A Sydney specialist is facing possible criminal charges after injecting 22 patients with dye containing caustic. Two of the patients, who were injected over a five-month period at Canterbury Hospital, have since died. Four of the other 20 are seriously ill in hospital.The doctor, who practices in the Inner West, has withdrawn himself from practice at the hospital, but was still seeing patients in his rooms yesterday. His staff said he was not available to comment.The Department of Health has called an internal inquiry and the Health Care Complaints Commission is also investigating how, between February 1 and June 7 this year, the doctor and his team used phials of dye which were clearly labelled as containing phenol, a caustic and toxic substance normally used only to deaden nerves in patients with chronic pain. It is also commonly an ingredient in antiseptic.But in these cases, it was injected into the patients' bile ducts during a test usually performed to see if there is a stone in the bile duct, or if the duct is blocked by a tumour.The caustic solution would have come into contact with the patients' bile and pancreatic ducts. After the procedure, it would have flowed out through their bowels.The chief executive officer of Central Sydney Area Health Service, Dr Diana Horvath, said she was unaware of this happening anywhere else in the world. The Department has referred the matter to the coroner to determine if there is any link between the procedure and the deaths of two of the doctor's patients.Dr Horvath said they had died within two months of having the procedure. The causes of their deaths had been recorded as a brain hemorrhage and a stroke.Dr Tony Speer, a gastroenterologist at Royal Melbourne Hospital who commonly performs the procedure, said it was possible the phenol had not caused any problems, particularly if the practice continued for five months before it was picked up."If this was causing severe illness it would have done so on the first patient and been investigated," he said. "But this is certainly not something we would recommend."The doctor informed the hospital on Monday night that the wrong solution had been used. The Department was informed on Tuesday, the complaints commission investigation began yesterday and the patients affected were assessed by gastroenterologists yesterday.

The nurses and pharmacists involved in the procedures have been removed from clinical duties. Dr Horvath said the doctor was "devastated".

The Minister for Health, Mr Craig Knowles, said that he expected that the Health Care Complaints Commissioner would determine with the NSW Medical Board whether the doctor involved should be formally suspended and "that of course the range of sanctions available to the (commission) include referral to the Director of Public Prosecutions if that should be found to be necessary".He was "shocked and frankly dismayed" and had no sympathy for the doctor involved."As far as I am concerned, from a lay perspective", it was gross negligence, he said."One would find it hard to believe that in a system such as ours you could have such a fundamental error by a clinician in the delivery of what should be fairly straightforward diagnostic services. I, of course, expect any and all individuals associated with this incident to be held fully and totally accountable for it." Ken McLaughlin, 48, has been sick for some time with Parkinson's disease and an undiagnosed liver complaint. He was booked into Canterbury Hospital on May 7 and had an ERCP on May 10.During that procedure, he was given a sedative. An endoscope was pushed down through his gullet and stomach to where the bile duct comes into his bowel. It is usually a hole only three to four millimetres wide.A thin catheter was then pushed through the endoscope up into the bile duct and filled up with the contrast solution.The duct was then x-rayed, the catheter and endoscope removed. The solution, containing 10 per cent phenol, as is usual in the procedure, was left in to work its way out through Mr McLaughlin's bowel."Ken has a liver complaint which causes him to become jaundiced," said Mrs McLaughlin. "After the test, he was brighter yellow than he had been before." But it gradually faded away and "since then he hasn't been any worse," she said.The gastroenterologists who interviewed them asked whether he had any symptoms. Mrs McLaughlin said the only unusual thing was that her husband's throat had been sore. Some blood was taken from Mr McLaughlin and he was advised to come back on June 21.