When I started investigating Macchiarini's operations in 2015, the management of Karolinska University Hospital and Karolinska Institutet had long claimed that they had only performed life-saving care.

When their own four doctors and researchers discovered the opposite, they were opposed and threatened.

It was not until my and Dokument from within the series on SVT,

Experimenten

in January 2016 revealed what was going on, that they had to start investigating what had actually happened.

The management then blamed the incident on the Italian surgeon Paolo Macchiarini himself and fired him.

Based on research fraud

When the scandal became known, both management and Paolo Macchiarini himself continued to claim that they only had the patients' best interests in mind.

But the fact is that seven out of eight patients lose their lives in outrageous and very painful conditions.

After just over two years, Karolinska Institutet also stated that Macchiarini's scientific work on plastic throats was based on research fraud.

Operated on baby

However, Paolo Macchiarini was able to continue working as a surgeon and publish new research papers.

In 2018, one of his operations again resulted in headlines for "groundbreaking" surgical experiments.

It was at the University Hospital in Bursa, Turkey, that he performed an extensive reconstruction of the trachea of ​​a five-month-old baby - a procedure that, according to the Turkish press, was world-unique.

How it went for the little child is not known.

In 2020, Chief Prosecutor Mikael Björk brought charges against Macchiarini for aggravated assault and causing bodily harm.

He said that the surgeon had shown "special ruthlessness and rudeness" in his professional practice when he carried out illegal operations that were contrary to Swedish law, science and proven experience.

This means that the activity cannot be considered healthcare.

Nor had Macchiarini been involved in any licensed research study.

The responsibility of managers

It is very good for healthcare and medical research that prosecutors and police have now succeeded in taking the Macchiarini scandal to court.

A conviction in Solna District Court would have consequences in principle for Swedish and perhaps international healthcare.

Advanced surgical research and treatment require many involved.

Even if only one person were to become legally responsible, it is also managers' and management's omissions or assistance that is required for this to occur.

Therefore, it is important to get clarity on a number of issues:

When does criminal liability arise in healthcare for doctors who violate ethical or scientific principles?

What responsibility do hospital and university management have for illegal activities?

When should colleagues, managers and management have realized what was going on and acting?

A conviction should also contribute to patients and their relatives receiving proper excuses or compensation.

They have not yet received it.

Advertised the operations

Macchiarini himself also believes that it is unfair that only he is charged.

The Swedish operations had approvals from managers and hospital management.

Both Karolinska Institutet and Karolinska Hospital had repeatedly used Macchiarini's operations and research in advertising for how good their own operations were.

The district court's ruling is expected on May 23.

Whatever it is, both the prosecutor and the accused will probably appeal to the Court of Appeal.

At the earliest, the case can be legally tried this autumn.