Dr Joe Motwani built up a global reputation for his use of a new treatment to unblock clogged arteries as alternative to open heart surgery. His record of helping cardiac patients avoid major procedures was recognised as one of the best in the world. Such was his success rate that he described himself in an email to colleagues at Derriford Hospital in Plymouth as a treatment “machine”. But as his own “personal ambition” overtook his clinical judgment and he began to ignore his patients’ best interests, the General Medical Council heard.
He pioneered the use of a technique called percutaneous coronary intervention (PCI), which involves clearing clogged blood vessels by inserting a tiny wire through an artery in the wrist. Patients were given “biased” advice encouraging them to undergo the treatment when drugs or surgery would have been more appropriate, a GMC fitness to practice panel heard.
On occasions patients were asked to discuss their options while still sedated on the operating table after initial procedures to assess the size of the blockage while others were treated prematurely, the hearing was told.
But when colleagues questioned his decisions he ignored them and failed to take advice from heart surgeons about what was in patients’ best interests, it is alleged.
Despite his well-earned reputation, Dr Motwani’s ambition “overtook and overrode” his clinical judgment, Andrew Hurst for the GMC, told the panel. “This case concerns the crossing of the clear line between responsible pioneer as Dr Motwani sees himself and the headstrong adventurer, where the responsible and measured practice of clinical medicine based on informed consent has on occasions been replaced by irresponsible ambition and indeed personal conceit,” said Mr Hurst.
Two patients with severe heart disease died less than a year apart after Dr Motwani performed the “high-risk” procedures, the panel was told. In July 2005 a man died two days after the heart procedure as a result of complications, the GMC heard. The man had not been treated for heart disease for two years because colleagues had previously considered the risk was too great, it is claimed. But Dr Motwani told the patient of “new lower mortality figures” for the PCI procedure, the panel heard. A second patient died on the table in April 2006 after the second of two attempts to unblock blood vessels using PCI procedures.
It was a procedure “which he should not even have been undergoing”, said Mr Hurst. Dr Motwani, of Tavistock, Devon, faces a total of 30 allegations relating to his surgical treatment of a total 24 patients.
He has admitted performing a PCI on nine patients whose cases were borderline but denies failing to act in their best interests, acting in a way that was not clinically appropriate and risking compromising their condition. In respect of several others he denies obtaining consent while they were under sedation.