Teo took out ‘huge part of normal brain’ and slapped patient across face
A risky operation by surgeon Dr Charlie Teo left a patient without a quarter of her brain before she fell into a vegetative state and later died, a medical hearing has heard.
A risky operation by neurosurgeon Dr Charlie Teo was the largest tumour resection one surgeon had seen in more than 50 years, with another concerned about the “huge amount of normal brain tissue” removed, a hearing has heard.
That evidence was given on the third day of a medical hearing into Dr Teo’s conduct, which also heard the controversial doctor slapped a patient across the face in front of her family after she wouldn’t wake up from surgery — a move Dr Teo has defended.
The hearing brought by the Health Care Complaints Commission showed Dr Teo had removed almost the whole right frontal lobe of the woman’s brain in an effort to remove about half of the tumour which was mingled in with normal brain tissue.
Post-operation scans showed to the hearing revealed a huge black hole that indicated about a quarter of the brain was missing.
Professor Bryan Stokes said: “I have been practising since 1965 and this would be one of the largest resections that I have ever seen” and claimed it was almost guaranteed to leave the patient worse off neurologically.
But he added Dr Teo had said in his pre-operation report to the patient that it would likely “make her worse,” though he was only trying to prolong her life.
The 61-year-old woman, who was terminal before the surgery but without being given a definitive timeline of life expectancy, fell into a vegetative state after the operation on 25 February 2019 and died a month later.
Professor Paul D’Urso agreed a significant amount of normal brain tissue was taken out, but said “every surgeon in this country would be guilty in not declaring they take out normal brain tissue to access tumour”.
While Prof Morokoff said it was correct surgeons “usually take out normal brain cells, it usually does not change the risk profile”.
“With this, I would resecting a huge part of normal brain including critical structures that will substantially increase the risk.”
The revelation of the slap, which one surgeon described as “assault,” was aired in the last minutes of the third day of the hearing into Dr Teo’s alleged misconduct.
Outside the hearing, Dr Teo told news.com.au it was only a light tap and that doctors do it all the time to try to wake patients up.
The three other surgeons were asked by HCCC barrister Kate Richardson SC for their view on a complaint by the family of the woman who was slapped.
Reading from a list of factual assumptions, Ms Richardson said:
“The practitioner inappropriately slapped patient B across her face in the presence of her family in circumstances where the patient was unconscious.”
All three surgeons said slapping a patient across the face was never medically appropriate, even as an attempt to wake them up.
Prof Stokes said: “In my view this is actually assault – it’s totally inappropriate”.
Professor Paul Es-dosso said the act was unacceptable, regardless of whether the family was there, while Associate Professor Andrew Morokoff said he had never seen any surgeon do that. He called it a “social and cultural insult”.
Speaking with media outside the hearing, Dr Teo defended the move, saying patients react better to the slap when they are in a coma than other methods used.
He said he moved the family away like he always does, but they could see it through the gap of the curtain.
Earlier on Wednesday, the hearing heard Dr Teo performed a risky surgery for a highly aggressive and complex tumour in one third of the time two other experienced surgeons would have taken.
It heard that same surgery had “no benefits”.
Associate Prof Morokoff and Prof Stokes were cross-examined about Dr Teo’s “quite radical resection” of one 41-year-old woman’s terminal brain stem glioma.
She never recovered from the October 2018 surgery and died months later.
Associate Professor Michael Murphy from the judging panel asked what the surgeons thought about the procedure going from 9:12am to 10:55am.
Prof Stokes said while Dr Teo was a “very slick surgeon,” the operation was “too quick in (his) view”.
“It would’ve taken me at least four hours to do the same operation, at a minimum,” Prof Stokes said.
Prof Morokoff said he would be “surprised” if someone told him they did it in 90 minutes.
However, he said he would not go as far as to say he would be “concerned” at the time, because “if it goes well” it could be “quite fast”.
The surgeons both said there would be a “high chance of mortality and morbidity” with this type of surgery.
Both surgeons told Ms Richardson they agreed the risks far outweighed the benefits.
When Ms Richardson went further to ask if they saw any benefits, Prof Morokoff said “no” and Prof Stokes said only if it were to be followed up with radiation or chemotherapy.
Speaking to media outside the hearing, Dr Teo said the medical hearing against him is “soul-destroying” and the loved ones of patients who died had been “hoodwinked” by other doctors.
“I’ve devoted my life to my patients. I mean, you don’t survive 35 years in the game doing the world’s most difficult brain tumours if you don’t care for your patients,” he said.
“Really – they would have destroyed me earlier than now, if I had been this terrible person I am made out to be”.
“They’re trying to paint me to be some sort of money hungry, reckless, non-compassionate doctor. I just love my work,” he said.
The hearing is investigating complaints of alleged misconduct in relation to two terminal patients Dr Teo operated on in 2018-2019 who fell into a vegetative state or coma and did not recover.
Dr Teo’s lawyer, Matthew Hutchings, has argued throughout the hearing his client clearly communicated the extent and likelihood of risks two both patients in question.
He submitted one widowed husband’s memory was clouded by how emotional he was at the time and that Dr Teo’s only goal was to buy his patients some time, though he never guaranteed that would happen.
The hearing continues.