The Ella Tannous Case: When Every Lebanese Suddenly Becomes A Doctor

Ella Tannous

I just wasted 7 years of my life in medical school.

Naturally, when you live in the country with the likes of professor Marcel Ghanem, Dr. Joe Maalouf, Tony Khalifeh and their friends, is there a point for you to remotely try to get an education? They will tell you what you need to know, give you medicine crash courses and guide public opinion on the matter.

Clearly, they’re the ones who know everything and those doctors are just backward-minded folks who only care about money.

Ella Tannous is a young 9 months old whose pediatrician is now in jail. Why is he in jail? Because we live in a corrupt country where security forces get carried away by the sensational reporting of Kalam Ennas and other similar shows to ruin the life of a man simply because of the science of Marcel Ghanem’s report and that dramatic Lord of the Rings music in the background and the tears of the child’s mother as she whispers: why can’t my little girl play with barbies?

Again, what would I know. I’m sure that policeman in between his Malek el Tawou2 sandwiches was busy reading medical textbooks. Give me the differential of a crying baby, kind sir. Oh, you have cramps from all the garlic consumption? Excuse me.

According to her parents, Ella had a high grade fever for which they contacted her pediatrician, Dr. Issam Maalouf, who ran some tests that revealed Ella most likely had a viral illness and prescribed medications to lower her fever.

However, Ella’s fever did not subside and upon contacting the doctor again, he told them not to worry and to use cold towels to try and drop her temperature.

When the parents saw that their child’s situation did not improve they took her to the hospital. It was a Sunday. The pediatrician did not see Ella that day and instead saw her the following day when she had already deteriorated.

He got her transferred to AUBMC where further treatment was done. Ella, however, was in shock and in a state called DIC (Disseminated Intravascular Coagulation) and had gangrene in her limbs, which had to be amputated to save her life.

This is what happened with Ella Tannous according to her parents:

*cue in dramatic music.*

What happened to their child is surely devastating to them and Ella’s parents have every right to be sad and heartbroken over what happened to their daughter.

But just because someone’s daughter had complications does not make that person a doctor who can go on air and pretend they know what makes sense scientifically and what doesn’t. It also does not give Marcel Ghanem or any Lebanese media, who were quick to jump on this very delicious scoop, the right to become full blown medical professionals who spent their times doing night duties in pediatrics.

So let’s go with what we know one by one:

1) Ella’s blood tests revealed a viral illness. Viruses are not treated with antibiotics as Ella’s father was alluding should have happened. In fact, the side effects of those antibiotics and possible increasing resistance to them make their use in viral illness not recommended. How do you treat a viral illness, scientifically? You provide symptomatic relief. A patient has fever? You give anti fever medication. A patient has a sore throat? You provide pain relief, etc.

2) Ella’s fever persisted. Viral illnesses can have fevers that persist. You still give anti-fever medications and monitor. This is what you do, unless LBC or Annahar have new guidelines that we need to be aware of, in which case enlight us please.

3) Ella deteriorated and they contacted her physician as they took her to the hospital. He didn’t recognize them at first. Well, bring the guillotines. A pediatrician could not recognize over the phone a patient out of the hundreds that he has. He must be incompetent. Issam Maalouf’s mistake? He did not go see Ella that day at the hospital. However, that hospital is a university hospital and they should have been reporting back to him every single that happened with Ella as she would’ve been admitted under his care.

4) Ella’s fever continues and she starts experiencing decreasing urine output and becomes lethargic. These are signs of dehydration and deterioration. Dehydration can lead to kidney damage because blood flow to the kidney is decreased which causes something that is called acute kidney injury. This is not what probably happened to Ella, however.

5) Because of her decreasing immunity fighting the virus, Ella contracted another bacteria called Group A Strep (GAS). This bacteria is virulent and has been known to cause a wide array of complications when not recognized and treated early. To recognize and treat it early, you need to maintain a very high level of suspicion which in the setting of a clear viral illness, such as Ella’s case, was not the case.

Due to her low immunity, Ella had a dissemination of GAS. This led her to go into septic shock and full blown DIC. Septic shock is an extremely lethal condition whereby the body cannot adequately find the overwhelming infection. DIC is a complication of septic shock that leads to the depletion of the body’s ability to coagulate the blood through the formation of little clots that block blood vessels across many organs and vessels. The condition is extremely lethal.

In fact, the combination of septic shock and DIC is usually unescapable. Ella is lucky to be alive. Do you know why she’s lucky to be alive? Because her pediatrician saw the signs early enough to transfer her to a hospital that can manage her well.

 

Bring The Pitchforks, Why Don’t You:

After all that they’ve done, I can’t believe the Lebanese populace still trusts Lebanese media blindly when it comes to medical issues just because they’re sensationalized enough for their liking.

This is the same media that wanted to convince you we had a Guillain-Barré virus.

This is the same media that, a few years ago, ruined an OBGYN’s life by pretending they know medicine and accused him of killing one of his patients who was giving birth. That patient had an amniotic fluid embolism that is a lethal and extremely rare complication of giving birth. That doctor’s future was ruined anyway. He was also thrown in jail for something out of his hands before the courts realized that he was thrown in jail simply because of Tony Khalifeh’s report at the time.

Issam Maalouf joins the growing list of doctors whose entire career rests upon the whims of a reporter who understands nothing and who goes by what the parents or family of a patient are saying as if they know what’s happening, as if they know the medicine behind diseases. A devastated parent is not a doctor.

This is the same media that now has you convinced a competent doctor is now where he belongs, behind bars, and has you changing your display pictures to “Justice for Ella” snapshots.

When faced with a report from the Lebanese Order of Physicians about what actually happened, that same media downplays the report as inaccurate. Because clearly, the Order of Physicians does not know the medicine behind what’s going on. Those physicians did not go to med school for years and then did residency and fellowship programs for more years only to be ridiculed on air for being imbeciles.

Complications in medical scenarios happen. Not every single complication, despite how deliciously journalistic it looks, is a headline story.

With all due respect to a patient’s family, the esteemed reporters across the Lebanese republic and the people holding the pitchforks in Ella’s defense: You really have no freaking clue what you’re saying. Stop suggesting treatment modalities. Stop suggesting scientific explanations. Stop ruining people’s lives just because it makes for fancy headlines.

And then you get the Ministry of Health pretending they suddenly understand medicine to bring their pitchforks too. You know, that same ministry who turned Lebanon’s food safety issue into a Star Academy-like nominee-every-week report fashion.

There is a reason we go to medical school for endless years. There is a reason we do residency for another batch of endless years. Only doctors can know when medical errors occur. Only doctors can judge another doctor who does a medical error. Only doctors know how to treat patients and diagnose them. Only doctors know how to manage complications.

This is not elitism. This is common sense. This extends to other professions as well. I can’t judge the work of an architect, but an architect can. I can’t judge the work of an electrical engineer, but another electrical engineer can, etc.

The bottom line is: I just wasted 7 years of my life in medical school, that much is clear. Because clearly, Marcel Ghanem and his friends know better than me and all my colleagues.

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230 thoughts on “The Ella Tannous Case: When Every Lebanese Suddenly Becomes A Doctor

  1. I have read every single word in your document around three times. I do agree with you that when someone should be put in jail it should not be because of a reporter or because of emotions. That I guess is what everyone should agree on.
    No one is pretending to be doctors. I am an engineer and I know nothing about being a doctor. I also understand when someone completely unaware of my major gives me a lecture.
    Since I’m a software engineer; I would like to give an example related to my field. So, let us assume you are using an application which you trust so much, and you all your personal information (private photos no one should see social security number visa card number etc..). Then you wake up to see that all those personsal information of yours are spread all over the Web because of a hack due to a complication that went wrong with the programmer (we face complications too). If you’re reaction is gonna be oh well Okay mistakes happen no would should be held responsible for exposing my personal information then please forget everything I said and don’t bother reading further. However, if you would feel.that this mistake shouldn’t have happened since you trusted the programmer with your info, then please forgive me but we trust doctors with much more (our lives). The same you demand an explanation of how your info could publicized, I think when medical complications happen, we also deserve an explanation. A good explanation is not that medical complications happen. A good explanation is why they did and why weren’t they prevented? Mostly is every western country when a cop.kills someone in self defense, he or she is put under severe investigation to determine what happened. I don’t believe questioning a doctor when a baby girl lost her limbs is quite acceptable. I speak for myself I want to know why this happened? The doctor was smart enough to cut her limbs to stop the baby from dying, but why did it had to reach to that? Yes I want a reason. Also accusing the ministry of health of turning health food issue into start Academy is something I did not like.

    I also here am speaking for myself I want to know which restaurants have healthy food or not. In every country in the world a n inspections happens, and the restaurant which doesn’t abide gets publicized. The people deserve to know.

    I am sorry for my long comment, but this is my opinion. What happened to this poor little girl is devastating. God be with her and her family. Hope no other family has to suffer from the same thing.

    Reply
    • I fully agree with you on your first point. And this is what was said in previous posts: conduct an objective, unbiased investigation of the medical records, results, and charts (these are the objective findings, not heresay from the doctors or parents), then issue a detailed report of such findings so the general public knows what happens, and then you can discuss it on social media, talkshows, etc.

      Regarding the food and restaurants, no bad publicity should be made. The restaurant has to be shut down immediately. And this is what they do abroad. They don’t “publicise”. They don’t show mercy. The law is the law.

      I was in the US recently, and had an ice cream at a store there. A week later, I go back to find that ice cream shop closed. It turned out that another shop of the same chain was linked to an outbreak of Listeria, so the entire chain was shut down. There was no 8PM news break mentioning this. Justice was swift and firm.

      Reply
  2. I read ur post and I understand ur view from a medical point. However
    there is a medical responsibility for a Doctor attending any case eventhough complications may arise and this is what parents expect when they decide to admit their kids into hospital.Ur frustration is more because the doctor has been arrested,let justice be above everyone and if investigation shows that what happened with Ella is due to neglicence then I think the Dr has
    to be liable if that is proven.Secondly, I dont see any problem that media put this case into public as this will shed the light on how 2 avoid these disasters especially that parents shock and trauma is massive.I have worked as a nurse in Lebanon and in Australia and I can tell you the difference in medical care is massive.We r responsible for our acts and its a must to have indemnity insurace shall we r found liable and incase of mistakes.
    This is a humanitarean case let justice be above everyone.My heart goes to these parents and instead of being sarcastic about their tears we should support them and put
    ourselves in their shoes.

    Reply
  3. It’s funny how you’re still a medical student and yet you already have that deluded sense of arrogance and superiority which Lebanese doctors are afflicted with. Also interesting how you already have adopted that alienation from patients and how you’ve created this objectifying distance between yourself and your “customers”, referring off handedly to Ella’s mom’s “few tears” and her “raging dad” alluding that they’re putting on an act just to implicate the “innocen” doctor. As though they haven’t just lost a daughter to what’s worse than death. What Lebanese doctors lack is indeed, as you say, not knowledge and scientific expertise, but rather empathy and a sense of humanity. Maybe a more humane doctor would have interrupted his Sunday barbecue to attend to his little patient and fulfill the duty he swore to uphold.
    This doctor has admitted his guilt, so bark up another tree.
    You very rightly belong to that guild of butchers.

    Reply
  4. I just can’t believe what an ego-centric article this is… any scientific point you made or were trying to make is unfortunately completely obscured by your ego and inability to see anything beyond it. Because here you are ranting on and on about a bunch of privileged doctors’ “lives being ruined”, while making this baby’s amputations and her parents’ suffering seem to be like an unfortunate sideline issue. Excuse me, but who is the person whose life was ruined here???

    I don’t care about journalists or media – they are just doing their job, and everyone knows that journalists exaggerate everything – but you don’t really need Marcel Ghanem or media to tell us that when a doctor, when *anyone*, makes a mistake (and clearly a mistake was made, likely one of malpractice), the very least he or she can do is own up and take responsibility. People can understand that what happened was not intentional. People can understand that doctors are not perfect. People can understand that he made a mistake, or that he could have done a better job at caring for this girl and following up with her condition. But sidestepping responsibility and treating what looks to be a negligent doctor as a hero is not acceptable, and your unbelievable disrespect for the patient and her parents (Lord of the Rings dramatic music and all), and your making fun of people’s emotions is really shameful. If you really want to be a doctor, start learning how to care about people.

    Nobody cares about your degree or how many years you wasted studying it ( I don’t think anyone would want their doctor to be such an asshole) We care about that poor girl and what could be done to prevent such sad sad stories from happening in the future, we care about having accountability while respecting the rights and responsibilities of both patients and doctors. I’m only saddened to know that future doctors like you will have their own interests at heart rather than their patients’.

    Reply
    • Hey,

      The point of this article is that just because something is sad doesn’t give you the right to blame on an innocent man. I don’t know what you work as, but in a generalized poor example, imagine a sexually molested girl suddenly accuses you of raping her. Its sad for her, its a tragedy but its not ok to the other party. Look at the situation logically instead of seeing chomped off limbs. If you understood medicine you would understand it wasn’t his error. I don’t know the guy but its sad to see someone pay for something that’s not their fault as a poor political statement to make people happy. Catch real doctors who operate on patients who don’t need surgeries and paralyze them, catch a doctor prescribing Xanax pills for a heart conditions, catch real malpractice not a genuine attempt at medicine in a 1 in a million case. This happens all the time in America where sueing is rampant, no one sues of DIC, the patient is lucky to be alive. DO research, learn the medicine before you judge. Think for someone elses sake, don’t hate this doctor because their are other Lebanese doctors who are bad.

      Reply
      • On a sidenote, I know my grammar is terrible. Please ignore obvious mistakes. Admins of this site add an edit function if possible.

        Reply
  5. its very obvious that Ella suffered from septic shock. Wether starting antibiotics early on could have saved her arms and legs is debatable since in the best scenarios mortality from septic shock is probably 50% if not more . The fact that Ella had gangrenous extremities is suggestive of a complication that usually happens from Using pressors such as levophed which is usually used to raise blood pressure in people who have low blood pressure from septic shock. The doctor could be faulted for negligence because delaying care in these situations could be very detrimental . I agree the way the case was played in the media such as on kalam elnass is irresponsible and bad journalism . However, for the longest time I felt that doctors in Lebanon act sometimes like they’re above the law and the fact they can’t be sued makes at least some of them act irreponsibly and negligently. In a way , I think this is a good wake up call for some doctors in Lebanon that they can’t continue to practice bad medicine with impunity.

    Reply
      • True some doctors hear are horrible, but you can’t send an honest man to prison as a political statement. I agree, we have terrible ethics in Lebanon. I heard of one gyno who places all his patients on caesarians just so he doesn’t waste time with natural births, regardless of need. All orthopedics love recommending disk herniation surgery when there is high chance of no change and some even paralyze the patient. Find a real malpractice case, not this guy!

        Reply
        • This guy was negligent, according to all the smart people who commented here, and according to the available information. Whether he is criminally negligent, it remains to be seen. As to your point about “political statement,” let me explain to you one important aspect of the law–DETERRENCE. If this doctor was found criminally negligent, sending him to prison would send a clear message to his negligent ilk, who would definitely be extremely careful in the future. The purpose behind applying the laws is not punishment for the sake of punishment or ruining someone’s life; rather it is to make an example for others. As a result, the society, as a whole, is better for it.

          But the most concerning point to all of us should be the way The Order of Physicians handled the case. I hope the media will be relentless in exposing their hush-hush methods of investigating their own, behind their closed ivory doors. (Talking about the fox guarding the chicken!)

          Perhaps, the author of this article would write, with the same passion, another blog to urge people to donate money (lots of it) for that little girl who has a life-long suffering ahead of her. Then perhaps his 7 years in medical training would not be such a waste.

          Reply
  6. While I agree with many points you’ve raised, I would have to call you on a couple of things in your harangue.

    Faulting a parent for saying “antibiotics” while he should have said “antiviral” could be considered a smoke screen on your part. To you, as a physician, it’s important. To the parent, it’s semantics. We both know what he meant. Talking about the difference between treating bacteria vs. viruses and the whole business of super-infection is immaterial in this sad case, and it only clouds your passionate explanation.

    This leads me to my second point. You have neglected in your rather lengthy account to give us a timeline as to how long it took the little girl to develop gangrene, and the physician’s behavior during that crucial time. What took place BEFORE they reached the “teaching hospital” is what you should have chronicled. Had you done that, you would have won me over, as many others.

    But on to the crux of the matter.

    The system in Lebanon is archaic, screwed up and inhumane. I don’t mean the medical system; I mean the government. If I hit someone at night who is driving against traffic on his beat-up moped with absolutely no lights and kill him, I automatically go to jail (for questioning). If I can’t afford a lawyer to defend myself, I could be in those subhuman places for months, if not longer. To automatically jail someone (who’s clearly not a danger to society) without a hearing, let alone a trial, is insane.

    The same thing goes for the doctor. I think he should have his day in court where experts can argue pro and con and have someone (hopefully a clean one) in a black robe decide whether the doctor was criminally negligent or it was one of those rare, unforeseen cases.

    As to the medical/hospital system in Lebanon (though this point may be irrelevant to this case), there needs to be a healthy, non-punitive environment where health professionals are encouraged to report medical errors without the blaming and shaming or losing their job. Sweeping it under the rug would not help the hospital to improve the system and reduce medical mistakes.

    There also needs to be a professional liability insurance system, where the patient/victim can be compensated for their injuries, while doctors are protected from being jailed but at the same time held liable for repeated negligence.

    As to the media, Marcel Ghanem may have been disingenuous and self-serving by airing the plight of the little girl to the rest of the country. But the non-transparency of the Lebanese Order of Physicians in how it conducts its business is just as insane and corrupt as the government, and it may make a Marcel Ghanem out of many other well-meaning, frustrated journalists who are in the dark of what’s going on in that ivory tower in Furn Ech Chebbak.

    Reply
  7. While I agree with many points you’ve raised, I would have to call you on a couple of things in your harangue.

    Faulting a parent for saying “antibiotics” while he should have said “antiviral” could be considered a smoke screen on your part. To you, a physician, it’s important. To the parent, it’s semantics. We both know what he meant. Talking about the difference between treating bacteria vs. viruses and the whole business of super-infection is immaterial in this sad case, and it only clouds your passionate explanation.

    This leads me to my second point. You have neglected in your rather lengthy account to give us a timeline as to how long it took the little girl to develop gangrene, and the physician’s behavior during that crucial time. What took place BEFORE they reached the “teaching hospital” is what you should have chronicled. Had you done that, you would have won me over, as many others.

    But to the crux of the matter.

    The system in Lebanon is archaic, screwed up and inhumane. I don’t mean the medical system; I mean the government. If I hit someone at night who is driving against traffic on his beat-up moped with absolutely no lights and kill him, I automatically go to jail (for questioning). If I can’t afford a lawyer to defend myself, I could be in those subhuman places for months, if not longer. To automatically jail someone (who’s clearly not a danger to society) without a hearing, let alone a trial, is insane.

    The same thing goes for the doctor. He should have his day in court where experts can argue pro and con and have someone (hopefully a clean one) in a black robe decide whether the doctor was criminally negligent or it was one of those rare, unforeseen cases.

    As to the medical/hospital system in Lebanon (though this point may be irrelevant to this case), there needs to be a healthy, non-punitive environment where health professionals are encouraged to report medical errors without the blaming and shaming or losing their job. Sweeping it under the rug would not help the hospital to improve the system and reduce medical mistakes.

    There also needs to be a professional liability insurance system, where the patient/victim can be compensated for their injuries, while doctors are protected from being jailed but at the same time held liable for repeated negligence.

    As to the media, Marcel Ghanem may have been disingenuous and self-serving by airing the plight of the little girl to the rest of the country. But the non-transparency of the Lebanese Order of Physicians in how it conducts its business is just as insane and corrupt as the government, and it may make a Marcel Ghanem out of many other well-meaning, frustrated journalists who are in the dark of what’s going on in that ivory tower in Furn Ech Chebbak.

    Reply
  8. Dear all,
    A humble and respectful intervention.
    Thank you all, because you have principles and you showed interest. Sorry, we’re not discussing a subject like faith where we have believers and atheists and where each one tries to convince the other party.
    Some Facts:
    1- You are innocent UNTIL PROVEN the contrary
    2- You are practicing retrospective medicine or retrospective judgment. It is always easy when they give you all the answers.
    3- The poor child was seen on his way to AUH by the most experienced and the best renommee pediatrician, who also couldn’t do the diagnosis; which means, it wasn’t so obvious.
    4-The dr. we are blaming has 30years educational experience, who attends yearly the American seminars..
    5-somebody mentioned Rochester criteria and that he should have run lab tests. He did and they were normal. Knowing that 40% of directors of emergency programs in the U.S do not follow them.
    6- Drs are not God. Everywhere they have unavoidable complications: the Canadian Prime Minister Bouchard had his leg amputated, the same day after an infection. This means you have unfortunately sometimes devastating germs. When he was discharged, he was thankful.
    Please check & Google it.
    7- The Dr wasn’t nonchalant. It is not him. He saw the child at least twice during the first 4 days, while she was still at home. On Sunday, he didn’t go because the 8th year Dr didn’t notice anything abnormal. I remind you, even, the next day, the big shot professor didn’t notice it was severe. i remind you also that the super infection with the streptococcus germ came later, and doesn’t have any relation with her diarrhea.
    8- It is not that easy to guess even when it is obvious: a study done on 75 emergency physicians asking them about a simple identical case, all said it is dehydration after acute gastro-enteritis.
    Even when he gave them the answer: is it a septic shock: only one rose his hand.(ACEP NEWS SEPT 2010.
    9- Both children (and her sister) are under the care of the pediatrician for some time, so parents knew him and what he represents. But like after a Divorce, he or she becomes a monster.
    10- The order of Physicians has an average of 3 daily lawsuits and took some serious measures, and Drs have malpractice insurances. But we can’t just apply American standards in Lebanon. Resuscitation of a 800 g costs 250000$ without Drs’ fees. Here 90 % do not pay their 3000$ fees.
    11- The more you want to tease Drs, the more it will cost you: they will X the exams, the admissions, the Antibiotics prescriptions, and the antibiotics resistance, which is the most dangerous war >>>> 2nd world war.
    12- There are mistakes and unavoidable errors.
    Show a little compassion for each other, a little love and a lot of mercy.
    God loves you all.

    :

    Reply
      • Compassion with who exactly ! The guy confessed for god’s sake. Stop trying to make him seem so innocent.

        The only compassion due is for this poor child who was a victim of negligence and a victim of a corrupted Order of Physicians that is trying to cover up for him.

        Reading this blog, I could write an article with titled “when most Lebanese physicians desperately try to defend negligence”.

        The case and/or the incarceration of the concerned is not personal to any other doctor except for insecure physicians lacking self confidence.

        To some of the doctors who are defending the negligent physician:
        Enough with the baseless grandiosity and the disrespect to your community, your patients, and your profession.

        Reply
        • My advice to you my friend is to either learn to read other peoples post and consider what we say or go to medical school. Either way Lebanon has no future in this environment for medicine with Lebanese ignorance at its finest. If the Canadian Prime minster cuts off his leg with the same condition and you are so ignorant to still say that this is the doctors fault then god help you with the rest of your life.

          Reply
        • So this is basically your issue. continuing to undermine people and defend a losing case though the negligent physician admitted his error (although its obvious why he admitted error and not negligence). who told you that I’m not in a position to know whether this is negligence or do not have medical background supporting my opinion ! oh ya, sorry, you’re the only medical expert; or shall i say the only medical student expert !

          It is people like yourself who should turn into research because you surely will never make it as a physician or you will but will fail as a human. Since you’re still a student, i think you’d better stop here… try moving to psychology or even fine arts; it may be better for your human side.

          My friend, or not, the Lebanese society that you just disgraced is the the society that you and your parents obviously belong to and its not ignorant at all. Its not the time where physicians talk and the patient listens and abide. it is rather the time where the patient/significant other should ask, discuss, and agree to his plan of care…

          Before trying to impose your opinion on the Lebanese society with your patronizing attitude; else they are ignorant if they didnt accept it, please try to understand that its not personal to you or to any good physician out there. so, please spare us the drama…

          Reply
      • Blaming an innocent man as a psychological relief for the little girl with no hands is not ethical. Be rational. Its sad but its not his fault. This is displacement of the real issue. Ruining someone else’s life who did his job doesn’t bring her arms and legs back! 2 lives destroyed, 1 by god 1 by society. This is not justice, this is barbaric.

        Reply
        • Two lives destroyed, 1 by the negligent physician and the other by the justice of the society that is well aware and trying to make you ethically think towards your patients and encentivise the human part of you as a doctor…

          Reply
        • Have you read what you typed here? Psychological relief for the girl???? Have you seen pictures of this poor creature smiling while she doesn’t know what happened to her because of this animal. Rational? Are you mentally retarded or simply an idiot?This man should be executed after they amputate his limbs, maybe then your word “barbaric” could apply.

          Reply
        • Ahmad habibi,
          I gave you some credit the first time I chatted with you, please don’t disappoint me.Take a break for one day only. don’t post any comments until you reflect on the issue a bit. Forget about your books and what you are learning now. Don’t listen to what your teachers are telling you don’t read any newspapers or listen to the angry doctors around you. Sit back and reflect on the issue well. This is not the doctor you want to be one day. Be strong and accept the truth the way it is then move on.
          Remember Ella every time you see a patient. this is the only way her suffering will not go in vain. Remember Ella all the time and keep repeating to yourself:” I will be a better doctor than Issam Maalouf.”

          Reply
        • lek ya Ahmad ya ayre.
          ente ba3ed ma shefet shi men el barbaric yalle 3ambtebke 3le, bokra 7atshoufo bass y3al2oukon 3al khwezi2.
          shou mfakkar el 3alam kella baheyem?!!!

          Reply
    • so besides being an insensitive bitch you are threatening us by what the doctors might do if they are teased??? and you talk about mercy? do you have any of that in your cruel heart?

      Reply
  9. Dear all,
    A humble and respectful intervention.
    Thank you all, because you have principles and you showed interest. Sorry, we’re not discussing a subject like faith where we have believers and atheists and where each one tries to convince the other party.
    Some Facts:
    1- You are innocent UNTIL PROVEN the contrary
    2- You are practicing retrospective medicine or retrospective judgment. It is always easy when they give you all the answers.
    3- The poor child was seen on his way to AUH by the most experienced and the best renommee pediatrician, who also couldn’t do the diagnosis; which means, it wasn’t so obvious.
    4-The dr. we are blaming has 30years educational experience, who attends yearly the American seminars..
    5-somebody mentioned Rochester criteria and that he should have run lab tests. He did and they were normal. Knowing that 40% of directors of emergency programs in the U.S do not follow them.
    6- Drs are not God. Everywhere they have unavoidable complications: the Canadian Prime Minister Bouchard had his leg amputated, the same day after an infection. This means you have unfortunately sometimes devastating germs. When he was discharged, he was thankful.
    Please check & Google it.
    7- The Dr wasn’t nonchalant. It is not him. He saw the child at least twice during the first 4 days, while she was still at home. On Sunday, he didn’t go because the 8th year Dr didn’t notice anything abnormal. I remind you, even, the next day, the big shot professor didn’t notice it was severe. i remind you also that the super infection with the streptococcus germ came later, and doesn’t have any relation with her diarrhea.
    8- It is not that easy to guess even when it is obvious: a study done on 75 emergency physicians asking them about a simple identical case, all said it is dehydration after acute gastro-enteritis.
    Even when he gave them the answer: is it a septic shock: only one rose his hand.(ACEP NEWS SEPT 2010.
    9- Both children (and her sister) are under the care of the pediatrician for some time, so parents knew him and what he represents. But like after a Divorce, he or she becomes a monster.
    10- The order of Physicians has an average of 3 daily lawsuits and took some serious measures, and Drs have malpractice insurances. But we can’t just apply American standards in Lebanon. Resuscitation of a 800 g costs 250000$ without Drs’ fees. Here 90 % do not pay their 3000$ fees.
    11- The more you want to tease Drs, the more it will cost you: they will X the exams, the admissions, the Antibiotics prescriptions, and the antibiotics resistance, which is the most dangerous war >>>> 2nd world war.
    12- There are mistakes and unavoidable errors.
    Show a little compassion for each other, a little love and a lot of mercy.
    God loves you all.

    Reply
    • Danielle,

      I agree, the theatrical way this doctor was pulled to jail was needless here. the problem is that the due process in the Order of Physician was a joke. Ella’s parents and anybody with a common sense realized it was unfair. Forget about doctor’s fees and all the economics of medicine. Let us do the right thing. the ethical thing. let us make Ella’s tragedy a turning point in our healthcare. Doctor Maalouf’s actions should have been evaluated and disciplined by a competent group of peers away from the press. Actions taken against him should be available to the public. When the system is corrupt however, the press will interfere, make no mistake. Welcome to the new world. Wait until your patients start talking about you on facebook!
      the bottom line is this. was doctor Maalouf Negligent? could he have done a better job? could he have saved her if he followed the standards of care (regardless of what the ER doctors would do in China)? Would he have been in this situation if he told the parents: let me make some phone calls?

      If Ella was your patient, would you have
      1. Seen her and examined her on the day she got admitted?
      2. Made sure her vital signs checks were ordered appropriately and interpreted them well
      3. Checked her input and output
      4. Spoke with the resident on call and told him what to look for?
      5. came to check the baby when the nurses called to tell you she has not voided?
      6. Obtained a blood culture? and followed up on the tests
      7. Took time out cancelled your office appointments and thought about what else could be making her worse?
      8. Listened to the parents concern and promised you will ask a colleague if they would do anything different?
      9. When it became obvious that she was really sick, would you have picked up the phone to speak with the chief residents at AUH or Hotel Dieu to arrange a decent and safe transfer of care?
      It was unfortunate that all he told the parents was that she will be better and babbling your ears off tonight! sad! no?
      Cheers

      Reply
      • Zahi Kassas, MD, you talk from your American branch of medicine as if things are similar here.

        The hospital she was in did not have the resources for the extensive monitoring you are asking for.

        The hospitals do not provide transport and as such it’s always up to the Red Cross, which is spread so thin that sometimes they can’t do emergency transportation of patients from one hospital to the next.

        A pediatrics resident went with the little girl in her car.

        The doctor definitely called whoever was taking care of her at her other hospital to inform them of her case. The protocol of transfers also requires a detailed history paper, copies of all tests done, etc.

        The day the doctor did not visit was a Sunday. In the days before Sunday, he had seen the patient twice. As she was being admitted to a university hospital, there are doctors on call and pediatrics resident who were able to update him on her situation. I’ve seen medicine in the US and when it’s your day off or if there’s a colleague on call you CAN not go to the hospital.

        The baby started exhibiting signs of dehydration the following day – Monday – which is when he recognized the problem and transferred her.

        The list goes on. The point is: medicine in Lebanon is different than medicine in the US. You are practicing, as Danielle said, retrospective analysis on a situation of which you already know the answer and judging with tools that are at your disposal there that are not present here.

        Reply
        • You bring good points Amalia. Thank you.
          How could a child in septic shock be transferred in a family car? Who in the red cross refused to take the baby to AUH? and, how come they have not been investigated?
          Who was the accepting doctors in Hotel Dieu that refused caring for a near death patient? Have they faced disciplinary actions?
          What can a resident do in a family car? could he give her fluid boluses on the way. My understanding is that she was in septic shock at AUH and needed heavy resuscitation meds on arrival. Did Dr Maalof know she was in septic shock before the transfer and still put her in a family car? If he did that was a problem, and if he did not that was even worse!
          How come a reputable hospital did not have the right resources to care for a baby in shock?
          You seem to know a lot about the baby initially. Not asking you to break confidentiality, but did this baby really had a virus to start with?
          Now with my comments.
          It is true, it is very easy for us to discuss the issue after the fact. But we would not be here if it was not for the author of the blog who seemed to blame everybody, but not the parties involved. True we do not know all the fact and we are not in the presence of a court of law. We are just trying to understand and make better changes to our healthcare. As I said earlier, Dr Maalouf’s biggest punishment is the memory of Ella’s tragedy. He should not be in jail. But we should not hide our heads in the sand assuming that all the failures that occurred were an act of God. Let us be strong and make things better.
          Let Ella’s tragedy make us better at taking care of the little ones.
          Let us make sure doctors do their jobs well.
          Let us create a system where Hospitals always have an attending physician in house
          Let us empower the nurses to speak up when they see something wrong and
          Let us build a better transfer system between hospital, rather than making patients shop around in their private cars.
          Let us change the idea we have in Lebanon that doctors should not face any accountability.
          The doctor’s strike should aim to make healthcare better, to get better equipment, staffing and resources to hospital on the outskirts so they function like AUH and Hotel Dieu.
          And more importantly, we better fix our Naquabeh to make it more up to date with the demands of the century
          If we don’t do that Amalia, there will more more and more Ellas (God forbid)
          Nice talking to you again.

          Reply
  10. “Do No Harm” is the first core ethical principle we learned in medical school. I feel with Ella’s case there was harm done on both sides of the fence:
    1) A viral illness doesn’t automatically equal good prognosis, I think that is a common misconception amongst the general population, and so the attending physician acted in the best possible way in order to prevent further complications…Ella is definitely lucky to be alive!

    2) However I do understand where Ella’s parents are coming from. It was certainly not the attending physician’s place to give these parents a sense of “false reassurance” when their daughter was showing signs of septic shock. You did not address the fact that Ella’s mother went from being told that her daughter’s blue limbs were a normal result of the fever and that she would be fine to having her deal with the fact that her daughter is handicapped a few hours later? Yea, I’d be angry as hell too! Do we even know if these parents consented to the amputation? Had they been kept in the loop from the very beginning, they would have been more informed of the situation and thus would not have felt the urge to resort to mass media to incur justice.

    Also, you really shouldn’t be defending a doctor who doesn’t remember his patients’ names by saying it’s because he has hundreds of other patients. He doesn’t deserve to be thrown in jail, but this is what happens when you treat a disease and only identify a patient by their disease. Maybe treating “Ella the person” would not have made much of a difference in terms of her disease outcome, but at least it wouldn’t have put the parents in a situation where they felt like they were being neglected or not taken seriously.

    The major problem with doctors in our society is that they are free to make medical decisions without feeling the need to provide accurate and truthful reasons as to why this decision is the best course of action (to the best of their knowledge) to the patients and their families. Taking the time to educate the patient may not affect the outcome of the disease, but it will surely go a long way to build a lasting trust between doctor and patient.

    Reply
  11. “Do No Harm” is the first core ethical principle we learnt in medical school. I feel with Ella’s case there was harm being done on both sides of the fence:
    1) A viral illness doesn’t automatically equal good prognosis, I think that is a common misconception amongst the general population, and so the attending physician acted in the best possible way in order to prevent further complications…Ella is lucky to be alive!

    2) However I do understand where Ella’s parents are coming from. It was certainly not the attending physician’s place to give these parents a sense of “false reassurance” when their daughter was showing signs of septic shock. The mother goes from being told that her daughter’s blue limbs were a normal result of the fever and that she would be fine to having her deal with the fact that her daughter is handicapped a few hours later? Yea I’d be angry as hell too. Do we even know if the parents consented to the amputation? You failed to address that point in your essay. Had they been kept in the loop from the very beginning, they would have been more informed of the situation and thus would not have felt the urge to resort to mass media to incur justice.

    Also you really shouldn’t be defending a doctor who couldnt remember his patient by simply saying it’s because he has hundreds of other patients to tend to. He didn’t deserve to go to jail, but that’s what happens when you treat the disease and not the person. Maybe if he had treated “Ella the person” this wouldn’t have made much of a difference in terms of her disease outcome but it would have definitely not led the parents to feel as if they were being neglected and not taken seriously.

    The major problem with doctors in our society is that they are free to make medical decisions without feeling the need to provide accurate and truthful reasons as to why this decision is the best course of action (to the best of their knowledge) to the patients and their families. Taking the time to educate the patient may not affect the outcome of the disease, but it will surely go a long way to build a lasting trust between doctor and patient.

    Reply
  12. So sorry if I sound technical here,
    1.Do we know for sure there was a virus in the beginning? How? a CBC is not a reliable test to confirm a viral infection. Do we have an id on the virus? or this is just a speculation of the physician in question (and the medical students in the forum)? Keep talking about a virus as long as you want, unless we have an id on a virus we cannot call it a viral infection at this age without ruling out more serious infections first. why are we assuming the strep bacteria was a secondary infection? even if it did, how come it was not caught on time. How come when the patient started deteriorating (poor perfusion, poor urine output, altered mental status) nothing was done to figure out the reason for the deterioration. Were the blood tests repeated? cultures obtained? what answers did we obtain to explain the deterioration? Nothing was done and we kept hoping that things will get better on their own
    2. Why are we assuming that the fever was not caused by the strep bacteria from the start?
    3. Had our doctor followed the standards of care that are universally used by pediatricians all over the world for febrile infants with no definite source of infection, the bacteria could have been caught within 12-24 hours of the onset of fever (the strep bacteria grows fast and its identification is very easy). These standards of care for a child Ella’s age include obtaining blood and urine cultures immediately when the baby looks sick and when there are no definite source of infection. Unless we have a lab evidence of a virus (RSV, EBV, CMV, Influenza…), we should not assume that the patient had a virus. What other clinical signs of a viral infection did the patient have (runny nose, congestion, cough,….Does not look she had any. did she? please help me clarify the issue.
    4. Many pro-doctor advocates are arguing that he did not want to prescribe an antibiotics for a viral infection (still no proof of a virus) to minimize the risk for resistance blah blah… It sounds to me he did exactly the contrary of what he was advocating when he prescribed Augmentin to the sibling of Ella few days before! What bacteria did the sibling have? was it strep? A doctor who is worried about drug resistance would not prescribe Augmentin so quickly. What happened to just amoxicillin or penicillin?
    5. The doctor, despite being popular on facebook, having loud friends, and a corrupt naquabeh in his pocket, failed to adhere to the simplest rule in Medicine. Examine his patient. A whole day passed in the hospital without him checking on her! Where was the standard of care in that? Sick enough to get admitted, worried parents, worried nursing staff. deteriorating baby…Still no visit to the hospital to check on his patient? I appreciate all the great things people say about him, but this was poor medicine and he did not do anything to prove it otherwise. May be he was burnt out. Still he should have asked a colleague to cover him and go see the baby
    6. Ella is a beautiful name and the patient is adorable. how could he forget his sick patient’s name?
    7. patients do not move from viral infections to DIC without warning signs. how come these warning signs were ignored. Ah sorry, I forgot. Vital signs were not checked appropriately. the blood pressure was only checked on admission. Where was the doctor to make sure his Patient was being monitored correctly? at home. thought it would be ok for his patient to toast in 40 degree fever until he checks her > 24 hours later.Even after he checked her he missed to identify her deteriorating clinical status.
    8. He kept telling the parents she was going to be fine. When was he going to worry? At what point was he going to jump and get a blood culture? He never had a sense of urgency and never took his patient seriously. At what point was he going to pick up the phone call a colleague and say “jeez, I don’t know what is going on. Any ideas?” A little of incompetence mixed with some negligence and a bit of arrogance will cost a baby her extremities sometimes.
    9. Even a medical student cannot miss multi-organ failure. where was he the whole time. the nurses were documenting the baby’s urine output (or lack of) for him to look at. Did he look at it? nobody did obviously except the parents.
    the list will keep growing if I had the time to keep typing. In Summary, I reiterate, the family put their trust in a doctor who was not worthy of it, neglectful and incompetent, the care provided by the hospital was substandard, the Nurses needed to learn to speak up. When they see something is wrong they should speak up and call the doctors or his superiors. The transfer of the baby to AUH was short of being a medieval act. Parents were allowed to carry their near death baby in their private care to shop around for a better hospital. And on top of this you get a naquabeh that is corrupt and rotten. Let us start by cleaning the Naquabeh from its corrupt doctors so we can start combing through the good and the bad doctors in the community.
    Finally, to the medical students in the forum, You are the future of medicine in Lebanon. Do not keep the same attitude. a little of humility goes a long way in making great doctors. Do not be followers, ask questions, challenge every fact, feel for your patients, Humility, compassion and devotion will make you proud one day; not just knowledge. Knowledge is the easy part my friends.
    God Bless you Ella. may he give you and your parents strength and patience.

    Reply
    • Great words. Thank you for taking the time.

      It’s clear that doctors here in Lebanon have a serious PR problem. Not because of a few bad apples, not because the majority of them don’t work their butts off and do great work, but because of the non-transparency and arrogance of their Order of Physicians. Had their Naqabeh been so open and robust in its self-regulating and self-policing itself, there wouldn’t be this bad taste in people’s mouth.

      Ahmad Medical Student needs to stop wining about the people of Lebanon and threatening to leave. He needs to be part of the solution not the problem. He needs to look inside the Leb. medical community and ask the tough questions. Lebanese Order of Physicians is a big part of the problem. He should go to that ivory in Furn Ech Chebbek and start using the power of his pen THERE.

      As to the author of this article, I think he should write another passionate essay and, this time, title something like, “A Giving State of Mind”– a fund-raising campaign for Ella to help her with her future extreme challenges. I doubt his blog would have as many dissenters.

      Perhaps then, his last 7 years would not be such a waste after all.

      Reply
  13. Also, and most importantly, could Ella have some sort of an immune deficiency? Strep infections at this age are usually rare, let alone the invasive type. I hope her Doctors at AUH now are trying to get more answers.

    Reply
  14. It would be best if people knew the whole story before commenting, instead of relying on what the media said. A lot of assumptions and twisted information…
    And keep in mind how much emotions are involved here making it quite difficult seeing the truth

    Reply
  15. Dr Malouf is the pediatrician to my children. We used to live in the area and we found him very thorough. He always wrote notes and checked the children’s history when we visited. I would call him to get his opinion when we moved overseas for a year. When we later returned and moved to Beirut I was not so impressed with the other Dr’s. They never took notes or checked through the history so we started driving all the way to Jbeil just to see Dr Malouf. Obviously there are two sides to every story and this is very tragic for all involved. Yes Dr’s should be held accountable if they make terrible mistakes, however it is not always easy to know what is wrong with young children. Especially because they can’t tell you how they feel or what their symptoms are. However in my humble opinion he was always the one pediatrician that I went to for a second opinion. He has always been a great Dr to my children, I was very surprised to hear him being neglectful. He may have made a mistake, or only done what he could with the information he had, but I doubt he was negligent.

    Reply
  16. Dr. Maalouf did not see his patient on Sunday. He deviated from the standard of care: not malpractice, simply negligence. Undefendable: either you see your patient or you have adrquate coverage. If you can’t do either simply tell the patient to go to another hospital and see another doctor or you must be scared you would lose the business? Well either lose business or patients may lose their life. This is not a trial of your stupid media or that of stupid people or that of the medical community. It is that of a doctor who failed to fulfill his duty.

    Reply
  17. Hi everybody, what a nice day.
    I am fully with Mohammed and Co: we should support Ella and all children with Handicaps.
    What bothers me is we don’t find any of the million people who want to support her when it comes to action, when it should be translated into time or money…
    We are in charge of 2 NGOs and we help others from time to time and of course we serve in dispensaries. And, strangely enough, I noticed that there are doctors working for free in these institutions!
    I beg you because you have a lot to give, APPARENTLY, please contact us.
    Otherwise I would think that people have a lot to say and a little, too little to give.

    We had a big, huge, undescriptible Catastrophe, don’t create another.

    Love you all.

    Reply
    • Please give us specific contact information (names, phone #s) of the two NGOs you mentioned. Let us make something good (however modest) out of something awful. I invite all commenters in this thread to give money on Ella’s behalf. Dr. Elie Fares, the author of this article we’re debating, could take the initiative and write up something, or start a Facebook page for donations for Ella. He seems both passionate and eloquent.

      Let’s make something good out of something bad.

      Reply
      • I’m not sure about the currency although I remember it’s USD.

        Anyway, I support this initiative and ready to discuss thoughts and ways to move forward.

        Reply
        • I wish it were true, but I highly doubt it. FYI, 1$ = 1,500 L.L. That makes the supposed pledged amount by the Ministry around $100,000. A good, modest start, but hardly enough.

          How about if we contacted the Lebanese Red Cross, asked them to appropriate a special account in Ella Tannous’ name, and then we could all start sending in our donations? If you’re game and willing to donate please reply. My email address is samrxster@gmail.com I will fill you in on all the details once I contact them. But first, I would need some solid pledges. ;-))

          Reply
        • Good idea. I’ll send you my contact details via email. Guess Dr Kassass and Danielle would be interested to brainstorm with us on this

          Reply
      • Agreed but it is to be noted that the ministry of health already pledged 150 million dollars for rehabilitation and other related interventions…

        However, I see no harm is starting a fund under her name to assist her and others having similar conditions. I suggest that the fund can be managed by a reliable NGO. Could be that of Samir’s…

        Would be great to hear some thoughts. lets arrange a conference call and see how we can manage this.

        Reply
        • Starting a fund through a well-established, licensed NGO that knows all the logistics and maintains public trust would be the best way to go about it. The Ministry’s 150,000,000 L.L. (while mashkooreen) is only a small fraction of what lies ahead in costs.

          To the good doctors or Samaritans abroad who are reading this, if you have friends or know of any institution(s) that would take Ella under their wing and could provide prosthesis for her, that would be wonderful!

          “Out of everything bad that happens to you, something good will come if you look hard enough.”

          Let us all look hard enough.

          Reply
  18. For Zahi, the MD:
    Every single issue incriminating Dr Maalouf is so easily rebutted, please believe me: You don’t know the details, you just hear what the parents and the media are telling you. This is not ethical vis-a-vis your colleague Dr Maalouf. Unless you are aware of the file, you should not discuss these issues. If you are really a Doctor, you should know that there are multiple sides for every story; including the discussions, the phone calls, the clinical state of the baby and how Dr Maalouf saw her, what he told the parents and what he was thinking (because he has 30 years of experience !!), which antibiotics she had on saturday and sunday, how where her limbs on sunday, etc …and how much money is expected to be paid to the parents at the end of the trial, ,,,,.
    Yes, this is harsh, but true. The only victims here are the baby and the Doctor. The unprecedented crazy media coverage is strange, to say the least !! Lawyers say that every minute on the media will influence the judge to increase the penalty by 100.000$. SAD for Ella, but so true …
    Please, put yourself in his shoes and tell us what what would you have done different, if the resident calls you and tells you the baby is OK; or, worse, if you came at 10:00 on Sunday, found her OK !!
    For the issue of not showing up Sunday: Please refer to what happens in the world, since you are calling upon standards. There is no place in the whole wide world, where a pediatrician, or a doctor is expected to come on a Sunday. In the best places in North America, the resident is the sole doctor. If he doesn’t ask for help, nobody comes before Monday. Not in Lebanon, not in Europe and not North America. However, the Doctors call by phone to make sure everything is OK, and this is what happened. The expectation of a patient admitted saturday is to be seen Monday by the attending doctor if nobody alerts him about deterioration. The team failed to function properly, and he is taking full responsibility as he should. I don’t want to defend him. The judge will sort out what happened. But nobody is allowed to lynch him publicly, not you, and certainly not the media, and certainly not for such a dreadful disease.

    PLease, be fair and ethical. He needs it and the profession needs it.
    THE HEALTH MINISTER GAVE MARCEL GHANEM THE FILE AND TOLD HIM GO PUBLIC !!
    MARCEL GHANEM SAYS : THE DOCTORS ARE BARKING LIKE DOGS.

    You are encouraging him to do that and more. No profession can be attacked. you can attack a person, but not a profession. This is an unprecedented arrogance and abuse from some arrogant people. They should be stopped.

    Reply
    • You are talking about arrogance? All what you typed here is NOT arrogant? Shitheads like you can only be deterred by the likes of Marcel Ghanem. Only in Lebanon you and your likes can make a 100$ every 10 minutes and no one can touch you when you malpractice. Try to show some empathy for that little soul you arrogant asshole.

      Reply
  19. Medicine is not an exact science! people die, it happens. I have always been very comfortable with the medical care in Lebanon. An individual doctor shouldn’t be arrested until a trial has been held and clear malpractice has been proven. It’s not fair to try him in the media. I do have to say, however, nobody loves a good conspiracy theory more than the Lebanese….

    Reply
  20. Ruin the life of a man because of science of Marcel Ghanem, Music of lord of the rings and tears of child’s mother!!!!!
    What about the child who lost her hands and legs you animal !!!!!!
    Now if an architect admitted that he made a mistake in designing your house and it collapsed on your head inshalla ya rab, will his reputation be more important than your life?
    I think yes because you are just an animal!

    Reply
    • First of all, it’s the engineer who designs the building’s construction, not the architect.
      Second of all, should an incident happen and the building collapse, a formal investigation will occur, and only at the end of it will the guilty be prosecuted. In this case, Dr Maalouf was put in jail before any investigation took place. That’s the big problem. Whether he is guilty or not is another thing.

      Reply
      • What part of his confession you don’t understand ! you’re “starting to sound like a broken record of screeching music, on a loop.”

        Nothing personal !…

        Reply
        • Since you guys keep talking about a confession, let me tell you what that “confession” means.

          You are saying he confessed to neglect, doing Ella wrong and whatever.

          This is incorrect.

          What he confessed to was a “Misdiagnosis,” which essentially means he did not know she had a strep A infection.

          Nowhere around the world is a misdiagnosis grounds enough for an arrest, jail time and a criminal sentence.

          Now carry on with calling me names, I’m certainly enjoying it.

          Reply
        • I fully understand his confession. I even explained it in a previous post. You simply seem to have ignored it or did not understand it. Kindly refer to Dr Elie Fares’s explanation.

          At any rate, I think we can all agree to the wrong “process” of which Dr Maalouf was a victim, and on working towards helping Baby Ella adapt to her new life.

          I can try to get in touch with the gentleman who makes the 3D printed limbs if it helps.

          Reply
        • Eliefares, khaye, No one said he confessed to neglect. Negligence was deduced by the facts mentioned in several parts of this blog.

          He confessed of error in diagnosing the child’s illness for the exact reason you mentioned and to try to avoid being convicted with neglect !

          Can you please explain to me with objectivity, why some physicians are taking this case personally and are punishing the patients of Lebanon in collective manner ! Did the society accuse every single physician of those with negligence ?! Of course not. HOWEVER, some physicians, who constitute minority, are not worthy of the title (not sure if you agree though).

          What I’m trying to say is that the way this case is being dealt with by some physicians and their attitude towards the public are what made this matter go against the physicians themselves.

          Reply
        • I think that no matter how much information about the case was presented here, there are still a lot of variables and unknowns that could only be known through the medical record (which is the most important legal document). A lot of stuff are based on media, word of mouth, emotional parents. That doesn’t mean they’re not true. It just doesn’t mean it’s the whole truth.
          Regardless, the reason why the physicians in Lebanon are taking a stand is because of the following (I know because my appointment with an AUB physician was canceled and he explained to me why they were doing what they are doing):
          Dr Maalouf was imprisoned BEFORE the result of an investigation was given (and before his “confession”). This means that he was considered as guilty until proven otherwise, instead of the other way around. They are not defending whether he was right or wrong.

          And I totally agree. A minority of physicians are ruining the reputation of the rest of them. Unfortunately, that’s what sticks out the most and gets talked about at family lunches.

          Reply
        • CM. on the contrary I agreed with you 100% on that he confessed error and your reasoning behind it.

          On the other hand, I think now we’re talking. Ways to assist Ella and how to help her is what should have been discussed from the beginning and should’ve been the reaction of the defenders.

          A multidisciplinary team is being formulated to brainstorm on such tipoc. If interested please feel free to send your contact details to samrxster@gmail.com

          Reply
        • Good. I’ll see if I can reach the 3D printing company and I’ll email samrxster.

          At any rate, apologies for the broken disk analogy. Good night.

          Reply
  21. For your knowledge, the guidelines say: if a fever persists more than two days you have to undertake Antibiotics therapy (broad spectrum) even if the infection is caused by a virus. That’s to prevent bacterial superinfection, especially in pediatric population.

    Reply
  22. Thank you Mohammed for replying to my email and offering ideas.

    Thank you CM for reaching out to the 3D printing company.

    Thank you Danielle for starting it all. I hope you could join us soon in our efforts to do something nice for Ella.

    Thank you Dr. Fares for getting us together in this forum. I still think you’re the best man to use the power of the media to make it happen.

    And thank you to whoever wishes to help out in this little endeavor.

    Reply
  23. By the freedom of expression every person Lebanese or not Lebanese has the right to speak about the topic he wants medical, political, social , so a bit of humility will be good for you mister docta, by the way did you forget to sign your long article?

    Reply
  24. first thanks for the clarification , i dnt watch news 3adatan, but by mistake on social media, just one question out of curiosity, does gangrene appears at that age ? eno mesh lezim tkoun ktir twaja3it ?

    ba3den shou metwa2a3 mnel 3alam? suddenly yefhamo eno el media 3am betkazib ? they r asleep ..

    i loved your article

    Reply
  25. The problem in Lebanon is that the likes of Marcel Ghanem & Co act as Judge, Jury and Executioner for any issue or story that raises the numbers of audience for their TV stations which should and must have a Legal “Security Valve” policy/ office who clear what to say and what to stop.
    Maybe, and I repeat MAYBE, the Dr. was put in jail for his own safety (Maybe) against the rage & fury of Ella’s family, that I sympathy with them all the way, in a country where Law and Order are a Myth.
    The authorities should’ve joined hands with the Medical syndicate to form a Board of Inquiry to investigate and go through every documents, test and instruction given that lead to this actual condition of Ella, Prior arresting and of throwing a respectable professor in jail and ruining his reputation and life.
    On the other hand, the Medicine syndicate CANNOT go to strike and leave patients in danger, pain and subject to aggravated their illness and condition which might have negative and bad consequences that nobody want. By going to strike and refusing to treat any patient the (Doctors) are committing few felonies including “intentionally harming an individual”, Attempted murder of second degree and other issues that are punished by law.

    Reply
  26. to the person who wrote this article .. god help any patient who will visit your office one day .. second u r an arrogant idiot .. 3rd u r a piece of shit no doubt. like most lebanese idiot mentality doctors thinking if they are doctors they are god on earth . bottom line i feel sorry any country who will let practice medecin with this all this ahit that u have in your mind

    Reply
  27. stateofmind13 I just stumbled over your blog trying to understand what happened to that poor baby and …fell over. What kind of a man has the heart to write such a conceited pamphlet after the life of misery that baby was just handed! ” Shut up ” I feel like saying….all of your detractors on this forum are right, you stink of misplaced ego and stop ranting about your seven years studying i dono what, all you are is human weakness, the one that leads rapists to say “she was underdressed”, bastards to say “she asked for it ” and so many more stray minds that dig alibis from dead corps.
    Baby Ella was mis diagnosed by an arrogant doctor, like many over here, who was possibly too busy leisuring around to come and visit an emergency UNDER ONE YEAR OLD BABY WITH HIGH FEVER AND SERIOUS SYMPTOMS SINCE OVER TWO DAYS. Shut up again you sick man, whoever let you study medicine should beat themselves up and burn your diploma (if you have any) at once and prevent retards like you to put more lives in jeopardy.You seem to lack the basic empathy that drives ‘most real doctor’s ‘ to this field. instead it feels like you belong to the rotten Bmw owners one. Do you also have a chalet in Faraya? Stay away from curing people or giving your opinion on curing them for that matter.
    “Baby Ella is lucky to be alive”???? As a trunk person? How dare you. You think we live in Alice’s wonderland you schmuck? What type of life do you think Ella and her family will have from now on? Will you have your son marry her? Would you hire her for a nice job? You better! and meanwhile why don’t you amputate yourself from just half a thing : your brain.
    Thank you

    P.S: have some real guts and publish this

    Reply
  28. Dears, Please lets pray for Ella and Dr Maalouf, they are both suffering!!
    Moreover, I do believe that Mr. Marcel Ghanem and Mr. Joe Maalouf should be held responsible for being unprofessional, and for presenting self emotions in a case were medical judges should give there definite and ONE WORD.

    Reply
  29. I am a physician in North America, I’m very curious as to why Dr. Maalouf didn’t admit Ella as an inpatient for monitoring. I don’t know any physician who would send a child home with the knowledge of a viral infection and a fever. That’s a situation that can go downhill very fast, which it did in this case. If you’re saying that the general public hasn’t the slightest clue about medicine then why send a sick child home with two parents who would have no idea how to monitor and manage their child.

    Reply
    • Finally! Someone from the same side of the world. Thank you for reiterating what I have been saying for a long time. It is not a palatable excuse to say the initial hospital do not have enough machines etc. The monitoring I have been talking about is basic in every hospital. I cannot fathom why most of the people here cannot grasp that.

      Reply
  30. Someone needs to be at fault? The hospital who under their care this happened? The nurses who are probably busy with their mobiles or the doctor because he was too busy to check on the girl. Or possibly the parents or the girl because she did not have immunity. In a country where the doctors are the “other army” (please forgive us) doctors should get away with everything. Next you will hear that engineers are another army and disaster hits and a building collapses, it is probably residents had too much furniture. All over the world there exist malpractice cases and Lebanon should be no different.

    Reply
  31. As much as I despise sensational journalism, this particular case requires a serious scientific investigation and legal trial.

    Treating patients over the phone is never a good idea.

    Parents waited five days before they went to the hospital. They should have ignored the doctor and gone to the hospital on the third fever day.

    Reply
  32. There has been negiligence and 3 misdiagnosis,will you keep defending this guy??we have no grudge against respected doctors(who are few),but this one was neglectfull.

    Reply
  33. according to your article without any name :
    …Again, what would I know. I’m sure that policeman in between his Malek el Tawou2 sandwiches was busy reading medical textbooks. Give me the differential of a crying baby, kind sir. Oh, you have cramps from all the garlic consumption? Excuse me.

    According to her parents, Ella had a high grade fever for which they contacted her pediatrician, Dr. Issam Maalouf, who ran some tests that revealed Ella most likely had a viral illness and prescribed medications to lower her fever.

    However, Ella’s fever did not subside and upon contacting the doctor again, he told them not to worry and to use cold towels to try and drop her temperature.

    When the parents saw that their child’s situation did not improve they took her to the hospital. It was a Sunday. The pediatrician did not see Ella that day and instead saw her the following day when she had already deteriorated.

    He got her transferred to AUBMC where further treatment was done. Ella, however, was in shock and in a state called DIC (Disseminated Intravascular Coagulation) and had gangrene in her limbs, which had to be amputated to save her life.
    ………………

    ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

    my opinion is that all those so called doctors that traeteed her are responsable but the biggest respònsability goes upon that first idiot ( Dr. Issam Maalouf, who ran some tests that revealed Ella most likely had a viral illness and prescribed medications to lower her fever. )

    he is the first responsable and those who folowed are other idiots …

    of course what you expect in a country like thsi SHit called lebanon . No responsabilities NOt punishments for those so called doctors who have the guts go go BARKING on medias supporting their mafia camarade ..

    this ISSAM MAALOUF shorld be cut into pieces to be an example for his fellow mafia gang

    some comments are so STUPID and juts reflect what kind of stupid people in this shit called lebanonn

    GUs : you are right but calling them animals is a n INSULt to the animals
    these are craetures should not breathing in this world . i am referring to this crimninal called isisam maalouf and all the SHIt that backed him

    ……………..and to the politician ;: running for presidency

    you have lost your human feeling ..
    at least ADOPT this innocent girl and pay all the necessary COST for her body member IMPLANTATION

    many countries Do implant members …
    ( Not that shit called france ) who would ask for millions of euros to do so
    REALLLy LEBANON is a small piece of SHIT ….a jungle SHIT SCUM like ISSAM MAALOUUF and his mafia gang Do these terrible things to innocent babies and bark about it on TV

    shit on you

    Reply
  34. “Ella is lucky to be alive. Do you know why she’s lucky to be alive? Because her pediatrician saw the signs early enough to transfer her to a hospital that can manage her well. ”

    YESSSSS 7 years in medical school and you’re still a 7mar(a). What saved her life is a miracle not some stupid Dr who should have known a high fever causes low immunity and might lead to a surinfection and she’s a freaking 9 mo old. He should have cared more.

    I hope you never get your license. you’re stupid.

    Reply

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