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

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

Urquhart is accustomed to pain. Abused as a child by his father, he left home at 15 and as soon as he was old enough, he joined the army to become a paratrooper. But in 1993, during a training exercise, he jumped from a plane and was catapulted into the ground at 75km/h. He survived, but was left in a wheelchair.

In 2016, he thought his fate could be reversed when he asked celebrated surgeon Munjed Al Muderis to operate on him. The former soldier would be able to walk for the first time in decades, and fulfil his dream of escorting his daughter down the aisle.

Instead, the procedure left the veteran with a chronic infection and the worst pain he had ever experienced – like there was “a welder blowing on my legs”.

Former SAS paratrooper Mark Urquhart was left in excruciating pain after an operation by Munjed Al Muderis.

Former SAS paratrooper Mark Urquhart was left in excruciating pain after an operation by Munjed Al Muderis.Credit:Scott McNaughton

Al Muderis, Urquhart says, did not seem interested. “This is normal, you’ll be right,” he recalls the surgeon saying. In one of their final meetings, Urquhart says he was told to spray his legs with “Febreeze” – an air freshener sold in supermarkets – to deal with the smell, which had grown so bad he says he “could taste it”.

“I couldn’t believe it,” Urquhart says. “That was the end.”

Al Muderis has built a glittering reputation for his treatment of amputees since arriving in Australia as a refugee from Iraq in 1999. He performs a procedure called osseointegration, in which he inserts a titanium rod into the bone of the residual limb. The rod fuses with the bone and protrudes through the skin to connect to a prosthetic. At best, it restores people’s ability to walk without the blisters and discomfort of a normal “socket” prosthetic.

For this work, Al Muderis has been praised by Prince Harry and made NSW Australian of the Year. His journey fleeing Saddam Hussein’s regime has inspired many. He has been lauded repeatedly in the media, including by delighted and devoted patients, and has become an influential voice in advocating for refugee rights.

Prince Harry with amputee Lieutenant Ali Spearing, who lost both legs in Afghanistan, and Munjed Al Muderis.

Prince Harry with amputee Lieutenant Ali Spearing, who lost both legs in Afghanistan, and Munjed Al Muderis.Credit:Rohan Kelly

Now a joint investigation by The Age, Sydney Morning Herald and 60 minutes has uncovered a darker side of Al Muderis’ booming and lucrative practice. Interviews with more than 25 patients, 15 surgeons and a dozen of Al Muderis’ current and former business associates have raised serious questions around the professor’s approach to patient selection and aftercare. Patients in Australia and internationally have described experiences ranging from life-changing to life-destroying. According to some, risks were minimised when their operations were explained to them, complications ignored and patients left wheelchair-bound or mutilated.

Former nurse Shona, whose surname has been withheld for privacy reasons, speaking publicly for the first time, identifies what she says are unethical practices by the well-known surgeon, including high pressure sales tactics and an abusive workplace culture. Patient-turned-promoter Fred Hernandez agrees. A tranche of leaked internal documents reveal a grow-at-all-costs mentality and a public image out-of-step with reality.

Retired Alfred hospital plastic surgeon John Anstee, who performed the first osseointegration procedure in Australia, says the way Al Muderis has treated some of his patients was simply unacceptable.

Al Muderis acknowledged in an interview that mistakes had been made, and he apologised to patients who felt abandoned or hurt. Ultimately, however, he blames vested interests in the prosthetics industry who he believes are working to destroy him.

“Look, I’m not perfect. I openly admit if I made a mistake to a patient, I openly apologise to the patient,” he told The Age, the Herald and 60 Minutes. “The facts are that the vast majority of patients are extremely happy.”

Prized patient

The military training accident that left Mark Urquhart in a wheelchair was the worst of bad luck. At 450 metres above the ground, his body flipped, and the parachute wrapped around him, leaving him helpless as he plunged into the ground.

Mark Urquhart’s army service was cut short when he became an incomplete paraplegic in 1993 during a paratrooping incident. 

Mark Urquhart’s army service was cut short when he became an incomplete paraplegic in 1993 during a paratrooping incident. 

After two years of rehabilitation, Urquhart was medically discharged from the army. He was diagnosed as an incomplete paraplegic, with no feeling in his legs but residual movement in his hips. Despite the disability, he built a successful sporting career in bobsledding, basketball and biathlons. He won three gold medals at the Invictus Games – where he was singled out by Prince Harry for “incredible sportsmanship”.

But Urquhart never gave up on his dream of walking again. “When I met Munjed, I thought ‘this is my chance’.”

In 2016, he gave Al Muderis permission to amputate both his legs above the knee and insert rods into the residual bones. Despite suffering a stroke during surgery, the operation was considered a success. Less than three months later, Urquhart took his first steps. He was embraced as a prized patient and promoted the procedure on the Sunshine Coast.

WARNING: DISTURBING IMAGE BELOW

But almost immediately, Urquhart noticed something was not right. The wound around the protruding bone looked infected. He went to Al Muderis for help, but he claims to have been turned away time and time again.

“It smelt like a dead body,” he says.

For years, he says he was told the smell of rotting flesh, redness, oozing pus and blood were normal and part of the healing process. Even when, one hot summer, Urquhart’s wound was infested by maggots, he was told there was nothing to worry about.

Still image from a video clip of maggots infesting Mark Urquhart’s wound where the metal bar emerges from the stump of his leg.

Still image from a video clip of maggots infesting Mark Urquhart’s wound where the metal bar emerges from the stump of his leg.

Al Muderis sought to treat the exposed bone using skin grafts but this was unsuccessful. The infection worsened and eventually developed into osteomyelitis, a chronic infection of the bone. Now, Urquhart is wheelchair-bound once again. This time, though, he has no legs and deals with chronic, severe pain and a reliance on heavy-duty painkillers as he waits to have the final rod removed.

“It affects everything. Your brain, your mind, it drives you insane. You can’t fix it. It feels like someone is standing there with a welder blowing on my legs. They always feel like they’re on fire.”

Al Muderis said he could not comment on specific patients, but explained maggots were not as bad as they looked and the clinic now had a written protocol for dealing with fly-blown wounds.

“I acknowledge that some people feel abandoned. I acknowledge that people have the feeling that we did not do our duty of care. This is not the aim. We try our best to give every patient the care they deserve.”

Urquhart emailed the Department of Veterans Affairs last year, which uses taxpayer funds to pay for former soldiers to have osseointegration, about his experience. “I feel I was a pay cheque for him as aftercare is pathetic,” he wrote to the department in February 2021. “I would prefer not having another Australian veteran to go [through] what I have and live in even more constant pain.”

He says this complaint went nowhere.

‘Life changing’

Osseointegration is immensely invasive: it creates a permanent open wound, known as a “stoma”, which must be carefully managed to avoid infection. A healthy stoma is when the skin grows neatly around the implant, but in some cases, patients deal with ongoing discharge or bleeding from the wound.

When successful, the procedure gives amputees a new life by removing the blisters that come with traditional sockets and allows greater control over prosthetic limbs. It has been performed on clusters of amputees around the world in specialist clinics since the 1990s.

But Al Muderis modified the surgery time, taking it from two stages to one, and significantly reduced rehabilitation requirements. The changes allowed him to do more surgeries and Australia to become the fastest-growing destination for osseointegration.

A 2016 research paper shows his clinic completed an average of 25 surgeries a year, compared to 11 in the Netherlands and 1.8 in the United Kingdom.

His work has attracted high-profile praise, including from the likes of former NSW premier Gladys Berejiklian and Prince Harry. “It is life changing, it really is,” Prince Harry told reporters in 2015.

“It changes everything about you, whether you’re military or civilian. It’s really incredible what he’s [Dr Al Muderis] done, and the story and the background is pretty spectacular as well.”

Behind the scenes, former confidantes and some patients say it’s a different story. Among them are 71-year-old Carol Todd, who was told she could have the operation even though her bones had stopped growing when she was 12 and she had lived an active life using sockets. Now her pain is so bad she screams at night, feels 20 years older and new doctors say the only option is to amputate what is left of her leg, or she will die.

Brennan Smith, another military veteran, was also sold on the idea of walking again, but says: “I was never told about the constant oozing, the blood, the pain. It was not what I was marketed, not what I was sold.” He, too, has developed a reliance on painkillers.

Rachael Ulrich says Al Muderis’s clinic did not properly consider her complex vascular disorder, which meant she developed blood clots. She was not put on blood thinners during the surgery and almost died.

Former head nurse Shona worked with Al Muderis’s team for three years but quit in 2017 after she became uncomfortable with the clinic’s approach to patient selection and aftercare.

“I found it ethically compromising, as a nurse, and as a person,” she says. “These people are worse off and suffering because of something that I’ve potentially sold them. What have I done? It’s not right.”

Shona is a former nurse at Al Muderis’s Osseointegration Clinic.

Shona is a former nurse at Al Muderis’s Osseointegration Clinic. Credit:Rhett Wyman

Despite being hired in a medical role, Shona quickly discovered her primary job was “a salesperson”. “I was to get patients to sign the consent form, get them over the line, get them to the clinic, get them to surgery,” she says. “Because I was a nurse, people trusted me.”

The people she was courting were those in pain who wanted their lives back. “They don’t want to be an amputee anymore. The vulnerability played to Munjed’s advantage,” she says.

If a prospective patient said no, Shona says she would put them in touch with patients who had positive outcomes or downplayed the risks. But as the practice grew, so did the list of patients dealing with problems. Shona says her phone was inundated with patients in despair and, “I didn’t know how to help them”.

Like other surgeons who perform osseointegration, Al Muderis began his practice with caution. According to several clinicians who have worked alongside him, he initially avoided patients with health problems that could undermine their recovery, such as diabetes and vascular disease. But Shona, some of his patients and other surgeons say that, as he performed more surgeries and became more confident, the criteria broadened to the point where Al Muderis developed a reputation for rarely turning anyone away.

According to Al Muderis: “We knock back a significant proportion of patients. We don’t offer osseointegration surgery for patients just because they demand it. We offer it if a patient needs it.”

An unsuitable candidate

In his practice, prospective patients are assessed by a team of specialists for their suitability and given the opportunity to raise concerns. However, according to those who have worked in the clinic, Al Muderis was the ultimate decision-maker and could overrule his colleagues. In Urquhart’s case, medical records from Norwest Private Hospital show pain specialist Andrew Paterson concluded he was unsuitable: amputation and osseointegration could exacerbate Urquhart’s existing pain and PTSD, possibly leading to muscle spasms, anxiety attacks or self-harm.

Al Muderis went ahead nonetheless. A year later, Urquhart was in unbearable pain and Paterson quit, citing “ideological differences” with the team. Shona and other staff, speaking anonymously to protect their positions, say Al Muderis was a demanding boss and staff worked long hours in often hostile settings.

“The way he spoke to you, treated you, he would humiliate you in public. It was quite degrading and traumatic. That was the way he ran the team – that kind of abusive way,” Shona says.

Al Muderis provided a long list of peer-reviewed articles ahead of the interview that showed his team published the positives and negatives of the surgery. In relation to the team’s culture, he acknowledged there could be “robust discussions” but overall, he said the team had “grown stronger and more unified” over the past 12 years.

“We can be hotheaded … But it’s very healthy and the whole aim is to put the patient at the centre.”

A sales culture

In 2012, Las Vegas amputee Fred Hernandez sent a business proposal to Al Muderis. In exchange for free surgery on his above-knee amputation, Hernandez said he would promote osseointegration in the giant US market. Hernandez said awareness of the procedure there was low, and proposed to change this by “mimicking American advertising activities”. One year later, he was on a plane to Sydney, in what was the beginning of a lucrative partnership.

Initially, Hernandez was paid invoices of $US3500 ($A5170) a month to promote the surgery. He later signed a contract, which included $US1000 commissions for every patient that Hernandez sent to Australia.

Using telemarketing-styled phone scripts, Hernandez sold osseointegration as a holiday, where patients could explore the attractions Down Under while undergoing a life-changing procedure. He shared his own personal experience to encourage patients to sign up and provided brochures detailing other patient success stories. In the US, personal testimonials and advertising of medical procedures are legal but in Australia, they are banned.

Al Muderis’ public relations employee intervened during the interview with The Age, the Herald and 60 Minutes, to claim there could be “real implications” if the surgeon were accused of using testimonials, before citing the industry regulator’s definition. “It means sharing a story in a positive light and providing a recommendation,” she said.

Al Muderis’s partnership with Hernandez was lucrative. Each US patient returned a net profit of $US75,000, according to court documents filed by Al Muderis and his companies in the Nevada District Court. The growing business contributed to the doctor’s life of luxury. In 2018, he made headlines for purchasing a $10 million penthouse in Sydney’s Lavender Bay. Nowadays, he is seen driving around the harbourside suburb in a blue McLaren or in his wife, Claudia’s yellow Lamborghini.

“My personal life is my personal life. Have you seen the latest Australian Taxation Office report?” he said. “It showed that surgeons are the highest earners in this country. It is a fact, and I’m not dissimilar to any other orthopedic surgeon in this country.”

“I enjoy cars, but I work very hard for what I do.” Al Muderis with his wife’s Lamborghini SUV.

“I enjoy cars, but I work very hard for what I do.” Al Muderis with his wife’s Lamborghini SUV.Credit:60 minutes

However, Al Muderis denied his clinic used advertising and denied Hernandez was paid commissions.

“Why would I do that? Why would I do that? I have patients,” Al Muderis said. “We’re choked with patients. We can’t even do our day-to-day work, in a sensible way. We try to provide safe practice and I don’t have enough hours in the day to function.”

He also said he was “philosophically against anyone raising money through Gofundme to pay for their surgery. ”This is not my practice. This is not what I would do. This never happened in the past, would never happen in the future.” However, leaked documents show the professor instructed staff to “teach [a patient] how to do fundraising for his surgery”.

Over time, the relationship between Al Muderis and Hernandez began to deteriorate. After the business relationship ended, Hernandez wrote a lengthy post on Facebook, alleging poor treatment of patients and staff.

Al Muderis now describes Hernandez as a “real piece of work”. He sued him for defamation in the US, claiming the Facebook posts were financially motivated and began only after he took a job with a competitor. Hernandez lost and was ordered to pay $US2.4 million in damages. Facing bankruptcy, Hernandez is now seeking to have that judgment overturned.

“I regret ever having been involved with him.”

An open secret

When Al Muderis’ team became aware of this joint investigation, American employee Nikki Grace-Strader instructed certain patients to get in touch. Supporters sent a large number of emails detailing the benefits of osseointegration and praising Al Muderis’ personal care.

Washington patient Cindy Asch-Martin said: “I won’t have a bad word said about Al Muderis.

“I know a few people who had osseointegration done by him and for some reason, there was bad blood between them and they started talking very negatively about him. I was sickened by that.”

Asch-Martin travelled to Australia in 2019 for the surgery, paying $US60,000. On her return to the US, she suffered a traumatic infection where her leg “literally exploded”. She spent a further $US30,000, returning to Australia for revision surgery. Since then, she says she has been able to walk and exercise after being told by other doctors she would be confined to a wheelchair for life.

Asch-Martin says she is grateful she was given a discount for a procedure originally quoted at $US100,000, after she sent a heartfelt message to the team explaining her financial and emotional circumstances.

“Munjed has had almost more patients than any other surgeon in the world. He continues to perfect it. And he’s doing an amazing job and I am extremely grateful for having Munjed in my life to be able to count on him when I need him.

“He’s there for me and listens to me. That’s the type of doctor I need.”

A number of high-profile surgeons working in Australia’s largest hospitals disagree. Speaking anonymously because they were not authorised or not willing to speak publicly, they said Al Muderis’s “aggressive” approach to surgery has been described as an “open secret” in the medical fraternity.

One described Al Muderis’ patient selection as “entirely inappropriate”. A man, “who was homeless, psychotic, living under a bridge, came to us in acute psychosis 72 hours after the treatment”, the surgeon said. “He was found at St Leonards station walking on his prosthetic stump that was infected.”

Osseointegration “was never intended to be done en masse,” said another, “It’s not something you should be banging into everybody.”

A third described an anorexic woman who was a pathological exerciser, and who had her legs amputated after an infection. Al Muderis gave her osseointegration so she could continue running. “If you interview the patient, she will say it was done right,” said the surgeon. “But if this person wants to pathologically exercise, we shouldn’t enable that.”

In response, Al Muderis said his practice was innovative and bound to attract criticism. “It’s a new technology. These are clinicians who are of the old school and they don’t like change.”

Former Alfred hospital head of plastics John Anstee, who performed the very first osseointegration in Australia in 1990, acknowledges he is conservative and could be considered “old school”. But he said the plight of Urquhart, Smith and Todd and other patients was simply not acceptable.

Loading

Anstee has watched the expansion of Al Muderis’ practice, and has treated some of his former patients. He acknowledges risk-taking is essential for innovation in medicine, but says there are general principles that must always apply. Surgeons must not hide from their problems.

“Complications will arise,” he said. “But if you do have a complication, you’ve got to wear it. You’re the surgeon. It’s your problem. You fix it.”

He’s also never seen maggots in a surgical wound.

He says he is speaking out to protect others.

“I don’t like to see unnecessary suffering.”

Dr John Anstee.

Dr John Anstee.Credit:Jason South

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

https://www.smh.com.au/national/oozing-and-maggots-the-stories-one-of-australia-s-most-celebrated-surgeons-doesn-t-want-you-to-hear-20220906-p5bfr8.html?ref=rss&utm_medium=rss&utm_source=rss_national How Munjed Al Muderis left SAS paratrooper Mark Urquhart’s legs mangled in disarray

Joel McCord

InternetCloning is an automatic aggregator of the all world’s media. In each content, the hyperlink to the primary source is specified. All trademarks belong to their rightful owners, all materials to their authors. If you are the owner of the content and do not want us to publish your materials, please contact us by email – admin@internetcloning.com. The content will be deleted within 24 hours.

Related Articles

Back to top button