Why was a rogue Dundee doctor able to continually botch operations and leave patients with lifelong injuries before he was finally struck off by NHS Tayside?
That’s what has left victims who have won compensation and campaigners fighting for a public inquiry into disgraced Professor Sam Eljamel baffled and angry.
Bombshell whistleblower accusations are at odds with when NHS chiefs say they first found out about concerns over the neurosurgeon.
Those who suffered at Prof Eljamel’s hands now feel vindicated after insisting for years the health board knew more than they let on.
Here are five key questions we put to NHS Tayside on Friday – and their responses.
1 – When did NHS Tayside first learn of concerns over Eljamel?
Health board chiefs have long insisted alarm bells were first signalled over the rogue surgeon’s conduct in June 2013, when he was put under supervision.
That’s despite the fact he had been employed by NHS Tayside since 1995 and had been harming patients for years.
But former colleagues of Prof Eljamel told the BBC the health board had been alerted to his malpractice in 2009.
One doctor said: “It went all the way up to the board. They all knew about it.”
Prof Eljamel was later suspended after he had been placed under supervision, and he gave up his right to practise in the UK in 2015.
The neurosurgeon’s lawyers argued NHS Tayside should have been equally culpable when he was ordered to pay one victim £2.8 million.
But judges rejected this argument and said Prof Eljamel was solely liable for the payout.
NHS Tayside told us: “Reviews to date, including external reviews of Professor Eljamel, have not raised concerns relating to Professor Eljamel’s practice before 2013.
“NHS Tayside commissioned a Royal College of Surgeon’s review of Professor Eljamel in June 2013, which completed in December 2013.
“Professor Eljamel was suspended as a result of this Royal College of Surgeons review in December 2013 and he never returned to work in NHS Tayside.”
2 – Were junior surgeons left to operate on patients unsupervised?
To this day many of Prof Eljamel’s victims continue to suffer and live in pain due to the catastrophic mistakes he made during operations.
But accusations of negligence against him extend to claims he often left junior doctors to do surgeries unsupervised.
Whistleblowers say NHS Tayside knew Prof Eljamel was regularly away from Ninewells Hospital doing private work when he should have been at the operating table.
Victims of botched operations now say they are unsure if the disgraced neurosurgeon even operated on them in the first place.
Campaigner Jules Rose, from Kinross, said: “I’ve always been swaying back and forth if it was the registrar that performed my botched operation.
“Now upon hearing what this surgeon has said, it increases my inquisitiveness to seek the answer.”
Victim Pat Kelly told us: “I have always doubted that Eljamel showed up for my operation.
“I am now going back to Police Scotland to ask if they will now question those present in the theatre that day.”
NHS Tayside said: “Training guidelines state junior surgeons are supervised at all times, with the level of the supervision dependant on the trainees’ experience and the procedure complexity.”
3 – Were NHS Tayside staff warned not to speak out?
Central to accusations of a cover-up within NHS Tayside are bombshell claims junior staff were warned not to raise complaints against the rogue doctor.
A surgeon who spoke to the BBC said doctors were warned there would be negative consequences for speaking out.
One whistleblower said: “I did raise concerns at the time but I was shut down. We were told we would never get our traineeship.”
NHS Tayside told us: “All staff are encouraged to speak up if they have concerns and there are many ways in which staff can do this.
“Staff are made aware of these when they are employees of NHS Tayside and professional members of staff also have guidelines within their professional codes which set out how they can raise concerns.”
4 – What background checks were done by NHS Tayside before hiring Eljamel?
NHS Tayside has previously insisted all correct procedures and necessary checks were carried out before they decided to employ Prof Eljamel.
But we have previously revealed the disgraced surgeon already had a history of lying before he started working in Dundee.
Prof Eljamel was working towards a specialist degree at Connecticut University in 1995, but then quit and told them he would finish it elsewhere.
There is no record he ever did complete the fellowship, and he was hired by NHS Tayside later that same year.
Despite failing to complete the course, he later lied on his own website and claimed he had obtained his degree in the United States.
The Scottish Government told us NHS Tayside never verified whether he earned his fellowship since it was not relevant to the post they were hiring him for.
Prof Eljamel also bizarrely paid for a fake “Man of the Year” vanity award to boost an old copy of his CV.
He was listed as a “fellow” by the American Biographical Institute, a now defunct organisation which was listed as a scam.
NHS Tayside said: “All appropriate checks were made in line with Scottish Government guidance and HR processes with qualifications checked and verified.”
5 – Who was responsible for reviewing Eljamel’s performance as a surgeon?
As an employee of NHS Tayside, Prof Eljamel would have been subject to reviews of his performance from higher-ups within the health board.
But it is unclear who was responsible for scrutinising his record as a surgeon at Ninewells and if any concerns were ever flagged.
The Courier asked the health board for full copies of Prof Eljamel’s appraisal records between 1995 and 2013 via a freedom of information request on May 15.
But the health board said they were not able to share this since personal information pertaining to a former member of staff was confidential.
On Friday, NHS Tayside said: “All consultants were appraised in line with national medical appraisal arrangements of the time.”
What happens next?
For a long time the Scottish Government rejected demands for a public inquiry.
First Minister and former health secretary Humza Yousaf last year insisted remaining questions were for NHS Tayside to answer.
Prof Eljamel’s patients branded him “unfit” to become first minister as a result.
But the government is now considering an independent probe as a possible next step in light of the latest revelations.
Mid Scotland and Fife Tory MSP Liz Smith says a full inquiry is the “best option” given the seriousness of whistleblower accusations.
Dundee-based Labour MSP Michael Marra insists the case for a public probe is now “beyond doubt”.
