Well-known paediatric surgeon Professor Peter Beale was in the dock again this week as the state and defence presented closing arguments in his murder trial, writes MedicalBrief. Also in court this week, in a separate case, was renowned Headache Clinic founder Dr Elliot Shevel, charged with the murder of a patient (see story in Medico-Legal below).
Lawyers for Beale, charged with the murders of three children who died after surgeries he had performed, argued in the Gauteng High Court this week that he had no motive to kill them or defraud their parents.
News24 reports that he has also been charged with two counts of fraud for allegedly performing “unnecessary” procedures to recoup the more than R1m he had lost in a Ponzi scheme.
Closing arguments were presented on Monday and Tuesday, with Prosecutor Elize Le Roux saying: “I remind the court that the three children should have not died. That is a notion that is echoed by the state’s experts and on the circumspect of evidence.”
She said the court should find him guilty of murder in all cases, and if it did not find intent, should consider culpable homicide.
Beale’s defence, however, argued that the lack of consent itself could not be the cause of death and highlighted the complexities and uncertainties surrounding the necessity of surgical procedures.
Le Roux highlighted the different cases of the three children, starting with a 10-year-old who died in October 2019 due to complications allegedly related to a procedure Beale performed.
The child had a problem with excessive vomiting, and two medical experts had already testified it could have been caused by anxiety.
Le Roux said the court was tasked with determining the necessity of an operation that, according to multiple medical professionals, seemed unwarranted.
“The state’s overwhelming evidence suggested the operation was not required, especially given the findings of (medical expert’s name withheld due to court order), which ruled out the presence of severe intestinal conditions.”
Le Roux said the defence claimed Beale’s decision to operate was a discretionary one, based on the child’s history and symptoms, including vomiting blood.
However, there were contradictions in this narrative.
Blood loss
“Despite Professor Beale’s assertion that the child was vomiting blood, which might warrant further investigation, the central piece of evidence – the report – was misrepresented. All the medical professionals, except (medical expert), have stated the operation was unnecessary, and conservative treatment was advisable,” she said.
She further argued that the court needed to establish Beale’s credibility regarding the interpretation and presentation of the medical report.
“He said he misread it, but his explanation for misreading the report is not convincing. He is an experienced professional who has reviewed numerous similar reports. His claim of misreading crucial information that negated the need for the operation is dubious at best,” she said.
Regarding a three-year-old boy who died after a procedure by Beale in 2012, it is alleged he defrauded the mother by claiming that pathology results before his death revealed a rectal biopsy, showing Hirschsprung’s disease and requiring surgical intervention.
Le Roux said the mother reportedly said that if the report had been explained to her, she “would have never consented to the operation”, and that Beale “deliberately told her her son had this condition, knowing that he didn’t”.
The boy’s cause of death was consistent with septic peritonitis as a complication of surgery for Hirschsprung’s.
The state then moved on to the death of a 21-month-old girl in 2016.
Beale claimed she was required to undergo a procedure called a laparoscopic Nissen fundoplication, but after surgery, her oxygen saturation levels plummeted.
Beale was accused of failing to adequately or appropriately assess and address the blood loss suffered, causing the baby to go into bradycardia or suffer a low heart rate.
Le Roux argued in her closing statement that the child died “as a result of blood loss”.
Her life might have been saved if there were blood available in time “because we know that she lost a lot of blood during the procedure”, she argued.
Principles
Advocate Ian Green SC, for Beale, said the state’s case hinged on critical legal principles.
“These are, essentially, that there is no consent. There’s always some risk of death in surgery. There was a death… What they (the state) don’t do is identify the specific acts causing the death. And that is required.
“The lack of consent does not kill. They don’t die from it. That’s why it’s an irrelevant point. That’s why it is not the act on which thesState can rely for the deaths.”
He argued that “consent can be ignored on this”.
“I'm just going to go through it again. Consent can never be an answer to murder. You cannot consent to death. It’s just against policy. The killing would always remain wrongful. So… the absence of consent doesn’t help the state on the murder charge. It’s irrelevant.”
Advocate Barry Roux SC, also representing Beale, emphasised the complexity of the case and the high burden of proof required.
“It’s not a case where we have a witness saying, ‘That’s the accused, he shot the deceased, we saw him’. And it’s maybe a fight on self-defence. It’s a case with many intricacies, many difficulties, with many questions that will remain.”
He further argued that the prosecution had not met the necessary standard of proof beyond a reasonable doubt, and that on the allegations of fraud and intent, “You cannot commit fraud on a negligent basis. Either you intend to make a misrepresentation, or you did not have it. The fact that he made a misrepresentation is true.”
Roux urged the court to consider the broader context and inherent uncertainties of the case. “If you suggest Professor Beale… wanted to murder the three children and defraud the parents … why? It makes no sense.”
Prosecutor Elize Le Roux dismissed the theory that Beale had no motive.
“Motive is still not an essential element of any crime. What matters is the objective evidence laid before the court. While understanding the motive behind a crime might offer some insight, it is never possible to truly get into the mind of the perpetrator. This is precisely why motive is not a required element of crime,” she said.
However, Judge Thifhelimbilu Mudau asked the state to view a statement made at a 2009 conference in which Beale told a colleague he had lost more than a million to a Ponzi scheme and was willing to assist in surgeries to recover the money he had lost.
And on Beale apparently misreading a biopsy report, she said: “The judiciary is held to high standards, similar to medical practitioners. Misreading a report or misunderstanding evidence has consequences, but it does not equate to criminal sanction. The fact remains that one cannot use the misreading of a report as a defence to be treated differently.”
Le Roux conceded that accountability was essential, and said: “The fact of the matter is… one cannot hide behind a misreading of a report. The law must always consider gross negligence as outlined in past cases.”
The judgment is set to be handed down on 4 March 2025.
See more from MedicalBrief archives:
Defence in Peter Beale trial questions mother’s memory
State witness ‘biased’ and ‘reckless’, Beale’s lawyer claims
Accused paediatric surgeon Dr Peter Beale struck from HPCSA register