It is a curious defence, the one summed up Thursday by the lawyer for Dr. Behnaz Yazdanfar, the former family doc-turned-cosmetic surgeon who is charged with professional misconduct and incompetence in the Sept. 20, 2007 death of Krista Stryland.
The 32-year-old Toronto real-estate agent died of hypovolemic shock, which means there is inadequate circulatory volume to sustain the normal functioning of vital organs, after what's called a "large-volume" liposuction procedure to remove fat.
Tracey Tremayne-Lloyd was giving her closing submissions to the disciplinary panel of the College of Physicians and Surgeons of Ontario, which has heard evidence over more than 60 days.
Basically, Ms. Tremayne-Lloyd said that the college is on a witch-hunt against Dr. Yaz, as she is widely known; that its prosecution of her amounts to a persecution and that her client's few acknowledged errors were nothing compared to the mistakes of others, who were more responsible for Ms. Stryland's care than she was.
If only, Ms. Tremayne-Lloyd said, the panel "follows the evidence," the members will realize there is not "a scintilla" of truth to the allegations against her.
The entire hearing, she said, was nothing but "poisonous, unsubstantiated, nasty character assassination… It's outrageous what's gone on here. Let's look at the evidence; let's follow the evidence."
This latter, Ms. Tremayne-Lloyd said so often, it was occasionally tricky to remember one was not watching CSI Miami, with that tiresome Lieutenant Horatio Caine, but rather a real-live proceeding.
Virtually everyone who was involved in Ms. Stryland's care at Dr. Yaz's Toronto Cosmetic Clinic that day has faced or is facing discipline proceedings by their professional colleges.
The CPSO, for instance, is also proceeding against Dr. Bruce Liberman, the anesthetist, its investigation starting Nov. 27, 2007; that hearing is drawing to a close and will resume this fall.
Similarly, the college sought to restrict Dr. Liberman from practising in the interim, just as it has Dr. Yaz pending the panel's decision. But when the matter went to the Ontario Divisional Court, the court ruled the two cases were easily distinguishable and that there was no evidence of probable harm to future patients posed by Dr. Liberman.
But the point is, the college isn't singling out Dr. Yaz - except, of course, insofar as her alleged professional shortcomings may have come to personify one side in the simmering battle between those doctors who, without surgical training or with minimal training, are allowed by the college to do "cosmetic procedures," and the long-trained plastic surgeons who also do them.
But otherwise, as prosecutor Carolyn Silver said in her reply, there's no evidence that "anything other than the usual investigation … led to this prosecution."
The two nurses who were on duty at the clinic that day are also being investigated by their college. Considering the care and treatment given Ms. Stryland, it seems only reasonable.
She went into the operating room as a healthy young woman. By 3:15 that afternoon, by the most favourable light to Dr. Yaz et al, Ms. Stryland was dying, and by much of the evidence she was in trouble, her condition deteriorating, almost as soon as she was wheeled into the recovery room.
Yet but for Dr. Liberman - who allegedly failed to recognize how serious her condition was and certainly didn't call 911, but was at least leaving the O.R. to check on Ms. Stryland and tried to stop her decline - no one else did anything to help the young woman.
It was at 3:15 that Dr. Yaz admits learning how grave was her patient's crisis, yet she spent only 30 seconds with her before returning to another patient having lipo, finishing up that procedure, and scrubbing out.
Then, by her own admission, she paced the halls, in a state of panic, for another 17 minutes before finally calling 911 herself.
By the time the paramedics arrived, Ms. Stryland was ashen, lying in a pool of dark bloody fluid (leaking from her body so much that one of the paramedics needed a plastic apron to stop the splashing) and vital signs absent.
Dr. Yaz didn't accompany Ms. Stryland to hospital, made no notes and actively thwarted the college's attempts to interview her staff and conduct its probe (and that was the Divisional Court saying that, not the college or the prosecutors).
Indeed, within two days, she was back doing more large-volume liposuctions, just as the college alleges, removing from her patients more than the recommended maximum amounts of fat and fluid.
After her death, for instance, an autopsy revealed Ms. Stryland had had liposuction at 23 sites over her body (multiple sites is another risk factor), and that Dr. Yaz had removed 6.6 litres of fluid in total, what one expert witness said "in a small lady is a heck of a lot." The standard in Ontario is a maximum of five litres total fluid.
Ms. Tremayne-Lloyd has alleged the college, under pressure from plastic surgeons, is persecuting Dr. Yaz (an assertion the court rejected) and hints at some vague conspiracy.
Yet the in-cahoots shoe seems to better fit, as Ms. Silver pointed out, Dr. Yaz and her staff. It's the clinic which is paying for the nurses' lawyers and it's one of them who has recently enjoyed a "recovered memory" that just happens to put more distance between the time she and Dr. Yaz recognized Ms. Stryland was in difficulty.
At the end of the hearing, though every person on the medical team had a role to play, the standard of care given that nice young realtor was, as one expert testified of Dr. Yaz's work in another case, "so far from the standard of care it's frightening."
The panel has retired to consider its decision.
cblatchford@globeandmail.com