Virginian anaesthesiologist Dr Tiffany Ingham Credit:The Washington Post When a medical assistant noted the man had a rash, the anaesthesiologist warned her not to touch it, saying she might get "some syphilis on your arm or something," then added, "It's probably tuberculosis in the penis, so you'll be all right." When the assistant noted that the man reported getting queasy when watching a needle placed in his arm, the anaesthesiologist remarked on the recording, "Well, why are you looking then, retard?" There was much more. So the man sued the two doctors and their practices for defamation and medical malpractice and, last week, after a three-day trial, a Fairfax County, Virginia, jury ordered the anaesthesiologist and her practice to pay him $US500,000 ($645,000). The plaintiff, identified in court papers only as "D.B.," wanted to maintain his anonymity and did not want to comment about the case, said his attorneys, Mikhael Charnoff and Scott Perry.

The anaesthesiologist, Tiffany Ingham, 42, could not be reached for comment, and her attorney, D. Lee Rutland, did not return messages seeking comment. Ingham worked out of the Aisthesis anaesthesia practice in Bethesda, Maryland, which the jury ruled should pay $US50,000 ($64,000) of the $US200,000 ($258,000) in punitive damages it awarded. Officials there did not return a call seeking comment. Ingham no longer works there, an Aisthesis employee said, and state licensing records indicate she has moved to Florida. An anaesthesiology practice in Tavares, Florida, said she no longer worked there. Calls to a number believed to be Ingham's were not returned, and there was not an answering machine or voicemail at that number. On the opening day of the trial last week, the gastroenterologist who performed the colonoscopy, Soloman Shah, 48, was dismissed from the case. Court documents state Shah also made some insulting remarks - "As long as it's not Ebola, you're okay," Shah was recorded saying during the rash discussion - and did not discourage Ingham from her comments or actions, which included writing on the man's chart that he had haemorrhoids, when he did not. Neither Shah, who did not return a message left at his office, nor the lawyers on either side would comment. The lawyers also would not discuss whether Ingham or Shah faced disciplinary action from the Virginia Board of Medicine. No actions are listed against either on the board's website. After five minutes of talking to you in pre-op, I wanted to punch you in the face and man you up a little bit.

The jury awarded the man $US100,000 ($129,000) for defamation - $US50,000 ($64,000) each for the comments about the man having syphilis and tuberculosis - and $US200,000 ($258,000) for medical malpractice, as well as the $US200,000 ($258,000) in punitive damages. Though the remarks by Ingham and Shah perhaps did not leave the operating room in Reston, experts in libel and slander said defamation does not have to be widely published, merely said by one party to another and understood by the second party to be fact, when it is not. "I've never heard of a case like this," said Lee Berlik, a Reston lawyer who specialises in defamation law. He said comments between doctors typically would be privileged, but the Vienna man claimed his recording showed there was at least one and as many as three other people in the room during the procedure, and that they were discussing matters beyond the scope of the colonoscopy. "Usually, all [legal] publication requires is publication to someone other than the plaintiff," Berlik said. "If one of the doctors said to someone else in the room that this guy had syphilis and tuberculosis, and that person believed it, that could be a claim. Then it's up to the jury to decide, were the statements literal assertions of fact? The jury apparently was just so offended at this unprofessional behaviour that they're going to give the plaintiff a win. That's what happens in the real world." One of the jurors, Farid Khairzada, said that "there was not much defence, because everything was on tape." He said that the man's attorneys asked for $US1.75 million ($2.25 million) and that the $US500,000 ($645,000) award was a compromise between one juror who felt the man deserved nothing and at least one who felt he deserved more. "We finally came to a conclusion," Khairzada said, "that we have to give him something, just to make sure that this doesn't happen again."

The colonoscopy took place in Shah's surgical suite on April 18, 2013, according to the man's lawsuit. While being prepped for the procedure, the man apparently told Ingham that he had passed out previously while having blood drawn and that he was taking medication for a mild rash on his genitals. Because he was going to be fully anesthetised, the man decided to turn on his cellphone's audio recorder before the procedure so it would be on to capture the doctor's post-operation instructions, the suit states. But the man's phone, in his pants, was placed beneath him under the operating table and inadvertently recorded the audio of the entire procedure, court records show. The doctors' attorneys argued that the recording was illegal, but the man's attorneys noted that Virginia is a "one-party consent" state, meaning only one person involved in a conversation need agree to the recording. The recording captured Ingham mocking the amount of anaesthetic needed to sedate the man, the lawsuit states, and Shah then commented that another doctor they both knew "would eat him for lunch." The discussion soon turned to the rash on the man's penis, followed by the comments implying the man had syphilis or tuberculosis. The doctors then discussed "misleading and avoiding" the man after he awoke, and Shah reportedly told an assistant to convince the man that he had spoken with Shah and "you just don't remember it." Ingham suggested Shah receive an urgent "fake page" and said, "I've done the fake page before," the complaint states. "Round and round we go. Wheel of annoying patients we go. Where it'll land, nobody knows," Ingham reportedly said. Ingham then mocked the man for attending Mary Washington College, once an all-women's school, and wondered aloud whether her patient was gay, the suit states. Then the anaesthesiologist said, "I'm going to mark 'haemorrhoids' even though we don't see them and probably won't," and did write a diagnosis of haemorrhoids on the man's chart, which the lawsuit said was a falsification of medical records.

After declaring the patient a "big wimp," Ingham reportedly said: "People are into their medical problems. They need to have medical problems." Shah replied, "I call it the Northern Virginia syndrome," according to the suit. The doctors argued that the Vienna man did not suffer any physical injury or miss any days of work. The man's complaint said that he was "verbally brutalised" and suffered anxiety, embarrassment and loss of sleep for several months. "These types of conversations," testified Kathryn McGoldrick, former president of the Academy of Anesthesiology, "are not only offensive but frankly stupid because we can never be certain that our patients are asleep and wouldn't have recall." Washington Post