Doctors warned on traveling to practice in Emirates

Around the globe, physicians express outrage in the case of an oncologist prosecuted in the United Arab Emirates despite being cleared of wrongdoing by a medical panel.

By — Posted May 1, 2013

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The World Medical Assn. is telling physicians to think twice about working in the United Arab Emirates after the criminal case of a South African physician raised serious concerns about the fairness with which the country addresses medical-legal matters.

According to news reports, 78-year-old Dr. Cyril Karabus was arrested in August 2012 during a vacation stopover in Dubai. In 2002, the retired pediatric oncologist worked briefly in Abu Dhabi on a locum tenens basis. While there, he treated a Yemeni girl with acute myelogenous leukemia. She died after the family refused a bone marrow transplant.

Dr. Karabus returned home to Cape Town, South Africa, uneventfully in 2002 but was later tried and convicted in absentia on charges of manslaughter and fraud related to the girl's care. He had no knowledge of the trial or conviction until he was arrested in 2012. After multiple hearings were postponed, he was released on bail in October 2012 but not allowed to leave the country.

A UAE medical committee examined the case in March and cleared Dr. Karabus of wrongdoing. A judge acquitted him of all charges, yet prosecutors have repeatedly appealed the ruling. As of this article's deadline, the legal hurdles to the physician's freedom appeared to be cleared, and Dr. Karabus awaited only the return of his passport so he could leave the country.

The World Medical Assn. adopted a resolution April 3 saying it “believes that Professor Karabus is being treated in a manner which fails to meet international fair trial standards and should be allowed to return home immediately.” The WMA also will “advise doctors thinking of working in the UAE to note the working conditions and the legal risks of employment there,” the council resolution said (link).

The South African Medical Assn. has gone further, calling on all physicians and health professionals to boycott the UAE. WMA President Cecil B. Wilson, MD, said that although there are always considerations about safety when physicians travel abroad to practice medicine, the UAE case against Dr. Karabus stands out.

“There's a lot of violence against health workers, physicians and others around the world in general, but that kind of violence relates more to areas where there's armed conflict,” said Dr. Wilson, former president of the American Medical Association. “This kind of thing, where it's an established government that's not really in an area of armed conflict, it's pretty egregious.”

The American Medical Association shares the WMA's concerns about the Dr. Karabus case, in particular, and the medical-legal climate in the UAE more broadly. In an April 30 letter to Secretary of State John Kerry, AMA Executive Vice President and CEO James L. Madara, MD, called the Dr. Karabus case “disturbing” and urged the State Dept. to “look into the situation in the UAE and, if warranted, issue a travel advisory for the UAE directed to U.S. physicians who might be planning to practice there.”

The State Dept. “should advise physicians to consider the legal risks carefully before signing any contracts to work in the UAE,” Dr. Madara wrote.

Austrian doctor also ensnared

The UAE's legal approach to Dr. Karabus is not unique.

Dr. Eugen Adelsmayr of Austria headed a surgical intensive care unit at a Dubai hospital from 2004 to 2009. In 2012, he was tried in relation to the 2009 death of a Pakistani quadriplegic patient who was dependent on mechanical ventilation, had frequent cardiac arrests and required a pacemaker. Dr. Adelsmayr said the hospital declined to pay for a permanent pacemaker, yet when the patient died of a cardiac arrest it was he who was charged with murder. He says that forged translations of medical documents from English to Arabic were presented at his trial.

Allowed to travel home to be with his dying wife, Dr. Adelsmayr refused to return to the UAE. On Oct. 21, 2012, he was found guilty in absentia and sentenced to life in prison.

“After what I went through and what is happening to Professor Karabus now, I would warn every colleague to avoid work in the UAE, especially those in high-risk fields like the ED, ICU and OR,” Dr. Adelsmayr said.

The WMA does not provide any kind of rating of countries' legal climate for physicians. Instead, American doctors should check with the State Dept. and consult their attorneys before traveling abroad to practice, Dr. Wilson said.

“Physicians going to other countries need to know of cases like this and things related to the legal system,” he said. “Is it a country where rule of law is established, with due process and a speedy process?”

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