The health board did not ask for any references from his most recent work but said the surgeon had not worked since 2011 so there were no colleagues from the last year who could provide a reference.
The doctor told interviewers of two previous patient-related incidents and that he could be "forthright" in his opinions but they did not consider that an issue. A Google search also found a "couple of isolated complaints" but they seemed to fit with the doctor's version of events.
He was employed but by 2014 three written complains had been made by patients about his communication, personality and demeanour.
The business manager discussed two of them with the surgeon but his neither his supervisor or the clinical leader were made aware.
A new business manager took over in 2014 but was not made aware of the complaints about the surgeon. Records of complaints did not name the staff involved either.
A fourth and fifth complaint were made and by late that year the new business manager had confirmed he was receiving more complaints than his orthopaedic surgeon friends.
In February 2015 a colleague made a formal complaint stating he would resign unless concerns about the foreign surgeon were addressed.
An external review was commissioned and the extension to the surgeon's contract was cancelled. During the review the surgeon left the country and could not be contacted.
The commissioner found the health board had failed to carry out adequate reference checks and to place adequate systems in place to identify a pattern of concerning behaviour. He also expressed concern over the lack of supervision given the surgeon's history.
"It has an obligation to select competent staff and monitor their continued competence; provide proper orientation and supervision of its staff; and establish systems necessary for the safe operation of its hospitals," Hill said.
He made a number of recommendations in relation to improving the DHB's recruitment, supervision, performance management, complaints management processes and conducting annual performance appraisals.
Interim chief executive Derek Wright said to staff via the health board's intranet that the doctor left in 2015.
"While some things have changed for the better since this doctor worked here, and we have tightened up our recruitment and complaint processes, we still have work to do in these areas," he said.
"This is a timely reminder of the importance of following our recruitment policies, particularly getting references from the applicant's most recent manager."
Last year the orthopaedics department coming close to losing its accreditation last year after registrars were found to not be performing enough elective surgeries to meet training requirements.
Today's findings come after a State Services Commission report into the spending of disgraced former Waikato Health Board chief executive Dr Nigel Murray revealed he was stood down from his job at a health authority in Canada months before he secured the Hamilton role.
The commission said the critical information was missed in checks by former DHB chairman Bob Simcock during Murray's recruitment in 2014 because Simcock did not ask Murray's former employer for a reference.
