Surgeon recalls 'hard decision' before breast op on wife

A consultant surgeon charged with a €700,000 breast cancer insurance fraud said he made "a hard decision" when he chose to perform a lumpectomy on his wife while she lay conscious on an examination table in his clinic.

"A doctor is a human being and human beings can sometimes be happy and sometimes sad, sometimes laugh and sometimes cry, sometimes can be brave and sometimes can be a coward and I was scared," Dr Emad Massoud said in evidence in his defence at Dublin Circuit Criminal Court .

He told his defence counsel Mr John Peart SC (with Mr Charles Corcoran BL), that his wife was left with a scar that "any surgeon would be proud of".

Dr Massoud (aged 52) and his wife, Mrs Gehan Massoud (aged 43), of Woodview, Brownstown, Ratoath, Co Meath have pleaded not guilty to intent to defraud two companies by falsely pretending that Mrs Massoud had suffered breast cancer and that there was an obligation on them to settle serious illness claims.

They deny intent to defraud €685,658 from Scottish Provident Ltd on March 25, 2002 through having it made payable to Permanent TSB and €45,338 on February 22, 2002 from Lifetime Assurance Company Ltd by having that sum transferred to their account at the Bank of Ireland in Letterkenny, Co Donegal.

When asked by prosecuting counsel Mr Dominic McGinn BL, in cross-examination, who was "the real Mohamed Hilal", the surgeon indicated on their claim forms as having removed the lump, Dr Massoud replied: "He is sitting in front of you. I am him" but he added that he had admitted this from the start of the trial.

Dr Massoud said he discussed his wife’s prognosis with his friend and colleague Dr Hilal who suggested that she have a mammogram on her right breast to exclude the possibility that cancer had developed there.

He said Dr Hilal also advised that Mrs Massoud have both radiotherapy and chemotherapy but said there was "no way" she would have the suggested treatments.

Dr Massoud said that the mammogram his wife had after the operation would not have shown up the location of the lumpectomy because "the surgical field was outside the field of the mammogram".

He said that when he sent in the histology request forms to the Mater Hospital, he used Mr Hilal’s name to cover himself and he later had to continue to use the name on the insurance claim forms because he knew he would also have to send the pathology reports to the company.

Dr Massoud said that an earlier prosecution witness, Dr Mohamed Elsayed Attia, who claimed to have seen a jar containing human tissue in the Massoud’s home sometime after his mother-in-law had been diagnosed with cancer was "a clever illusionist".

"He has used some facts to create this illusion. He just made up this story. The insurance company welcomed the story, the insurance company, out of greed, then went to the Gardaí who welcomed the story; I was arrested on the basis of one statement from Dr Mohamed Hilal; there was no garda investigation whatsoever to prove I had committed fraud," Dr Massoud said.

Pressed by Mr McGinn on the garda investigation, Dr Massoud accepted that gardaí "were perfectly entitled to interview him" after the surgeon the couple claimed had performed the lumpectomy, denied doing it.

Dr Massoud said that Dr Attia was "lying" when he claimed earlier in the trial that an Egyptian man who was working for Dr Massoud in 2001 brought his mother-in-law’s breast tissue to Ireland so that the family could have a second opinion.

He said that nobody would ever be allowed to take a sample from a hospital and only a slide would be needed for a second opinion.

Dr Massoud said there also was high security in the airports at the time because it was just after the 9 /11 attacks in America and during the foot-and-mouth precautions in Ireland and the man would not have got away with carrying a jar of human tissue onto a plane.

Earlier, Dr Massoud told Mr Peart said it was not 100 % in the best interest of the patient to wait three months to have surgery to remove a suspicious lump because, if it was cancer, with every day that passed the cancer could spread more.

He said both he and his wife understood that the end result was going to be the excision of the lump so they decided that he should remove it as soon as possible.

He agreed with Mr Peart that general anaesthetic is preferred by most surgeons while carrying out this kind of surgery because it is more comfortable for the patient but he added that it is possible to remove lumps under local anaesthetic if, for example, the patient was "unfit" for the general anaesthetic.

Dr Massoud accepted his counsel’s suggestion that in Ireland surgeons were not allowed to operate on their own family but added that it was allowed in Egypt.

He said he was aware he was breaking ethical codes of conduct but agreed that both he and his wife had "concerns about delay" when they decided to operate in his clinic under local anaesthetic.

Dr Massoud said his wife found the lump on September 25, 2001 and he operated on October 5. He used a local anaesthetic that included a chemical which narrowed the blood vessels and prevented bleeding during the surgery.

He said he was expecting to remove a 3cm tumour but in such an operation a margin of normal tissue that surrounded the lump, which might look suspicious and appear unhealthy, was also removed.

Dr Massoud said he removed more tissue than he expected and had to split the sample to fit it into two pathology jars.

He said he sent the sample to the pathology department in the Mater Hospital the following Monday and was "very concerned" when his wife was diagnosed as having "invasive lobular cancer". The report had also said that the tumour had been completely removed and the cancer had not spread.

Dr Massoud said he and his wife discovered two weeks later that her mother had also been diagnosed with breast cancer and they later received the pathology report relating to her diagnosis from Egypt.

He said there were many differences between his wife’s and her mother’s pathology reports: the tissue samples taken from the breasts were different sizes, shapes and colours; both women were diagnosed as having different types of cancer and grades of cancer; and different surgical procedures had been used to remove the lumps.

The trial continues before Judge Patrick McCartan and a jury of seven men and four women.