Mum 'never able to forgive hospital' for son's care by suspended Cambridge surgeon
Jack Moate was operated on by Kuldeep Stohr before he died
A mum says she will "never be able to forgive" Addenbrooke's Hospital in Cambridge where her late son was treated by a suspended surgeon.
Nine-year-old Jack Moate died less than two months after being operated on by Kuldeep Stohr, at the hospital in September 2015.
Jack, who had many complex medical needs and limited mobility, spent almost eight hours in surgery for the operation on his hips by Ms Stohr, an orthopaedic consultant who specialises in children, at Addenbrooke's.
"I'll never be able to forgive the hospital for what happened," Elizabeth Moate, Jack's mum, said.
"They sent my boy home and he died in agony."
'Fatal physical harm was caused'
Jack died in November 2015 and since then, his care has been reviewed as part of a wider exercise.
A letter from Cambridge University Hospitals NHS Foundation Trust (CUH) to Ms Moate said an independent clinical expert who reviewed Jack's care found "there was evidence that fatal physical harm was caused".
The letter, dated February 2 of this year, stated: "In the NHS, fatal harm means at the time of reporting, the patient, in this case Jack, has died and the incident may have contributed to the death."
It continued that "we have reported Jack's case to the coroner", who would be in contact with Ms Moate "to discuss next steps".
Ms Moate said her son had epilepsy and was largely wheelchair bound, although he could sit independently and unaided on the floor without any back support, and was able to stand in a standing frame and use a walking machine.
Jack suffered "significant blood loss" in a procedure which left his right hip wrongly aligned and his left hip unstable and unhealed.
Ms Moate said she was concerned about him undergoing surgery due to his complex conditions and as he was highly susceptible to infections.
"I said I didn't want him to have surgeries on both hips at the same time," she said.
"I'd have much rather him had one operation at a time; "I felt pressured into signing the consent form."
She said that she wanted "answers and justice for Jack".
Trust apology
In a statement, Dr Sue Broster, chief medical officer at CUH, said: "On behalf of the trust, I offer my unreserved apologies for the failings in Jack's care.
"Our thoughts remain with his family, and we are doing everything we can to support them at this extremely difficult time.
The trust said last March that the care of "almost 700 patients who have undergone planned surgical procedures" would be reviewed.
Jack's case was reviewed as part of a wider external clinical review commissioned by the trust last year into the practice of Ms Stohr amid concerns about care that was "below the expected standard".
His cause of death was recorded at the time as deep vein thrombosis, cerebral palsy alongside epilepsy.
Solicitor Elizabeth Maliakal, of Hudgell Solicitors who represents Ms Moate, said Jack's death "pre-dates all investigations and reviews carried out into Ms Stohr's practice".
"Had it been properly and fully investigated at the time, action to address her shortcomings could have been taken then, and we may well not be where we are now, with more than 700 cases being reviewed," she said.
Ms Maliakal wants to see a public inquiry into how concerns around Ms Stohr's care for patients were overlooked, and calls for a meeting with the Government "as a matter of urgency".
Reviews
Concerns were raised as early as 2015 and were the subject of an external clinical review in 2016.
A separate independent review, which reported back last year, highlighted how the 2016 review raised concerns about Ms Stohr's surgical technique and judgment but it was "misunderstood" and opportunities to act on the findings were "missed".
He had regular physiotherapy, which sometimes caused pain, but he mainly coped well with his many life-limiting conditions, and was able to understand commands and communicate using facial expressions and noises.
"The external retrospective clinical review, led by Andrew Kennedy KC, into the cases of patients who received care by Kuldeep Stohr remains ongoing and we continue to focus on supporting all patients and families affected," Dr Broster said.
"We will publish a summary of the review findings once all cases have been reviewed and discussed with those affected, and remain committed to implementing improvements to our services to ensure that cases like Jack's cannot happen again."
Ms Stohr was removed from clinical practice in 2024 and subsequently suspended, which she remains.
It is expected that the clinical review process will conclude this summer, with the trust set to publish findings and any recommendations.