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Cyprus Internet Directory [ A medical minefield ]

A medical minefield

EVEN when it comes to scientific evidence, courts cannot be certain of the facts.
This can be deduced from the latest clash of medicine with the law in a medical negligence case concluded at the beginning of this week.

In the 48-page ruling, the Judge worryingly writes that, “the court has heard conflicting versions as to the facts and the interpretation of the facts.”

The outcome was a victory for the plaintiff, a woman who had sued for negligence after she had had bunion surgery on both feet on August 25, 1999.

The history of the case records the patient choosing specialist orthopaedic surgeon Dr. Alkis Lapithis to perform her operation after a friend had recommended him.

The patient was operated upon and left hospital the same day, wearing casts on both feet.

During the healing process, the patient visited Lapithis for post-surgical treatment.
After five weeks the patient complained of persisting pain in her right foot and, after a visit to Lapithis, he referred her to his replacement orthopaedic specialist Dr. George Siamisis.

Lapithis then left the country, while Siamisis advised corrective surgery on her right foot.

The patient did not concur and sought the professional opinion of other doctors, one of whom suggested she go to Israel to have the surgery, which she did.

She then sued Lapithis for misdiagnosing her problem, for malpractice (by cutting off a piece of her joint surface) and for not providing correct duty of care.

Lapithis told us that, “the patient kept removing her casts, therefore jeopardising her healing process. The result was that she needed further surgery to rectify the problem.”
Indeed, in his decision the judge acknowledges as much.

The court also sided with Lapithis’ version of events which transpired between August 25 and October 10, 1999.

What undid the doctor was partly the content and manner of Siamisis’ testimony, who had in fact been called to testify on behalf of the defence.

Siamisis had first admitted that “it was an error due to negligence” to the patient, but then rescinded his comment.

His statement under oath that it is “his tactic not to testify against his colleagues” was also damaging.

According to Judge Zomeni, “this attitude was ubiquitous when he was giving his testimony.”
However, Professor Meir Nyska, the Israeli doctor who performed the corrective surgery on the patient, was judged as giving an “honestly thoughtful testimony” in favour of the plaintiff.
Zomeni thought that Nyska, who performs 150 of these surgeries per year, was “the most experienced”.
Therefore, when Nyska argued that Lapithis had bungled the surgery this carried more weight.
Nyska argued that Lapithis had cut off more than he should and had also cut at an incorrect angle.
Lapithis told us that, “Nyska kept playing with words”, and that this type of surgery “should be adjusted to each patient accordingly, therefore to say that I have cut off more than I should have or that my angle was incorrect is moot.”
The judge ruled that the medical bibliography Lapithis submitted as evidence referred to another operation and was therefore irrelevant.
Zomeni also rejected the testimonies of the other two witnesses that Lapithis brought to his defence.
A research orthopaedic from Greece and the radiologist who took the X-rays of plaintiff, were judged as, “having tried to help the defendant rather than, as it was their duty, to provide the court with an honest account.”
The court accepted the testimony of Sergios Sergiou on behalf of the plaintiff, an orthopaedic surgeon who has performed 1,000 such operations up to now, who said that “cast removal was not enough to cause damage shown after surgery.”
X-rays were also under contention in the trial, both sides arguing over the angle of shots.
Legal sources have told us that the case is well-bound and legally credible, estimating chances of successful appeal as being very low.
“No scientific man ought ever to become a partisan of a side… To do so is to prostitute science and to practice a fraud on the administration of justice.”
Zomeni quotes this from a legal philosophical tract of 1938: seven decades later, it remains as relevant as it did then.

Defensive medicine?
IMBIBING the medical profession with legalism carries the significant risk of introducing fear into the doctor-patient relationship.
“Is this why we took the Hippocratic Oath? To practice defensive medicine?” Siamisis told the Sunday Mail.
“We will be too afraid to perform operations lest we are sued and the extra costs needed for operations will be borne by the patients,” he added.
Lapithis also expressed his concerns, explaining that, “doctors have stopped being doctors and have become photographers.
“At every stage of the operation we have to stop, take photographs, see if the photographs are acceptable and then proceed.
“The operation now takes me three times as long since I constantly have to stop and start. In effect, this means that I now treat fewer patients for more money since operation costs rocket.”

(Source: Cyprus Mail)

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