By Charlotte Grieve

Tim and Leah Mooney.Credit:Wolter Peeters

Leah Mooney believes walking is in her genes. Her father never owned a car, and a 20-kilometre hike through Sydney’s Ku-ring-gai bushland used to be how she cleared her mind.

Now she walks slowly and with a limp. She was one of high-profile surgeon Munjed Al Muderis’ earliest patients, but her treatment went horribly wrong and became the subject of a years-long lawsuit that generated hundreds of pages of documents, including medical records and independent reviews.

Finally, after two operations, a broken drill bit was found left in the bone. Al Muderis failed to diagnose a raging infection – despite fluid oozing from her leg, blood tests and alarmed calls from other doctors. The infection spread to her bone and fused her knee stiff.

Leah’s husband Tim is a veteran who was conscripted to serve in the Vietnam War and later diagnosed with a rare form of cancer related to Agent Orange poisoning. He’s had more than 15 surgeries, lost his eye, ear and jaw, and has skin grafts covering his face.

“What happened?” he says with a wry smile, pointing to an old photograph capturing his youth.

Tim Mooney in the Vietnam War. 1970.

Despite all this, he says the years dealing with Al Muderis were the worst in his life. Now the couple, who describe themselves as typically shy and don’t like to make a fuss, are on a quest for justice.

They have sent letters to industry regulators – the Health Care Complaints Commission and Medical Council of NSW – calling for an apology after their complaints were dismissed without proper investigation. They’ve requested meetings with NSW Health Minister Brad Hazzard and GP-turned-Independent MP Sophie Scamps to discuss their concerns.

The Age and Sydney Morning Herald have revealed a string of allegations against Al Muderis’ medical practice since September, including concerns around patient selection and post-operative care, and particularly infection management.

For the Mooneys, this is a story about the inadequacies of medical regulators to hold health professionals to account – a charge accepted by some surgeons who are dismayed by the lack of action on complaints.

“Failure of the Medical Board to act reinforces doctors’ reluctance to make reports,” trauma surgeon Professor Elton Edwards says. “The Medical Board has a role here and needs to reconsider its involvement in these cases and responses when complaints are made.”

The Mooneys’ extended family holiday to Canada that went horribly wrong.

Standing in her kitchen surrounded by family, Leah lowers her gaze as tears fall down her cheek. She feels bad for the patients who came after her who say they have suffered at Al Muderis’s hands.

“I feel guilty we did not stop him when we had the chance,” she says. “We should have kept fighting. It was never about money – we wanted justice.”

Ski trip gone wrong

When the Mooneys and extended family travelled to Canada’s Big White for a ski trip in 2011, it was a celebration. Tim’s health problems had subsided and their youngest of four sons was in his final year of school.

Then Leah badly broke her leg in a skiing accident. It changed their lives.

Even with the correct treatment, Leah was told her leg might never fully repair. Canadian doctors put it in plaster and she flew home for treatment.

The couple landed back in Sydney on a Sunday and were sent to Sydney Adventist Hospital – one of the few private hospitals available that day in the northern beaches. The senior surgeon on duty, Ali Gursel, was about to go on holiday, Leah says, so the case was referred to an ambitious young doctor – Munjed Al Muderis.

Al Muderiswas unknown at the time, and had passed his orthopaedics exam three years earlier. He told colleagues he had an “interest in trauma surgery” so was given responsibility for Leah. The surgery was later described as a “complex” procedure. When she came out of the operating theatre, Leah’s leg pointed sharply in one direction. Her son, Paul, says he didn’t need a medical degree to understand something was wrong.

“We said, ‘What’s going on?’ The leg is literally crooked, it’s twisted. He brushed it off, said it was a problem with the plate and he’d have to change distributors.”

Al Muderis booked Leah in for another surgery at a separate facility, Macquarie University Hospital. Leah was worried about going under the knife again, but Tim recalls Al Muderis saying: “I won’t get it wrong again, my reputation depends on it.”

Afterwards, in rehab, Leah wasn’t allowed to do physio in the pool because her wound was weeping fluid, and when she was sent home the leg kept swelling. She was worried about infection, but Al Muderis insisted there was no sign of one.

Eventually, she sought a second opinion from a Narrabeen sports physician who was alarmed by the “serious ooze” coming from puncture wounds. He ordered blood tests which indicated she had a deep tissue infection or osteomyelitis (chronic infection of bone).

The doctor rang Al Muderis to share the results. But the surgeon was “defensive” and “rude”, according to Tim and Leah’s recollection of conversations at the time. Al Muderis later wrote to the doctor, thanking him for his concerns but insisting there was no infection and claiming “osteomyelitis … is a diagnosis that we don’t like to use in orthopaedic surgery”.

Dr Watson was shocked to see Leah Mooney’s swollen leg.

Over the next few months, Leah continued to deal with pain, swelling and stiffness in the leg. Each time she asked for antibiotics or raised concerns about infection, Al Muderis would protest, saying the doctor who ordered the blood tests was “not a trauma surgeon”. He showed them photos of what a “real infection” looks like.

Tim’s health then took a turn for the worse. Despite needing help herself, Leah became his carer. Overwhelmed by stress one day, she went to stand outside for some fresh air and slipped. She broke her hip and was rushed to hospital. The accident saved her life.

Doctors noted the hip but were more concerned about her leg, which was swollen and red. It was here osteomyelitis was finally diagnosed, more than five months after Al Muderis’ second surgery. She was put on an antibiotic drip and informed about the seriousness of the damage to her knee caused by the untreated infection.

For months, she slept in a makeshift bed near the kitchen because she could not climb the stairs to the bedroom. She became nauseous and lost her appetite due to the heavy medication.

Nurses quietly told the Mooneys to start taking notes and collecting files because they thought there may be grounds for a lawsuit.

Unbearable pain one night prompted Leah to admit herself to Royal North Shore Hospital. There, another surgeon ordered X-rays and found a broken drill bit, fractured bones, septic arthritis and a knee virtually fused into a locked position, that could bend just enough to cause extreme pain.

The surgeon said her long-term prognosis was poor: she was not eligible for a knee replacement and was told she would likely have a stiff leg for the rest of her life.

“Amputation is also a possibility, though I would consider this unlikely,” he said.

Bring in the lawyers

A few weeks later the Mooneys engaged lawyers and started paying thousands of dollars for independent medical reports to assess her treatment.

Melbourne surgeon Elton Edwards found Al Muderis had lied and was ultimately responsible for Leah’s pain and suffering.After the first surgery, Leah’s had bone curved at twice the acceptable level, creating a deformity which indicated “poor technique”, he wrote in a medicolegal report.

Edwards said the second surgery should not have been necessary, and Al Muderis’ later explanation of a planned “two-stage” procedure had “the hallmarks of a misrepresentation of the procedures performed”.

His scathing assessment was backed up by at least four other specialists, who found mistakes had been made, diagnoses missed, and that an infectious disease expert should have been enlisted sooner.

After the Mooneys’ initial complaints to health regulators were dismissed, they offered to provide the new medical reports to have the case reopened.

“I am writing to inform you that I am very disappointed with [the] review of my case,” Leah wrote to the NSW Medical Council in March 2013. “I now have reports from prominent surgeons and would be happy to send them on to you.”

The request was never followed up.

The Health Care Complaints Commission said it had obtained an extensive statement from Al Muderis about Leah’s treatment, and had consulted independent experts before escalating the matter to the Medical Council after which point, a spokesman said, they could no longer intervene.

Both regulators said it was illegal to comment on individual health practitioners, but the HCCC confirmed it had received fresh complaints, “which have raised a range of different issues, some of which rest within other jurisdictions – including the Australian Health Practitioner Regulation Agency and the Therapeutic Goods Administration”.

Al Muderis’ registration record shows he has never been reprimanded.

‘My life ended’

In the early stages of the lawsuit, Al Muderis phoned the Mooneys and, according to contemporaneous notes, apologised for what happened. He said it wasn’t his intention but asked them to wait for the insurer to settle, the notes say.

Negotiations with the insurer dragged on for years.

Leah’s limited mobility forced them to leave the family home of more than three decades and move to a single-storey flat in Narrabeen, closer to her brother and sister-in-law who helped with care.

In a statement, Leah wrote: “My life ended the day I let Dr Al Muderis operate on me… It has been so tough and will continue to be so for the rest of our lives.”

Leah said it had been her “loving responsibility” to care for her husband but she was “filled with guilt” that their roles had now swapped. In a statement written in 2016, Tim lamented the loss of his wife’s ability to walk.

“Leah’s greatest passion is the outdoors and nature to see her walking is to see her in her element. She just loves it so much.”

He said before the ordeal, Leah had an enthusiasm and love of life. “But now it is as if she is untrusting, suspicious and extremely anxious bordering on depression. She has night sweats and [often] she jumps up starts and shocked with a cry.”

In the years since, Leah has worked hard to regain her independence and says her mental health has improved. “But as I get older, the rest of my body is wearing out because of the consequences of how I walk,” she says. “It’s a constant battle.”

Another look at the system

As the litigation wore on, Tim’s cancer worsened. His weight dropped to 55 kilograms and his doctors told him there was nothing more they could do. He was given three months to live.

Tim rushed to court to give evidence but did not want to leave Leah to fight the legal battle on her own. Reluctantly, the matter was settled under confidential terms.

“We should have taken it to trial,” Leah says. “But we really couldn’t.”

After the settlement, Leah pushed to get Tim on a clinical trial in a last-ditch effort to save his life. Despite the slim odds, he’s now in remission.

The couple recognise all doctors experience some complications among their patients, but are concerned by the common pattern of failing to diagnose infections before it’s too late.

Now in their 70s, the Mooneys are taking up the fight again. Earlier this month, they sent letters to health regulators seeking an apology and explanation about why their complaint was not handled properly. Tim has also sent a letter to outgoing NSW Health Minister Brad Hazzard and Federal MP Sophie Scamps calling for a meeting.

“The federal government injects millions and millions of dollars into healthcare. We think it also has a responsibility to monitor and set standards for medical practitioners.

“It is time that the government has a relook at the system and Dr Al Muderis. It may need a complete overhaul.”

Scamps has accepted the Mooneys’ invitation. Hazzard has not yet responded. Al Muderis declined to comment.

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