Review of the latest NPA statements surrounding Prof Beale’s medically related murder case.
#dropitandwait #BeforeItIsTooLate
Review of the latest NPA statements surrounding Prof Beale’s medically related murder case.
01/02/2022
#itistoolate #timeforevidence #sciencewilljudge
Case is postponed to January 2023.
Originally charged in November 2019.
The State is expected to call 49 witnesses, including clinicians and people who worked at the two hospitals where the children died.
The new further charge of Culpable Homicide?
The surgeon operated on a patient, the patient passed away from a myocarditis found in Post Mortem?
Statement:
"The primary MEDICAL cause of the death of the deceased was noted as myocarditis [which is inflammation of the heart] in a person undergoing SURGERY," the indictment read.
Review:
The incidence of myocarditis in children is uncertain but it is estimated that 1 per 100,000 children per year are affected. It has been reported that 0.05% of all pediatric hospitalizations are for myocarditis. Understanding the incidence of myocarditis is problematic because the disease is difficult to diagnose.
Charge of 1st Degree Murder?
The surgeon operated on a patient, the patient passed away.
Statement:
"Having intentionally misled the complainants (parents), into believing that the surgical intervention was necessary when in truth and in fact it was not, the accused knew that he was placing the life of the deceased at risk when it was not necessary to do so. Notwithstanding the fact that the accused was aware that there is an inherent risk with any surgical intervention undertaken, the accused recklessly continued," the indictment read.”
The fraud charge relates to the results of a distal oesophagal biopsy.
Review:
(The science)
EGD (esophago-gastroduodenoscopy) AND BIOPSY IN GERD: EGD allows direct visual examination of the esophageal mucosa and mucosal biopsies enable evaluation of the microscopic anatomy[19]. Endoscopic findings in patients with GERD include esophagitis, erosions, exudates, ulcers, strictures, hiatus hernia, and areas of possible esophageal metaplasia. A continuously patent gastroesophageal junction (GEJ) seems to be helpful to predict esophagitis in biopsies[20].
Recent global consensus guidelines define reflux esophagitis as the presence of endoscopically visible breaks in the esophageal mucosa at or immediately above the GEJ[12,13,21]. The identification of esophagitis with EGD has specificity 90%-95% for GERD[22], but has a poor sensitivity of around 50%[23]. About 50% of adult patients with GERD symptoms (i.e., heartburn and/or regurgitation) showed normal endoscopy in referral centers[24], but studies from community practice demonstrated that 53% to 70% of the patients had non erosive reflux disease (NERD)[25-29]. Erosive esophagitis (EE) does not seem to be as common as previously suggested in adults[30].
In regard of the pediatric population, a recent multicenter survey in 7188 children aged 0-17 years that underwent EGD showed 12.4% prevalence of EE[31] whereas a previous single center had showed 34.6% prevalence in 402 children[32]. The criticism for the studies in children is that patients who had EGD were not patients with GERD symptoms only, therefore the prevalence of EE in pediatric patients might be underestimated.
Acid suppression before EGD may significantly limit the sensitivity of endoscopy as a diagnostic tool. A recent study has shown that PPI use contributes significantly to the classification of GERD patients into the NERD-phenotype. NERD adults on PPI therapy demonstrate some features that are significantly different from PPI-naïve patients, but similar to EE patients. This observation supports the notion that some PPI-NERD patients are actually healed EE patients, and that an overlap does exist between the GERD phenotypes[33].
Evidence from adult studies indicates that visible breaks in the esophageal mucosa are the endoscopic signs of greatest interobserver reliability[34,35].
OPERATOR EXPERIENCE is an important component of interobserver reliability[36,37].
There is insufficient evidence to support the use of histology to diagnose or exclude GERD[11].
Several variables have an impact on the validity of histology as a diagnostic tool for reflux esophagitis[54,58].
These include sampling error because of the patchy distribution of inflammatory changes and a lack in standardization of biopsy location, tissue processing, and interpretation of morphometric parameters. Histologic findings of elongation of papillae and basal hyperplasia are nonspecific reactive changes that may be found in esophagitis of other causes or in healthy volunteers[53,54,58-60].
The PRIMARY role for esophageal histology is to rule out other conditions in the differential diagnosis, such as eosinophilic esophagitis (EoE), Crohn disease, BE, and infection[12,53]. EoE may have typical endoscopic features such as speckled exudates, trachealization of the esophagus, or linear furrowing; HOWEVER in up to 30% of cases the esophageal mucosal appearance may be NORMAL[51]. Two to 4 mucosal biopsy specimens of the proximal and distal esophagus should be obtained aiming diagnosis of EoE[52]. The number of eosinophils more than 15/phf is the major histological criterion of EoE[51,52]; however eosinophils have been found in a lower number in the esophageal mucosa of asymptomatic infants younger than 1 year of age[61], and in symptomatic infants with cow’s milk-protein allergy[62].
Finally, endoscopically visible breaks in the distal esophageal mucosa are the most reliable evidence of reflux esophagitis. Mucosal erythema, pallor, and increased or decreased vascular pattern are highly subjective and nonspecific findings that are variations of normal. Histologic findings of eosinophilia, elongated papillae, basilar hyperplasia, and dilated intercellular spaces, alone or in combination, are INSUFFICIENTLY sensitive or specific to diagnose reflux esophagitis.
CONVERSELY, absence of these histologic changes does not rule out GERD.
Endoscopic biopsy is important to identify or rule out other causes of esophagitis, and to diagnose and monitor BE and its complications.
Goldani HA, Nunes DL, Ferreira CT. Managing gastroesophageal reflux disease in children: The role of endoscopy. World J Gastrointest Endosc 2012; 4(8): 339-346 [PMID: 22912907 DOI: 10.4253/wjge.v4.i8.339]
https://www.wjgnet.com/1948-5190/full/v4/i8/339.htm
Review the law:
First, the court has to find that there was an intention to kill. Then the court must look at the evidence to determine (based on the surrounding circumstances) whether there is premeditation or planning.
What is clear from all the definitions of ‘plan’ and ‘premeditated’ above is that there is a thought process involved with both concepts. Both require a person to have thought about the act to be done. The act done is then not by accident or mistake but deliberate.
Finding that the murder was planned requires that there must have been a plan, design, or scheme in place. The accused must have thought about the murder days in advance, the planning must have been done in order to ensure that the act of murder is successful.
https://www.derebus.org.za/murder-intention-premeditation-pre-planned-what-does-it-all-mean/
Statement source:
Murder-accused paediatric surgeon Peter Beale charged in connection with another child's death
01/02/2022
Lwandile Bhengu
Paediatric surgeon Professor Peter Beale appeared in the Gauteng High Court in Johannesburg on Tuesday.
He is charged with the murder of 10-year-old Zayyaan Sayed who died after Beale operated on him.
On Tuesday, a culpable homicide charge was added in connection with the death of a toddler.
Paediatric surgeon Professor Peter Beale, who faces charges of murder and fraud, has also been charged with culpable homicide in connection with the death of a 21-month-old toddler.
Beale, 73, appeared in the Gauteng High Court in Johannesburg on Tuesday in connection with all of the charges against him, including the culpable homicide one.
The case was postponed to January 2023.
He is accused of unlawfully and negligently causing the death of a 21-month-old Alissa Strydom and is accused of the murder of 10-year-old Zayyaan Sayed.
Sayed died in October 2019 at Netcare's Park Lane Clinic shortly after he performed what was meant to be a routine laparoscopic operation for reflux.
"Having intentionally misled the complainants (Sayed's parents), into believing that the surgical intervention was necessary when in truth and in fact it was not, the accused knew that he was placing the life of the deceased at risk when it was not necessary to do so.
"Notwithstanding the fact that the accused was aware that there is an inherent risk with any surgical intervention undertaken, the accused recklessly continued," the indictment read.
The fraud charge relates to the results of a distal oesophagal biopsy performed on Sayed before the surgery.
In connection with the culpable homicide charge, it is alleged that Strydom was admitted to Mediclinic Morningside in July 2016 for the same procedure as Sayed and died that night after the procedure.
A post-mortem examination found that her tongue, heart and liver were pale.
"The primary medical cause of the death of the deceased was noted as myocarditis [which is inflammation of the heart] in a person undergoing surgery," the indictment read.
In Zayyaan's case, Beale was charged alongside anaesthesiologist Dr Abdulhay Munshi. Munshi was gunned down in Norwood, Johannesburg in September 2020, before the trial started.
The State is expected to call 49 witnesses, including clinicians and people who worked at the two hospitals where the children died.
The matter has been set down for 16 January 2023 but it will proceed earlier if a date in the latter part of 2022 is available.