Neurosurgeon Dr Charlie Teo appeared back before the NSW Health Care Complaints Commission for three days this week, where he faced allegations that his evidence was ‘opportunistically untruthful.’
The commission is seeking a professional reprimand for Dr Teo with additional conditions imposed on his work as a surgeon and a professional standards committee will now deliberate on the outcome of the hearing and any necessary disciplinary actions.
On Monday 27 March 2023, Dr Teo faced a full day of questioning by the HCCC’s barrister, Ms Kate Richardson SC, which focused heavily on the decision-making process that Dr Teo followed when operating on patient A and B.
Ms Richardson highlighted that despite a known risk factor of 60%, as attested to by expert witnesses, Dr Teo had decided to cross the midline of the brain when extracting tissue from Patient A, resulting in the West Australian’s subsequent vegetative state and eventual death.
“I did something wrong; clearly, I damaged this lady,” Dr Teo said.
“I went too far into normal brain. Whatever happened, I take full responsibility. It was my hands, my technique, my doing that she didn’t wake up.
“I made an error, a surgical error. I went too far, and I damaged this lady.”
After reviewing the post-operative MRIs Dr Teo said he now believed that he had ‘been too aggressive.’
“I think that I’ve probably gone across the midline… one to one-and-a-half millimetres… but that’s enough to damage a patient when you’re doing surgery in this area,” Dr Teo said.
“I mean, I’ve clearly gone too far somewhere.
“I wanted to stick to the enhancing portion [of the tumour], but sometimes you stray into the non-enhancing portion.
“That can be tolerated in some parts of the brain, but clearly wasn’t tolerated in this patient.”
Dr Teo stressed that Patient A’s pre-surgery brain scans had revealed a midline shift, which influenced his decision to operate.
“This patient could have died at any time – within minutes of the scan, or days or weeks of the scan,” he said.
“I’ve made errors in the past where I haven’t appreciated the urgency of a midline shift and they’ve died – I would rather err on the side of caution now and say, ‘you could die at any minute’.”
Regarding Patient B, Dr Teo explained that he had most likely removed a part of the brain that was crucial to her functioning but stressed that with the current ability to map the neural networks of the frontal lobe, this outcome could have been avoided.
“I agree I took out a bad part of the right frontal lobe that caused the deficit,” Dr Teo said.
“I think you could have avoided this terrible outcome with the knowledge we have today – I will not do a right frontal lobectomy now without mapping those networks. It’s not mainstream, but it should be.”
The proceeding turned heated on Monday, with Dr Teo and Mr Richardson frequently talking over each other, and at one point during Ms Richardson’s repeated questioning, Dr Teo threw his head back in frustration to address the entire gallery.
“Really, are we going to go on about this?” he exclaimed.
Chairperson Ms Jennifer Boland was often required to intervene regarding an ‘exhausted line of questioning.’
On Tuesday 28 March 2023, Ms Richardson’s closing submissions for the HCCC questioned the reliability of Dr Teo’s testimony, alleging that he had changed his account during the hearing in light of other evidence presented – most notably, the post operative MRIs.
“He was being untruthful and deliberately trying to sidestep evidence of his own experts, which was so damning when it comes to the risks he proposed,” Ms Richardson said.
“Dr Teo should not be accepted as a witness of credit… His evidence should not be accepted unless it’s corroborated by other material.”
“He could no longer maintain the position that he had stuck to one side of the brain stem,” she said.
“He was not frank with this committee.”
Even though letters of support from 10 overseas-based neurosurgeons and 47 former patients were submitted to the committee, along with three emails and one letter of support from Australian medical professionals, no formal statements of support were provided for Dr Teo by his colleagues.
On Wednesday 29 March Dr Teo’s lawyer, Mr Matthew Hutchings, said in his closing remarks that ‘what neurosurgeons intend to do prior to a surgery, and what actually occurs, sometimes varied greatly.’
“Mere disagreements with someone’s best guess cannot be seen… to be a lack of insight and lack of understanding,” he said, and urged the hearing to try and avoid ‘hindsight bias’ when ruling on their decision.
Dr Teo still denies all charges of negligence and told media and supporters outside the hearing that any negative outcomes were within the expected risks of undergoing brain surgery.
“It’s not through malice. It’s not through neglect. It’s not through malpractice. It’s just that we try our hardest,” Dr Teo said.
“And sometimes things don’t turn out for the best.”