Inquiry after amputations

The chairman and current senior executives at the hospital became aware of the operations only last summer when the surgeon sought clearance to perform a third.

Each patient, both male, had one leg cut off to treat a rare psychiatric condition known as Body Dysmorphic Disorder, in which the victim becomes obsessively convinced that some part of his or her body is defective.

In extreme cases - for example where the patient becomes acutely depressed and at risk of suicide or self-mutilation - psychiatrists may conclude that removal of the affected part is the only way to resolve the matter.

However, it is difficult to find surgeons willing to carry out such amputations. It is understood only a few of these operations are carried out worldwide each year.

The first patient was from England and the other from Germany. They came to Falkirk after the surgeon there heard about their cases on the medical grapevine and offered to help.

Hospital sources emphasised the investigation was not disciplinary in nature, and that the surgeon, who is still working at the hospital, had done nothing illegal.

He had extensive psychiatric reports on each patient, indicating the need for the operations, and consulted professional bodies before going ahead. It is understood the General Medical Council is aware of the situation, and has taken no action.

He also cleared the first operation with senior executives in charge of the then Falkirk Royal Infirmary Trust: the medical director, Mr Douglas Harper, now retired, and the chief executive, Margaret Duffy, now finance director with Lothian University Hospitals Trust.

The second, at the beginning of April last year, was also cleared with Mr Harper but Ms Duffy had already left.

However, neither the chairman of the Falkirk Trust, Mr Ian Mullen, nor the Trust Board knew at the time what was going on.

Mr Mullen, now chairman of the Forth Valley Acute Hospitals Trust - comprising Falkirk and Stirling Royal Infirmaries - was told last summer after the surgeon approached the new trust's chief executive, Mr Jim Currie, for permission to begin assessing the third patient, from the US, for the treatment.

Permission was refused pending investigation by the ethics committee, which has been set up since the two operations as part of

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the development of clinical governance in the NHS. The operations were performed privately, the fees going to the NHS. They appear to have been successful, in that the patients' clinical conditions have improved.

It is unlikely the Trust Board will agree to these procedures being carried out as they have previously, with reservations about Falkirk's becoming a world centre for the elective amputation of healthy limbs.

Mr Mullen was unavailable for comment last night but the trust issued a statement: ''It is true that the trusts ethics committee has been conducting an inquiry into body dysmorphic disorder operations at Falkirk and District Royal Infirmary. The committee's findings are expected early next week.''

An expert in BDD, Dr Katharine Phillips, believes as many as one in 50 people may suffer from it, mostly in their 30s. They are typically obsessed with their face, skin or hair, but can be haunted by any part of the body, says Dr Phillips, a psychiatrist at Butler Hospital in Providence, Rhode Island.

The severity of BDD varies, she says. Some sufferers check mirrors frequently, perform lengthy and elaborate grooming rituals before leaving the house, and frequently seek plastic surgery. Others are prisoners in their own homes, refusing to work, socialise, or even be seen in public.

Cases documented by Dr Phillips in her book - The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder - include people who missed family weddings, birthday parties and funerals because of their fears. In extreme cases, they have committed suicide.

Sufferers sometimes do not turn to psychiatrists because they attribute their obsession to their actual appearance, not their perception. Amputation, however, remains a rare and controversial treatment.