Doctor suspended after performing laparoscopic surgery without required training  

The Medical Tribunal has upheld a one year suspension of Dr Irfan Ashraf after finding that he performed laparoscopic surgery despite not

Islamabad: The Medical Tribunal has upheld a one year suspension of Dr Irfan Ashraf after finding that he performed laparoscopic surgery despite not completing the required training for independent laparoscopic procedures and operated at a healthcare facility that lacked an Intensive Care Unit and other essential facilities needed to deal with serious complications.

The Tribunal also upheld a Rs100,000 fine and a ban preventing Dr Irfan Ashraf from performing laparoscopic procedures until he completes proper certified training.

The judgment, announced on July 8, 2026, came in an appeal filed by Muhammad Zahid Niaz, whose father Niaz Ahmad died after a chain of medical treatment that began with laparoscopic surgery at Saleem Polyclinic in Mian Channu on December 31, 2016.

The case took a serious turn when the disciplinary inquiry examined the actual training record of Dr Irfan Ashraf. The inquiry found that although he had taken part in laparoscopic procedures during his postgraduate training, most of his experience was as an observer or assistant.

According to the judgment, Dr Irfan Ashraf had not completed the required number of procedures at the higher training levels needed to show independent surgical ability. The record showed that he had not completed even a single Level V procedure, which represents the stage at which a trainee is expected to perform laparoscopic surgery independently without supervision.

The Tribunal said this was not simply a case where a normal surgical complication had occurred. The main concern was that Dr Irfan Ashraf undertook an elective laparoscopic operation without having demonstrated the required independent competence and at a facility that did not have the necessary backup facilities.

The patient, Niaz Ahmad, suffered an injury to the common bile duct and hepatic vascular structures during the surgery. He was later taken to Bahawal Victoria Hospital in Bahawalpur for further treatment. He subsequently received treatment at Sheikh Zayed Hospital in Lahore and underwent an interventional radiological procedure at Lahore Medical Complex. Despite prolonged treatment at several hospitals, he died on March 4, 2017.

The Punjab Healthcare Commission had earlier investigated the matter. It found that Saleem Polyclinic did not have the required infrastructure, qualified human resources and licensing needed for such surgical procedures. The Commission imposed a financial penalty on the owner of the healthcare establishment and referred the conduct of Dr Muhammad Saleem Akhtar and Dr Irfan Ashraf to the medical regulator for disciplinary action.

The medical disciplinary committee later appointed Prof Dr Tanwir Khaliq, an experienced general surgeon, as an independent medical expert. He examined the medical record and assessed the standard of care, the management of laparoscopic complications and the facilities available at the clinic.

Prof Dr Tanwir Khaliq concluded that the operation had been performed at a relatively small healthcare facility without an ICU and other essential backup facilities. He also found that Dr Irfan Ashraf was not sufficiently proficient in laparoscopic surgery, particularly when dealing with complications.

The Tribunal noted that Dr Irfan Ashraf himself acknowledged that Saleem Polyclinic did not have an ICU or the facilities required to manage serious complications from laparoscopic surgery.

The Tribunal also noted that Dr Irfan Ashraf had been working as a Senior Registrar at Bahawal Victoria Hospital, where better surgical support was available. When questioned about why the operation was carried out at the private facility, the explanation was that the patient wanted the surgery there.

The Tribunal rejected this reasoning. It said a patient’s preference cannot remove a surgeon’s professional responsibility to determine whether a healthcare facility is safe enough for the planned procedure.

The case also raised questions about what doctors tell patients about their professional skills. The disciplinary committee found that Dr Irfan Ashraf had represented himself as independently competent to perform laparoscopic surgery even though his training record did not show that he had completed the required independent procedures.

The Tribunal said the evidence supported three major findings against Dr Irfan Ashraf. He performed an elective laparoscopic operation at a facility that could not properly manage foreseeable complications. He represented himself as independently competent despite incomplete training. He also exposed the patient to avoidable risk by choosing a facility without the necessary support instead of a properly equipped tertiary hospital.

However, the Tribunal did not hold every doctor involved in the patient’s treatment responsible. Dr Muhammad Saleem Akhtar, the owner of Saleem Polyclinic, received a warning rather than a disciplinary punishment. The Tribunal found that there was no evidence that he personally performed the operation or took part in the surgical decision making.

The Tribunal said ownership of a healthcare facility alone was not enough to impose the same disciplinary punishment on Dr Muhammad Saleem Akhtar as the operating surgeon. However, the warning required him to ensure that his facility was not used for procedures beyond its capacity.

Dr Khurram Shafiq Khan was also cleared of professional negligence. His involvement came later, after the patient had already suffered complications from the earlier surgery. His role was connected with an embolization procedure to control bleeding from the hepatic artery.

After examining his role, the disciplinary committee found no clear connection between the procedure performed by Dr Khurram Shafiq Khan and the patient’s eventual death. The Tribunal found no reason to disturb that decision.

Muhammad Zahid Niaz had appealed because he believed the punishment against Dr Irfan Ashraf was too weak considering that his father’s treatment ultimately ended in death. He also wanted stronger action against Dr Muhammad Saleem Akhtar and Dr Khurram Shafiq Khan.

The Medical Tribunal, chaired by Justice (Retired) Safdar Saleem Shahid, rejected the request for harsher punishment.

The Tribunal said a tragic medical outcome does not automatically mean that every doctor involved was negligent. It explained that medical procedures can have known complications even when reasonable care is taken. The important question is whether a doctor failed to meet the level of skill and care expected from a competent doctor in similar circumstances.

In the case of Dr Irfan Ashraf, however, the Tribunal found that the disciplinary committee had enough evidence to establish serious professional misconduct.

The punishment included suspension of his medical licence for one year, a Rs100,000 fine, and a ban on performing laparoscopic procedures until he obtains proper certified training. The matter was also sent to the College of Physicians and Surgeons Pakistan for consideration of his laparoscopic training credentials.

The Tribunal said the punishment was not minor because losing a professional licence directly affects a doctor’s ability to work. It also said the restriction on laparoscopic surgery directly addressed the problem identified in the case and was aimed at protecting future patients.

The Tribunal further stressed that advanced surgery should only be performed at healthcare facilities that have the equipment, staff and emergency support needed to deal with possible complications.

The judgment also warned that doctors must honestly represent their training and professional abilities. A medical qualification, the Tribunal said, carries an important responsibility because patients trust doctors with their lives and health.

The appeal was ultimately dismissed and the original disciplinary decision was fully upheld. The one year licence suspension, Rs100,000 fine and ban on laparoscopic surgery against Dr Irfan Ashraf will remain in force until the required certified training is obtained. The warning issued to Dr Muhammad Saleem Akhtar and the clearance of Dr Khurram Shafiq Khan were also maintained.