Napoles' bleeding could lead to cancer, doc says

MANILA, Philippines - The chief of the Makati Medical Center's Department of Obstetrics and Gynecology on Tuesday told a Makati court that businesswoman Janet Lim Napoles has the right to choose her own doctor and hospital for the treatment of her uterine myoma.

Dr. Santiago del Rosario who was presented by the defense panel as an expert witness in the hearing continuation of Napoles' petition for surgery and hospital confinement at the Makati Regional Trial Court Branch 150 said  that the businesswoman has that right under the Declaration of Lisbon on the Rights of the Patient which was adopted by the World Medical Association in 1981.

"The Declaration of Lisbon, enacted by the World Medical Assembly, recognizes the patient's rights. The patient has the absolute right to choose his doctors and seek medical attention. The patient has the right to choose medical attention from her physician of her own choice," he said.

"The patient whether free or incarcerated has that same right," Del Rosario, a doctor of more than 60 years in practice as a gynecologist and former president of the Philippine Medical Association added.

Police Inspector Michelle Daguno, head of the gynecology ward of the Philippine National Police General Hospital, earlier told the court that Napoles  has a 6 cm. uterine myoma which has caused her uterus to be distended to the size of woman who is three and a half months pregnant.

Daguno told the court that should the court order it, the PNP general hospital has doctors who could perform the surgery on Napoles and have the myoma removed.

Daguno however added that there is no urgency for Napaoles to undergo surgery to remove the myoma as it is not life-threatening.

"Based on the size, it is not dangerous and life-threatening. Myoma uterine can go away. When you go into menopause, it will not grow bigger," said Daguno who had also earlier examined Napoles at the PNP General Hospital.

A uterine myoma (also called fibroid, leiomyoma, leiomyomata, and fibromyoma) is a benign (non-cancerous) tumor that grows within the muscle tissue of the uterus. There can either be one dominant myoma in the uterus, or a cluster of many small myomas. Uterine myoma ranges in size from larger than a melon to as small as a coin.

According to www.myoma.co.uk, 20 percent to 50 percent of women of childbearing age have uterine myoma. While many women do not experience any problems, symptoms can be severe enough to require treatment. For example, a very large myoma may cause the uterus to stretch to the size of a six- or seven-month pregnancy.

Daguno, when asked by presiding judge Elmo Alameda said the PNP general hospital has 40 doctors, five of whom are obstetrician-gynecologists (OB-GYN) who could perform surgery on Napoles to remove the myoma.

However, when asked by Judge Alameda, Daguno said that unless ordered so by the court, PNP doctors could not operate on Napoles if she refuses.

Daguno said that while Napoles is considered a detainee, she retains the right to choose her own doctors.

"She must consent to the operation," said Daguno.

Daguno added that the removal of a uterine myoma is an elective procedure and that it could be scheduled.

Daguno, who has 16 years of experience as an OB-GYN, said she could perform the surgery on Napoles at the PNP General Hospital.

Last March 4, Napoles, through her lawyers asked the court to be allowed to have surgery and be confined at the St. Luke's Medical Center at the Bonifacio Global City.

In an 11-page "Motion to Undergo Medical Surgery and Hospital Confinement" filed through her lawyers, Fay Isaguirre Singson and Evita Magnolia Ansaldo, Napoles asked that she be allowed to undergo surgery at the St. Luke's Medical Center-Global to have what appears to be a cyst found in her uterus removed and then be hospitalized for post-operative care.

Meamwhile, Del Rosario said Napoles' reported myoma with heavy bleeding is a serious medical concern as it could lead to cancer.

"Newspapers said she was bleeding for one month. Myoma with bleeding commands an immediate medical attention especially with women of middle age. In women of middle age, bleeding introduces cancer and when cancer is part of the doctor's impression, a delay can spell the difference between a cure and no cure. And cancer is a serious medical condition," he said.

Del Rosario added that only a medical center is equipped to treat Napoles unlike the PNP General Hospital, which he said, lacks the needed facilities.

According to Del Rosario, Napoles' on and off bleeding last December has led to a loss of 1 gram of hemoglobin.

"In effect she lost two liters of blood. A normal person has six liters of blood. A lost of that much will affect your motion," he said.

Del Rosario added that heavy bleeding for Napoles who is now 50 years old is unusual as the average Filipina stops menstruating at age of 49.

"She is a 50 year old woman, even if she looks just 40. In these women, they have the risks of cancer of the reproductive tract more than the average woman. One of the possibilities of a 50 year old woman having bleeding, is cancer..." he said.

When asked by the prosecution panel, Del Rosario admitted that there are other ways to treat uterine myoma aside from surgery, including the use of steriods, artery embolization and hormone therapy. However, he stressed that of these methods, surgery remains the safest.

"The only danger in surgery is bleeding. But it is easy to clamp and suture. It has been performed by specialists. These other methods are limited,"he said.

Del Rosario also said that depending on the results of more tests, Napoles could undergo either an operation just to remove the myoma (myomectomy) or even remove the entire uterus (hysterectomy).

Del Rosario also told the court that while either a myomectomy or a hysteroctomy would only take an hour to be finished, the healing and recovery time at a hospital could take from four to six weeks.

"Basta binuksan ang abdomen, that is already a major operation," he said.

The court has set one more hearing on Napoles petition on March 21 at 10 a.m. as Judge Elmo Alameda ordered that a doctor who conducted laboratory tests on Napoles' blood samples last October at the Accucell Diagnostic Laboratory be subpoenaed and made to appear in court.

Alameda ordered that Dr. Romil Aguirre be summoned after the court learned that the results of a test showing a drop in Napoles' hemoglobin count from 12.6 grams to 10.4 grams was for a woman identified as "Jenny Tan."

Del Rosario told the court that Napoles' lawyers earlrier informed him when they sought his expert opinion that "Jenny Tan" was in fact Napoles. Del Rosario said Napoles' lawyers told him that the businesswoman's identity in the test result was kept secret for security purposes.