Excerpts from an interview with an ETS surgeon

The following are excerpts from a recent interview between a member of the Kiwi ETS Group and a New Zealand ETS surgeon.


Interviewer: I spoke to a neurologist who said that the Sympathetic Nervous System plays a role in a lot of different functions in the body, and a couple of the ones he mentioned were: lung function, heart function…um, brain function, blood vessel function, sexual function, for example. So, what I wanted to ask you is…when the SNS is cut or cauterised – whichever method a surgeon prefers to use – how does that system maintain its equilibrium after it has been cut into?

ETS surgeon: Ah…I don’t think you can really say. A lot of the reason why the operation works is unknown. Like if you operate on someone for facial blushing…the four people I’ve done for that, I’ve told them beforehand that um, that we don’t really know why the operation should work because you’re cutting the sympathetics that normally supply the arm and they’re interested in the face.

It’s not very logical that the operation would work…like I say, you cut the sympathetics to the arm. But what you say, about what happens to the sympathetics afterwards and all that sort of stuff, I don’t really think anyone knows. And so the results...those who do get bad compensatory truncal sweating…it’s very unpredictable.

Interviewer: Is that not a concern – that the mechanism, what the surgery actually does, how it stops sweating and blushing, is not actually understood?

ETS surgeon: Yip.

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Interviewer: There are two health practitioner insurers in Australia – MDVA and Avant – and they will not insure for ETS because they said they received too many complaints related to ETS for the number of surgeries being performed.

Again, is this something that is a concern to the community of surgeons doing the surgery?

ETS surgeon: Ah, I don’t think so. I don’t think that is that well known.

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Interviewer: So related to all that, as well as those Australian insurance companies I mentioned not insuring practitioners for the procedure, in 2005 a Finnish Organisation – FINOHTA, the Finnish Office for Health and Technology Assessment – they did a review and their conclusion was that there was “a lack of controlled trials and no reliable evidence for the effectiveness of ETS for excessive sweating in the face and hands or for flushing in the face”. They also concluded that the treatment had no impact on social phobia and was associated with significant immediate and long term adverse affects.

Further to that, in August last year, the Australian Safety and Efficacy Register of New Interventional Procedures – surgical, they released a report. I believe it was passed on to the Royal Australasian College of Surgeons (RACS) that same month - August 2009. Their conclusion was very similar. They said there was a lack “high quality, randomised trial evidence” on the surgery that made it “difficult to judge the safety and effectiveness of the technique”. They said there is a potential number of safety issues associated with ETS surgery, and they suggested a full systematic review be undertaken to assess the safety and efficacy of the surgery.

As someone who is seeing a few patients every year for the surgery, what do you think about those two reviews? Do they concern you?

ETS surgeon: Yeah, that’s accurate. It doesn’t necessarily mean that it’s a bad operation.

Interviewer: Is it more that they’re saying there needs to be more research done?

ETS surgeon: Yeah exactly, it means that if you looked at all the studies, there’s not much useful information in it.

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Interviewer: Further to what we talked about before, the review done in Finland and the one recently done by Asernip-s in Australia...you mentioned an American support group. There is also a support group in Sweden, there is also a support group in Australia and there’s also one here in NZ for people who had bad outcomes from the sympathectomy surgery, and I also believe there is a Japanese language website, and a Taiwan Chinese website that were created by people who had bad outcomes from the surgery.

All these support groups and all these websites seem to suggest quite a high number of unhappy patients. What do you think about that?

ETS surgeon: You shouldn’t undertake the operation unless you’re aware there is a possibility of a bad outcome like that.

Interveiwer: Do you think there are issues around the consent process – that people aren’t being adequately warned about the possible side effects?

ETS surgeon: Ummmmmmm....probably.

Update on complaint against NZ ETS surgeon Murray MacCormick

The following was written by the ETS patient who is making the complaint. They have given their permission for this to be circulated.

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"Still no reply to my letter dated 2 April, 2010, to Murray MacCormick.

"My advocate from the Health and Disability Commissioner came over this morning and we talked. She had a copy of the Kiwi ETS Group's support letter to the Commissioner and was very impressed with it. She had also read the web pages I had given her and was quite surprised that the surgeon continues to perform ETS and said this is a very valid complaint.

"However, an advocate goes into the meeting and says nothing. They are there only to call a meeting off should it "get ugly". Without her being able to help or say anything it seems pointless. I would probably be so upset and make a complete fool of myself and my surgeon would probably suggest a shrink.

"All MacCormick is required to say is sorry. Not good enough.

"When you go to these meetings you are only allowed to talk about yourself, others are not to be mentioned.

"When or if MacCormick's response letter arrives, I will leave a message with his secretary saying that his reply took too long and my complaint has now gone to the Commissioner.

"I encourage others to do the same, whether our complaints go in together or separately."

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The Kiwi ETS group is supporting this patient in complaining to the HDC, and we urge any unsatisfied ETS patients of Murray MacCormick to make a complaint.

One complaint about one surgeon is nothing out of the ordinary to the Health and Disability Commissioner. However, several complaints about one surgeon from patients who all had the same surgery should hopefully be cause for alarm and warrant a thorough investigation.

NZ ETS patient makes official complaint about their surgeon

A New Zealand ETS patient has just begun the process of making a complaint about their ETS surgeon, Dr Murray MacCormick, to the Health and Disability Commissioner (HDC).

Updates on how the complaint progresses will be posted here. The Kiwi ETS Group has written a letter in support of this ETS patient to the HDC, highlighting the fact that several New Zealand ETS patients we have had contact with are dissatisified patients of Dr MacCormick because of the disabling and devastating side effects their ETS surgeries have left them with - side effects Dr MacCormick never warned them about or downplayed the likelihood/severity of.

In addition, the letter highlights the following issues with Dr MacCormick's decision to offer ETS to this patient.

1.) The patient was suffering from excessive facial sweating as a side effect of medication they were taking. However, at that time, the patient was not aware what was causing the excessive facial sweating - after all, they are not a medical professional.

You would think that in such a case, an experienced doctor, which Dr MacCormick indeed is, would extensively question the patient about their medical history, any medication they were taking, and how long the sweating had been a problem for, and use their medical knowledge to determine that the sweating was not actually hyperhidrosis but a far simpler problem that could easily be alleviated by adjusting or changing the patient's medication.

Instead, within the space of a 15-minute consultation - the first ever consultation between Dr MacCormick and this patient - the doctor recommended ETS to treat the excessive facial sweating and scheduled the surgery to take place within the week.

2.) Even IF the patient had indeed had facial hyperhidrosis, ETS surgery is suppposed to be a last resort treatment for hyperhidrosis when all other non-surgical treatment options have been tried, and have failed. However, as the patient did not even have hyperhidrosis, they should never have been considered a candidate for ETS.

The letter also points out that Dr MacCormick, as a private practitioner, made a sizable sum of money from performing the ETS surgery on this patient.

The patient now lives with disabling severe CS and other side effects commonly reported by ETS patients - ongoing fatigue, painfully dry skin on the arms and mysterious pains in the limbs and extremities.

This patient's story is one of the most shocking we have heard to date about ETS in New Zealand.

If you are a dissatisfied past patient of Dr Murray MacCormick, now would be a good time to make your dissatisfaction known to the Health and Disability Commissioner. The higher the number of distressed patients, the harder it will be for the HDC to take the issue lightly.

ETS surgeons in NZ and abroad

To help other ETS patients find this blog - whether they be potential ETS patients or patients who regret having had ETS - I will list the names of all the ETS surgeons I am aware of.

ETS surgeons in New Zealand:
Murray MacCormick (Auckland)
David Ferrar (Hamilton)
Thodur Vasudevan (Hamilton)
Ross Blair (Tauranga)
John Mercer (Christchurch)
David Lewis (Christchurch)
Malcolm Gordon (Christchurch)

ETS surgeons in Australia:
Peter Y Milne
Barry Beiles
Roger Bell
Hamilton White
Raffi Qasabian
John Preston Harris
Sanjay Sharma
Marek Garbowski
Philip Middleton
David Marshman
Spero Raptis
Ben Anderson
Chris Hensman
Richard Gilhome
Ray McHenry

ETS surgeons in the UK:
Christer Drott
-Drott used to practise in Sweden and performed ETS on thousands of patients throughout the '90s. Drott stopped practising in Sweden when a Swedish support group for those living with disabling side effects from ETS gained widespread media attention and ETS was temporarily banned in that country.

Goran Claes
-As above...Drott and Claes now practise on Harley Street in London.

There are likely many more ETS surgeons that I am not yet aware of. I will add more surgeons' names with time.

Want to make yourself heard, officially?

I thought it was time to start putting some information on here about the legal options for people who have had bad outcomes from ETS surgery.

In brief, your options are:

-Make a complaint to the Health and Disability Commissioner

-Make a 'Treatment Injury' claim to ACC

-Take your surgeon to court

Click here for links to information on 'How to Complain About a Doctor' and 'How to be Aware of and Enforce Your Rights as a Patient'.

I will add more on this topic later.

For now, know that there are options available to you, and as ACC recently informed me, at least seven people right here in New Zealand have already made treatment injury claims in relation to their sympathectomy surgeries. Six of these seven claims were accepted.