Vivienne Nathanson: An update on Cyril Karabus

Vivienne Nathanson In August 2012 the retired South African paediatrician, Professor Cyril Karabus, was detained as he passed through Dubai airport on his way home from a family wedding in Canada.  When I wrote an editorial on this in October last year, I outlined the charges against him. Around that time he was finally freed from the prison in which he had been held, and allowed instead to stay in a colleague’s home in the UAE. Having had to surrender his passport Professor Karabus has not been allowed to return to his family in South Africa, and his series of appearances in court bare a strong relationship to a farce.

So what has happened?  The simple answer is that a number of court dates have been set and met, during which the courts have been presented with the fact that the clinical notes of the patient to whom the manslaughter charge relates are missing.  The courts have repeatedly called for the notes to be found, and shared with defence lawyers, or stated that their absence would void any charges.  But the notes have still failed to appear and the courts have not freed Cyril Karabus; instead they have suggested other actions such as appointing a panel of experts to advise on the medical treatment.  That panel has referred the matter back to the court.

How could a group of experts comment on the appropriateness, or not, of medical treatment without a contemporaneous record of the condition  of the patient, the results of necessary tests and the notes of the treating physician on what he was ordering to be done?  And medical notes are exactly that; a contemporaneous record of what a doctor thinks, plans to do and does, based upon his or her knowledge of the patient, including relevant laboratory and other tests.  But the notes here are missing. Anyone making a judgement would be doing so based upon hearsay or in an evidence-free zone.  Doctors asked to give advice on whether treatment was correct or not expect to see evidence on what was done.  It is the basis of medical practice, and in these circumstances the basis of whether any treatment was given or withheld, and whether that was the right decision.

Meanwhile the continued effective detention in the UAE of a man against whom evidence-free charges have been laid gives rise to serious concerns.  Should anyone be confident on working in a country where such non-cases are allowed to drag on apparently endlessly?  Given that Cyril Karabus never knew that the first trial took place, in his absence, nor was warned about the previous sentence found against him, anyone dealing with frail and vulnerable patients should think twice.  South Africa is warning its nationals to avoid working in the UAE.  Should the BMJ be reintroducing its black box for poor employers, and stating on its jobs site that those thinking of working in the UAE should take advice?   Even if the next hearing on 27 February reaches the right conclusion travel through the UAE clearly carries risks.

So where next?  Will the court attempt to find another alternative solution to make up for the missing notes?  Will the notes miraculously reappear?  If they do will anyone trust that they are the original and unaltered notes from a decade ago?  Or will the court finally make the decision it should have long ago? In the absence of any evidence Cyril Karabus must be freed to return home.  And the UAE should rethink the way it considers medical cases.  The absence of evidence must mean that arrests should not happen, or at the very least be for a very brief period.  6 months of effective detention when there is no evidence of any crime is a gross breach of human rights and must not be tolerated.

Vivienne Nathanson is Director of Professional Activities, BMA