A top doctor for NHS Tayside says there was a missed opportunity to stop a disgraced brain surgeon from operating long before his eventual dismissal, an inquiry has heard.

Dr James Cotton, executive medical director for NHS Tayside, says Dr Sam Eljamel could have been struck off seven years prior to his eventual sacking in 2014.

Speaking before the Eljamel Inquiry, Dr Cotton told senior counsel Jamie Dawson KC that he would have personally stopped the surgeon from practising long before he was sacked after a number of concerns were raised about him, leading to him being placed under supervision in June 2013 before he was struck off.

The senior counsel asked if something had gone wrong with Dr Eljamel’s supervision requirements.

Dr Cotton replied: “Fundamentally, yes.”

He added: “Many times I have put myself in the shoes of thinking about the concerns raised around the surgical practice of a surgeon, and I cannot understand, based on two really simple principles of decision making: is was it safe for patients and was it safe for staff?

“But fundamentally, was it safe for patients not to have either, as a very bare minimum, supervised the surgical practice of Dr Eljamel, when there were concerns raised, or if there had been additional concerns raised, I cannot understand why he was not removed from operating, if not other elements of his practice.

“And I fundamentally can’t understand that level of supervision.”

The inquiry heard that the supervision the doctor was under involved weekly meetings where he discussed his patients, but did not address his practice in itself.

Dr Cotton said: “The evidence that I’ve got, I cannot understand why he was allowed to continue to operate alone, or was continue was allowed to operate or operate at all. I cannot understand that.”

He added: “I think a proper risk assessment should have been taken place, and whether he needed direct supervision of his surgical practice, as in one-to-one supervision, or not operate at all, or suspended, and that that would require probably some subject matter expertise at the time.

“But I can say to you, as medical director, that’s the decision making process I would be starting to think about when I read those concerns.”

The senior counsel interjected: “But I think you said a moment ago that that he should not have been allowed to operate. Is that right?”

“Yes, I don’t think he should have been. I think if I was to make that decision today, I would not let him operate.”

The inquiry then heard how a fellow medical practitioner made a complaint against Dr Eljamel in December 2012 to the chief executive of NHS Tayside, alleging a botched sight surgery.

Another sight surgery complaint was made back in 2007, and the senior counsel pressed Dr Cotton as to whether these examples, along with the many other allegations of malpractice over the years, should have led to Dr Eljamel being stuck off sooner.

Dr Cotton said: “It could and should have happened, yes.”

The panel also heard how Dr Cotton denied there was any form of cover-up into Dr Eljamel’s actions throughout the years.

The inquiry, before Lord Weir, continues.