NHS Tayside carried out a due diligence review into Professor Sam Eljamel, who it employed as a consultant neurosurgeon from 1995 until retiring in 2014, and its findings were published on Thursday.
A health board "put patients at risk" from a surgeon after ignoring external warnings he was a "poor doctor", a report found.
A statement from NHS Tayside said: "This was indirect supervision which means he was not supervised directly in the operating theatre by another neurosurgeon." An investigation was dropped in 2014 when the surgeon retired, which Dr Johnson said was a "missed opportunity for learning" which would not happen today. The RCS warned about his "probity" in October 2013, mid-way through the supervision period, and said there were signs he was "a poor doctor" - however NHS Tayside made no escalation of supervision.
NHS Tayside held the due diligence review to "assist the medical director in their assessment of the adequacy of procedures to detect signals of concern relating to the practice of Professor Eljamel". It also looked at the trust's response to external scrutiny, and the current policies in place. Concerns were raised about "clinical performance" at a meeting in June 3, 2013 but "it was concluded by the medical management that Professor Eljamel had reflected and altered his practice significantly".
The report said: "There was inadequate senior input which resulted in inadequate assessment of risk and consideration of patient safety. There is no documentation to suggest that suspension or restriction to practice was considered."
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