Patient ‘scared to sever relationship’ with Al Muderis

A Texan woman has told a court she had “reasons” not to trust orthopaedic surgeon Dr Munjed Al Muderis after a procedure in Australia, but was scared to sever the relationship in case anything went wrong with her implant.

Rachael Ulrich gave evidence in the Federal Court in Sydney on Wednesday about the lead-up to her osseointegration surgery, and her correspondence with Al Muderis in the following years.

Rachael Ulrich (right) leaves the Federal Court after giving evidence on Wednesday.Credit: Rhett Wyman

Osseointegration involves titanium pins being inserted into the residual bone of amputee patients to attach prosthetic limbs.

Al Muderis is suing The Age, The Sydney Morning Herald, and 60 Minutes over stories published in 2022 which he alleges conveyed a series of defamatory meanings, including that he negligently performed osseointegration and failed to provide adequate aftercare.

Nine, which owns the media outlets, is relying on a range of defences, including truth, honest opinion and public interest.

The court heard Ulrich’s foot was amputated in 2015. She established a GoFundMe page titled “Rachael needs a new foot” in 2016 to raise money for her surgery in March 2017, which she was told was going to cost $101,799.

Under cross-examination, Ulrich alleged the surgeon told her before the operation that her bone “looks like Swiss cheese right now”, that she was “nearly osteoporotic” and “it would mean, maybe, the implant wouldn’t fuse to my bone”.

Asked by Al Muderis’ barrister Sue Chrysanthou, SC, whether she was aware a pre-surgery test showed her bone mineral density values were within the normal range, Ulrich replied: “I don’t remember that, no.”

Ulrich claimed Al Muderis was concerned and alleged he had said they would “give it a go”.

In hospital in the days after her surgery, Ulrich said she complained of a sharp pain in her calf and shortness of breath, was rushed into a CT scan and diagnosed with pulmonary embolisms.

She was asked whether she brought medical records to Australia, and said, “they didn’t request them, no”. She agreed she did not have medical records about her prior blood clots in 2009 and 2014.

Asked by Chrysanthou why she had ticked “no” to having any blood or clotting disorders on a signed patient health questionnaire, Ulrich said, “I don’t have a clotting or blood disorder”.

She said she “just assumed that any doctor would know that a vascular anomaly” would give rise to a clot risk. Ulrich said she told another physician before surgery that she did not have any active clots.

Ulrich agreed with Chrysanthou’s suggestion that she “kept in friendly contact” with Al Muderis in 2017 and 2018. The court was shown messages between the pair in which Ulrich updated the surgeon on her progress and asked about attending various US medical conferences.

Ulrich claimed at a conference in San Antonio she showed Al Muderis a screw digging into her leg and a tunnel wound, and alleged he told her she would “need to pay $5000 for a piece of hardware”.

“That’s when I was done with him in my head,” she said. “I mean, I was friendly with him because he had sort of drilled it into my head that he was the only surgeon in the world who could fix something with his patented implant in my body if something went wrong with it.”

In response to Chrysanthou’s suggestion the “negative” interaction did not occur, Ulrich said, “It did happen”.

The court heard Al Muderis and his US representative Fred Hernandez, with whom Ulrich was friends, had a falling out.

Ulrich accepted she had “liked” a Facebook post by Hernandez in September 2023 which said, “Busted time and time again. Narcissist!” above an image reading “You’re a liar” in big, black letters.

Asked by Chrysanthou whether she “chose Fred’s side” in the dispute, Ulrich said, “I had my own reasons for not trusting Munjed”.

Nine’s barrister, Dr Matt Collins, KC, asked Ulrich about the origin of this “lack of trust” and her reasons.

“It started in Australia,” she replied. “I was scared to sever this relationship because if something went wrong with this, who was going to help me? Since USA doctors and surgeons were scared to even touch my leg with this implant in it.”

She said there was “no accountability” when she ended up in the cardiac care unit, and “no admittance that his [Al Muderis’] team had been negligent and not listened to me and had dismissed my complaints for about 24 hours with all of my symptoms when I kept saying, ‘I’m pretty sure I have a blood clot’.

“That’s about it, what had happened to me in Australia and then with the piece, him saying I needed to pay that exorbitant amount,” she said.

She said she had not lodged a complaint against Al Muderis but had lodged one with the hospital.

Earlier, double amputee Mark William Urquhart denied exaggerating his medical problems in an email to Al Muderis’ partner Claudia Roberts on December 17, 2020, when he ceased being a patient.

Urquhart had been seeing Al Muderis since 2015 and agreed for him to perform osseointegration surgery on his legs two decades after he was medically discharged from the army following a failed parachute jump. He became addicted to painkillers and was left a partial paraplegic after surgery to remove a morphine pump that delivered pain relief straight to his spinal cord.

Mark Urquhart leaves the Federal Court after a second day in the witness box.Credit: Flavio Brancaleone

In the email, Urquhart wrote: “My legs, as you have seen by photos and videos I have sent you ages ago, are a disgrace. I’ve asked about the smell and the exposed femur being the source of infection.”

He continued that he was “basically ignored” and told, “Nahhhh, it is fine”; that for the fourth or fifth time, he had maggots appear on his stumps, and that he “cannot continue to live this way”.

During cross-examination, Urquhart agreed he had been “very upset” when he wrote the email.

Chrysanthou suggested: “And you were exaggerating the problems that you say had occurred.”

“That’s your opinion, ma’am, not mine, thank you,” Urquhart replied.

Asked by Chrysanthou whether he accepted it was “quite wrong” to say Al Muderis had ignored his problems, Urquhart replied: “No, ma’am, I don’t, actually.”

He said he did not have a “bad enemy relationship” with Al Muderis, rather they “just don’t have a relationship any more”.

The trial continues.

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