PAGE 5

surgeon series , with

The study , he noted , was

deficit — paralysis or locked-in

captured what was described as

patients selected based on “ the

also not randomised .

syndrome — was just 5 %.

the “ underlying philosophical

exclusion of radiographically

“ The evidence for radical

The figure was an “ extreme

debate ” about Dr Teo ’ s care .

defined diffuse tumours ”.

resection of high-grade ( dif-

underestimation ”, he said , a

It was the view , which Dr Teo

Patients were mostly paedi-

fuse ) BSG in adults is extremely

sentiment that was echoed by

appeared to embrace , that “ the

atric , and the authors concluded

limited and suggests that gross

Professor Stokes .

surgeon is merely a service pro-

that survival was better with

total resection / radical resec-

Professor Morokoff also crit-

vider who should offer what can

near total or gross total resec-

tion is rarely attempted or

icised Dr Teo for introducing

be done … and the patient is free

tion compared with biopsy or

achievable , likely associated

Patient A to a young patient

and willing to decide what they

subtotal resection .

with high risk of neurological

in the waiting room before

want ”.

But Professor Morokoff said

morbidity and has an unclear

the procedure took place and

This was in breach of the

Associate Professor Andrew Morokoff .

there was a small number of biopsy patients only ( just three ), and again , the grade / histopathology of the tumour was the major factor predicting survival .

survival benefit .”

He questioned why , despite all this , Dr Teo told Patient A before the procedure that the risk of profound neurological

describing the patient as “ a good example of successful brainstem surgery ”.

For the committee , Professor Morokoff ’ s testimony

Royal Australasian College of Surgeons ’ code of conduct , which declares no surgeon should “ directly or indirectly perform or encourage indiscriminate

or unnecessary medical

interventions ”.

“ If treatment options , such as

the radical surgery in this case ,

are offered with overemphasised

benefits of prolonged survival

and under-emphasised

risks , especially when the risks

include a high chance of death

or prolonged coma , then I don ’ t

believe real informed consent

has been obtained ,” Professor

Morokoff said .

“ In my opinion , surgeons

should not offer and should

not perform surgery that

is futile and high risk just

because the patient ‘ willingly ’

consented to it .”

The surgery

The detailed discussions of what

happened during the procedure

itself came late in the inquiry

because Patient A ’ s postoperative

MRI scans were only produced

midway through the

hearings .

Asked to review them , Professor

Morokoff said they showed

that all of the enhancing part of

the tumour in the tectum had

been resected by Dr Teo and that

tissue from both sides of the

midbrain had been resected .

He rejected the suggestion

that 95 % of Patient A ’ s tumour

was in the right side , saying it

was more of a midline tumour

( 60 / 40 right compared with left ,

5

or 70 / 30 , but definitely not 95 ) and that the tumour was also

diffusely spread outside the

tectum .

Asked if Dr Teo had gone into

the normal brain during the

operation , he said : “ I wouldn ’ t

say it ’ s normal brain , but he ’ s

gone into the area of the T2 or

flair abnormality that is part

of the diffuse extension of the

tumour up into the thalami on

both sides …

“[ But ] I would think in this area it would be highly risky

and probably unreasonable to

go beyond the enhancing part

of the tumour , especially in this

location , yes ...

“[ In ] this area , going beyond

the enhancing part of the

tumour , I would consider highly

risky .”

Asked whether Dr Teo had

strayed across the midline , he

said : “ Yeah . I mean , there is no

clear anatomical midline in that

region . There ’ s nothing that tells

you this is the midline . It ’ s just

all brain tissue . But in his resection

, he ’ s definitely included

both right and left side .”