He tells how he could not find a second tumour although another doctor found one a month later A surgeon with 45 years' experience said yesterday that even after multiple examinations he could not find a second tumour in a patient's rectum - although another surgeon found it one month later. Pannalal Nandi was defending himself at a Medical Council disciplinary inquiry sparked by a malpractice complaint from the patient, journalist Ray Heath, who has since died. The council heard that Dr Nandi removed one tumour in May 2003, but Heath continued to experience symptoms and consulted another surgeon later the same year. He died of cancer in 2004 at the age of 59 after an operation to remove the second tumour. He had been undergoing chemotherapy and radiotherapy. The council concluded the hearing yesterday and will hand down a verdict later. Heath's widow, Mary, and son Andrew were at the hearing but refused to comment. The inquiry heard that Heath consulted Dr Nandi - listed by the council as a specialist in cardio-thoracic surgery - in April 2003 after he had felt discomfort in his rectum since 2002. A general practitioner had said he was showing symptoms of haemorrhoids which caused an obstruction. Dr Nandi diagnosed rectum cancer after a CT scan showed 'two things' in his rectum, one of which was a 6cm-diameter tumour that the surgeon found in a digital examination. He said he could not find any other tumours that could have caused an obstruction. He operated to remove the tumour with general surgeon Lai Cham-kwan at the Adventist Hospital on May 6, 2003, but no other tumours were found before or during the operation. The inquiry heard that general surgeon James Donald Greig, who found the second tumour in Heath's rectum, questioned why Dr Nandi had been unable to detect it. Dr Nandi was asked by the council's legal officer why he had not used a sigmoscope, an optical device for viewing the lower colon, to examine areas his fingers could not reach. Dr Nandi said he did not consider using one as the scope could have ruptured the tumour and might have shown nothing because of the obstruction in the rectum. 'There is no 100 per cent success in anything,' he said. 'A good surgeon knows when to stop.' He also said he had the idea 'foremost in mind' that Heath might have another tumour so he had spent 30 minutes during the surgery to look for other tumours with Dr Lai but failed to find any. Asked why this was not recorded in his notes about the operation, he said: 'It's not possible to write everything down during a surgery. Sometimes the examination we did might be like a reflex.' Expert witness Lam Ching-wa testified on Monday last week that an obstruction in the rectum was no reason to skip using the sigmoscope to look for a second tumour. Dr Lam said yesterday it was also possible that Dr Nandi would have been unable to find that tumour with a manual examination and CT scan. Heath was a former business editor of the South China Morning Post. Case notes 2002 Ray Heath feels discomfort and finds blood in his faeces April 2003 After a general practitioner says Heath has symptoms of haemorrhoids, Heath consults specialist Pannalal Nandi. A CT scan indicates a 6cm-diameter tumour in his rectum and 'suspicion of a second possible tumour'. Dr Nandi conducts a digital examination, but does not use a sigmoscope, and finds no second tumour May 6, 2003 Dr Nandi operates on Heath at Adventist Hospital to remove the 6cm tumour. He claims to have examined the patient's rectum for at least 30 minutes without finding signs of a second tumour. The examination is not marked in the doctor's notes May 28 Heath visits another doctor, Donald Greig, after he experiences the same symptoms he had before the operation. Dr Greig finds a second tumour in Heath's rectum and questions whether the tumour could have grown since Dr Nandi operated September 2003 Dr Greig operates on Heath to remove the second tumour. Heath receives chemotherapy and radiotherapy. Patient files a malpractice complaint against Dr Nandi October 11, 2004 Heath dies in Adventist Hospital Source: Evidence from Medical Council hearing