain for weeks after their surgeries, but that Gayed would send junior staff to debrief them during their recovery to avoid facing questions. Tragically, one woman died after he failed to tell her she had hyperplasia, a condition of the uterus that can indicate cancer. He also failed to refer her to a cancer specialist. He then performed an ablation procedure on her – the surgical destruction of the lining of the uterus – which goes against all medical advice because it can disguise cancer in women with hyperplasia and trigger further cancer growth. By the time the woman came in to the hospital emergency department in February with heavy vaginal bleeding, five years had passed and her cancer was advanced. The doctors could not save her.
The hospital immediately audited Gayed’s other patients going back a decade and identified nine other women he had treated with ablation despite the presence of hyperplasia. They are in the process of having biopsies to find out if they have cancer. The hospital also realised Gayed was performing ablation at a staggering rate – almost 60% more frequently than his peers. One of the women who was called back for a review is 78 years old and said she now knows she should never have had ablation, given she had hyperplasia and was going through menopause.
- Vicki Cheadle in Taree
Vicki Cheadle was one of Gayed’s ablation patients a decade ago. After the surgery, she said she was in agony and felt extremely ill. What she did not discover until eight months later was that her uterus was filling with putrid and infected blood, because Gayed had sealed her cervix shut. She needed emergency surgery to treat the infection that had subsequently developed in her uterus, and in the process lost one of her fallopian tubes.
“The days following the procedure to clear out my infection, I had to visit the surgeon who did the surgery for a follow-up visit,” Cheadle said. “At his clinic, he told me all that he had found wrong in what Gayed had previously done to me, and at length he told me what he would’ve done to treat me if I had been a patient of his instead. He told me flat out that Emil Gayed had botched my procedure, and that basically I would have died if I had been made to wait any longer for surgery to fix it.”
Cheadle immediately sought legal advice. She asked the surgeon who treated her infection to support her case with a statement, and to her shock, he told her he would not.
“He threatened me, and told me he would make sure no doctor in Taree would treat my sons or myself if I took legal action against Gayed,” she said. “That he would get on the stand and lie, because I was lucky any doctor operated on me and that I should respect Gayed’s training and experience.”
Word that she was considering legal action also got back to her GP, who advised her not to proceed. Cheadle said she felt patronised, dismissed and scared. She had no idea so many other women had been affected until she read Guardian Australia’s stories. She still suffers crippling reactive arthritis triggered by the infection, and is now furious his colleagues did not report him and feels compelled to speak out.
“I still have issues because of that butcher,” she said.
Lyndsay Heaton also described Gayed as a “butcher”. Her case is tragic and helped set off the first investigation into Gayed by the HCCC. But she is angry that complaints were not made earlier or that, if they were, they did not result in Gayed being barred from medicine for life. In the first HCCC investigation, Heaton is described simply as “patient B” to protect her identity. But she said the case notes from the hearing before the NSW civil tribunal did not do her story justice, and that she now wanted to make her story public.
- Lyndsay Heaton in Forster
When Heaton was diagnosed with a vaginal polyp in July 2015, Gayed told her it would need to be surgically removed. He said that while he was removing it, he could perform endometrial ablation, which is often performed on women suffering heavy bleeding, but Gayed also performed it on patients with endometriosis, a crippling condition where the lining of the uterus grows in other places, such as the fallopian tubes and pelvis. Gayed told Heaton ablation would result in lighter periods and protect her against pregnancy. She and her partner had six children between them and did not want any more, and Gayed made the procedure sound quick and easy, so she agreed.
She had the surgery on 11 November and it seemed everything had gone well. But by Christmas, Heaton’s breasts and stomach had swollen. Her partner asked if she was pregnant, but she knew that was not possible because they had been unable to have sex while she recovered from the surgery. By January it was clear something was wrong. She went to her GP, who confirmed she was pregnant. The next day, she felt her baby move for the first time.
“I’d had four kids, so I knew what pregnancy felt like and I knew I must be at 16-odd weeks once I felt the baby move,” she said. “I realised that meant I had to have been pregnant at the time of my surgery.” A pregnancy is something surgeons ordinarily look for before performing an ablation or would detect during the procedure.
She rang Gayed, and he told her “not to jump the gun”, she recalled. She made an appointment to see him a couple of days later at his private clinic, where he performed an ultrasound.
“The ultrasound just absolutely wrecked me, because I could hear my baby’s heartbeat,” Heaton said. “It was just so, so hard. I was crying so hard. Gayed explained with the endometrial ablation they put 100 volts of electricity through your uterus. That’s what kills the lining and he said that because of that the foetus had likely been affected and that the baby wouldn’t be normal.”
He also told her that because of the ablation there was a chance she had a condition where the placenta attached to the uterus, and that if it tore away, she could bleed to death. He told her she needed an abortion, a procedure Heaton said she did not agree with and would never normally want.
“But he said I was 19.6 weeks pregnant and we had to act quickly because legally you can only terminate up to 20 weeks, so there wasn’t really time to stop and think.”
That afternoon, Gayed sent her to the hospital for a full ultrasound, and she and her partner decided to go ahead with the abortion because of the risk to her and her baby’s life. Heaton went back to Gayed’s private rooms after the hospital ultrasound, and his secretary was already on the phone calling abortion clinics.
“This was a Friday, and they had an abortion booked in for me in Sydney on the Monday,” she said.
They were told the procedure would cost $2,400, which they could not afford. Gayed wrote Heaton and her partner a cheque.
“He said it wasn’t an admission of liability but a gesture of good faith. I was absolutely numb at the time, everything was happening around me. And then he told me that I’d actually have to give birth to the baby during the abortion. I couldn’t cope with that. Gayed said to me, ‘Well how did you think an abortion happens?’ I ended up absolutely hysterical, to the point that he prescribed me Valium that night so I could sleep.”
- Top: A cheque made out to Lyndsay Heaton’s partner for the payment of expenses from Gayed’s clinic. Bottom: A cheque from Gayed’s clinic to Femme Medical
Heaton and her partner went to Sydney and, because the abortion was complicated, had to stay two nights. Heaton found the experience traumatic and still struggles to cope. She tried to get on with her life, but then she got a call from the Manning hospital’s head of obstetrics, Dr Nigel Roberts.
In 2015 Roberts had been alerted by the HCCC that it was investigating a complaint against Gayed. Roberts called the complainant into the hospital to interview her and find out more about what had happened. She had nearly died after a procedure Gayed had performed. During the interview, she mentioned Heaton, who is her friend, and asked Roberts if it sounded right to him that Gayed had paid for the abortion.
Roberts immediately asked to speak to Heaton and during their conversation Heaton realised Gayed had never told the hospital that he had failed to detect her pregnancy or that he had sent her for an abortion. He had assured Heaton he would tell the hospital to investigate her case to examine how the pregnancy was missed. Under NSW law, it is mandatory for doctors to immediately report such a catastrophic mistake so that it can be reviewed.
“I was really angry,” Heaton said. “Until that point I thought everything had happened the way it was supposed to, and then to find out he hadn’t even reported it ... absolutely nobody knew.”
Roberts acted swiftly. By this point, it was February 2016 and he called Gayed in for a meeting. Gayed was told he was under investigation and that he could not contact any of the patients who formed part of the inquiry. He was barred from performing most surgeries, and resigned from the hospital.
Gayed walked out of the meeting and immediately tried calling Heaton. She let the call go to her voicemail. He left a message trying to explain himself, saying the reason he had not reported her case to the hospital was because he was waiting for her six-week post-abortion consultation.
Gayed was again ordered by the authorities not to contact Heaton. Instead, he had the secretary at his private clinic, where he was still working, call Heaton at her workplace. The secretary asked Heaton if she would still be attending her post-operative check-up. Again, Heaton asked not to be contacted.
- A text message to Lyndsay Heaton from Gayed
Gayed persisted and began texting her. He told Heaton the reason he had not detected her pregnancy before operating on her was because she had a bicornuate uterus, a condition where the uterus is shaped like a heart. But a specialist at the John Hunter hospital in Newcastle later rejected this, saying her uterus was normal. Roberts agreed, saying that if Heaton really did have a bicornuate uterus, it would have been detected when she had her first child 24 years earlier.
Then the letters came. Gayed began writing to Heaton, asking that receipts from her trip to Sydney for the abortion be sent to him. His clinic sent her a stamped envelope and told her to “honour the agreement”. Heaton ignored the letters, instead sending her receipts to the hospital and investigators.
But she is angry that her case and seven others that made up the original HCCC investigation led to only a three-year ban on Gayed. While the clinical director of the Manning, Osama Ali, has vowed never to let Gayed work in the Hunter New England region again and has alerted all hospitals where he was known to work, there is nothing to stop him from re-registering and practising elsewhere once his ban is up. Even after he had left the Manning, he continued to work at his private clinics while the investigation was under way. He then closed them down and handed in his registration in April 2016, well before he was found guilty of misconduct and penalised with the ban in June this year.
- The clinical director of the Manning Rural Referral hospital, Dr Osama Ali
Gayed did not defend himself from the HCCC’s case against him. But he continues to deflect the blame and insists his behaviour was above board. Ali, who confronted Gayed with the accusations, said Gayed had insisted he was not at fault. Ali describes what Gayed did to Heaton as “almost criminal”.
It is Ali, with his gentle manner and clinical expertise, who has been put in charge of rebuilding the hospital’s reputation and contacting all the women Gayed is believed to have harmed. It’s a task he concedes has been distressing, and he wants to help the affected women as swiftly as he can. Meanwhile, Gayed has begun accusing the hospital of running a campaign to destroy his character.
Documents obtained by Guardian Australia show Gayed obtained his bachelor of medicine at Ain Shams University in Egypt. He became a fellow of the Australian College of Obstetricians and Gynaecologists in 1993. He was first registered as an obstetrician and gynaecologist in 1994, and worked at the Manning for about two decades, as well as at the Mayo private hospital, a private clinic in Taree, and at private clinics in Dee Why and Mona Vale in Sydney.
The chief executive of the Hunter New England health district, Michael DiRienzo, said the hospital now relied less on visiting medical officers such as Gayed, who often saw public patients for appointments in their own clinics and then used the hospitals for major procedures and surgery. An obstetrics clinic has been opened at the hospital so that doctors can see patients “in-house” and this ensures the hospital has copies of all medical records. This had also helped increase transparency, DiRienzo said.
But many of Gayed’s former patients are struggling to get their medical records, now that he has left town. He is believed to be living in Sydney but no longer answers his mobile phone, and has closed his private practices. It makes it difficult for women who suspect they have been harmed to have their cases properly reviewed.
“I personally have been involved in this process and I can tell you it’s a really, really hard part of the conversation when you talk to those women, and I really feel for them,” DiRienzo said. “I’m really sorry they’re in this position but the message is if they are concerned about treatment they had at hospital and want to be assessed, even if they don’t have all of their records, we will assess them.”
Many of Gayed’s victims were young when they met him and felt intimidated when they tried to speak up.
Christy Smith was 20 when, in July 2002, he stitched up tears in her vagina after childbirth. When she went for a routine pap smear to a doctor a few months later, Smith mentioned to her that she had not been able to have sex since giving birth.
“When she checked me out, she was horrified,” Smith said. “She said Gayed had stitched my vagina almost shut. She couldn’t even give me a pap smear ... she was really disgusted, and she even drew a picture of it for me, of how it looked. She said I needed to go see a gynaecologist and get it fixed. I still feel mutilated.” She saw a specialist in Newcastle to get surgery to repair it.
- Christy Smith in her home in Kendall
But the specialist Smith went to for her next pregnancy – the same one who told Cheadle he would not support her legal case – said she was overreacting when she told him what had happened with Gayed previously. He did not accept that Gayed had done something wrong.
“I felt put down and basically didn’t feel there was anyone I could trust with what had happened to me in Taree,” Smith said.
Another woman, Talia Sly, had a similar experience when she tried to speak to the same senior surgeon. She was 37 weeks pregnant in 2010 and extremely ill with pre-eclampsia, a pregnancy complication causing high blood pressure, vomiting, nausea and pain. She went into hospital and Gayed was on duty. Sly said the nurses told her she needed to be induced and have her baby as soon as possible, but Gayed overruled them. Eventually, after a few days in hospital, she began to pass out and could barely speak. The nurses rushed to Gayed, and she remembers him “storming in” to induce her.
“I was 19 years old,” she said. “He didn’t say a word to me when he came in. I was so scared.”
After giving her drugs to induce labour, Gayed left and the nurses took over. She was in labour for more than 24 hours and they again grew worried when her contractions stopped. They called Gayed.
“My baby was delivered in two minutes,” Sly said. He gave her an episiotomy almost immediately, a procedure where the opening of the vagina is cut and made larger. “I lost a lot of blood immediately and needed a blood transfusion,” she said. “He stitched me up and left.”
- Gayed’s medical practice in Taree
When Sly became pregnant again two years later, she didn’t want Gayed to touch her but the other two obstetricians in town had waiting lists that were months long. At 34 weeks, she went to hospital again suffering the effects of pre-eclampsia, and being a public patient, had no choice but to see Gayed.
He prescribed her a medication and sent her home. She and her mother went to a pharmacy in Forster that afternoon to fill the script and the pharmacist was “outraged”, Sly said.
“She said, ‘Who the hell prescribed these? This will cause serious harm to an unborn child.’ She was so outraged that she tried to call Gayed. He told the pharmacist it was one of his medical students that wrote the script. But that’s not true, because I was there when he wrote it.”
Sly’s mother was so concerned about her daughter’s treatment that she called another senior obstetrician and gynaecologist in Taree that evening. He told her to bring Sly to the emergency department at 8am the next day. On examining her, he told her she needed an emergency caesarean.
Sly and her mother asked him to do it because they wanted to avoid Gayed, but he told them: “It’s all politics around here, we don’t take each other’s patients.” He then went and spoke to Gayed and told him to perform the C-section.
“Dr Gayed walked into my room and threw down the papers in his hand and said he was doing the caesarean ‘right now’,” Sly said. “He gave me the filthiest look. When he walked out of the room, he said to my mum and mother-in-law who were waiting outside, ‘Does she always get what she wants?’”
After her son was born, Gayed came back into the room to circumcise him even though Sly had not asked for the procedure. Sly refused to allow him to do it.
Sly was diagnosed with tears in her abdomen after her C-section. Her recovery was slow and traumatic but she said she felt it was partly her fault because she was so young.
“I always just thought Gayed just really didn’t like me, I thought it was me, that I really didn’t know how to do this pregnancy thing right,” she said. “That’s a reason I didn’t complain.”
Jade Howard hopes Gayed “never touches another women, ever again”. She was almost 40 weeks pregnant when her water broke and she realised it had a dark green substance in it, which is meconium, the first faeces of a newborn infant. It is a potentially dangerous condition, because the baby can inhale the fluid and become very ill. A previous ultrasound had also found the umbilical cord was wrapped around the baby’s neck, and doctors hoped the baby might flip and get untangled from it. It was a complicated pregnancy.
- Jade Howard at her home in Cundletown
When Howard was rushed to hospital at 6am, Gayed did not seem concerned by the meconium waters despite the nurses frequently raising the topic with him. Six hours later, he told the nurses to induce Howard to bring on the contractions, and he then went home. The next morning, when he returned to work, the baby still had not arrived, and he decided to do a C-section.
“After he was born, I noticed my baby was breathing weird and I asked the midwife ‘Is this normal?’” Howard said. “They rushed him into the special care nursery where I later found out he’d developed pneumonia. He’d inhaled the meconium, and he needed a gastric tube and IV lines, and he was so, so swollen.”
While her baby was being treated, Howard began to feel sick and was in severe pain. She had developed a post-operative infection and took weeks to recover.
Many women have similar stories of infections following surgery, and of having severe pain ignored. More than 20 of them have contacted Guardian Australia. Some said they had heard rumours about Gayed over the years, while others said they had thought they were the only one to have suffered harm. All were shocked that he had only been barred from practising for three years after the HCCC’s first investigation. But with a fresh investigation under way, and more patients wanting to tell their story, it seems likely that the three-year ban might be increased.
The director of Catherine Henry lawyers in Newcastle said that in her years of representing patients she had seen firsthand how difficult it could be to get a doctor deregistered for life. There had to be a pattern of deliberate harm proven, she said, as opposed to a clinical error that could be explained by complications or a difference in approach between surgeons.
While she said there were similarities among Gayed’s patients in Taree, his negligence ranged from performing unnecessary surgeries, to failing to leaving women with serious infections, to failing to keep good medical records.
- Victoria Street in Taree
Several women told Guardian Australia that when they approached a major law firm in the region, Stacks Lawyers, they were turned away. The managing director of the firm told Guardian Australia: “As a general rule we do not accept instructions against local professionals because it could lead to a conflict of interest because a lawyer in the firm might have had past dealings with that local professional.”
With senior hospital staff telling them they had overreacted, the local law firm unable to take their cases on, and their bodies in physical and psychological pain, many of the women focused instead on recovering from their treatment. Now that Gayed has been exposed, they have begun to talk to their families and to each other. And when they do, they often find that there are others who have a story about Gayed.
The case raises serious questions about the accountability of senior doctors and points to a culture of doctors protecting their own. Surgery involves a team. When things go wrong, anaesthetists, general surgeons, nurses and assistants are present. While even the most minor of procedures carry complication risks, and even experienced surgeons make mistakes, Gayed’s errors were egregious and frequent. His negligence was either noticed and not reported, or if they were reported, did not make it up the chain of command.
The HCCC, Ali and DiRienzo are now grappling with the aftermath as those who worked most closely with Gayed face questions. “If an investigation also identifies other persons or practitioners with potential knowledge, information or involvement, the commission has powers to receive information from them, and other practitioners can also be formally added to the investigation,” a HCCC spokesman said.
“If evidence of possible criminal activity by a health practitioner is revealed through a commission assessment or investigation process, the commission refers all relevant information to NSW Police and NSW Police will provide back to the commission material relevant to its investigation.”
The reputation of the Manning’s obstetrics and gynaecology department is bruised. And Taree, a sleepy coastal town, is reeling. While Guardian Australia was in the town, women who once thought they were alone in their trauma called and emailed, wanting to share their stories.
Guardian Australia has made multiple attempts to contact Gayed about the new allegations made against him. Gayed, meanwhile, has not returned Guardian Australia’s calls.
- Do you know more? Contact melissa.davey@theguardian.com
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