A leading orthopedic surgeon has been grilled over whether he illegally and unethically found patients in the United States for his leading prosthetic limb surgery.
Munjed Al Muderis is suing the Nine Network for defamation over a series of reports he claims ruined his reputation and set back the field of prosthetic limbs by 20 years.
On Monday, the surgeon faced questioning by Nine barrister Matthew Collins KC during which he admitted he did not have a licence to practise medicine in the US.
He said he only met with patients to give general medical advice regarding osseointegration surgery, in which prosthetic implants are surgically attached to the bone of an amputated limb.
Despite Dr Collins taking him to emails that referred to these events as "clinics", the surgeon denied they could be described in this way.
"It was a gathering," Dr Al Muderis said when asked if he was conducting a clinic.
In a May 2018 email ahead of an event in New York, Dr Al Muderis's colleague Solon Rosenblatt warned about the use of the word "clinic".
"Munjed will get into trouble for holding a medical clinic without a medical licence," Dr Rosenblatt wrote.
"That is a grave offence and could mean serious fines and also revoking of his visa."
In a separate email, Fred Hernandez - an American contractor for Dr Al Muderis's firm who also had one of his implants - sounded the alarm bell.
"There is no need to blast social media on this (as) he has no credentials to see patients in the US and a posting will only bring it to the attention of the wrong people," he wrote.
When pressed in the Federal Court about the reason for the emails, Dr Al Muderis denied knowing that he was proposing to do something illegal.
"And you sought to cover it up," Dr Collins added.
"There's nothing to cover up," the surgeon shot back.
The court heard Mr Hernandez was paid a monthly salary of $US3500 ($A5445) and earned a $US1000 commission for each implant he sold.
But a confidentiality clause barred him from divulging that he gained financially through these sales.
"Do you consider it ethical for a former patient of yours to receive a commission for the sale of your implants if they have not disclosed they are receiving the commission?" Dr Collins asked.
Mr Hernandez was an employee and it was irrelevant whether he was an ex-patient or not, Dr Al Muderis said.
"He got paid a salary and he got paid a commission per implant," he said.
"I can't comment about the ethics around it."
Earlier in the day, the doctor was grilled about an Australian patient, war veteran Mark Urquhart, who eventually removed his implant after complaining of pain, a protruding bone, foul odours and maggots.
"I have ruined clothes and furniture because of leaking body fluid and the continual bleeding," he wrote to the surgeon by email on December 17, 2020.
"Yesterday I sat on the toilet and as I sat a spurt of blood pfff all over the floor and even spitted out far enough to get the back of the toilet door."
Mr Urquhart, who is now wheelchair-bound, had been responding well to the implant and it was concerning he had gone to another surgeon to remove it, Dr Al Muderis told the court.
The hearing before Justice Wendy Abraham continues.
