Warning of 'hindsight bias' in Charlie Teo hearing

Lawyers for brain surgeon Charlie Teo have warned a disciplinary board to avoid "hindsight bias" in ruling over surgeries he performed that left two female patients with catastrophic brain injuries.

Dr Teo faced a final Health Care Complaints Commission (HCCC) hearing in Sydney on Wednesday, before deliberations begin as to whether he should receive a professional reprimand and additional oversight on his practice.

Allegations include that Dr Teo failed to properly inform the patients of the risks involved with surgery, failed to gain proper patient consent, slapped one of the patients in the face and used unprofessional language during consultations.

Commission Council Kate Richardson said during her closing submission Dr Teo removed an extensive section of one patient's right frontal lobes without informing her first.

Dr Teo's lawyer Matthew Hutchings argued what neurosurgeons intend to do prior to a surgery, and what actually occurred, sometimes varied greatly.

He said judgements were sometimes made "in the heat of the moment" during a procedure and that a "hindsight bias" shouldn't be applied to the complaints.

Earlier on Wednesday, Ms Richardson argued Dr Teo showed a lack of judgement and insight in how he interacted with patients' families and how he dealt with discrepancies between his own views and the opinions of other experts.

She questioned the future risk to the public in Dr Teo's response to allegations he slapped a patient across the face in view of her family members.

Dr Teo told the hearing this week it was not a "Will Smith-type slap" and that he would continue to rouse patients using the method.

"He identified in his view his key shortcoming was that he did it and the family could see," Ms Richardson said.

Mr Hutchings noted Dr Teo's skill as a surgeon was not in question by any of the experts who appeared at the hearing.

"It cannot be said the surgery wasn't done with due care and skill, appropriately attempting to deliver on what was planned," he said.

Mr Hutchings said when surgeons have poor outcomes, as was the case for Dr Teo, they reflect on them in order to learn so they can do better next time.

"It's the very thing that medical science relies on. We learn as we go. It's an iterative process," Mr Hutchings said.

Passionate support for Dr Teo may hold little weight in the board's decision whether to impose a professional reprimand and conditions on him.

Letters from ten overseas-based neurosurgeons and 47 former patients and their families were tendered to the board, along with three emails and one letter of support from Australian medical professionals.

No formal statements of support were provided by Australian-based neurosurgeons despite Dr Teo reaching out to two of his colleagues, the hearing was told.

Commission junior counsel Megan Caristo submitted that the expert panel give "little weight" to the material as they don't relate specifically to the complaints facing Dr Teo.

"There is not anything in those letters or statements on their face to show the authors … were aware of the complaints and their particulars" Ms Caristo said.

Dr Teo has previously admitted he did something during surgery that caused the injuries to the women, but firmly rejected suggestions he was negligent.

"I also want to try to understand why the patient had a bad outcome," Dr Teo told the inquiry on Tuesday.

"Clearly I've gone too far somewhere."

A four-person Professional Standards Committee will deliberate on a decision.