How Munjed Al Muderis left SAS paratrooper Mark Urquhart’s legs mangled in disarray

When Mark Urquhart’s new medical doctors noticed the state of his legs, they have been horrified. Bone was protruding from one among his amputated thighs and maggots had eaten away at his flesh.

Urquhart is accustomed to ache. Abused as a toddler by his father, he left dwelling at 15 and as quickly as he was sufficiently old, he joined the military to develop into a paratrooper. However in 1993, throughout a coaching train, he jumped from a aircraft and was catapulted into the bottom at 75km/h. He survived, however was left in a wheelchair.

In 2016, he thought his destiny might be reversed when he requested celebrated surgeon Munjed Al Muderis to function on him. The previous soldier would be capable to stroll for the primary time in many years, and fulfil his dream of escorting his daughter down the aisle.

As a substitute, the process left the veteran with a persistent an infection and the worst ache he had ever skilled – like there was “a welder blowing on my legs”.

Al Muderis, Urquhart says, didn’t appear . “That is regular, you’ll be proper,” he remembers the surgeon saying. In one among their closing conferences, Urquhart says he was advised to spray his legs with “Febreeze” – an air freshener bought in supermarkets – to take care of the scent, which had grown so dangerous he says he “may style it”.

“I couldn’t imagine it,” Urquhart says. “That was the top.”

Al Muderis has constructed a glittering repute for his therapy of amputees since arriving in Australia as a refugee from Iraq in 1999. He performs a process referred to as osseointegration, wherein he inserts a titanium rod into the bone of the residual limb. The rod fuses with the bone and protrudes by the pores and skin to hook up with a prosthetic. At greatest, it restores folks’s capability to stroll with out the blisters and discomfort of a standard “socket” prosthetic.

For this work, Al Muderis has been praised by Prince Harry and made NSW Australian of the Yr. His journey fleeing Saddam Hussein’s regime has impressed many. He has been lauded repeatedly within the media, together with by delighted and devoted sufferers, and has develop into an influential voice in advocating for refugee rights.

Now a joint investigation by The Age, Sydney Morning Herald and 60 minutes has uncovered a darker aspect of Al Muderis’ booming and profitable observe. Interviews with greater than 25 sufferers, 15 surgeons and a dozen of Al Muderis’ present and former enterprise associates have raised critical questions across the professor’s strategy to affected person choice and aftercare. Sufferers in Australia and internationally have described experiences starting from life-changing to life-destroying. In accordance with some, dangers have been minimised when their operations have been defined to them, problems ignored and sufferers left wheelchair-bound or mutilated.

Former nurse Shona, whose surname has been withheld for privateness causes, talking publicly for the primary time, identifies what she says are unethical practices by the well-known surgeon, together with excessive stress gross sales ways and an abusive office tradition. Affected person-turned-promoter Fred Hernandez agrees. A tranche of leaked inside paperwork reveal a grow-at-all-costs mentality and a public picture out-of-step with actuality.

Retired Alfred hospital plastic surgeon John Anstee, who carried out the primary osseointegration process in Australia, says the way in which Al Muderis has handled a few of his sufferers was merely unacceptable.

Al Muderis acknowledged in an interview that errors had been made, and he apologised to sufferers who felt deserted or damage. Finally, nonetheless, he blames vested pursuits within the prosthetics business who he believes are working to destroy him.

“Look, I’m not excellent. I overtly admit if I made a mistake to a affected person, I overtly apologise to the affected person,” he advised The Age, the Herald and 60 Minutes. “The info are that the overwhelming majority of sufferers are extraordinarily completely satisfied.”

Prized affected person

The navy coaching accident that left Mark Urquhart in a wheelchair was the worst of dangerous luck. At 450 metres above the bottom, his physique flipped, and the parachute wrapped round him, leaving him helpless as he plunged into the bottom.

After two years of rehabilitation, Urquhart was medically discharged from the military. He was identified as an incomplete paraplegic, with no feeling in his legs however residual motion in his hips. Regardless of the incapacity, he constructed a profitable sporting profession in bobsledding, basketball and biathlons. He received three gold medals on the Invictus Video games – the place he was singled out by Prince Harry for “unbelievable sportsmanship”.

However Urquhart by no means gave up on his dream of strolling once more. “After I met Munjed, I believed ‘that is my likelihood’.”

In 2016, he gave Al Muderis permission to amputate each his legs above the knee and insert rods into the residual bones. Regardless of struggling a stroke throughout surgical procedure, the operation was thought-about a hit. Lower than three months later, Urquhart took his first steps. He was embraced as a prized affected person and promoted the process on the Sunshine Coast.

WARNING: DISTURBING IMAGE BELOW

However nearly instantly, Urquhart observed one thing was not proper. The wound across the protruding bone regarded contaminated. He went to Al Muderis for assist, however he claims to have been turned away time and time once more.

“It smelt like a lifeless physique,” he says.

For years, he says he was advised the scent of rotting flesh, redness, oozing pus and blood have been regular and a part of the therapeutic course of. Even when, one scorching summer season, Urquhart’s wound was infested by maggots, he was advised there was nothing to fret about.

Al Muderis sought to deal with the uncovered bone utilizing pores and skin grafts however this was unsuccessful. The an infection worsened and finally developed into osteomyelitis, a persistent an infection of the bone. Now, Urquhart is wheelchair-bound as soon as once more. This time, although, he has no legs and offers with persistent, extreme ache and a reliance on heavy-duty painkillers as he waits to have the ultimate rod eliminated.

“It impacts every part. Your mind, your thoughts, it drives you insane. You may’t repair it. It looks like somebody is standing there with a welder blowing on my legs. They all the time really feel like they’re on fireplace.”

Al Muderis mentioned he couldn’t touch upon particular sufferers, however defined maggots weren’t as dangerous as they regarded and the clinic now had a written protocol for coping with fly-blown wounds.

“I acknowledge that some folks really feel deserted. I acknowledge that individuals have the sensation that we didn’t do our responsibility of care. This isn’t the purpose. We strive our greatest to provide each affected person the care they deserve.”

Urquhart emailed the Division of Veterans Affairs final 12 months, which makes use of taxpayer funds to pay for former troopers to have osseointegration, about his expertise. “I really feel I used to be a pay cheque for him as aftercare is pathetic,” he wrote to the division in February 2021. “I would favor not having one other Australian veteran to go [through] what I’ve and reside in much more fixed ache.”

He says this criticism went nowhere.

‘Life altering’

Osseointegration is immensely invasive: it creates a everlasting open wound, generally known as a “stoma”, which should be fastidiously managed to keep away from an infection. A wholesome stoma is when the pores and skin grows neatly across the implant, however in some circumstances, sufferers take care of ongoing discharge or bleeding from the wound.

When profitable, the process provides amputees a brand new life by eradicating the blisters that include conventional sockets and permits larger management over prosthetic limbs. It has been carried out on clusters of amputees around the globe in specialist clinics because the Nineteen Nineties.

However Al Muderis modified the surgical procedure time, taking it from two levels to at least one, and considerably lowered rehabilitation necessities. The adjustments allowed him to do extra surgical procedures and Australia to develop into the fastest-growing vacation spot for osseointegration.

A 2016 analysis paper exhibits his clinic accomplished a mean of 25 surgical procedures a 12 months, in comparison with 11 within the Netherlands and 1.8 in the UK.

His work has attracted high-profile reward, together with from the likes of former NSW premier Gladys Berejiklian and Prince Harry. “It’s life altering, it truly is,” Prince Harry advised reporters in 2015.

“It adjustments every part about you, whether or not you’re navy or civilian. It’s actually unbelievable what he’s [Dr Al Muderis] executed, and the story and the background is fairly spectacular as nicely.”

Behind the scenes, former confidantes and a few sufferers say it’s a special story. Amongst them are 71-year-old Carol Todd, who was advised she may have the operation although her bones had stopped rising when she was 12 and she or he had lived an energetic life utilizing sockets. Now her ache is so dangerous she screams at evening, feels 20 years older and new medical doctors say the one possibility is to amputate what’s left of her leg, or she is going to die.

Brennan Smith, one other navy veteran, was additionally bought on the concept of strolling once more, however says: “I used to be by no means advised concerning the fixed oozing, the blood, the ache. It was not what I used to be marketed, not what I used to be bought.” He, too, has developed a reliance on painkillers.

Rachael Ulrich says Al Muderis’s clinic didn’t correctly contemplate her complicated vascular dysfunction, which meant she developed blood clots. She was not placed on blood thinners in the course of the surgical procedure and nearly died.

Former head nurse Shona labored with Al Muderis’s staff for 3 years however stop in 2017 after she turned uncomfortable with the clinic’s strategy to affected person choice and aftercare.

“I discovered it ethically compromising, as a nurse, and as an individual,” she says. “These individuals are worse off and struggling due to one thing that I’ve doubtlessly bought them. What have I executed? It’s not proper.”

Regardless of being employed in a medical position, Shona shortly found her major job was “a salesman”. “I used to be to get sufferers to signal the consent kind, get them over the road, get them to the clinic, get them to surgical procedure,” she says. “As a result of I used to be a nurse, folks trusted me.”

The folks she was courting have been these in ache who needed their lives again. “They don’t wish to be an amputee anymore. The vulnerability performed to Munjed’s benefit,” she says.

If a potential affected person mentioned no, Shona says she would put them in contact with sufferers who had optimistic outcomes or downplayed the dangers. However because the observe grew, so did the listing of sufferers coping with issues. Shona says her cellphone was inundated with sufferers in despair and, “I didn’t know the best way to assist them”.

Like different surgeons who carry out osseointegration, Al Muderis started his observe with warning. In accordance with a number of clinicians who’ve labored alongside him, he initially averted sufferers with well being issues that would undermine their restoration, resembling diabetes and vascular illness. However Shona, a few of his sufferers and different surgeons say that, as he carried out extra surgical procedures and have become extra assured, the factors broadened to the purpose the place Al Muderis developed a repute for not often turning anybody away.

In accordance with Al Muderis: “We knock again a major proportion of sufferers. We don’t provide osseointegration surgical procedure for sufferers simply because they demand it. We provide it if a affected person wants it.”

An unsuitable candidate

In his observe, potential sufferers are assessed by a staff of specialists for his or her suitability and given the chance to lift considerations. Nevertheless, in keeping with those that have labored within the clinic, Al Muderis was the last word decision-maker and will overrule his colleagues. In Urquhart’s case, medical information from Norwest Personal Hospital present ache specialist Andrew Paterson concluded he was unsuitable: amputation and osseointegration may exacerbate Urquhart’s present ache and PTSD, presumably resulting in muscle spasms, nervousness assaults or self-harm.

Al Muderis went forward nonetheless. A 12 months later, Urquhart was in insufferable ache and Paterson stop, citing “ideological variations” with the staff. Shona and different workers, talking anonymously to guard their positions, say Al Muderis was a demanding boss and workers labored lengthy hours in typically hostile settings.

“The way in which he spoke to you, handled you, he would humiliate you in public. It was fairly degrading and traumatic. That was the way in which he ran the staff – that sort of abusive approach,” Shona says.

Al Muderis offered an extended listing of peer-reviewed articles forward of the interview that confirmed his staff printed the positives and negatives of the surgical procedure. In relation to the staff’s tradition, he acknowledged there might be “sturdy discussions” however general, he mentioned the staff had “grown stronger and extra unified” over the previous 12 years.

“We could be hotheaded … Nevertheless it’s very wholesome and the entire purpose is to place the affected person on the centre.”

A gross sales tradition

In 2012, Las Vegas amputee Fred Hernandez despatched a enterprise proposal to Al Muderis. In trade without spending a dime surgical procedure on his above-knee amputation, Hernandez mentioned he would promote osseointegration within the large US market. Hernandez mentioned consciousness of the process there was low, and proposed to alter this by “mimicking American promoting actions”. One 12 months later, he was on a aircraft to Sydney, in what was the start of a profitable partnership.

Initially, Hernandez was paid invoices of $US3500 ($A5170) a month to advertise the surgical procedure. He later signed a contract, which included $US1000 commissions for each affected person that Hernandez despatched to Australia.

Utilizing telemarketing-styled cellphone scripts, Hernandez bought osseointegration as a vacation, the place sufferers may discover the points of interest Down Below whereas present process a life-changing process. He shared his personal private expertise to encourage sufferers to enroll and offered brochures detailing different affected person success tales. Within the US, private testimonials and promoting of medical procedures are authorized however in Australia, they’re banned.

Al Muderis’ public relations worker intervened in the course of the interview with The Age, the Herald and 60 Minutes, to assert there might be “actual implications” if the surgeon have been accused of utilizing testimonials, earlier than citing the business regulator’s definition. “It means sharing a narrative in a optimistic mild and offering a advice,” she mentioned.

Al Muderis’s partnership with Hernandez was profitable. Every US affected person returned a web revenue of $US75,000, in keeping with courtroom paperwork filed by Al Muderis and his corporations within the Nevada District Courtroom. The rising enterprise contributed to the physician’s lifetime of luxurious. In 2018, he made headlines for buying a $10 million penthouse in Sydney’s Lavender Bay. These days, he’s seen driving across the harbourside suburb in a blue McLaren or in his spouse, Claudia’s yellow Lamborghini.

“My private life is my private life. Have you ever seen the newest Australian Taxation Workplace report?” he mentioned. “It confirmed that surgeons are the best earners on this nation. It’s a reality, and I’m not dissimilar to another orthopedic surgeon on this nation.”

Nevertheless, Al Muderis denied his clinic used promoting and denied Hernandez was paid commissions.

“Why would I do this? Why would I do this? I’ve sufferers,” Al Muderis mentioned. “We’re choked with sufferers. We will’t even do our day-to-day work, in a smart approach. We attempt to present secure observe and I don’t have sufficient hours within the day to perform.”

He additionally mentioned he was “philosophically in opposition to anybody elevating cash by Gofundme to pay for his or her surgical procedure. ”This isn’t my observe. This isn’t what I’d do. This by no means occurred previously, would by no means occur sooner or later.” Nevertheless, leaked paperwork present the professor instructed workers to “educate [a patient] the best way to do fundraising for his surgical procedure”.

Over time, the connection between Al Muderis and Hernandez started to deteriorate. After the enterprise relationship ended, Hernandez wrote a prolonged put up on Fb, alleging poor therapy of sufferers and workers.

Al Muderis now describes Hernandez as a “actual piece of labor”. He sued him for defamation within the US, claiming the Fb posts have been financially motivated and commenced solely after he took a job with a competitor. Hernandez misplaced and was ordered to pay $US2.4 million in damages. Going through chapter, Hernandez is now in search of to have that judgment overturned.

“I remorse ever having been concerned with him.”

An open secret

When Al Muderis’ staff turned conscious of this joint investigation, American worker Nikki Grace-Strader instructed sure sufferers to get in contact. Supporters despatched numerous emails detailing the advantages of osseointegration and praising Al Muderis’ private care.

Washington affected person Cindy Asch-Martin mentioned: “I received’t have a foul phrase mentioned about Al Muderis.

“I do know a number of individuals who had osseointegration executed by him and for some purpose, there was dangerous blood between them they usually began speaking very negatively about him. I used to be sickened by that.”

Asch-Martin travelled to Australia in 2019 for the surgical procedure, paying $US60,000. On her return to the US, she suffered a traumatic an infection the place her leg “actually exploded”. She spent an additional $US30,000, returning to Australia for revision surgical procedure. Since then, she says she has been in a position to stroll and train after being advised by different medical doctors she could be confined to a wheelchair for all times.

Asch-Martin says she is grateful she was given a reduction for a process initially quoted at $US100,000, after she despatched a heartfelt message to the staff explaining her monetary and emotional circumstances.

“Munjed has had nearly extra sufferers than another surgeon on the planet. He continues to excellent it. And he’s doing an incredible job and I’m extraordinarily grateful for having Munjed in my life to have the ability to depend on him once I want him.

“He’s there for me and listens to me. That’s the kind of physician I would like.”

Various high-profile surgeons working in Australia’s largest hospitals disagree. Talking anonymously as a result of they weren’t authorised or not prepared to talk publicly, they mentioned Al Muderis’s “aggressive” strategy to surgical procedure has been described as an “open secret” within the medical fraternity.

One described Al Muderis’ affected person choice as “totally inappropriate”. A person, “who was homeless, psychotic, residing beneath a bridge, got here to us in acute psychosis 72 hours after the therapy”, the surgeon mentioned. “He was discovered at St Leonards station strolling on his prosthetic stump that was contaminated.”

Osseointegration “was by no means meant to be executed en masse,” mentioned one other, “It’s not one thing you ought to be banging into all people.”

A 3rd described an anorexic lady who was a pathological exerciser, and who had her legs amputated after an an infection. Al Muderis gave her osseointegration so she may proceed working. “In case you interview the affected person, she is going to say it was executed proper,” mentioned the surgeon. “But when this particular person desires to pathologically train, we shouldn’t allow that.”

In response, Al Muderis mentioned his observe was revolutionary and sure to draw criticism. “It’s a brand new know-how. These are clinicians who’re of the old fashioned they usually don’t like change.”

Former Alfred hospital head of plastics John Anstee, who carried out the very first osseointegration in Australia in 1990, acknowledges he’s conservative and might be thought-about “old fashioned”. However he mentioned the plight of Urquhart, Smith and Todd and different sufferers was merely not acceptable.

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Anstee has watched the enlargement of Al Muderis’ observe, and has handled a few of his former sufferers. He acknowledges risk-taking is important for innovation in drugs, however says there are basic ideas that should all the time apply. Surgeons should not disguise from their issues.

“Issues will come up,” he mentioned. “However when you do have a complication, you’ve acquired to put on it. You’re the surgeon. It’s your downside. You repair it.”

He’s additionally by no means seen maggots in a surgical wound.

He says he’s talking out to guard others.

“I don’t prefer to see pointless struggling.”

Watch Charlotte Grieve, Tom Steinfort and Natalie Clancy’s 60 Minutes report on 9Now.