Lancet: Controversy over UK surgeon who amputated healthy limbs.(News)(Brief Article)(Statistical Data Included)

Terms related to this article: Amputations of leg / Investigations

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Controversy over UK surgeon who amputated healthy limbs.(News)(Brief Article)(Statistical Data Included)

Author/s: Sarah Ramsay
Issue: Feb 5, 2000

A Scottish hospital came under fire last week after it was revealed that one of its surgeons, Robert Smith, had done single-leg amputations on two physically healthy individuals with psychiatric disorders. "I have no doubt that what I was doing was the correct thing for those patients", Smith said.

In a statement released on Jan 31, Smith, of the Falkirk & District Royal Infirmary, explained that the patients had apotemnophilia, a type of body dysmorphic disorder in which the patient wishes to be an amputee. Smith's statement distinguished between the majority of apotemnophiliacs, whose the wish for amputation is driven by sexual motives, and the less-common form in which the individual feels "incomplete with four limbs" and resorts to extreme self-harm in an attempt to precipitate amputation. Smith's two patients came from the latter group and had undergone psychiatric and psychological assessment. "Following amputation, they both made a rapid and satisfactory recovery without complications. At follow-up both patients remain delighted with their new state", said Smith.

Less delighted are Smith's employers, the Forth Valley Acute Hospitals NHS Trust, who took over stewardship of the Falkirk hospital last year. Media coverage of the events has focused on the fact that National Health Service theatres and staff were used, although the patients, from England and Germany, had paid to have the amputations done privately and Smith waived his fees. The practice seems to have come to the Trust's attention when Smith received an amputation request from an American last year, whereupon the Trust's ethics committee launched an investigation.

Reporting last week, the ethics committee pointed out that Smith had received permission from his then Medical Director and Chief Executive and advice from the appropriate professional bodies, including the General Medical Council. Nevertheless, on Jan 31, the Trust released a statement indicating that apotemnophiliacs are unlikely to receive surgical treatment in Falkirk again.