A SUNSHINE Coast gastroenterologist testified he was not giving Jayant Patel "an out" as he defended the former Bundaberg surgeon's decision to operate on an elderly Bagara man.
Dr Johan van den Bogaerde, who works in Nambour, said waiting for Mervyn Morris to experience further rectal bleeding and become haemodynamically unstable would have resulted in a more complex surgery.
Dr van den Bogaerde, an expert witness in Patel's defence case in Brisbane Supreme Court on Monday, said there was no sign of an underlying chronic liver disease, heart problems or other issues that could have precluded surgery.
"I think one would probably call this a non-elective surgery," he said.
"Elective surgery would be something like a hip replacement in a patient with hip pain.
"Non-elective surgery would be a patient that had actually broken their hip and needed the operation urgently.
"In this case there was an acute bleed … and the assumption was made quite reasonably that this was a diverticular bleed.
"On the basis of that surgery was decided upon.
Dr van den Bogaerde said the difficulty crept in when it came to the timing of this non-elective surgery.
He said there was usually only a small window of opportunity to perform the surgery while the patient was in a "fairly stable state".
"Surgeons have to make decisions about when is the best time to operate and that makes surgery extraordinarily difficult," he said.
"There's an axiom about surgery that says a good surgeon knows how to operate, the better surgeon knows when to operate but the best surgeon knows when not to operate.
"The critical issue about surgery is to operate when the patient is in the best physiological state for the operation but not to operate a day or two or a week later when the patient has collapsed or something has made him in a worse physiological state."
Crown prosecutor David Meredith questioned whether Patel should have seen signs of radiation proctitis when he did a colonoscopy on May 2, a few weeks before the surgery.
When Dr van den Bogaerde agreed, he suggested the only inference that could be drawn was that Patel did not do a colonoscopy.
"No there's another inference that can be drawn that the radiation proctitis was so mild that it wasn't endoscopically apparent and that would fit a lot better with the clinical course of this patient," the doctor said.
Mr Meredith suggested that answer was "allowing Dr Patel an out".
"I'm not here to allow anyone an out, I'm just here to give my opinion, sir," Dr van den Bogaerde said.
The doctor said he, personally, had recommended surgery for only 10 to 15 patients with diverticular bleeding in the past 10 years.
Dr van den Bogaerde said he worked closely with surgeons but his recommendations were just that, with surgeons making the ultimate decision.
The trial continues.
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