How a surgeon repeatedly operated on women whose tests showed little to no trace of endometriosis

Key Concepts

• Endometriosis: A disease affecting approximately 1 in 7 Australian women, characterized by tissue similar to the uterine lining growing outside the uterus, causing pain and potential infertility.
• Laparoscopy: Keyhole surgery used to inspect the pelvis and remove endometriosis tissue.
• Hysterectomy: Surgical removal of the uterus.
• Oophorectomy: Surgical removal of one or both ovaries.
• Item Number 35641 (Medicare): A Medicare billing code for severe endometriosis surgery, offering a higher rebate than other endometriosis procedures.
• Pathology Report: A medical laboratory investigation of tissues to diagnose disease, in this case, to confirm or deny the presence of endometriosis.
• Clinical Governance: The system through which healthcare organizations are directed and controlled, ensuring quality and safety of care.
• Deep Infiltrating Endometriosis: A severe form of endometriosis where the tissue penetrates deeply into pelvic organs.
• Superficial Endometriosis: A less severe form of endometriosis, characterized by freckle-like spots on the pelvic lining.

The Case of Dr. Simon Gordon: Unnecessary Surgeries and a Culture of Silence

This investigation by Four Corners details allegations of unnecessary surgeries performed by Dr. Simon Gordon, a former gynecologist at Melbourne’s Epworth Private Hospital, on young women diagnosed with or suspected of having endometriosis. The program reveals a pattern of removing healthy tissue and organs, a lack of accountability, and a culture of fear preventing colleagues from speaking out.

I. The Patients’ Experiences: A Pattern of Harm

Numerous women, including Mary Spanos, Jess Foster, and Courtney Patton, recount experiences of undergoing surgeries with Dr. Gordon based on diagnoses of endometriosis, only to discover through pathology reports that no endometriosis was present.

• Mary Spanos: Initially diagnosed with endometriosis, Mary sought treatment from Dr. Gordon who recommended a laparoscopy. Despite Dr. Gordon’s assurances of extensive endometriosis, pathology reports revealed “nil” endometriosis present in five tissue samples. She continues to experience debilitating pain.
• Jess Foster: Experienced blinding pain after surgery with Dr. Gordon, despite initial mild endometriosis diagnosis. Pathology results from Dr. Gordon’s surgery showed no trace of the disease. She now requires high doses of opiates and ketamine and has lost her ability to exercise and work.
• Courtney Patton: Underwent seven laparoscopies with Dr. Gordon, resulting in the removal of her uterus and both ovaries. Pathology reports consistently showed no endometriosis, yet Dr. Gordon continued to bill for and perform surgeries for severe endometriosis. She is now infertile and suffers from PTSD. She was pressured into a hysterectomy despite warnings from another gynecologist.

These women report significant physical, emotional, and financial consequences, including chronic pain, infertility, PTSD, and substantial debt. Courtney Patton’s case is particularly egregious, with Dr. Gordon allegedly removing organs despite consistent negative pathology results.

II. Dr. Gordon’s Practices and Billing Concerns

The investigation reveals a concerning pattern in Dr. Gordon’s surgical practices and billing.

• Aggressive Surgery: Colleagues describe Dr. Gordon as performing “aggressive surgeries” on young women.
• Misleading Diagnoses: Dr. Gordon repeatedly informed patients they had severe endometriosis, even when pathology reports indicated otherwise.
• Billing for Severe Endometriosis (Item 35641): Dr. Gordon frequently used Medicare item number 35641, reserved for severe endometriosis cases, even when pathology reports showed no evidence of the disease. This item number offers a significantly higher rebate than other endometriosis surgeries. He charged higher out-of-pocket fees than other gynecologists.
• Lack of Transparency: Dr. Gordon reportedly failed to provide patients with their pathology results, hindering their ability to understand their diagnoses and treatment. He could not locate Courtney Patton’s pathology reports when requested.

III. Systemic Failures and a Culture of Silence

The program highlights systemic failures within Epworth Hospital and the medical regulatory system that allowed Dr. Gordon’s practices to continue for years.

• Multiple Complaints Ignored: Numerous complaints were lodged with Epworth management and the medical regulator regarding Dr. Gordon’s practices, including concerns about unnecessary surgeries and refusal to admit patients experiencing post-operative complications.
• Lack of Accountability: Despite these complaints, no effective action was taken to stop Dr. Gordon. Epworth’s director of medical services claims not to recall a specific complaint regarding Courtney Patton’s case.
• Fear of Retribution: Healthcare professionals expressed fear of speaking out against Dr. Gordon, citing concerns about career repercussions and isolation. One doctor spoke anonymously, fearing for her career.
• Financial Incentives: The higher Medicare rebates for severe endometriosis surgery (Item 35641) create a financial incentive for surgeons to perform more complex procedures.
• Clinical Governance Deficiencies: The investigation suggests deficiencies in Epworth Hospital’s clinical governance processes, failing to adequately monitor and address concerns about Dr. Gordon’s practices.

IV. Expert Opinions and Medical Perspectives

Several leading gynecologists and pain specialists provided expert opinions on Dr. Gordon’s practices.

• Professor Thierry Van Kai: Described Dr. Gordon’s surgeries as “totally unnecessary” and causing “more harm than good,” particularly in cases where patients had minimal or no endometriosis. He emphasized that surgery should be reserved for exceptional cases of extensive endometriosis.
• Dr. Desiree Yap: Highlighted the lack of faith in reporting mechanisms and the potential for career repercussions for speaking up about concerns.
• Dr. Peter Wright: Emphasized that surgery is not a cure for pelvic pain and that repeated laparoscopies can be harmful. He noted that the current evidence does not support laparoscopy as a good treatment for pelvic pain.
• Dr. Alice Whitaker: Explained that 80% of endometriosis cases are superficial and manageable without surgery.

V. The Aftermath and Calls for Change

Dr. Gordon retired abruptly after the Four Corners investigation began, leaving many patients without care.

• Opera Investigation: The medical regulator, Opera, is currently investigating Dr. Gordon’s practices.
• Epworth Hospital Review: Epworth Hospital has commissioned an external review of its clinical governance.
• Calls for Systemic Reform: The program concludes with calls for systemic reform to address the culture of silence within the medical profession, improve clinical governance, and ensure patient safety. There is a need to address financial incentives that may encourage unnecessary surgeries.
• Patient Advocacy: Patients like Mary Spanos and Courtney Patton are advocating for greater transparency and accountability within the healthcare system.

VI. Notable Quotes

• Mary Spanos: “I wouldn't be able to live with myself if I didn't come forward to try and prevent this from happening to other people.”
• Professor Thierry Van Kai: “In my opinion, the surgery performed by Dr. Gordon was totally unnecessary and caused more harm than good.”
• Courtney Patton: “I’ve had the opportunity to have a family taken away from me. I’ll never be able to get that back.”
• Dr. Desiree Yap: “I think we're deceiving our patients.”
• Anonymous Doctor: “I think most of us are scared. We've shared women's medical records with leading gynecologists who were shocked by what they believe is unnecessary surgery.”

Conclusion

The Four Corners investigation into Dr. Simon Gordon’s practices reveals a disturbing case of alleged medical malpractice, systemic failures, and a culture of silence that allowed harm to continue for years. The program underscores the urgent need for greater transparency, accountability, and patient safety within the healthcare system, as well as a shift in incentives to prioritize patient well-being over financial gain. The stories of the women impacted by Dr. Gordon’s actions serve as a powerful call for change and a reminder of the importance of advocating for patient rights.