SAMLA Mock Trial for your Edutainment - A Court Case is Legalised Warfare…

Report on the SAMLA Mock trial 13/08/16 at the CSIR ICC by Prof JHR Becker, Education Director and the Education Committee of SAMLA

Courtroom drama – for your edutainment!

Putting together a mock trial with all the ingredients of reality is not dissimilar to an art performance by professional actors. Except that the actors in the mock trial are professionals acting their professions. The audience, just like in a live performance, will know that it is fiction, yet will get involved with the characters and will have much to discuss intensely, during and after the event.

A mock trial – “A Court case is legalised warfare” according to Adv John Mullins

The plaintiff and the defendant each has a case to prove. Both sides must present their case in such a manner that, right until the final judgement, the audience must be on a knife edge about which side will emerge victorious. They want value for their money.  

The case

As in any good play, there has to be a villain, but who will it turn out to be?  In this case, is it the plaintiff who was wronged by the doctor who was supposed to give his best?  Did he renege on his duty of care? Or, is it the patient, who pressured the doctor into doing the operation. Is he at fault for being unreasonable. After all, he is a business man with a lot of savvy and he knew the risks…

The evidence of proof needs to be placed before the court, argued and presented by able counsel who believe in their cause and do their best for their client.

The CSIR ICC Diamond room was transformed into a court of law for the day

ROLE PLAYERS

Judges: Rt Hon Kathy Satchwell and Adv Stephen Farrell

Masters of Ceremony: Adv John Mullins SC and Adv Denise Fisher SC

Case presenter: Prof Hennie Becker (Surgeon)

Plaintiff’s experts: Dr Charl Olivier (Orthopaedic Surgeon)

                                Mrs Elzeth Jacobs (Occupational Therapist)

Defendant’s experts: Dr Rian Steyn (Orthopaedic Surgeon)

                                Mrs Sagwati Sebapu (Occupational Therapist)

Plaintiff’s counsel: Adv Johann Stroh SC and Adv Nicole Mayet-Beukes

Defendant’s counsel: Adv Thami Ncongwane SC and Adv Maude Letzler

Psychologist: Dr Henk Swanepoel (Clinical Psychologist)

Commentators on computer and to answer WhatsApp questions from the audience:          

                            Adv Carlos da Silva SC

                            Dr H Edeling (Neurosurgeon)

                            Mr Trevor Reynolds (Clinical Psychologist)

The case: A Business man coerces a surgeon into doing a risky operation

• 40- year-old business man
• Body mass index (BMI) 45
• Large pendulous panniculus adiposus of the anterior abdominal wall
• Latent type 2 diabetic (T2DM)
• Hypertensive well-controlled on a diuretic only
• Smoking 20/day, but has recently cut down to 5/day
• All other systems within normal limits, no previous surgery, no allergies
• Severe osteoarthrosis of both knees (bone on bone)
• Pain control with oral combination therapy, Tramal, Voltaren and Stopayne.
• Has had at least 4 cortisone injections in every knee. Hips and ankles are “playing up” but “not as bad as the knees”
• Runs (CEO) a multi-million Rand successful family business, very loaded diary, frequent business meals am and pm
• International commitments, uses company jet

The patient consults a knee specialist Orthopaedic surgeon who recommends that he drastically loses weight and stop smoking before an operation can be performed

• The patient loses 2kg down from 120kg to 118kg
• Smoking down to 3 cigarettes per day

After a short time, the patient returns to the doctor and pleads that he cannot “carry on like this.” He refuses to leave the consulting rooms unless the doctor has booked him for a total knee replacement - The doctor reluctantly agrees to operate

• The right knee is worse than the left knee and will be done first
• Patient gives full informed consent to the doctor
• The patient is booked in for a total right knee replacement
• All the necessary precautions are taken as per protocol (this doctor does ten knee replacements per week, his team knows exactly what is required)
• The right total knee replacement was performed
• Knee replacement protocol is strictly adhered to by all support staff
• On day three; the knee is red, throbbing pain, inflammatory markers rising sharply
• The patient is “flooded” with antibiotics, the strongest available
• The pain and redness settles, but inflammatory markers do not normalize
• The patient is mobilised as per protocol, but the knee remains very painful, more than would be expected
• MRI scan shows a fluid collection in the area of the repair? inflammation?
• Needle aspiration of the fluid shows turbid fluid, sent for MCS (Microscopy culture and sensitivity)
• The culture comes back with a “zoo” of nine different organisms present, enteric in nature, amongst others Salmonella and fungi

The weeks and months to follow are truncated:

The surgeon decides on surgical drainage, the wound becomes septic, the prosthesis is open to the atmosphere, the prosthesis is removed, spacer is placed and the patient develops DVT in both legs

The final outcome is an above knee amputation, the wound of which takes 6 months to heal because of the severity of the sepsis.

The patient now sues the doctor for damages as well as

• Pain and suffering and loss of normal function
• Loss of income, during his illness and because he cannot attend meetings without special amenities
• His marriage has imploded. Sexually he feels that he is compromised
• He will need lifelong occupational therapy to adapt to his new lifestyle.

The grounds for the claim: Operating under these circumstances; high BMI, apron of fat, pre DMT2, was negligent and the doctor should have refused

• The doctor should have known that under the “apron of fat” there are millions of bacteria being harboured
• Cleansing the skin, and preventing contamination from this source under the “apron of fat” is impossible, the doctor should have known it

The main argument is that a professional with such a huge sub-speciality and so much experience, should have anticipated this complication and never have embarked on the surgery that he was reluctant to do in the first place.

Quantum: R28M 

Teaching Objectives:

To get a better understanding of what happens in court and what is expected of the different role players, especially from the expert witnesses; and

To become aware of the dangers of coercion and working outside of one’s safe protocols as a practitioner (medical or other)

• The expert summary in terms of Rule 36 (9)(b)
• Professional conduct in Court
• Leading and cross-examining expert witnesses
• Factors taken into account by a Judge when delivering judgment on the case
• Consequences of a clinician succumbing to coercion by a patient
• Consequences of working against one’s better judgment

The expert bundle:

Adv Carlos da Silva expertly put together the bundle of documents as an example of how it should be done (These bundles can be accessed separately below).

Download Bundles by clicking here

Special techniques available on the day to facilitate audience participation and education were:

• Commentary on the process and education pointers by Adv Da Silva and Dr Herman Edeling from their computer to a screen (not visible to counsel, but visible to the audience); and
• A WhatsApp facility for questions and comments from the audience - screened, answered or re-directed to the commentators.

To all 300 delegates, thank you for attending.

 We hope to see you again at our future events.

SAMLA is invested in your excellence!

Glimpses of the event