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Welcome to BDD Story, detailing my experience with body dysmorphic disorder and rhinoplasty.
This website is intended primarily for visitors with an interest in the doctors and healthcare organisations in the UK with which I've had contact. By recounting the events with reference to appropriate documents I aim to publicise my experience [and aimed to advance my pursuit for justice].
The main subject is Mr N A Nasser's fitness to practise surgery. To more fully illustrate the events I also include, in the Priory section, the respective letters of Dr David Veale, failing to apologise for his flawed recommendation, and the Priory Healthcare Chief Executive, Dr Chai Patel, refusing me a refund.
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P.S. 14/9/07 - I recently met with a Harley Street surgeon for a consultation on the possibility of further scar treatment. He informed me that Nasser has now been suspended from Charing Cross Hospital, but that was all he would say ...
3/5/07 - I've copied Mr Bebb's letter of advice here (which he wrote as a favour following our meeting): http://www.flickr.com/photos/bddstory/ . I'm not going to post Richard Furniss's report as there seems little point. His advice was clumsy, short-sighted and failed in its duty spectacularly. It is an unpleasant realisation but I'm not going to dwell on it. Mr Bebb's advice says it all: Catto's decision to reject my case was wrong in law.
Congratulations, GMC. Nasser may be out there inflicting needless harm on his surgical patients for his own bizarre psychological satisfaction, but your self-serving contempt for fairness towards me as a patient has ensured that you may never have to find out if he is.
31/5/07 - I want to be able to forget about this whole thing but the scars inflicted by Nasser are a permanent reminder, and the lingering sense of injustice engendered by my contact with the GMC is a deeply unpleasant feeling that I have never experienced before. Under more normal circumstances I think I would have quickly realised that Richard Furniss's advice was badly flawed; however, the GMC's insidious officiousness was a tedious nightmare to deal with and I didn't want to have to sift through the records and formulate my argument in detail. So when I was forced to, it was too late. The perverse irony is that if I had represented myself I probably could have won a judicial review application (and would then have been able to obtain representation for the hearing). Of course the GMC ensured that their threat to seek costs was a disincentive to take that risk.
17/5/07 - I had accepted that I was never going to fully discover why Nasser effectively assaulted me; however, I just recently discovered a QC who doesn't need an instructing solicitor in order to give preliminary advice and has GMC experience: Gordon Bebb QC of Outer Temple Chambers ( http://www.outertemple.com/barristers.php?bid=60 ). I have now met with him and he thinks I have an arguable case, but that the delay since the GMC's last decision is a problem. He agreed that the GMC should have reopened my case on receipt of my expert-witness surgeon's initial letter, and he also advised that a judge could rule that my case should rightly be applicable to the President's review in the new GMC rules. A judge could override the abscence of a technical provision for complaints screened out by the old screening process, for the safety of Nasser's patients and on the basis that this lack of a transitional provision between the old and new rules is unfair. I had suspected this, before Richard Furniss's advice threw me off course. Mr Bebb thinks that the GMC's counsel likely didn't know which way to call it (there is no case law on this) and that the GMC were then swayed by RadcliffesLeBrasseur's pressure during Catto's review.
The GMC's support of Nasser is typical of its inability to differentiate between its statutory duty to protect patients and its illegitimate tradition of favouring established doctors. It is indicative of the GMC's conscious mishandling that the GMC's Fisher Field Waterhouse solicitor likely didn't want to put their name to their aggressively flawed letters - made in response to my judicial review action after Catto's decision and probably drafted by one of their solicitors, although signed by the GMC solicitor Janet Gray. Patients regularly trust Nasser with their lives, yet what he did to me indicates that he is a potentially dangerous surgeon. Doubtless Catto still feels comfortable sitting in his pseudo-modernist, glass and steel wreck of a GMC office block regardless that his resolutely self-serving instincts have ensured Nasser hasn't had to answer any questions in his own defence.
Mr Bebb QC is clearly at the top of his game and has been generous with his offer of help, but I am unable to obtain further legal funding to instruct him and even then the delay problem could be difficult to overcome. It is, at present, irritating to know that I was on the right track with my legal arguments before receiving Richard Furniss's advice. It seems that the strength of his advice favouring the GMC's position was negligent. If my Hodge, Jones and Allen solicitor had instructed Mr Bebb QC I would have brought a judicial review and probably 'won'.
18/2/07 - I should have brought a judicial review after the screening decision. I wanted to but my Alexander Harris solicitor advised me to wait. That's not an excuse though: I know it is my fault I didn't bring one. There is no doubt that I would have won. (The GMC probably would have acted in order to avoid one. Paul Philip claimed that the screening decision must stand because there was no evidence to support my allegations, but I think he would have reneged on that blatantly flawed and self-serving defence pretty quickly.) I wasn't on speaking terms with my brother then either, so didn't discuss it with him. After that my only hope was Rule 14 of the old GMC rules, but that illuded me; thanks again to the GMC's inability to do its job.
I know my BDD symptoms will most likely last with me for life; I'm 31 now and I've had them for as long as I can remember. What Nasser did was a profound abuse that can only be described as an assault. Revenge was not my motive for pursuing him; I wanted compensation (which I got) and answers. I am pretty sure I have worked out what Nasser was basically doing, as I have explained on this site. I want to know more about why he did it. But I never will. I'd also like to be able to warn his patients and know how widely his dysfunctional behaviour has manifested itself. It is possible I scared him so much that he has compartmentalised the behaviour and is no longer exhibiting it in any form; or he may be, or may do again at any time. In any case his competence is in question.
The GMC's perverse disregard for my human rights was in itself a profound abuse. I am trying not to resent the time my experience with the GMC took because I know that only wastes more time and energy. The GMC are still not fit to either investigate or adjudicate on doctors.
13/2/07 - I am out of time and could end up with costs if I went to court as a litigant in person, so I'm finished with this. The new evidence isn't enough to go on. At least it spurred me on to detail another example of how different in reality the GMC still is to the modern medical regulation body it claims to be. The GMC has been responsible for abuses of all kinds for a long time: human rights abuses, abuses of authority and of public trust; and those abuses continue. It often still sees itself as some kind of representative body for established doctors.
28/1/07 - I've sent the GMC a judicial review notice and will apply to Court as a litigant in person in two weeks. Today I read an interview in the Observer with GMC Chief Executive, Finlay Scott, that made my stomach churn. Expressing good intentions and making the right noises are one thing, but when you have presided over so many failings for so many years and your organisation continues to handle cases in the manner that they have mine it is indefensible and reeks of hypocrisy.
9/1/07 - I am now of the opinion that my instructing barrister made a mistake. I intend to serve the GMC with a judicial review notice.
My instructing barrister (Richard Furniss) was wrong to advise that only a "different" complaint within two years of the original could cause it to be reopened. The old GMC rules actually state "information or a complaint" constituting a "fresh allegation". My expert-witness surgeon's initial letter was submitted within two years after the GMC's rejection of my complaint, and before the new GMC rules came into place. It qualified as fresh information, and should have caused the GMC to commission an expert report and re-screen my original complaint. However, they agreed to wait for my expert-witness surgeon's report. The GMC were therefore effectively treating my expert-witness surgeon's initial letter as new information right up to the decision in Catto's invidious and insidious review. Then it took nearly three months to obtain funding, and my solicitor and barrister misunderstood the issues. That left me with a few days to make sense of it and apply for JR. I suspect that when the GMC received their barrister's advice after my initial judicial review action, their barrister recognised that they couldn't defend it. I am considering whether a judge could be so disturbed by the GMC's behaviour (and the allegations against Mr Nasser) that he/she might award a discretionary JR, as well as whether the new evidence regarding the previous complaints against Nasser can be involved.
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18/12/06 - I recently received some remaining records from the GMC, in response to a Data Protection/Freedom of Information request that I made before receiving my barrister's advice. Chunks of information are redacted, records have been withheld and others are missing from the GMC's response. However, they missed the redaction of one significant detail: a note by Peter Lynn to Andy Laing mentions that my complaint was the fifth to be made against Mr Nasser. The chances of there being a pattern of misconduct in these complaints seem to me to be very high, but as I can pursue this matter no further I am recording this detail here as part of the site's intention to act as a warning.
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This thing is clearly over for me now. I don't really regret it: it was a learning experience of some kind, and I know why I had to do it. I'm actually relieved that I now know I can't go any further with it. I'll post a short critique of the sorry GMC system and my case pretty soon, and this website will stay up as a warning.
For those reading this that I criticise: you were not worth my time, but my coming to terms with what you did was.
This page provides a retrospective chronology of the final events in my pursuit of Mr N A Nasser's fitness to practise surgery (proceeding from the events chronicled on the My Story page):
3/8/05 - On this date I posted my expert-witness surgeon's GMC report, on Mr N A Nasser's treatment of me, through a link in the GMC section.
19/8/05 - On this date the GMC had been in receipt of the report for approaching three weeks. This week my MP, Karen Buck, wrote to the GMC again - requesting an investigation into Mr Nasser in light of the report.
24/8/05 - I received the GMC's letter of reply. Paul Philip, Director of Fitness to Practise at the GMC, decided not to reply personally. Anna Neill's (Investigation Manager) letter states:
"...the GMC can only consider re-opening a complaint if we receive new information relating to the complaint which significantly alters the allegations originally considered by the screeners; or if we receive fresh allegations about the doctor. I appreciate that Mr [name withheld]'s report was not seen by the screeners who originally considered your case. However, I would not consider that the comments made by Mr [name withheld] significantly alter your orginal complaint. This is because Mr [name withheld]'s report again relates to the alleged substandard treatment provided by Mr Nasser which was the substance of your original complaint to the GMC. The screeners who considered your original complaint did not agree that the care given to you was substandard and therefore there are no grounds to reconsider the matter.
I understand that this is a matter you feel strongly about and appreciate that you are unhappy with our decision in your case. I am sorry that I am unable to assist you further."
Her letter doesn't properly explain why the GMC are unable to act on the expert-witness surgeon's serious allegations and it didn't seem credible. I managed to speak with the GMC President, Sir Professor Graeme Catto, on the telephone (it transpired that he had answered because his secretary was away) and he agreed to review their decision.
15/9/05 - I chased up on what was happening with Professor Catto's review by emailing him. He emailed a reply stating that he doesn't personally correspond with complainants but was refusing my request for an investigation, and that a letter would soon be sent out by the GMC.
17/9/05 - Nearly four weeks after requesting the review, I received a brief letter from Jackie Smith, Head of Investigation at the GMC. Meanwhile, my MP still hadn't received a proper reply to her letter mentioned above (only a holding letter shortly after it was sent).
Jackie Smith's letter states: "... I hope I have made the point, that the original decision taken by the screeners could only be reviewed in the light of new and fresh information or if there had been some procedural irregularity. Neither applies in this case. As such, the original decision stands. I know you will find this distressing, but I am afraid there is nothing further we can do to assist. Your complaint has been thoroughly considered on more than one occasion. Yours sincerely"
The screening records clearly show that there was a procedural irregularity in the screening decision (my allegation of assault was ignored) and my expert-witness surgeon's report certainly qualified as new information; so I set about bringing a judicial review.
23/9/05 - I now had a solicitor confirmed.
7/10/05 - My solicitor served a judicial review notice on the GMC. They were given two weeks to agree to investigate Mr Nasser on the basis of the expert-witness surgeon's new evidence, or we intended to apply to the High Court for a full JR hearing.
21/10/05 - The GMC contacted my solicitor. They would be receiving advice from their counsel on Monday and then wanted further time in order to consider it. They were given until Thursday, 27/10.
28/10/05 - My solicitor received a fax from the GMC solicitor Janet Gray claiming that I was technically out of time on my complaint as the screening decision should have been judicially reviewed, but that they would seek clarification from the expert-witness surgeon, on the grounds of him having supplied fresh information, in order to see if they should investigate. It seemed likely that they should, on the basis of what was clearly not just fresh information but fresh expert evidence detailing serious allegations.
29/10/05 - I received my own copy of the GMC's response, as well as a letter from my Hodge Jones & Allen solicitor ending our contract (although I would return to her) as our legal challenge had succeeded in making the GMC consider the report.
8/11/05 - I discovered who my GMC medical screener was, as her name wasn't properly deleted in one of the screening records I received from the GMC. It was Dr Pearl Hettiaratchy: http://pb.rcpsych.org/cgi/content/full/27/12/471-a http://tinyurl.com/38gt6m http://tinyurl.com/3cq59l . Despite some of her claims quoted in the linked articles, I think it's clear she failed me - and ultimately many others - in her duties of fairness and impartiality as a GMC screening doctor.
17/11/75 - I discovered that the GMC had asked my expert-witness surgeon for "any evidence". This seemed an unnecessary request considering his report's detailed references to my records supported by observations in his capacity as a senior UK facial plastic surgeon. What more evidence could they need to justify an investigation ?
2/12/05 - I received a letter from the GMC stating that my expert-witness surgeon had replied and they would respond within two weeks. I also received a letter, through my MP, from the minister for patient safety at the Department of Health, Jane Kennedy MP, claiming that her department was unable to get involved as the GMC is an "independent" body.
24/12/05 - On this date - Christmas Eve - I received the GMC solicitor's reply, a week later than promised in their last letter and without apology or explanation for the delay. This time she also copied me in on her letter to my expert-witness surgeon. I copied them to the Contact page. Essentially the GMC letter to the expert-witness surgeon demands all kinds of extra material in a rather officious tone (effectively punishing him for expressing his concerns), while her letter to me accuses me of delay and makes various other digs.
30/12/05 - At this point I was waiting for my solicitor to reply, but this email to her (composed with help from my brother, who is a barrister) details the direction I was heading: I copied this to the Contact page as well. Essentially it explains why I wasn't at fault for the length of time taken in my case and requested my solicitor to commence judicial review proceedings, as it seemed that the GMC had no legitimate excuse to be delaying the investigation of Mr Nasser.
10/1/06 - We decided to hold-off on bringing a judicial review, as it should only be used as a last resort.
11/3/06 - I copied my email to the House of Lords Appointments Commission, regarding Dr Chai Patel, in the Priory section.
I discovered from my expert-witness surgeon that the GMC had been in receipt of his revised report - with cross-references to academic articles added - for over three weeks. I copied it to the GMC page.
17/3/06 - I received the GMC's response - their first correspondence to me since Christmas Eve - through their solicitor. The letter is in lengthy and obtuse terms (which basically serve to obfuscate the legal detail), and makes an officious meal of the delays incurred in my case. This letter can be read here: http://www.flickr.com/photos/bddstory/
The old rules gave very limited power to re-open complaints once they had been screened out - with only a different complaint against the same doctor, within two years after the original complaint was screened out, allowing the original complaint to be re-opened. Unfortunately, the GMC failed to explain this, and I didn't discover it until receiving the barrister's advice documented at the end of this chronology.
The letter states (in obtuse terms) that complaints which had not progressed beyond the now defunct screening process apply to the new rules (for the purposes of complaints not yet screened out, i.e. pending more evidence, presumably), which came into effect in autumn 2004. The only power for the GMC to re-open a case is with the President's review (provided by the new rules), but complaints screened out by the old screening process don't have any provision for the President to review them. Why had the GMC not mentioned this until this point ?
But in case their view that they had no power to investigate was wrong and "as an act of goodwill" (as if further delaying this interminable process was a charitable act) the GMC President, Professor Catto, had decided to make a review of the case, as the report's newly added academic references had now supposedly satisfied the test of new evidence (it seemed that what he had led me to believe was his previous review no longer counted). It seemed to me that the original report satisfied this test.
Sir Catto gave myself and Mr Nasser twenty one days to make any further representations to him, and then intended to respond within a further twenty one days. However, no questions were to be asked of Mr Nasser at this stage.
The letter's claim was that Sir Catto could let the screening decision stand, refer it to what is the new replacement for that stage or refer it for investigation.
7/4/06 - Mr N Nasser's side asked the GMC for more time. I was now expecting a copy of his side's representation by sometime the next week.
13/4/06 - I emailed Janet Gray, GMC solicitor, asking if she had received Mr Nasser's representation, which her last email claimed was due today "at the very latest". But, her reply only states: "I have not received Mr Nasser's comments as yet."
19/4/06 - Mr Nasser was now given till the 26th.
27/4/06 - The GMC solicitor informed me that Mr Nasser's representatives had only supplied a letter addressing legal and procedural issues, which made no response to the allegations against Mr Nasser. Although she claimed that it was "not appropriate" for me to see this, I suspected that in the interests of fairness it was, as Professor Catto now intended to make his decision using this letter as Mr Nasser's representation. So I requested a copy.
17/05/06 - This date was the delayed deadline for the decision in Professor Catto's review. However, the GMC had so far only relented to let me see the other side's 'representation' - although they were still waiting for the other side to agree to its disclosure to me. Professor Catto's review then intended to include both sides' responses to each others' representations (my representation addresses the GMC's accusations of delay and references this website), but the timetable was yet to be set.
19/5/06 - I received a letter from the GMC solicitor. It enclosed a copy of the legal letter from Mr Nasser's solicitors, RadcliffesLeBrasseur, which Mr Nasser had recently consented to disclose to me.
Both sides were given two further weeks to respond to each others' representations. Professor Catto was to make his decision "as soon as possible" after that.
The other side's letter is dated the 24th April, and threatened bringing an urgent judicial review unless Professor Catto didn't carry out his review. It claims that they do not consider the lack of a provision in the GMC's new rules for the President to review cases screened out before the new rules came into place to still be analogous to its new replacement processes, which would have enabled the President to undertake a review and the GMC to potentially investigate.
With hindsight; Mr Nasser's representatives were right.
They also claimed that the allegations had gone beyond the time limit of five years stipulated in the rules. Ms Gray's accompanying letter points out that the time limit applies from the events in-question to the time when the GMC first become aware of them, and that the GMC received even the report within five years of Mr Nasser's operation on me.
Ms Gray asked me to "identify and explain the source of the underlying power" which enabled the GMC to investigate, with reference to their statutory rules (included in bundles with her letter informing me of Professor Catto's review). My Hodge, Jones & Allen solicitor was not currently acting for me, and would only have the funding to do so if I brought a judicial review. I am not a lawyer and should not have been expected to do the GMC's job for them by establishing if there were technical clauses in their rules which allowed them to investigate.
28/6/06 - This was the third week of Professor Catto's much delayed review. Two weeks ago Mr Nasser's side had refused disclosure to me of their response to my representation (which Ms Gray informed me was another legal letter) and their future correspondence with the GMC, which betrayed a curious secrecy on their part. Today Ms Gray emailed stating that their decision would take "a couple of weeks" more, but neglected to explain why. Clearly, Professor Catto's review timetable had proved worthless.
On the first of this month my MP, Karen Buck, wrote to Jackie Smith, Head of Investigation at the GMC, stating: "... I simply do not see why someone does not have a case to answer here. Now, I understand that the GMC is currently in the process of deciding whether or not to investigate the case. I would like to add my support in the strongest possible terms for looking into this case again." My MP also wrote to Andy Burnham MP at the Department of Health, stating: " ... the behaviour of the GMC in this case makes no sense at all. In fact I find it appalling. ... as a sufferer of Body Dysmorphic Disorder he has received the worst possible treatment - an opinion backed up by another cosmetic surgeon in the most forceful terms possible - and yet the GMC is still deciding to investigate. I find this position somewhat perverse. Is there anything you can do to make sure they investigate what has happened to my constituent ?"
5/7/06 - Ms Gray informed me that my MP's letter hadn't been received, so I got the letters re-sent.
15/7/06 - The "couple of weeks" were up and, predictably, I had received nothing from the GMC.
18/7/06 - My MP forwarded me a copy of Jackie Smith's recent reply to my MP's re-sent letter. It is typical of the GMC's general mishandling that they needlessly kept me in the dark for an extra week by neglecting to notify me personally of the continuing delay.
Ms Smith's letter states: "We do have Mr [name withheld]'s report, which we received from Mr [X] and which we have had for some time now. Mr [name withheld]'s report is detailed and needs careful consideration and because it is, we have taken longer than we had hoped to make a decision about whether we can reopen the complaint against Mr Nasser. ... Professor Catto will be in a position to let Mr [X] know the outcome by Friday 4 August 2006."
26/7/06 - I unexpectedly received a new independent surgeon report from the GMC. My reply to Ms Gray states:
"Thank you for your letter of July 25th, enclosing a copy of the report by Mr Devine.
I note that you expect a response within seven days. You have given me no previous warning; (1) that you would be obtaining a report from a further independent expert (that is, in addition to Mr [name withheld]'s report), nor (2) that you would be sending it to me at this time or that you would require any comments within seven days. In those circumstances the timescale that you propose for my response is obviously unreasonable.
I will respond once I have had the opportunity properly to consider the report and to consult others as I think appropriate. In the meantime I would expect Professor Catto not to make any final decision on this matter."
Mr John Devine's report is based on the flawed premise that the incisions in-question must have served a legitimate purpose - even though he has no explanation for them. However, there is no reference to the content of my expert-witness surgeon's report and it effectively leaves more questions than answers in trying to downplay the incisions in-question - which I maintain are by far the most serious aspect of Mr Nasser's treatment of me.
It is suspicious that this expert was chosen by the GMC: his enclosed CV makes no mention of any training, qualifications or experience as an expert witness. It is doubtful that he acts as an expert witness in other GMC cases. The GMC likely didn't inform me that they were obtaining the report so that I didn't ask to see him or ask about his credentials as an expert witness. He probably has an association with the GMC which enabled them to be confident of him fudging the more serious allegations, in order to lessen the impact on the GMC of the fact that they no longer have the power to investigate my case. I consider that this was a typically self-serving attempt by the GMC to whitewash the allegations before following up with their refusal to investigate.
2/8/06 - Ms Gray sent me a letter on this date, stating: "Mr Nasser's representatives have also asked for more time and in the circumstance it has been agreed to extend the time for comments from either party to expire on Friday 11 August 2006. No decision will be taken by the President before then and you will not hear from us until the following week."
4/8/06 - On this date Ms Gray sent me another letter, stating: "I advised that the time limit for commenting upon Mr Devine's report was extended and that you would not hear from us in the week commencing 14 August. However, the President will not be in the office and in a position to consider this matter until 21 August at the earliest. Unfortunately we will not be in a position to respond as indicated.
You will be provided with a definitive response by the end of week commencing 21 August, i.e. by 25 August."
18/8/06 - I copied Mr Devine's report and my response to it onto the bottom of the Contact page.
26/8/06 - Jackie Smith (Head of Investigation) sent an officious letter on behalf of Professor Catto, refusing to investigate, citing "no power": "regardless of the strength or weakness of the fresh material." However, the letter still didn't explain their lack of power to re-open my case in wholly clear terms, so a judicial review still seemed appropriate.
3/10/06 - My Hodge, Jones and Allen solicitor sent the GMC a judicial review notice. They were given two weeks to launch an investigation into Mr Nasser or we intended to apply to the Court for a judicial review hearing.
17/10/06 - My solicitor received an aggressive letter from the GMC (which was probably drafted by a lawyer outside of the GMC, although it is signed by the GMC solicitor Janet Gray). They threatened to seek costs if I applied for a judicial review but, again, did not fully explain their lack of power to re-open my case.
1/11/06 - Funding was finally granted by the Legal Services Commission ("staff shortages", apparently) to obtain legal advice from a barrister.
17/11/06 - The barrister instructed by my solicitor, Richard Furniss ( http://www.22oldbuildings.co.uk/Default.aspx?sID=14&cID=64&ctID=36&lID=0 ) of 22 Old Buildings Chambers [now of 42 Bedford Row Chambers], supplied a report stating that I have no prospect of success, despite what he acknowledges is my legitimate grievance against Mr Nasser. The time to bring a judicial review was within three months of the screening decision, and the GMC now have no power by law to investigate my case.
My final comment will be posted below.
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