Impaired Surgeon and Unsafe Locum Cover
An orthopaedic surgeon at a private hospital has been on call for two consecutive nights. During a theatre list, the anaesthetist notices slurred speech, a tremor, and the smell of alcohol. Two operations have already been completed; one had a near-miss with a retained swab. The surgeon cancels the remaining list but insists on seeing clinic patients because ‘there is no one else’. The medical director suspends his theatre privileges but asks him to continue outpatient clinics until a locum arrives. The locum is a surgeon registered in another country who has applied for Kenyan registration but has not received it. The hospital plans to let the locum cover emergency surgery supervised by the medical director, who is a physician, not a surgeon. The surgeon refuses a breath test and refuses to see an occupational health assessor, saying he is only stressed.
1. What immediate steps should the medical director take?
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The medical director should remove the surgeon from all clinical duties, including outpatient clinics, not just theatre. The priority is patient safety. The remaining theatre list should be cancelled, patients reviewed, and any retained-swab near-miss investigated and disclosed through the hospital’s incident process. A licensed surgeon with verified privileges must provide cover; the medical director cannot supervise emergency surgery outside their scope merely to keep the service open. The surgeon should be offered safe transport, treated with confidentiality, and given a written instruction not to attend patients until assessed. Objective observations should be documented. The medical director should notify the Council promptly and consider referral to an appropriate health and rehabilitation programme. Asking an unregistered locum to cover surgery would create a second, independent regulatory breach.
2. How should the Council handle the report and any return to practice?
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The Council should treat the report as both a fitness-to-practise and patient-safety matter. It should open an inquiry, request the hospital’s records, and require an independent health assessment focused on the surgeon’s capacity to practise safely. Interim conditions or a temporary suspension may be necessary while the risk is unresolved. The surgeon should be given notice of the allegations, an opportunity to respond, and confidentiality safeguards; the process should not become a public spectacle. If impairment is confirmed, return to practice should be gradual and conditional: treatment or monitoring, workplace restrictions, a named supervisor, random testing where appropriate, and a phased return to theatre. The hospital must confirm that any locum is registered and privileged before independent practice, and must maintain safe emergency cover in the meantime.
3. What should happen to the unregistered locum and the patients awaiting surgery?
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The locum must not provide clinical care, even under the medical director’s supervision, until Kenyan registration is granted and hospital privileges are confirmed. Observing, teaching, or attending meetings is different from treating patients. The hospital should contact the locum promptly, explain the legal position in writing, and arrange alternative licensed cover. Patients awaiting surgery should be triaged, informed of the delay, and referred to another licensed facility if the hospital cannot provide safe cover. Their records and consent discussions should be documented. The hospital should not advertise or imply that emergency surgery remains available unless a properly credentialed surgeon is in place. If the hospital has allowed unregistered practice, the Council should investigate the facility as well as the individual.