Concerns about the clinical practices of Peeyush Sharma, 41, were first investigated by Douglas Irving, the medical director at Stracathro hospital in Angus, who was himself suspended three weeks ago when issues were raised over his treatment of patients with breast cancer.
The suspension of two of the hospital's three general surgeons has plunged Stracathro into chaos. All accident and emergency services have had to be transferred to Dundee.
A file has been passed to the Procurator Fiscal, Scotland's prosecuting authority, following the death in a Dundee hospital of Alexander Brown, a 66-year-old grandfather, only hours after an emergency abdominal operation performed by Mr Sharma at Stracathro. Mr Sharma was unavailable for comment last night.
The records of some 400 patients treated by Mr Sharma since he arrived at the hospital last November are being reviewed. Yesterday, Doctor Gordon Paterson, who took over as acting medical director following Mr Irving's suspension, said he had been made aware of concerns about Mr Sharma's technique but there was no indication that action should be taken at that time.
"These were expressions of concern about his clinical practice in dealing with major cases. A lot of it would be major abdominal surgery," he said.
Mr Irving had discussed some of Mr Sharma's cases with him and had watched him operate. However, Mr Paterson admitted he had not discussed the matter directly with Mr Irving, whose own work is the subject of an external investigation.
The concerns went back months but Mr Sharma continued to carry out operations without supervision, as he was qualified to do. The full-scale investigation was ordered, and Mr Sharma asked to withdraw from practice, only after Mr Brown's death and what Dr Paterson indicated was further information coming to light.
Dr Paterson rejected suggestions that the hospital or the Angus NHS Trust had acted too slowly. "If we suspended every surgeon the minute anybody said 'I think there's a problem' there would not be many surgeons [operating]," he said.