My fights in Dublin, Ireland
Why the Royal College of Surgeons in Ireland, attacked Dr Jerome Manuceau
Abstract
During the year 2006 I did not treat people with French health insurance (Assurance Maladie). But as I was not banned from exercising, I continued to perform surgery to foreigners, especially Irish people. In Ireland, not any surgeon does know how to put a gastric banding on obese people, a private Irish clinic asked me to come to operate in Dublin. The Irish surgeons did not appreciate my presence and accused me of "doing a very high risk surgery, outside a big hospital". In fact, in Ireland, there is no legislation concerning private clinics. Moreover, I operated under the same conditions as in France.
My registration to the Irish Medical Council was suspended immediately. A year later I got a real trial where I defended myself (Irish lawyers are overpriced). My English being limited and misunderstanding the Irish accent, it was a game of massacre for their lawyer and their experts who were none other than those who had attacked me. The Irish Medical Council has finally removed me from its register, on the arguments:
« bad medical practices » (for practices that in France are considered normal) and « failure to report the prohibition to treat insured persons in France during the year 2006 ». In fact I did not report this ban for several reasons :
- it was not a disciplinary sanction, since the commission was equal
- it did not concern any professional misconduct ;
- it actually hid a political sanction imposed on me by the Ministry of Health ;
- in Ireland there is no equivalent procedure. There are only purely Ordinary or Judicial procedures. The French Medical Council (Ordre des Medecins), made them believe that it was a disciplinary sanction.
The French National Ordre des Medecins, at the request of the Paris Ordre des Medecins, has just decided that I "no longer meet the conditions of morality necessary to remain on the board of the departmental council of the City of Paris and had to be struck of this board ».
Everyone remembers that in 2007, this same National Ordre des Medecins considered the behavior of certain members of the Paris Order as perfectly moral, while the IGAS (General Inspectorate of Social Affairs) had raised that the remuneration of some advisers are "likely to be criminally qualified".
The Council of State (Conseil d'Etat) accepted my petition for protection of fundamental liberties (refere-liberte) and suspended the decision of the National Ordre des Medecins.
I - THE PROSECUTION
The problem begun when Pr Oscar TraynorDirector, Narional Surgical Training Centre sent a letter to Pr Gerry O'Sullivan, RCSI's President. Pr Gerry O'Sullivan informed the Medical Council and gave his opinion.
In his letter, Pr Oscar Traynor, reported four patients who had problems. Let us discuss about these four cases.
1) Mrs O. : he explains that "a short period after surgery she became acutely unwell and was transferred to Tallaght Hospital....At operation Pr Kevin Conlon found a perforation....with advanced peritonitis. He perfomed a repair of the perforation..."
But, the Discharge Letter (GP Copy) mentioned no perforation. In the Operation Chart : no perforation, and the result of the Specimen to Lab disappeared from the chart. This means that they did not find any infection.
In the Pr Kevin Conlon's letter written six months later, we read :
"during placement of the gastric band there was a gastric perforation which resulted in intra abdominal abscess formation .... at the time of operation I could see that the area in question had actually sealed itself".
But the first problem is that if a perforation existed, he could not see it, as the operation is performed behind stomach and not on the front wall. The second problem is that had never proved any infection.
Conclusion : Pr Kevin Conlon told two lies, to hide his mistake. Actually it was just a lung infection and to find it, it was sufficient to do a chest x-ray. Removing the band, he had shortened Mrs O.'s life.
2) Mrs C : this woman had never been to Hospital. Her problem was easily solved with a coagulating compress as usually. But the anesthetist was afraid and wanted to be sure that in case of problem, we could send her to Hospital.
Conclusion : this was not a complication but a "potential complication".
3) Mrs S : all patients having a Gastric Band, knew that they had never suffered from "severe pain". The problem was that this woman had so much fat around stomach that the biggest band was a little tight. So, she had difficulties in drinking. In this case, we put a vein drip and we wait for a few days. This patient refused and asked me to remove her band. During this second operation she had an "aspiration" which is an anesthetic problem. It can occur during any surgery and the surgeon is not directly involved. Generally, a few days of antibiotics are sufficient to solve the problem.
Conclusion : I was unjustly considered as the only responsible for this anesthetic problem.
4) Mr G : this man had a double renal transplant and his obesity was killing his kidneys. I asked him to give a letter from his nephrologist Dr John Donohoe. After the operation he had the same problem as Mrs S, in swallowing. He agreed to wait for a few days with I.V. fluids. Due to his renal problem, I sent him to Hospital. As you can see in the Discharge Summary, of Pr. D. O'Donoghue, he was discharged home four days later. So the "respiratory tract infection with atalectesis and renal failure" of Pr Oscar Traynor had never existed.
General conclusion : Pr Oscar Traynor told lies about each patient.
II - MEDICAL COUNCIL'S INQUIRY
1) I was quite alone to defend myself, as I could not afford a Barrister.
2) The committee knew that my English was bad and that I could not understand everything. When I asked the interpreter to help me, she answered me that she was here for the two French witnesses and not for me.
3) No member of the committee and no one among the specialist witnesses were Gastric Banding specialists.
III - MEDICAL COUNCIL'S CONCLUSION : PROFESSIONAL MISCONDUCT. WHY ?
1) My patients were not selected by a multidisciplinary team (psychologists and dietecians) , ..."and that the success rates for surgeons operating on their own would not be as satisfactory".
But they refused to compare my own statistics to those of the best gastric banding specialists. This comparison would have proved that the results were equivalent.
It was not the first time I refused to obey to the International Standards : in the early 90's, we were a few French Private Surgeons inventing the Laparoscopic Digestive Surgery (key hole surgery) against the international standards. Now, it is considered as the new International Standards of digestive surgery.
2) I "...had not made any or adequate arrangements for the management of any postoperative complications .... that such treatments should be performed in a proper hospital".
First : 2 minor complications among 300 proceedings, is a complications rate, equivalent to that of the best gastric banding specialists.
Second : in France, 80% of Gastric Banding is performed in private Clinics and not in Hospitals. And France is the most Health Regulated European Country.
3) "In ... an application for registration to the General Register of Medical Practitioners ... in which he confirmed that he had never "been subject to disciplinary proceedings by an authority with which you are or were registered as a registered medical practitioner" in circumstances where he had been prohibited in 2005 by Conseil National de l'Ordre des Medecins from treating patients within the French National Insurance system from 1st January 2006 to 31st December 2006."
This is false. I had never been suspended by the Conseil National de l'Ordre des Medecins as you can see in this Certificate. I had been prohibited to treat parients within the French National Insurance System during 2006, which depends excusively on the Health Ministry, after the unbearable Public Health scandal in Guadeloupe ( see www.desirade-sante.com ). It was a political sanction, not related to any patient.
To be honest, the fight that I had lead within a small group, during those events, to settle the truth, was similar to the fight lead by the Irish to conquer their independence.
Unfortunatly, contrary to the Irish, I had finally lost the battle.
AND THE OBVIOUS LIES OF Pr KEVIN COLON AND Pr OSCAR TRAYNOR ARE NOT PROFESSIONAL MISCONDUCT !!!
IV - MY CONCLUSIONS
1) Obesity is a very serious illness (it kills three times more than cigarettes). Gastric banding is a very little invasive surgery, reversible without deaths. Complications are rare and never serious if the surgeon is a "good" specialist. But it works only for motivated people. By-pass is invasive, irreversible, with a lot of complications and deaths.
2) In one year, I operated in Dublin, more than 300 patients with very good statistical results. So, I saved a lot of Irish lives. But the fact that three patients went to Hospital for minor problems, seems to be much more important for the RCSI and the Medical Council.
3) I have performed, since 1990, 15,000 laparoscopic digestive operations and 2,500 gastric banding in Private Clinics, in the same conditions as in Dublin (80% of surgery in France is done in Private Clinics). It happens that, I have to send patients who have complications, to Hospital, as any other Private Surgeon. That's the normal way of doing in France.
But in Ireland it is considered as abnormal, when they are MY patients.
4) The anesthetist and the surgeon form a team responsible for the operation.
However I was alone at the Medical Council.
5) Some cosmetic procedures are more invasive than gastric banding (Tommy Tuck for instance).
But all surgeons and anesthetists continue to work in Private Clinics without problems.