Infant death in Lucerne A baby dies tragically in hospital - and the state forces parents and doctors to go to court

The Lucerne child death trial against three hospital doctors shows that hardly anyone actually wanted this trial. The public prosecutor's office considered a dismissal to be justifiable at times, the defense and the family sought an amicable solution - in the end, the senior public prosecutor's office decided to prosecute anyway.

Right from the start of the second day of the trial, it becomes clear how unusual this trial is - a trial that will attract attention far beyond Lucerne on Wednesday and Thursday. The focus is on an infant just a few weeks old who was due to undergo surgery for a hernia at Lucerne Children's Hospital in November 2021. An operation that, in the opinion of the public prosecutor's office, was not urgent, but at the same time was based on a delicate medical situation: The documents contain a suspicion of Williams-Beuren syndrome, a rare genetic disorder that makes the cardiovascular system particularly vulnerable.

The parties in the courtroom meticulously reconstruct what happened in the operating theater. During the first inhalation of anesthesia, the baby's circulation collapses within seconds and the team has to resuscitate him. The baby stabilizes again, an immediate cardiac ultrasound shows no acute deterioration. And yet - as the indictment states - the pediatric surgeon, anesthesiologist and pediatric cardiologist decide to continue the procedure and start inhalation again.

This time, stabilization failed to materialize. The baby dies only a short time later from acute cardiovascular failure, facilitated by the underlying disease and the medication administered, as the forensic pathologist explains in a reconstruction in court.

Nobody wanted the trial - but it took place anyway

While the medical procedures are meticulously reviewed, a second topic comes to the fore in the courtroom: this trial was not actually intended to take place in this way. The cardiologist's defense lawyer recalls that the public prosecutor's office, parents and doctors had repeatedly discussed discontinuing the case for months. "The doctors tried to find solutions and answers together with the family right from the start. That would also have been possible out of court," he says.

An agreement was imminent on several occasions, but in the end the senior public prosecutor decided to press charges anyway. "Something is being feigned that isn't real - and the doctors are being plunged into an emotional abyss," the lawyer states.

The public prosecutor also later confirmed that there was a real question of stopping the proceedings. She says that they had considered dropping the case. However, because there was no admission of guilt and essential questions remained unanswered, the public prosecutor's office decided to take the case to court.

The family is not entirely convinced either

The family of the deceased baby stands between these positions. Their lawyer speaks of a "serious breach of medical care" and that the continuation of the intervention after the first resuscitation was "medically unjustifiable". It is "almost certain" that death could have been prevented if the suspicion of Williams-Beuren syndrome had been consistently taken into account - and if the child had not been put under anesthesia a second time.

According to the lawyer, the parents would have first demanded that all risks be clarified if the suspicion of a genetic disease had been clearly communicated to them. Instead, an "unnecessary risk" was taken. He calls for an "appropriate judgment" and makes it clear that the family is looking for answers that still concern them years after the incident.

But even here, it doesn't seem as if the father and the family's lawyer are completely convinced of the charges. The situation is also visibly stressful for the father: He is repeatedly on the verge of tears, for example when pictures of the dead baby from the forensic department are shown in the courtroom.

On the other side are three experienced doctors who fear not only for their reputations, but also for their professional livelihoods. The cardiologist's defense lawyer is demanding a full acquittal and satisfaction for his client. "You can't hurt a pediatric cardiologist any worse than that," he says of the accusation that his client condoned the death of a baby. The doctors would not hold a grudge against the family. "The state, and only the state, must now take responsibility for this unnecessary pain that it has imposed on the doctors."

A trial that marks everyone involved

The personal statements of the accused show how deeply the case has affected them. The cardiologist at the time describes it as "the worst thing that can happen to us" when you look into the faces of parents at the bedside of a deceased child. It was a unique event in his decades-long career that plunged him into a deep crisis.

The pediatric surgeon describes how she got to know the baby and the parents, examined them and finally prepared them for the operation. In her opinion, the hernia was an urgent reason for the operation. The fact that the child died after two circulatory arrests hit her hard. "It's the worst thing you can experience. It's a tragedy and I'm very sorry. But I didn't do anything wrong," she says in tears. Her lawyer accuses the prosecution of succumbing to an "error of hindsight" from a distance and overstretching responsibility retrospectively.

The anaesthetist who was responsible for the anaesthetic speaks of an "extremely drastic" experience - for the family and for himself. He emphasizes that after the first failed sedation, they did not simply "try again", as the indictment suggests. Instead, the child was stabilized, a cardiologist was consulted and the decision was made to continue the operation at what he considered to be the best possible time. Looking back, he says, there are two ways of looking at the fatal operation: "The simple answer is: yes, you could simply not start the second intubation. The difficult answer is: what would have happened later?" Medically, he would "do exactly the same thing again", he explains and emphasizes how convinced he is that he acted correctly.

Expert with a critical eye

The external expert on Williams-Beuren syndrome paints a differentiated picture. He attests that the three colleagues reacted quickly and made every effort to stabilize the child after the first circulatory collapse. At the same time, he is critical of the decision to induce the same inhaled anesthesia again shortly afterwards. "I would not have given the child a second anesthetic," he says. His alternative would have been to transfer the infant to an intensive care unit, monitor it and postpone the procedure - even if this would have been more stressful for the parents at first.

At the same time, the expert relativizes simple apportioning of blame: The death was the result of a combination of underlying illness, cardiac malformations and medication. He speaks of a "fateful" course that cannot be attributed solely to a single medication or a single decision.

Verdict to follow in writing - presumption of innocence applies

After the pleas of the public prosecutor, the victims' representatives and the defense, as well as the statements of the expert witnesses and defendants, the court closes the trial. The anesthetist uses his last word to express his condolences to the family and to report on a "trial by ordeal" that he had only survived thanks to a strong team in Lucerne.

The verdict will be sent to the parties in writing in the next few days. The presumption of innocence applies to all three accused doctors until a legally binding decision is made.

The trial ticker to read

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12.30 p.m.

"This is drastic"

"That day in November 2021 was extremely drastic. First and foremost for the family, who suffered the greatest possible loss. You have my deepest sympathy," says the anaesthetist in his final words.

"When you witness the death of a child, it's a drastic experience. In my case, it was a tensile test. I have a great team in Lucerne that stands behind me and supports me. This has enabled me to push ahead with my work over the last four years. I want to do the same in the future."

That concludes the hearing. The verdict will be handed down in the next few days and the parties will be informed in writing. blue News will provide a detailed summary shortly.

12.22 p.m.

Short reply from the defense

The defense keeps its reply short. "I hope that you can take something away from this trial, including the medical perspective," says the surgeon's lawyer, addressing the family. "In criminal proceedings, however, the rule is that when in doubt, you have to vote for the accused.

11.58 a.m.

"Then patients die"

"My predecessor was in favor of dropping the case. That's right - and that's what I would have recommended. But the public prosecutor's office saw it differently," says the family's lawyer.

Apart from that, the lawyer repeats some of the points he already mentioned in yesterday's plea. They should have reacted to the suspected diagnosis of a syndromic illness.

The lawyer also takes another look at the argument of the cardiologist's lawyer that children with WBS had already been operated on at the Lucerne Children's Hospital in the past. The cases cannot be compared, he says.

The lawyer also does not accept the defense's argument that the surgeon and the cardiologist had nothing to do with the sedation. "People always like to refer to the team when it fits - but not otherwise. All the relevant information should have been gathered by the time of the circulatory collapse at the latest." That just didn't happen. "If that's not the case, patients die"

11.54 am

"Professionals can also make mistakes"

"We have well-trained professionals at work here. But that doesn't mean that mistakes can't happen," says the family's lawyer in his reply. There was no urgency to the operation. The experts had clearly established that continuing the operation after resuscitation was not justifiable.

The child had indeed been stable after the first resuscitation. "But we don't know how long. That doesn't matter either - the cause of death was the initiation of the operation," said the family's lawyer.

11.52 a.m.

The replica follows

Now it's time for the reply. The public prosecutor says that they had actually discussed dropping the case beforehand. The proposal had come from both sides. Nevertheless, they had moved on for several reasons. For example, an admission of guilt was missing.

11.26 a.m.

"Caused a deep psychological scar"

"My client was summoned for questioning by the public prosecutor shortly before Christmas. From that point on, she had the status of an accused person - that was a shock for her," concludes the lawyer. "She suffered from this unjustified accusation and also cried. The proceedings, which lasted several years, left a deep emotional mark on her," explains the lawyer. He had asked for the case to be dropped for the reasons already explained. The public prosecutor's office did not listen.

"Now the surgeon is sitting in the dock. That didn't have to be the case," the lawyer concludes his plea.

Break until 11.45 am.

11.19 a.m.

"Acted in a professional manner"

"The surgeon's diagnosis was absolutely correct. She was not involved in the death of the baby," the lawyer continues. It was also not the surgeon's job to comment on specialist questions of anaesthesia or cardiology. "She acted in a professional manner", the lawyer continues. She was unable to recognize any danger to the baby's life.

11.09 a.m.

"Absurd and simply wrong"

"The surgeon applied her expertise absolutely correctly. She could not have foreseen the consequences of the anesthesiologist. It was not her job to research any disease-specific anaesthetic consequences," the lawyer continues.

"It was and still is tough for my client to be confronted with something like this," says the lawyer. The indictment accuses the surgeon "without any evidence" of having made an opinion about the anesthesia. The anaesthetist confirmed this once again on Monday. The accusation that she had contributed to the death "is absurd and simply false."

11.01 am

"You're mixing cabbage and turnips"

Now it's about the operation. The surgeon was not present when the anaesthetic was induced. "She would also have been out of place, because she only arrives when the anaesthetic has already been induced and the operation begins." At the time of the anaesthetic, she was in another operation. "The public prosecutor's office says that the pediatric surgeon should have stopped the operation. They are mixing cabbage and turnips here and venturing out on the branches."

10.46 am

Was IRM allowed to call in specialists?

The expert actually commissioned should have been allowed to consult "persons under his responsibility". Instead, he passed on the case in its entirety. "Both were and still are not in a position to assess a possible breach of duty of care by a surgeon."

By bringing in an external specialist from Germany, they acted autonomously and not on the instructions of the public prosecutor's office. "In my opinion, there is no legal basis for this," said the lawyer.

10.41 a.m.

"Task carefully performed"

The surgeon's defense lawyer also argues that the child was initially in good condition and that Williams-Beuren syndrome was not mentioned anywhere. "She performed her task carefully by correctly scheduling the operation. Her job was to decide whether or not there was an injury requiring surgery - she did that," the lawyer continues.

The surgeon's lawyer also emphasizes that the experts had no expertise in the relevant area.

10.37 a.m.

Reconstruction was difficult

The child's parents had not informed the surgeon of the geneticist's suspicions. "Either they should have done so - or they simply had no knowledge of this initial suspicion at the time. After all, it was not a finding," continued the surgeon's lawyer.

The expert opinion from the Institute of Forensic Medicine shows that "the entire medical records from the Lucerne Children's Hospital were available in a confusing format, which made it considerably more difficult to reconstruct the course of events", the lawyer continued. The accused would therefore have had no chance at all to find out all the details of the medical history.

10.32 a.m.

"Operation required without delay"

The surgeon's lawyer now also recapitulates the events. The suspicion of a hernia was first expressed in September. "The parents were given clear guidelines to take home with them on how to proceed should the child's condition change," says the lawyer.

In the four weeks or so after the first contact, the situation had become more acute. This is why the child was referred to hospital. "It required an operation without delay." An appointment for the surgical procedure was made around three weeks later because the baby still had to recover from a respiratory infection.

10.24 a.m.

The surgeon's lawyer makes his plea

Now the surgeon's lawyer makes his plea. "If you find my client guilty, even though she made a correct diagnosis and (...) she bears no responsibility, then you are subject to the retrospective error and make false assumptions regarding responsibility", he says right at the beginning.

The surgeon could not have exercised responsibilities beyond her discipline that would have prevented the infant's death, the lawyer says. "What should she have done differently?" He also demands satisfaction and an acquittal. "The charge is based on false considerations".

10.20 a.m.

"The state must now take responsibility"

The defense lawyer now argues why he is demanding satisfaction. The preliminary investigation and the criminal proceedings had hit the pediatric cardiologist hard. The accusation that he deliberately killed a child is terrible: "You can't hurt a pediatric cardiologist any worse than that." This is also not the family's fault. "The state and only the state must now take responsibility for this unnecessary pain that it has inflicted on the doctors."

10.16 am

"No alternative to action"

"There is no alternative to the actions of the accused," says the lawyer. The prosecution claims that the operation should have been postponed and further measures taken. "None of this would have changed the further course of action or the tragic course of events. The only difference would perhaps have been that other doctors would have been accused today," he explains.

No expert said that surgery or anaesthesia could have been dispensed with. "The accusation of negligent bodily harm or negligent homicide is quite simply false."

10.09 a.m.

"Freely invented" offense

The expert's presentation on Monday morning was "simply wrong" from a cardiological point of view, as several facts were not correct, the defense lawyer fiercely criticized. According to the lawyer, the expert opinion was "blurred beyond recognition" on Monday.

"The defendants did not breach any medical duty of care," the lawyer reiterates. The cardiologist had not made any orders and had not been involved in the operation. "The accused offense is fictitious."

9.58 a.m.

Expert witnesses were not qualified

The lawyer goes on to discuss the expert opinion of the Institute of Forensic Medicine. This does not meet the requirements of the Federal Supreme Court, the lawyer continues. It was not conclusive and the experts were not qualified.

The case law of the Federal Supreme Court is clear. "The professional qualifications of the expert play an important role in the judicial assessment."

The experts were not qualified for pediatric cardiology issues and were not allowed to give an expert opinion.

9.51 a.m.

"Arbitrarily composed specialist literature"

The experts from the Institute of Forensic Medicine had made "assumptions", the lawyer continued. "There was no team time-out with the cardiologist," he explains. "There wasn't even a team."

When he was called for the second time, he found a "completely different, dramatic situation" in the operating room. "No one could have foreseen this development."

The cause of death cannot be determined with a probability bordering on certainty, says the lawyer. "The IRM's experts are conjecturing with various speculations that are the result of randomly assembled fragments of specialist literature."

9.47 a.m.

Cardiologist was only on site for a few minutes

The cardiologist's defense attorney criticizes the expert opinion of the Institute of Forensic Medicine. No pediatric cardiologist was involved in the preparation. "The statement that a WBS was already suspected in the children's hospital is cardiologically incorrect."

Now it's about what happened in the operating room: the cardiologist was alerted by the anaesthetist during a session. He had found a "stable situation" in the operating theater. He was able to carry out an examination "within a few minutes" without any problems. "The findings proved to be unchanged." This was the end of the cardiologist's task. "He was no longer needed and was no longer involved in the further considerations."

9.39 a.m.

"There aren't even any guidelines"

There were only recommendations for patients with WBS. "There are not even guidelines for preoperative clarification in cases of suspected syndrome," the cardiologist's lawyer continues. Nowhere are there recommendations not to perform surgery. "The experts from the Institute of Forensic Medicine are expressing wishful thinking here."

The IRM report does not take into account the applicable clinical processes. "There is no process in which a cardiologist should be brought on board for such a clarification. There wasn't even a boat," the lawyer continued.

9.35 a.m.

Complications were not to be expected

The cardiologist's defense lawyer says that his client was not involved in the decision to operate. He was also not involved in the preparations. The tasks were clearly distributed. "He had responsibility for a very specific treatment - and only for this treatment," the lawyer continued.

"Even if Williams-Beuren syndrome had been suspected, the treatment would not have had to be different." In the last 30 years, 18 patients with WBS had been treated at Lucerne Children's Hospital, 10 of whom had undergone surgery. "There were no complications."

9.27 a.m.

"No knowledge of WBS"

The report to the disability insurance company also never mentioned Williams-Beuren syndrome. "If there had been a suspicion, this would have been extremely relevant for the position," said the defense lawyer. It was true that the syndrome was not mentioned anywhere, "because there was no knowledge of it".

This also meant that the doctors were unable to assess a corresponding risk - because they had no knowledge of it. "A suspicion of Williams-Beuren syndrome was neither recorded nor taken into account."

9.18 a.m.

Report was never acknowledged

The defense attorney recapitulates the events once again. No genetic clarification had been carried out. "Where was the suspicion of Williams-Beuren syndrome filed?"

The files of the public prosecutor's office had already mentioned a possible genetic disorder at an early stage. However, this was not consistent with the documents in the hospital. The doctors did not organize the medical history chronologically, as the public prosecutor's office had done. "In the digital document management system, the consultation was filed in such a way that it was not noted when information was obtained about the patient."

9.02 a.m.

The trial continues

The trial continues. The cardiologist's defense lawyer begins his plea. He demands an acquittal and satisfaction for the cardiologist.

The defense attorney says that, according to the federal association, the connection between Williams-Beuren syndrome and death by medication has not been proven. "The worst has happened to the private plaintiffs," he says. The doctors had tried from the outset to find solutions and answers. "That would also have been possible out of court."

There had been repeated discussions with the public prosecutor's office about dropping the criminal proceedings, also in agreement with the parents. However, the senior public prosecutor's office had announced that legal action would be taken despite advances. The lawyer criticized this.

"Something is being pretended that isn't there - and the doctors are being plunged into an emotional abyss." Even now, he still wants to reach an amicable settlement.

8.41 a.m.

Second day of trial coming up

The second day of proceedings in the Lucerne child death trial is scheduled for today, Thursday. There will be two more pleas from the defense, followed by a reply and a rebuttal. blue News tickers live from Lucerne.

This was the first day of the trial

The trial into the death of a baby in a regional children's hospital came to a surprisingly early interruption in the late afternoon. The trial will resume on Wednesday morning at 9 am.

Prior to this, the prosecution, the lawyer for the victim's family and the defense had engaged in an intense exchange of blows. The prosecution is requesting a partially conditional prison sentence of three years for all three doctors involved, six months of which are unconditional. The accusation is that the operation was continued after an initial resuscitation and was "medically unjustifiable".

The lawyer for the victim's family spoke of a "serious breach of medical care" and an "unnecessary risk" that ultimately led to the baby's death. The anaesthetist's defence, on the other hand, demanded an acquittal - their client had acted in a "standardized and guideline-compliant" manner without any indication of a genetic disease. In addition, the outcome was "very likely to be fatal later on".

An anesthesia expert consulted nevertheless criticized the procedure in the operating room. He would have transferred the child to the intensive care unit after resuscitation, stabilized him and postponed the operation.

It remains to be seen when a verdict will be reached.

Trial interrupted

The trial is interrupted surprisingly early. It will continue tomorrow at 9 am.

4.31 p.m.

"There is no reason to destroy his life"

"The fact that a different course of action would have been chosen in hindsight is irrelevant," the lawyer continues. However, what was known at the time of the baby's death was decisive in the assessment. The persuasive power of the Institute of Forensic Medicine was not given and was even "shaken", the lawyer continued. It had "clear weaknesses", the anaesthetist's lawyer picked apart the IRM report.

"My client stands by his responsibility. He has never tried to shift the blame. His behavior speaks not only for his honesty, but also for his integrity.

The anaesthetist had thought about quitting his job, the lawyer continues. "These are not just empty words. They were serious thoughts". The allegation that he had accepted death had hit the anaesthetist hard. "There is no reason to destroy his life now"

16:22

"The outcome would have been the same"

The case is not only medically complicated for laypeople. The pleadings are peppered with legal subtleties. For example, the lawyer argues that in the absence of a proven breach of duty of care and lack of causality, no guilty verdict can be reached on this point.

"The anaesthetist's actions would not have changed", his lawyer explains. "I'm sorry to say that the outcome would have been the same sooner or later."

16:06

"Would also have been fatal later"

"What would have been the alternative scenario?" asks the lawyer. The Institute of Forensic Medicine is making it too easy for itself when it says that the death could have been prevented by postponing the operation. "The operation would very likely have been fatal even at a later date," the lawyer is convinced.

3.50 p.m.

"Photos were not necessary"

"If the anaesthetist had been aware of a possible WBS disease, he would not have induced the anaesthetic," says the lawyer. "The photos from this morning caused an emotional-suggestive effect. That was not necessary. It would have been possible to argue without photos," says the lawyer. "It's impossible to draw conclusions about illnesses from photos," he says with conviction.

Otherwise, the defense lawyer repeats some of the arguments that the anesthetist had already put forward in his statement that morning. The anaesthesia procedure was standardized and chosen according to the literature.

The advantages and disadvantages of the possible induction of anesthesia had already been sufficiently explained. In addition, the anesthetist had explained why he considered a second anesthetic to be the only option. The anaesthetic used was one of those with the lowest risk of an allergic reaction.

15:47

Had no information about WBS disease

"The smaller the child, the quicker the operations should be planned", one of the experts explained, the lawyer continued. Operations should have been carried out within weeks to months. "As a layman, nobody can tell me that we should have waited months."

The Institute of Forensic Medicine had stated that it assumed a non-natural death. However, the Institute contradicted itself in its statements. And the various expert reports would also not provide a clear conclusion.

The lawyer went on to say that it could not be said beyond doubt that the anaesthetic had led to death, as this was stated in several expert reports. "The suspicion of WBS was recorded in one of 54 notes," says the lawyer.

The anaesthetist had read the electronic patient file, as is always the case. "There was no information there about a possible genetic disease - and he cannot be expected to know and read all the dossiers, including notes, for every patient."

3.39 pm

Now the anesthesiologist's lawyer speaks

The plea of the anaesthetist's lawyer now begins. He requests a full acquittal. This is indispensable. The anaesthetist had made extensive statements. "We are dealing with a person of integrity who conscientiously pursues his profession," says the lawyer about his client. "No responsible doctor accepts the death of his patient."

The WBS disease did not receive any in-depth attention. The suspicion of a genetic disease was not investigated in depth. "The parents did not want an in-depth investigation at the time, which is why they only wanted a consultation with a geneticist after the operation," says the lawyer.

This was not about apportioning blame. However, he wanted to point out that no diagnosis had been made, only suspicions. "There is no way around it".

3.23 pm

"I don't understand why they went ahead with the operation"

"In my opinion, the risk can never be higher than 10 minutes after an initial anaesthetic with resuscitation consequences," the lawyer continues. He does not understand how the conclusion can be drawn that the risk may have been even higher at a later point in time.

A stop was absolutely imperative, the lawyer continues. The circulatory instability after the first anaesthetic was alarm signal enough. To make matters worse, the doctors had not dealt with Williams-Beuren syndrome.

It would be obvious to any medical layperson that resuscitation is very stressful for the person. This is also the case for adults - and even more so for babies. "That's why I don't understand why they went ahead with the operation."

Without further surgery, the baby would certainly have survived the day, the lawyer is convinced. That is why the doctors should also be sentenced. He demands an "appropriate sentence". The court would have to decide whether the contingent intent was also fulfilled.

3.15 p.m.

"Unnecessary risk"

"We don't have a man weighing 80 kilograms here who is being subjected to this stress again just 12 minutes after the first anaesthetic," the family's lawyer continues. This is still a baby.

One of the counter-experts simply ignored facts and did not even mention the first anaesthetic. "This child obviously could not tolerate the anaesthetic," he says, referring to the necessary resuscitation.

Now the lawyer tears apart the main points of the defense. For example, the child's circulatory system was stable, "but that doesn't mean it would have stayed that way". No one could know for sure whether the circulation would remain stable, especially because resuscitation had had to be carried out shortly beforehand.

The point that the second instability only occurred after 20 minutes does not hold water either, says the lawyer. "I don't understand how this unnecessary risk was taken under these circumstances." The management was "completely inadequate".

There is repeated talk of an "experienced team". "But none of the doctors had in-depth knowledge of Williams-Beuren syndrome," says the lawyer. However, the doctors could have acquired the relevant knowledge - if they had given themselves the time.

3.12 p.m.

"We laypeople saw that something was wrong"

"If they had known about it, the parents would almost certainly have demanded that all risks be clarified first," says the lawyer. However, the parents had not been adequately informed by the doctors.

The defense's objection that the doctors were unaware of Williams-Beuren syndrome does not hold water. "Even we laypeople saw from the photos today that something was wrong here." The defendants had therefore not fulfilled their medical duty of care.

The Institute of Forensic Medicine had clearly established that it would not have been reasonable to put the child under anaesthetic a second time. "Today, the expert no longer wanted to say that. I have the impression that he got a bit cold feet - something like that always makes me suspicious," says the lawyer.

3.06 pm

"All the alarm lights should have gone on"

"It is part of medical care to clarify all sources of danger," the family's lawyer continues. The doctors would have had enough time to do this, after all, it was not an urgent operation. It may be that the doctors were not aware of the rare Williams-Beuren syndrome. "But then they have to do their research," says the lawyer - it's no different in the justice system.

"If the team members had dealt with the suspicion and the consequences of WBS, all the alarm lights should have gone on after the first resuscitation at the latest," he continues.

3 p.m.

Operation not medically justifiable

"In medicine, you don't work with certainties, but with probabilities. Medicine is not an exact science," the lawyer continues. "It's almost always risk assessments." However, according to the lawyer, the child died because it had been operated on. If there had been no surgery, the child would not have died. "Did the medical treatment take place with the necessary care?" asks the lawyer and provides the answer himself: "No!" According to the forensic medical report, the operation was not medically justifiable.

"Children are usually operated on if they weigh 5 kilos or more," the lawyer continues. This causes laughter and head shaking in the courtroom - there are also some doctors and hospital staff in the audience.

2.50 p.m.

"No diagnosis is needed"

The child only weighed around 3.5 kilograms at the time of the operation. There had already been a suspicion of a disease prenatally. There were several references in the files to a suspected illness. "It doesn't need a diagnosis, it just needs a suspicion to lead the doctors down the right path," he continues.

The baby was only nine weeks old when the operation was carried out, the lawyer continues. He also asks who was to blame. "It was said everywhere that the decision to continue was a collective one - today the anaesthetist says it was his decision alone."

2.40 pm

"Highly careless work"

The plea from the family's lawyer continues. He speaks of a "serious breach of medical care" and that the work was "highly careless".

The lawyer is convinced that the child's death could have been prevented "with a probability bordering on certainty". Contrary to the doctors' account, the case was relatively simple. "If the doctors had given themselves more time to wait for the genetic test, they could have prepared themselves better," he says. "Then we wouldn't be here today." The doctors should have given the child time to recover from the operation and resuscitation.

"I can't understand why the doctors carried out this operation and simply ignored the risks," the family's lawyer continues.

2.36 p.m.

Public prosecutor wants to go below minimum sentence

The fact that the baby could have died even if the operation had been postponed is pure speculation, says the public prosecutor. But the fact is that not all precautions for a clean operation and anaesthesia were taken, she continues. "The risk could certainly have been minimized by proper preparation."

The prosecutor is requesting three years' imprisonment for all three defendants, six months of which must be served, as well as fines and a fine. For respectable reasons, however, they did not request the minimum sentence of five years, but deviated downwards.

"The baby's death could have been avoided if the correct action had been taken," she concludes.

2.31 p.m.

"Preparation is the same as for healthy babies"

"It is incomprehensible that the pediatric surgeon did not read through the files in more detail based on the evidence," says the public prosecutor. If you enter the abnormal physical characteristics into ChatGPT, there is a direct indication of a genetic disease. "It was therefore obvious that something was wrong with the baby," says the public prosecutor.

A patient with Williams-Beuren syndrome must be monitored at all times and may only be sedated under special supervision - this information can be found quickly on specialist portals, says the public prosecutor.

Because the file repeatedly referred to a possible genetic disease, the risks of anesthesia should have been clarified in depth, says the prosecutor. "But no special measures were taken here. The preparation for the operation was exactly the same as for healthy babies."

2.24 p.m.

Several entries should point to genetic disease

"Today is about responsibility," the prosecutor opens her plea. She recapitulates the events once again. "The question is who can be held responsible." Opinions differ widely on these points. The defense argued that there was only one suspicion of the Williams-Beuren symptom in the files.

But that is not true, says the prosecutor. She says that there are several entries in the medical records that suggest a genetic disease. For example, there were entries stating that a genetic examination was to be carried out because physical abnormalities had been detected in the baby.

In the file, the suspicion of a genetic disease was also listed under diagnoses. According to the public prosecutor, ambiguous clinical pictures must be clarified by the doctors.

2.19 p.m.

Trial continues

The trial continues. The public prosecutor will now make her plea.

12.57 p.m.

"This is a tragedy - I am so sorry"

Now the pediatric surgeon reads out her statement. She also does not want to answer any further questions. She explains how exactly she got to know the parents and the baby. The surgeon then examined the baby and found no clear evidence of a hernia. According to the parents, genetic testing was recommended, but they were reluctant, the pediatric surgeon continues. A few months later, it was clear that the child had an inguinal hernia. "I had no doubts about this." An inguinal hernia is an urgent reason for surgery in babies. Injuries could have formed that could no longer heal.

The baby had been examined again two days before the operation, with no indication of any deterioration. She herself had been undergoing another operation at the time of the induction of anesthesia and had been called in when the first cardiac arrest occurred. The examination had not revealed any changes compared to the examination two days earlier. She then went to another operation until she was called in again when the resuscitation measures were initiated for the second time.

"His death hit me hard," says the surgeon tearfully. "It's the worst thing you can experience. It's a tragedy and I'm very sorry. But I didn't do anything wrong"

That concludes the evidence. There is a break for lunch, and it resumes at 2.15 pm.

12.53 p.m.

"It's the worst thing that can happen"

The cardiologist at the time now speaks and reads out his statement. "When you look at the faces of the parents sitting at the bedside of the deceased patient, it's the worst thing that can happen to us," he says. "I still feel infinite sorrow. But these are doctors who are among the best in their profession - not criminals or bunglers. It is a unique event in my decades-long career and plunged me into a deep crisis"

12.50 p.m.

"I would do exactly the same thing again"

"Would I do anything differently today? Yes, we are doctors," explains the anesthetist. "We look for findings and explain them afterwards. But we had no chance at the time, we couldn't explain why the baby had died. I wish I had known about it back then. That way I could have explained more to the parents. Despite the criminal proceedings, it is the parents' right that we could have explained our situation to them."

"Would I do anything differently medically? There is a simple and a difficult answer. The simple answer is: Yes, just don't start the second intubation. The difficult answer is: What would have happened later? Perhaps the child would have collapsed and we would have had to intervene in an emergency during the night - without specialists. I was responsible for the child and the intubation. That's why I would have done exactly the same thing again."

12.38 p.m.

Now the anesthetist speaks

First, the head anesthesiologist who was present during the momentous operation is questioned. "If you read the indictment, you could assume that we simply tried again after the first failed sedation. But that's clearly not the case," says the anesthetist.

Several pre-existing conditions had already been identified. However, he was not aware of the WBS. After the failed anaesthetic and the resuscitation measures, they had considered transferring the child to the intensive care unit. However, this was not justifiable because the child had torn out the intravenous line. A further cardiological examination was carried out, which found that the child's condition was stable.

It was the best possible time to continue with the operation. The findings and diagnoses were good, the cardiologist was on call and there was an experienced team on site. "It was in the patient's best interests to continue the operation," says the anesthetist.

It was not until 24 minutes after the patient was intubated again that another circulatory instability occurred - this time with fatal consequences.

The alternative scenarios, such as a transfer to the intensive care units without intravenous access, would also have posed risks.

12.30 p.m.

The questioning of the accused continues

The questioning of the defendants now continues. As already announced, they are exercising their right to refuse to testify in whole or in part. However, they want to make a statement together with their lawyers. The court will nevertheless conduct the questioning, and at the end each defendant can decide for himself which questions he answers.

12.28 p.m.

"Cannot defend the decision 100 percent"

The expert is asked whether he thinks the doctors' approach is comprehensible - after all, they don't have the same knowledge of WBS. "That's difficult. In the end, it's an individual decision. You have the child on the operating table, the doctors have given it some thought, but in the final analysis I'm missing a few steps, which I'm perhaps also branded by my experience. Certain steps are understandable to a certain extent. My individual decision would have been different. I can't justify the decision one hundred percent."

This concludes the questioning of the anaesthetist.

12.15 p.m.

"Would not have given the child a second anaesthetic"

The expert denies that the risk of death is always the same regardless of the anesthetic procedure. There are indeed strategies to significantly reduce the risk, he says.

The expert is now asked how he himself would have reacted. "They are three experienced colleagues. They did everything they could and, according to the files, reacted quickly to prevent circulatory compromise after the first anaesthetic and to resuscitate the child. However, I for one would not have given the child a second anesthetic. I would have said that this child would go to an intensive care unit, be monitored and stabilized first and then operated on a day or two later. Even if that means stress for the parents at first, because you come out with an unoperated child."

In the meantime, there would hardly have been any new diagnoses, confirms the expert witness. But during this time, the files could have been looked at again and the situation could have been reassessed. After such an incident, the child would first have to be stabilized - unless it was a matter of life and death.

12.04 p.m.

Would a different anesthetic have saved the baby's life?

"We always try to get the children to at least 5 kilos before an operation. That makes the whole anesthesia much easier," says the expert. As a reminder, the baby was significantly lighter at the time.

"A certain amount of preparation helps us to treat patients with Williams-Beuren syndrome specifically." For example, a different method of anaesthesia could have been chosen or a different center could have been selected, which could have ensured that the cardiovascular system was maintained with machines, for example.

The experts for specific diseases are well networked with each other. They always try to gather the best possible information on specific diseases. He himself receives an inquiry about Williams-Beuren syndrome about once a week, "including from dentists, for example, who have to administer sedation and are trying to get a recommendation."

11.57 a.m.

"Individual risk assessment"

He personally does not share the doctors' approach, the expert continues. "But it is always an individual risk assessment carried out by three very experienced colleagues." He personally did not have the impression that the surgical treatment of the hernia was as urgent as the cardiovascular risks of the baby.

He also did not share the opinion of the counter-expert opinion that anesthesia only had a marginal effect on the child's cardiovascular system. There are drugs that would bring about a more stable situation, says the expert. However, these would have to be administered intravenously.

11.50 a.m.

"Critical view" of the doctors' approach

"For my part, I try to avoid all medications that could have any negative effect on such a patient," the expert continues. For example, there would also have been the option of administering the anaesthetic intravenously instead of inhaling it. "I can still understand inhalation during the first induction. But to do it a second time after the events (resuscitation, note) - I have a critical view of that," the expert continues.

It is documented that the child was in a stable general condition. The intravenous access had been removed, the specialist continued. But, the expert continues, "I'm taking the medication again that I had problems with the first time. Difficult. Personally, I would have looked for a venous access and not have inhaled again."

11.44 a.m.

"Fateful and unpredictable"

In the event of an operation, the anesthetists, cardiologists and pediatric surgeons would examine the child beforehand, the expert continues. There are few patients with Williams-Beuren syndrome. "If you have such suspicions, I think you should sit down together and discuss it," the doctor continues.

The pathology would have persisted, the expert explains. "The question is always what could have been done. But whether it (the medical intervention, editor's note) is carried out today or tomorrow is irrelevant." If Williams-Beuren syndrome is known, preventative measures can be taken or the operation can be postponed for further clarification, the doctor continues.

Based on the course of events, he assumes that the death was a combination of various things, not just the medication. "It was fateful and unforeseeable." The drug was probably not solely responsible for the child's death. After all, several minutes had passed between the administration of the medication and the allergic reaction.

11.36 a.m.

"Suspicion lamp lights up early"

The speaker confronts the expert witness with contradictions from the various expert reports. One of them states that the diagnosis of Williams-Beuren syndrome was only a suspicion, but nothing more. "There are a huge number of syndromic diseases. As I work at the center of the syndrome, the suspicion light naturally goes on relatively early for me. The alarm goes off earlier," says the expert.

11.28 a.m.

High level of syndrome expertise

The anesthesia expert does not work at the Institute of Forensic Medicine. However, he has a high level of expertise in Williams-Beuren syndrome and was therefore consulted, he explains.

11.26 a.m.

Trial continues

The trial continues. The defense attorney wants to know how it came about that the forensic pathologist gave the presentation. She was invited by the court as an expert witness, she replies.

The trial continues with the expert witness for anesthesia.

10.56 a.m.

Could the syndrome have been overlooked?

The court president wants to know from the forensic pathologist whether she has ever come into contact with Williams-Beuren syndrome before. To put it in context: it is a very rare genetic disorder. The doctor says that she was aware of it, but only looked into it in detail during this autopsy.

The baby's medical records were very detailed. The suspicion of the syndrome was only mentioned in passing, the judge wants to know whether it could have been overlooked. The forensic pathologist is unable to answer this question.

The trial is now interrupted for a break.

10.52 a.m.

Syndrome findings only after death

Certain findings, including Williams-Beuren syndrome, were only discovered post-mortem, i.e. after the baby's death, says the judge. The forensic pathologist confirms this. However, Williams-Beuren syndrome had already been suspected in the medical records. Therefore, according to the forensic pathologist, even after the investigations had been completed, the question arose as to whether the mere suspicion should not have been taken into account in the treatment.

10.38 a.m.

What would a termination have changed?

After the first phase of circulatory instability with subsequent resuscitation, the operation was carried out without further clarification, the forensic doctors write in their report. According to the files, however, clarifications had already been carried out in the meantime. The doctor refers to the anesthesia expert, who is to be questioned below.

The judge wants to know from the forensic pathologist whether stopping the operation and further investigations would have changed anything. The doctor does not want to comment on this - according to the doctor, it is not possible to speculate on such treatments. It was not known what clarifications had actually been made.

10.37 a.m.

Counter-opinions become an issue

Now it's all about the counter-opinions. One of the reports states that there is insufficient evidence of an allergic reaction. In response, the forensic pathologist says that, based on the evidence she has just presented, it is most likely that such a reaction can be assumed.

The counter-expert opinion also states that there are numerous syndromic diseases in children. It was therefore not easy to draw conclusions about the William-Beuren disease. According to the forensic pathologist, children with possible diseases are seen again and again in forensic medicine. They then search the literature for possible coherences. All abnormalities in the heart known to her led to an increased risk during anaesthesia, the forensic pathologist continues.

10.33 a.m.

Cause of death clear according to forensic pathologist

The drop in blood pressure had led to a reduced supply to the heart. A drug had also led to a reaction. This combination led to the baby's death in an already reduced cardiovascular capacity.

For the forensic pathologist, the main cause was an allergic reaction. No evidence had been found that the drug had been administered beforehand.

10.32 a.m.

Anesthesia was risky

As the baby suffered from Williams-Beuren syndrome, the anesthesia was risky, the doctor explained. Due to the syndrome, the heart needs more strength to pump the blood through the body. This can lead to reduced blood flow. This is the case with anesthesia, for example.

10.25 a.m.

Various examinations without findings

Various tests had been carried out, for example for bacteria or viruses. However, no findings were made that could indicate a possible cause of death, says the forensic pathologist. In addition, massively increased levels of messenger substances were found - another indication that an allergic reaction had occurred.

10.21 a.m.

"Allergy cells" found in the baby

According to the forensic pathologist, cells were found in the baby's larynx that did not belong there - so-called mast cells. These would occur in an allergic reaction. In addition, fluids and other mast cells were found in the groin and lung area. These are also indications of allergic reactions.

10.15 a.m.

Father fights back tears

The internal findings are now also presented. Abnormalities were found in the heart, and a constriction was also found in the thoracic aorta. The forensic pathologist presents her findings with photos. It is a difficult sight for the baby's father, who is also present. He is visibly fighting back tears.

10.11 a.m.

External assessment carried out

First of all, an external assessment was carried out. The baby was small and light compared to other children, and the skin was rather flabby. In addition, 13 instead of 12 pairs of ribs were found. These were indications of syndromic diseases. As a reminder, the newborn was born with indications of a possible genetic Williams-Beuren syndrome, a rare genetic disorder.

10.08 a.m.

Forensic pathologist explains cardiovascular failure

According to the autopsy report, the baby died of acute cardiovascular failure, facilitated by the underlying disease and the medication administered. The forensic pathologist now explains how she came to this conclusion. The forensic pathologist warns that the facts of the case are complex and not easy for laypeople to understand.

10 a.m.

Questioning begins

Now the questioning begins. First, the forensic pathologist who prepared the forensic medical report is questioned. The speaker asks for indulgence if questions are worded incorrectly from a medical point of view - the aim is to find out as simply as possible what exactly happened in November 2021.

9.51 a.m.

Defense motion rejected

The court rejects the defense's motion to exclude. The two expert witnesses are admitted. It is a complex expert opinion, which also contains terms that are not familiar to lawyers. It was a matter of explaining the expert opinion and clarifying any contradictions. This was also in the interests of the accused.

The experts to be consulted had also received all expert reports, including those of the opposing party, the President went on to explain. All expert reports would also be included in the files. "It would have been up to the defense to file a motion to question the opposing experts. This did not happen," said the court president.

9.38 a.m.

Lawyer also applies for dismissal

The family's lawyer also applies for the case to be dismissed. He is astonished that these motions are only filed months later. After all, the request for questioning had been known for a long time. The fact that the application is only being made today probably has a tactical background.

The court withdraws to make a decision. Will the experts be allowed to testify or not?

9.37 a.m.

Public prosecutor wants to reject the motion

The public prosecutor asks the court to reject the application. It is essential to conduct the questioning again in order to gather evidence.

9.33 a.m.

Expert witness is said to be biased

The experts to be questioned have no knowledge of the other eights and expert opinions, the cardiologist's defense lawyer continues. "The two experts have already made statements to the detriment of the accused. If they are questioned again today, they will argue along the lines of their expert opinion. That contradicts fairness," the lawyer continued. The expert witness is biased in favor of the public prosecutor.

The senior physician's lawyer refrains from making his own presentation, but fully supports the motions.

9:24 p.m.

Defense wants to exclude expert witness

The anesthesiologist's defense counsel files a motion not to question the expert witness. The experts had prepared an expert opinion, he said, and that said it all. "I'm afraid that we'll end up running into a forensic show when I see what's being set up here," says the lawyer, pointing to the monitor that has been set up.

The cardiologist's defense lawyer also does not want to question the experts. He makes practically the same request. The court lacks the medical expertise to judge which of the available expert opinions now prevails. "The criminal court cannot make a medical assessment of the available expert reports by questioning the experts," the lawyer continues. If it did, the authors of all four expert reports would have to be questioned. This is the only way to make an overall assessment.

9.19 a.m.

Doctors want to partially refuse to testify

The doctors will not answer the questions during questioning and will exercise their right to refuse to testify. The defense lawyers have informed the court of this. They have also not yet given evidence to the public prosecutor. However, there will be a statement from the defendants, the court president announced.

9.16 a.m.

Long trial

The judge now explains the course of the trial. The trial has been extended from 1 to 1.5 days. The pleadings are expected to last around 4 hours in total, plus various questioning and a legal opinion. "I hope we make it through," says the court president.

9.08 a.m.

The trial begins

The court president opens the trial. The courtroom is filled to capacity.

8.55 a.m.

Trial begins at 9 a.m.

The trial begins at 9 am. There is a large crowd, the courtroom is well filled.

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