Last week, Solna District Court sentenced Italian surgeon Paolo Macchiarini for one of his plastic throat surgeries. Instead of care, a young woman suffered serious bodily injury – a serious crime, according to the district court.
But at the same time, the court acquits his other plastic throat interventions because it is claimed that they were justifiable – legally speaking. If the verdict is not appealed, the risks increase that more seriously ill patients will be used as experimental animals for untested and fatal inventions in the daily care of our hospitals.
In 2014, three surgeons and an intensive care physician sounded the alarm at Karolinska University Hospital and Karolinska Institutet that a colleague was experimenting with lethal methods on patients and lied about the results in his scientific publications. On Thursday, the result of the first trial came.
That the only penalty was a conditional sentence certainly perceived by many as offensive to the general legal consciousness, especially given that Macchiarini was convicted of an operation that led to the death of a young woman in torture-like circumstances with repeated suffocations for more than three years.
Even more astonishing is the court’s decision to acquit Paolo Macchiarini of the other two operations with plastic throat performed in Sweden. The court’s decision came despite the prosecutor presenting a solid and well-founded indictment in which it was shown during a month’s negotiations that the plastic throat method had never even been able to work and that it lacked both clinical and scientific basis.
During the trial, intensive care physicians testified about how the patients died in disgusting forms. Prosecutors have also shown that Macchiarini and the hospital led the patients behind the light and that they never gave informed consent and that Macchiarini also lied about his research results.
Despite the judges Björn Skånsberg and Ewa Lindbäck agreed with the prosecutors on almost all of these points, even when it comes to these plastic throat procedures, they claim that Macchiarini is free from liability, legally speaking.
How did they come to this heartbreaking conclusion? The judges gave two main reasons. First, the operations would have taken place in an emergency situation, that is, someone risked immediate death. Macchiarini’s operations thus did not violate the law.
In the medical world, there is talk of an acute risk of dying when a patient has a short time left to eleven. According to Karolinska Hospital’s investigator Kjell Asplund, the practice is that in that case it is a matter of hours or days.
Here are the judges’ conclusions hard to understand. According to the medical expertise provided by the court, Macchiarini’s operations did not involve any acute risk of death. The first two patients suffered from slow-growing tumors, which may not have been removed by surgery, but are treated palliatively.
The patients were asymptomatic and could move freely. They lived at home between care sessions and traveled by public transport themselves. Their diagnoses were serious, but they were not in a medical emergency. If they had escaped their plastic throats, all three would probably have lived for several years and perhaps even seen improved treatment methods develop.
In the case of the first patient – a young father of three – the National Board of Health and Welfare’s legal advice also confirmed that there had been several possible treatment options. Because the father’s tumor was relatively small, one could, for example, have tried to cut off the cancer and then sew the rest of the trachea together with traditional surgery.
That also Macchiarini and his colleagues were aware that it was not an emergency appeared before the court among through testimonies and correspondence about how the plastic throats were planned months in advance.
The district court’s other reason for acquittal – that the interventions were not “unjustifiable” is at least as difficult to understand. The judges seem to assume that the plastic throat method would have had some kind of scientific or clinical validity, despite the fact that expert witnesses showed that all evidence was lacking.
Science and experience did not provide any support for the method to have worked. The plastic throat had never been tested on animals or humans before Macchiarini used it. On the contrary, it was well known that foreign matter implanted in the airway does not work. Macchiarini himself had written about this in the early 2000s.
Instead of believing testimonies and statements from independent experts, the district court chose to believe Macchiarini when he claimed that he was sure that the plastic trachea would work. Why did it do that?
I did the documentary series “The Experiments” which was broadcast on SVT 2016. KI’s then chairman Lars Leijonborg denied for the longest time what had happened. After a debate with me in the Radio House, he defended his lack of questioning the management’s actions by saying that it consisted of people like principal Anders Hamsten, who was a professor and highly educated.
“How could I question a highly qualified medical expert at Karolinska? A person as deserving as Anders deserves to be believed in his word “, said Leijonborg.
To him it seemed it is enough with a professorship at KI for him to close down the critical thinking activity.
The judges of the district court are known for their experience and legal knowledge. Despite this, they stated in the judgment that one of the strongest arguments for the plastic throats being actually justifiable to use as a treatment method is that “a large number of prominent doctors” at Karolinska University Hospital – Macchiarini’s partners – never questioned the plastic throats. And therefore, according to the judges, the plastic throat method could not have been “considered doomed to fail.”
Macchiarini’s assistants and support troops at the hospital have really nice titles and prestige, which makes them “outstanding”. But in what ways do they also become impartial witnesses to the truth? They are doctors and managers who recruited Macchiarini to give Karolinska star shine and big grants. Colleagues who themselves contributed to the use of the plastic throats, and thus could have their own participation to hide.
For me who followed these events for years as an investigative journalist give the verdict a strange signal. The Health Care Act governs the work of our hospitals and requires that all activities follow “science and proven experience”. This has not happened in the case of the plastic throats.
It gives a dangerous signal: if the district court’s ruling gains legal force, the risk of new lethal experiments taking place in our hospitals increases – as long as you succeed in convincing your colleagues that you will succeed and the patient only has years (!) Left to live.
But the last word is not said. If the verdict is appealed, the Court of Appeal may perhaps give science and evidence renewed confidence.