Al Muderis has ‘poor reputation’ among surgeons, court told

A Sydney surgeon has told the Federal Court that Dr Munjed Al Muderis has a “poor reputation” among his colleagues and left a drill bit in a patient’s leg, in an explosive day of evidence during the prominent surgeon’s defamation case against Nine newspapers and 60 Minutes.

Orthopaedic surgeon Dr Dimitri Papadimitriou gave evidence in Sydney on Thursday that he performed surgery on one of Al Muderis’ former patients, Leah Mooney, in September 2011, after Al Muderis had performed two surgeries on Mooney earlier that year to fix her badly broken left leg.

Surgeon Munjed Al Muderis, on far left, and barrister Sue Chrysanthou, SC, at the Federal Court in Sydney last month.Credit: Steven Siewert

Papadimitriou, who specialises in hip, knee and trauma surgery and works at Royal North Shore Hospital, among other hospitals in NSW, was the first witness called to give evidence in the case by Nine, the owner of the media outlets.

“In the circles in which you move, what is Dr Al Muderis’ reputation as a surgeon?” Dr Matt Collins, KC, acting for the Nine-owned media outlets, asked Papadimitriou.

“Amongst my colleagues, the orthopaedic surgeons, he has a poor reputation,” Papadimitriou said.

“He’s considered to lack judgment, empathy, and on several occasions felt to have made poor decisions.”

Dr Dimitri Papadimitriou outside the Federal Court in Sydney on Thursday.Credit: Brent Lewin

Al Muderis alleges reports by the Herald, The Age and 60 Minutes in September last year convey a range of defamatory meanings, including that he negligently performed osseointegration surgery.

Osseointegration involves inserting titanium pins into the residual bone of an amputee to enable prosthetic limbs to be connected. Mooney was not an osseointegration patient.

Nine is seeking to rely on a range of defences, including a new public interest defence, truth, and honest opinion.

The court heard on Thursday that Al Muderis’ former patient, Mooney, was referred to Papadimitriou in September 2011 by an infectious diseases specialist because she appeared to have an infection in her left knee.

Mooney badly broke her left leg in a skiing accident in Canada in January 2011 and was operated on by Al Muderis in Sydney on two separate occasions in February that year to fix that injury.

The second operation by Al Muderis was effectively a revision of the first, the court heard.

Papadimitriou said his curiosity was piqued as to why the surgery was “redone after three weeks; that’s an unusual thing to need to do”.

He said he observed that the “fracture had been fixed in a poor alignment” during the first surgery, with the leg “going outwards”.

“The bone had been put in with the screws holding it crooked, basically”, Papadimitriou said, and Mooney had told him she had “woken up with her leg crooked”.

He said Mooney told him that “Dr Al Muderis had told her there was a problem with the [tibial] plate that had caused it, and he’d had similar problems with the plate in the past and that he would stop using that plate”.

“That plate is not the problem; it’s the application of the plate,” Papadimitriou said.

“The revision surgery had definitely improved the alignment greatly. It still wasn’t perfect, but it was much better.”

The court heard that Papadimitriou observed a drill bit had been left in Mooney’s knee during the initial surgery. He said this wasn’t always a problem, but “if you do have an infection it becomes one of the things that now need to be removed”.

Asked whether the drill bit could have been removed at the time it broke off, Papadimitriou said that “it definitely could have been removed” but a surgeon would normally “make an assessment [of] the harm that comes out of taking it out, versus the good that comes from taking it out”.

“We don’t like leaving drill bits in,” Papadimitriou said. “One of the reasons we don’t like leaving them in [is] it’s an awkward conversation with the patient … You’d rather tell them that everything went well.”

He said that it also “brings in a process where essentially there’s an incident form put in in the hospital”.

“I think it would have been removable and, looking at it, I would have removed it at that time,” Papadimitriou said.

He said that he told Mooney about removing implants, including the drill bit, and “she didn’t know there was a drill bit, and she was upset to find that out”.

“I told her that it was OK that it was in there; that it hadn’t harmed her being in there but … our treatment was going to need to remove it.”

Papadimitriou said his review of x-rays and CT scans led him to the conclusion that Mooney had osteomyelitis – infection of the bone – and septic arthritis of the knee, and “any prospect of joint salvage, we’d missed the boat for”.

“The joint was already destroyed,” Papadimitriou said, and had “almost no motion”.

“The infection had already pretty much done its worst locally, but it was still causing her symptoms in the sense of pain,” he said.

Mooney was still a patient of Papadimitriou, the court heard, and he described her as a “remarkable woman”.

Under cross-examination by Al Muderis’ barrister, Sue Chrysanthou, SC, Papadimitriou said he had never suggested to Mooney that she should sue Al Muderis.

“I want to suggest to you that you encouraged her to sue my client,” Chrysanthou said.

“No,” Papadimitriou replied.

Chrysanthou suggested to Papadimitriou that to the extent Mooney had an infection in her left knee, “it was a recent infection”. He disagreed and said the degree of destruction caused by the infection would take time.

The trial continues.

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