It will be a 4yr wait.Criminal medical murder case postponed to Jan 2024.
Update: Postponed again to Jan 2024
Joburg surgeon, 75, charged with murder of 3 patients may face more charges.
#dropitandwait #BeforeItIsTooLate
http://chng.it/RTfWcGdJ
Originally charged in November 2019.
Advocate Barry Roux representing Prof Beale
Same allegations, same response
And questions…
Myocarditis related surgery?
“It is alleged the doctor's recklessness in failing to adequately or appropriately assess and address the blood loss suffered ultimately caused the child to go into bradycardia. The patient died of myocarditis in a person undergoing surgery.”
Negative biopsies means no pathology?
“Beale allegedly knew there were no features of intestinal metaplasia nor any feature of dysplasia or malignancy in the sections of the distal oesophageal biopsy, and the procedure was neither necessary nor appropriate.”
Defrauding Vs Murder?
“He allegedly defrauded the child's mother by claiming pathology results obtained on 12 March 2012 at Parklane Netcare Clinic revealed a rectal biopsy stating the child had Hirschsprung's disease that required surgical intervention in the form of a rectal pull through.”
Source:
01/0/2023:
https://www.news24.com/news24/southafrica/news/joburg-surgeon-75-charged-with-murder-of-3-patients-may-face-more-charges-20230201
Does not change the questions asked last year:
Review of the latest NPA statements surrounding Prof Beale’s medically related murder case.
01/02/2022
#itistoolate #timeforevidence #sciencewilljudge
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 science)
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.
The signs and symptoms of myocarditis can be quite variable. Infants may show signs of listlessness, labored breathing and pallor. Frequently, they become disinterested in feeding or very fussy and difficult to console. Most older children will complain of abdominal or chest discomfort, fatigue or weakness. Respiratory symptoms such as increased work of breathing and wheezing may lead physicians to incorrectly diagnose children with asthma or pneumonia. It is not unusual for some patients to have experienced flu-like symptoms a few days or weeks before seeing a physician. Sometimes, sudden death is the FIRST sign that something is wrong.
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
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
https://www.news24.com/amp/news24/southafrica/news/murder-accused-paediatric-surgeon-peter-beale-charged-in-connection-with-another-childs-death-20220201