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Beale ignored advice not to operate on children, state claims

As the murder and fraud trial of Dr Peter Beale got underway this week, with the first state witness taking the stand, the prosecution charged that the top paediatrician ignored colleagues' advice not to perform a risky procedure on a three-year-old, who died.

The state also suggested that Beale had lost a lot of money in an investment scheme and chose to perform unnecessary and costly surgery on three children for the money, notes MedicalBrief.

The Gauteng High Court heard that Beale, facing three counts of murder and two of fraud, was involved in an investment scheme in which he had lost a lot of money – hence his doing unnecessary and costly surgery on the three children who died after he’d operated.

The two fraud charges related to his allegedly lying to the children’s parents about the results of medical tests. According to a Beeld report, Beale said in his plea explanation that he “misread” the biopsy results of a young boy and did not deliberately misrepresent the biopsy results to the parents.

The state alleges that the parents sought a second opinion before agreeing to the medical procedure. The second doctor was hesitant to perform any procedure, but Beale allegedly convinced the doctor that it was appropriate based on the results of the biopsy.

Financial crisis

The lead senior prosecutor, Advocate Elize le Roux, said that in the 2000s, Beale participated in an investment scheme and suffered substantial financial loss, reports News24.

“Due to this loss, he recklessly and fraudulently undertook unnecessary paediatric surgeries to re-establish his financial position," Le Roux said, adding that Beale had allegedly confided in a witness that he had lost money in an investment scheme and would wouldn't mind even being in an operating room as an assistant surgeon just so he could financially recoup his losses.

However, Advocate Barry Roux SC, for Beale, denied the state’s allegations, and added that he could not adequately respond as these were not part of the charges.

Another News24 report says a fellow surgeon testifying in the trial, told the court that Beale tried to recruit him to a pyramid scheme with a joining fee of R1m.

According to the testimony of the surgeon, Beale confided in him in 2009 and told him he had lost a substantial amount of money in a pyramid scheme and said he wanted to perform more surgeries to recoup money he lost in the investment.

The witness said Beale told him this during a British Association of Paediatric Surgeons conference.

The witness told the court that he and Beale had known each other since 1996 and said, while Beale told him about his financial losses, he went on to make an unusual comment, which he had not forgotten.

"He mentioned he needs to recoup the money he lost in a pyramid scheme. He said he was willing to assist other doctors conducting operations. He was known not to assist other doctors because he was a surgeon."

The witness said Beale tried to recruit him to join a pyramid scheme at some point.

"He asked me whether I would be interested in joining a pyramid scheme he was part of. He told me the minimum joining fee was R1m. I knew where it was going, so I respectfully declined the offer," the witness told the court.

Earlier, the witness told the court that Beale left the hospital after operating on a 10-year-old boy while being fully aware that there were complications with that particular patient.

According to the witness, there were complications with the procedure, as it took longer than it should have. The witness told the court that the procedure for the 10-year-old should take, at most, 90 minutes and, in the worst-case scenario, three hours.

But, with this procedure performed by Beale, it took four hours, which he said proved there were problems, although they seem to have not been noted, as hospital records don't reflect that.

The witness also told the court it was not necessary to operate on the 10-year-old, who suffered from constant vomiting.

According to the witness, medication could have treated the condition.

He said that he suspected the boy could have been suffering from anxiety or stress, which could have been related to schoolwork.

He said a referral to a child psychologist or psychiatrist was another option for treatment for the deceased child.

Defence cross-examination

The defence kicked off its cross-examination of the state witness, focusing on the medical evidence.

Beale is represented by Advocates Roux SC and Ian Green SC.

Green started by saying there may be morbidity and mortality even in the hands of the best surgeons. The witness agreed with this statement.

Green then said that the standard Beale should be judged on must be that of a reasonable paediatrician and not the super paediatrician.

"When there is a death of a patient, we must be cautious in saying there must have been misconduct on the hands of the doctor," Green said.

The witness agreed but added that most of the time someone would have not done their job correctly and that could be a nurse or someone else in the medical team.

Green told the witness that he misled the Health Professions Council of South Africa (HPCSA) hearing.

The witness earlier testified that he was part of the committee that sat in Beale's hearing in relation to the death of a three-year-old boy alleged to have died due to complications following a procedure performed.

Green asked the witness why he didn't disclose to the chairperson of the inquiry that he had assessed and given his medical opinion to the parents of the deceased child.

On Monday, the witness testified that he was approached by the parents of the deceased child, who wanted to understand the death of their child and also possibly see where things could have gone wrong.

Green told the witness that the three-year-old had a long-standing medical problem which affected his development and functioning.

Green said the child was visually underweight compared to his twin brother, and his actual weight was way below expected levels.

The witness, however, disputed this and said that the development of non-identical twins didn't follow the same pattern.

Beale is accused of murdering three children, who died between 2012 and 2019, as a result of procedures he had performed on them.

The first was a three-year-old boy who died in March 2012.

Beale allegedly also defrauded the mother by claiming pathology results – obtained before the child’s death at Parklane Netcare Clinic – revealed a rectal biopsy, and that he had Hirschsprung’s disease, requiring surgical intervention.

Beale allegedly knew there was no confirmation of the existence of the disease in the rectal biopsy, and, according to the first state witness on Tuesday, had embarked on a complex operation for a non-existent disease while convincing the parents that the procedure was relatively simple.

The witness, a paediatric surgeon who worked at several public and private hospitals in Gauteng, told the court: “I have little doubt in my mind he knew the surgery was unnecessary but ignored (the results of a) rectal biopsy for monetary reimbursement or, less likely, (because) he was unstable.”

The cause of death was consistent with septic peritonitis as a complication of surgery for Hirschsprung’s.

The witness said the child was suffering from constipation, which he described as a common illness among young children and which didn't necessarily require surgery.

He said most medical facilities treat between three and 10 children every week for constipation.

The witness also told the court he was part of the committee that oversaw Beale's disciplinary hearing at the Health Professions Council of South Africa (HPCSA), in connection with the death of the child.

Beale has been removed from the HPCSA register.

Second tragedy

In 2016, the paediatrician allegedly caused the death of another child, this time a 21-month-old girl at Morningside Mediclinic.

She was born with oesophageal atresia and suffered from gastro-oesophageal reflux disease, and Beale claimed she needed a procedure called a laparoscopic Nissen fundoplication. But after the operation, the child’s oxygen saturation levels dropped.

Beale is accused of failing to adequately or appropriately assess and address the blood loss suffered, which ultimately caused the baby to go into bradycardia or suffer a low heart rate.

Three years later, he is accused of causing the death of a 10-year-old boy at Parklane Clinic, and of telling the parents that he had intestinal metaplasia, for which he needed a laparoscopic Nissen fundoplication procedure.

However, according to the state, Beale knew there were no features of intestinal metaplasia nor any feature of dysplasia or malignancy in the biopsy, and the procedure was neither necessary nor appropriate.

The state has lined up more than three dozen witnesses to show how Beale’s actions “led to the children’s deaths”. He has pleaded not guilty to all charges.

In a statement, Medical Protection Society (MPS) said: “While our thoughts are with the families of the patients involved during this difficult time, we also recognise the concern this and similar cases have generated across the medical community.

“The prospect of facing criminal charges after an error accompanied by patient death, when doctors are acting in good faith and in difficult circumstances, is worrying.

“Doctors want to do their very best for patients, but medicine is not an exact science and healthcare environments are fast moving and complex. Unfortunately, this means complications and adverse outcomes do sometimes occur.

“Healthcare professionals need to be held accountable, however, criminalising alleged errors in the absence of any intention to cause harm helps no one.  Families lose a loved one through tragic circumstances, doctors risk losing their career and liberty, and the fear of criminal charges may have a negative knock-on effect on patient care.

“MPS’ work on behalf of the profession to secure a long-term solution to the issue of how criminal law is applied in a healthcare setting continues. We are pleased our call for the South African Law Reform Commission to investigate the criminal liability of healthcare professionals has been heard, and we will continue to push for reform.”

 

Beeld article – Pediater ontken operasies is onnodig gedoen vir geldelike gewin (Restricted access)

News24 – Prof Beale tried to recruit fellow surgeon to Ponzi scheme with R1 million joining fee, court hears

News24 article – State claims Beale performed '’unnecessary paediatric surgeries’ to recoup money from failed investment (Restricted access)

 

News24 article – Beale ‘ignored biopsy report’ on child’s health and chose to operate for money, court hears (Restricted access)

 

See more from MedicalBrief archives:

 

Accused paediatric surgeon Dr Peter Beale struck from HPCSA register

 

Culpable homicide charge added to surgeon Peter Beale’s murder/fraud case

 

Culpable homicide case against Beale moved to High Court

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