A Blackpool Victoria Hospital surgeon who tried to cover his tracks after he operated on a breast cancer patient without looking at pre-op scan results has been suspended.
Sadagopan Varadarajan, who has since left the hospital, was described as "evasive" at a misconduct tribunal which stripped him of his ability to work in health care for eight months.
The panel, which heard evidence over a two week period in Manchester, concluded: "Mr Varadarajan demonstrated that he has the capacity to be dishonest over a significant period of time for his own benefit, including during these proceedings."
But it stopped short of striking him off, saying: "There is no suggestion of similar behaviour during his almost four decades of medical practice... His dishonesty has all arisen as a result of his treatment of one patient."
Varadarajan, who qualified in India and has practiced in the UK since 1983, had been working at the Vic as a breast and endocrine consultant surgeon for 12 years prior to his blunder, which happened in October 2014.
He failed to look at the results of an MRI scan before performing a 'wide local excision' on a woman called 'Patient A', which removed part of her breast, the tribunal ruled.
That could have left her needing more surgery.
Varadarajan also failed to "obtain adequate and appropriate consent" from the patient, who had "high anxiety", because he didn't discuss the option of having a mastectomy instead; the potential risks and benefits of the procedure; the possibility of it failing; or follow-up treatments like radiotherapy and chemotherapy.
He was also chastised for failing to communicate with his colleagues; and for not keeping an "adequate and appropriate record" of discussions, the patient's anxiety levels, and the "rationale behind [his] decision to continue with the procedure in the absence of the MRI report".
He then "sought to inappropriately influence" a colleague, 'Dr B', by "suggesting" they have given him a "verbal report of the MRI scan".
Nathan Moxon, chairman of the Medical Practitioners Tribunal Service (MPTS) tribunal, said: "He stated that Dr B conveyed to him that Patient A's tumour was 'localised to one area' (or words to that effect). As a result of Dr B's confirmation, Mr Varadarajan stated he felt he was able to perform the procedure.
"However, the tribunal is satisfied to a high standard ... that the discussion on October 17, 2014, never took place in relation to Patient A. Nevertheless, the tribunal considered that Mr Varadarajan approached Dr B after the procedure, upon learning it was being investigated as an untoward incident, in order to influence Dr B to disclose that he had given a verbal report on Patient A.
"He did this to protect himself from foreseeable criticism of his actions".
At a later disciplinary hearing, Varadarajan said: "In honesty, I have never been to one of these hearings before", despite knowing that was untrue, the panel said. He had attended a disciplinary hearing in February 2013.
"The tribunal found Mr Varadarajan to be evasive when giving oral evidence, particularly during cross-examination whereby he often sought to analyse and critique questions rather than answering them, and when answering questions often failed to do so directly," the panel ruled.
"Further, there were areas of his evidence in which the tribunal is satisfied to a high standard that he sought to mislead."
They included Varadarajan saying he sent a letter to Patient A's GP saying she wished to conserve her breast, when it said no such thing.
In a witness statement he claimed he turned up at work to find Patient A on his theatre list and the MRI written report unavailable and said he felt it was too late to stop the surgery because she had been anaesthetised, even though medical notes show he examined her before the surgery and before she was anaesthetised.
He said he didn't record Patient A's high anxiety "as it had already been recorded by the anaesthetist" even though he admitted he had not seen the anaethetist's record.
And he claimed he had forgotten about his previous disciplinary hearing, with the panel saying it "does not accept that an intelligent professional would forget that he was subjected to disciplinary action and a sanction..."
Varadarajan, who went on to work as an agency surgeon for the Wrightington, Wigan and Leigh NHS Foundation Trust but is no longer working there, according to a spokesman, told the tribunal he now accepts he should have had a full MRI report before carrying out the procedure, which was successful, though he maintained that he got a verbal report.
He admitted he should have "done things differently" but challenged the panel's findings of dishonesty. He said the proceedings had been stressful on him and his family and said he was "happy to pay the price" and wants to be a "better person and a better doctor".
"The tribunal took full account of the fact that Patient A had not been harmed as a result of the procedure," the tribunal said. "However, it accepted the evidence that MRI scans show whether a lesion is multi-focal.
"In this case, Mr Varadarajan proceeded upon the assumption that it was a localised lesion. That assumption proved to be correct. However, had Mr Varadarajan been incorrect, and the lesion was multi-focal [ie there was more than one tumour], this would have resulted in Patient A requiring further surgery, which would have been avoided had multi-focality been identified prior to the initial surgery.
"The clinical care provided to Patient A therefore fell seriously below the standards expected of a reasonably competent consultant breast surgeon."
It added: "Mr Varadarajan dishonestly attempted to influence Dr B in an effort to cover up his own clinical failings. Further, he dishonestly stated incorrect information during disciplinary proceedings that were undertaken to investigate those clinical failings.
"The tribunal found Mr Varadarajan's dishonest actions in this regard to be particularly serious and undermining to public confidence in the medical profession."
It "considered" that Varadarajan had "demonstrated a degree of insight and had attempted to remediate his practise deficencies" and now "understands that he must have all relevant pre-operation material before undertaking surgery".
He had completed further training and also understood the importance of getting "adequate and informed consent" from patients, and that he "must maintain records to ensure continuity of patient care".
But it said: "The tribunal was satisfied, given that Mr Varadarajan had attempted to influence a colleague and mislead disciplinary proceedings, public confidence in the profession and in the GMC [General Medical Council] as its regulator, would be undermined if a finding of impairment were not made..."
"Further, the tribunal noted that Mr Varadarajan demonstrated a lack of candour within his evidence during the facts stage of these proceedings...
"The eight-month suspension imposed by the tribunal marks the seriousness of Mr Varadarajna's misconduct."
In a statement, Blackpool Teaching Hospitals NHS Foundation Trust said: "This is a long standing case and Mr Varadarajan has not worked for the Trust since 2016.
“As soon as concerns were raised about Mr Varadarajan’s practice the trust carried out its own investigation and referred him to the relevant professional bodies.
“The trust co-operated fully with those bodies throughout their investigations.’’