Friday, April 26, 2024

MEDELLÍN, COLOMBIA: Circumcision Patient Murders Urology Surgeon


Feelings of revenge by circumcised men against the doctors who circumcised them are not unheard of. In fact, poetry has been written on the subject. What is unheard of, however, is the revenge actually taking place. In this post, I'm going to post about an assassination incident that happened in Medellín, Colombia, where a patient takes matters into his own hands.
What I've done is taken different reports in Spanish, translated them and posted them here to give a composite picture of what happened, what people at the scene of the crime have said, as well as what the family of the assassin had to say.

The following was taken from El Tiempo:
 Alleged assassin of urologist found lifeless in a restroom at Clínica Medellín
Urologist Juan Guillermo Aristizábal
On the morning of Thursday, April 18th, Colombian urologist Juan Guillermo Aristizábal was assassinated at Clínica Medellín, a clinic located in the El Poblado district in Medellín, Colombia. It happened at 10:30am, consultation room 908, when consecutive shots were heard on the 9th floor following a fire. He fired point blank, in succession against the specialist without saying a word.

"An armed person enters with a firearm and attacks a physician working in his consultation room who dies on the spot," Óscar Lamprea, comander of the Aburrá Metropolitan Police Force said. "The aggressor exits and seals himself up in another consultation room."

The incident the urologist's assistant wounded and is being attended at the same medical facility for a bullet wound. The woman, who has been identified as Daniela Díaz, survived the incident, is recovering and is not in any critical condition.

After the shooting, those who were on site alerted the authorities whom arrived within minutes.

"There's a fire of unknown origin. The presence of somebody in the consultation room from which smoke is emerging can be confirmed. The police went in in full force and cleared the area but did not find anyone. When they opened the door to the bathroom, they found a person with no signs of life, who would be the presumed aggressor with a firearm by his side," the official added.

Since there were no official captured suspects for this crime, many present were required by the authorities to give their side of the story. The police spoke with more than 10 persons who have been dismissed.

The following was taken from infobae: (information repeated above omitted)
Assassin of Juan Guillermo Aristizábal Identified
The murderer of the Medellín doctor has been identified as 38yo Jhon Ferney Cano González, a patient who had "unwanted results." It appears the culprit intended to burn down the clinic, and then committed suicide in one of the bathrooms of the medical center.

Cano González is said to have been suffering schizophrenia. According to Juan Camilo Arango, a friend and colleague of the murdered doctor, "We physicians are in a precarious situation because we're victims of constant death threats and extortion by blackmail, because we’re seen from the point of view of results, and not a means. Everyone wants to be guaranteed favorable results, but people forget that we're not machines, but humans attending other human beings."

Previous reports suggest that the urologist had been attacked and threatened by the same patient on previous occasions, causing the doctor to seek restraining orders to prevent Cano from accessing the clinic. Arango says this is relevant because it affirms that the patient attacked Aristizábal due to unfavorable results. He says "Memo" (short for Guillermo) had problems with the patient due to an adverse outcome, because, he argues, the culprit was a psychiatric patient who blew the negative results out of proportion due to trauma or his psychiatric pathology, and had threatened "Memo" for a long time.

It is speculated that, even though the patient signed the consent form for the procedure he would undergo, everything indicated that he presumably had a mental disorder.

"For medical ethics, you have to inform the patient about everything that could happen; the patient signs the document to indicate that he was fully informed, but with a psychiatric complication, he could have signed 50 consent forms and the patient would have still had a problem and acted on it. These consent forms are for legal purposes, where the rights of the patient are protected, but never the rights of the physician," said Arango, friend of the murdered doctor.

According to Arango, coincidentally, despite the fact that the doctors' assistants and personnel the clinic were already aware of previous threats, "His secretary was tending to a medical appointment, and a different assistant who was uninformed about the matter was at the front desk, and it looks as if this man, the one who committed suicide, the assailant, was in a psychiatric appointment. He ascended and took advantage of the moment to cause disaster."

When asked as to whether the medical facility knew about this case, Arango said "I know that the situation in which we live in this city and in the rest of the country is one of much insecurity. I imagine that the administration knew what was happening, and, as far as I know, this person was being attended here in the psychiatric department at this institution. I don't know where they could have failed."

Juan Camilo Arango, friend and colleague of the urologist alleges that the assassin was a "mental patient, and that he was at the clinic for a psychiatric appointment, but another news report says differently; in this report by El Paíz, Jhon Ferney Cano actually sat in the waiting room, waiting to be called.
According to the Secretary of Security for the city of Medellin, after being called by doctor's assistant Manuel Villa, he approached Daniela Díaz, attacked her and immediately headed for consultation room 908, where 58yo urologist Juan Guillermo Aristizábal would be working. Cano shots and the doctor died. It was then he locked himself up in the consultation room and lit it on fire.

The police arrived and attemped to convince him to turn himself in, but he refused, and minutes later, the men in uniform enterd by force. They inspected the room full of smoke and found Cano in the bathroom, sprawled dead on the floor with the revolver he used by his side.

The incident, which happened in the tourist district of El Poblado de Medellín, generated panic in and out of the clinic, which was evacuated in order to resolve the situation.

Friends and family of Aristizábal allege that this assassination was entirely preventable. They say that the doctor already knew Cano and had him referenced as a dangerous person. According to the urologist’s friend and colleague, the assassin had been a patient of Aristizábal until a procedure went wrong. Arango affirms that Cano suffered psychiatric problems he never overcame.

"He exaggerated probably due to a trauma or his psychiatric pathology and he threatened the doctor over a long period of time. There were many death threats that were taken to the authorities," Arango said. Arango has a plastic surgery practice on the 7th floor of the building where the assassination happened. "He was a patient with psychiatric problems and his scapegoat was Dr. Aristizábal."

Aristizábal practiced as a urologist at Clínica Medellín for over 25 years. He graduated from CES University, specializing in health and located in the capital of Antioch, where he also gave classes in neurology and semiology. He would play the drums on his free time. He was married to María Isabel Trujillo, with whom he had two children, Paulina and Miguel. Another doctor from the same clinic told El Colombiano that he would remember him as "an excellent person and great friend."

The subheading on a different report by Noticias Caracol reads "An affront to all medicine." It is this report where we finally learn that the patient was unhappy with the results of a circumcision.
The crime was "an affront to all of medicine in this country." says Arango. "Quite simply we doctors have been put on a tier of gods, and we're not gods, we're human beings. Medicine is not science, medicine is the art of interpreting signs and symptoms, which are different in each human being. It needs to be clear that we are human beings attending other human beings. We are not robots. We also suffer, cry, we stay up late worrying about the problems our patients have, and to be a doctor we have to have much human quality, and people are not acknowledging this; they're stigmatizing us and we're always in danger. I've personally had to face grave situations."

I'm not sure if my readers can read between these lines, but, to quote Queen Gertrude from Shakespeare's Hamlet; "The lady doth protest too much, methinks." Arango really wants to pin Cano as a "psychiatric patient," but this is a fabrication, and when you put together that both Arango and Aristizábal operate on healthy patients, (Arango realizes plastic surgery, and Aristizábal profits from circumcision) it becomes clear that Arango is no stranger to fending off disgruntled patients with adverse outcomes, and his guilt is doing the talking.

In a different report, where news outlet El Colombiano has gone to the family of the assassin, who say that although he did have appointments with Aristizábal, Cano was no "psychiatric patient."
Pictured: Assassin Jhon Ferney Cano González

Family members of Jhon Ferney Cano narrate that he was the youngest of 7 siblings, lived with his brother Alexander Cano in the same room, and tended to talk extensively about the difficult situation he was facing, and how he suffered constantly due to the adverse medical outcome of his medical procedure.

"He never told me that this is action he would take. I’m in disbelief and I keep telling myself that this is all just a bad dream," said his brother Alexander, shocked by the news. "We as his family want it to be known that we are as shocked and surprised as the doctor’s family."

Recently, Cano's family found a 362-page-long text file on Jhon's personal computer, where he narrates his suffering due to a circumcision, with which he justifies the medic's homicide. The document was protected with a password that after various attempts, the family was finally able to decipher.

Marcela Cano, Jhon's 2nd sister, said he had a lot ahead of him. He studied 4th semesters of electrical engineering and enjoyed activities such as basketball, and collecting guitars.

"We never expected it would all end this way for him," they shared. "The lack of medical help was due to a series of manipulations on the part of the first doctor who attended him. Initially, he was able to get appointments by way of his EPS, but then, after facing long delays, he chose to go to a private doctor." This is how he arrived at Aristizábal's office.

"It was a misdiagnosis and a bad procedure, together with lack of information that provoked two and a half years of continuous pain," said one of his sisters. Jhon did go to many psychiatric and psychological appointments, although he was not a psychiatric patient before. On the contrary, psychological care was recommended to rule out that his problem was mental.

Jhon's text file narrates that he was medicated with various antidepressants. After investing much money in treatment without any success, he felt abandoned by the medical system.

The problem with the uorolgist started when he tried to confront him for the consequences of the surgery. "This isn't going to stay the way it is," Jhon told the doctor. After the threat, the doctor reported him and Jhon was summoned to the prosecutor's office.

"His search for help at other urological consultation offices in Medellín was not fruitful, as the doctors he encountered didn't want to incur any responsibility for the poor procedure" said one of his sisters.

The physical pain that Jhon would experience was not taken seriously by various physicians, who attributed his woes to mental problems, his family said. Even so, "He insisted that his pain was real and that it increased every day." After telling his brother Alexander his symptoms, he sought medical help in different places, but he faced the same evasive answers.

"It started with a pain in his penis, specifically in the urinary meatus, located at the tip. After his first revision at the EPS, they told him his pain was of mental origin, even though he insisted it was physical and it increased every day, even going as far as feeling it in his spine." This is what his brother said regarding Jhon's symptoms.

At first, Aristizábal did not consult Jhon directly. Instead, Jhon first sought help with Aristizábal's teacher, who referred him to Aristizábal after deciding to retire. According to his family, in one appointment, it was determined that John suffered anxiety due to the pain, but he also expressed feelings of revenge.

In his last days, his state deteriorated notably; he stopped eating, he became withdrawn and wouldn't say a word. It is unknown how he got the firearm he used in the crime, although it is speculated that it could have been through a past acquaintance. The whereabouts of his cell phone are unknown.

"We tended to talk late. One night, he told me the pain began as he tried to sit down; he felt a sudden pain in his back that radiated to his organs and nerves of his spine until reaching his penis. He tried to find help at various medical departments, even dermatology," the family said.

"He lost more than half of his sensation, and he could no longer be with any woman; he left his girlfriend and would not sleep. He was always repeating that he needed to get revenge. He told us, and a psychiatric doctor also kept a record. Despite filing complaints, there was negligence on the part of the Prosecutor's Office. We tried to talk to him, but he remained resolute even after the settlement hearing. That day, the doctor offered 5 million in compensation, but John didn't accept it on advice from his lawyer," his brother said.

“On psychiatric observation records, the psychiatric department wrote "expresses desires of revenge." The Prosecutor's Office already knew there were threats, but was negligent. Even though we all tried talking with him, he had already made his decision and he had a clear goal. We never thought he'd actually go through with it. Jhon said that the pain was as if there were a beehive at the end of his penis all day long.”

The family's one claim was their demand for his medical history. They comment that Jhon, in his intention to seek treatment from other places, asked for his medical history, but he was told that it had all been destroyed, and that, apparently, it no longer existed at Clínica Medellín.

The unfolding of this story, with the death of the doctor at the hands of Jhon, has left deep pain and emotion across many families and all of the community. While Jhon's family seeks answers and his medical history, the pain and suffering also experienced by the doctor, and other people affected by this tragedy cannot be ignored.

This was a difficult post to write because as I read these reports, I don't know what side to take. On the one hand, murder is murder, and I want to feel sorry for the doctor and his family, but on the other hand, I can't feel sorry knowing how evasive he was actually being. His "friend" is trying to help cover for him by trying to label the assassin as a "mental patient" and it's disgusting. If Jhon’s family is correct, other doctors didn't want to touch him because of how badly the procedure was screwed up.

Questions arise. If, as Aristizábal's friend insists, the assassin had a record of "schezophrenia," what is the reason he was not first referred to the correct department instead of asking him to sign an informed consent form? Why did the doctor receive that form as "legit" if it was known that, allegedly, the patient didn't have full faculty? Would this not have been taking advantage of an impaired patient to obtain a sham consent form?
Was the patient actually fully informed of all the risks of adverse outcome?

Was there actually a medical necessity present warranting surgery? Or did the doctor sell John a bill of goods?

While it's true that patients can exaggerate and raise false claims, doctors also have to cover their own asses, and it is clear here that the doctor's "friend" seems worried that the patient may indeed have had a legitimate claim. There has to be a reason why he seemed intent on writing him off as a "mental patient." On the one hand, doctors do need to be protected. On the other, so do patients. Charlatans and grifters do exist, and where liability can be waived by signing a consent form, a patient can be screwed over if he was in fact, not actually fully informed, or worse yet, misinformed.

The friendly doctor here is trying to paint the situation such that doctors are "victims," but the situation is a lot more nuanced than that. Doctors who are treating sick patients, patients who have clinical indication for treatment and surgery have nothing to fear. Patients must understand that an outcome may not be favorable. But when it comes to doctors operating on the HEALTHY, the situation is rather different, because a patient who faces an adverse outcome has gone from a healthy state, one where he is not facing a problem at all, to a state were there is now an iatrogenic problem that wasn't there in the first place, and there are reasons why doctors who perform circumcisions may not be fully informing their patients as to the negative outcomes, namely that they reap profit from the procedure.

If this man was fully informed, he should have understood what he was getting himself into. On the other hand, it is problematic if doctors are in a position where they can perform surgery without fully informing, or even misinforming their patients of adverse outcomes, and be immune to lawsuits having obtained a sham consent form from patients.
While I can't condone men shooting the doctors who circumcise them, laws do need to change, but not in the may Arango hopes; it's patients who need to be given the power to sue doctors who didn't fully inform them. Doctors need to be absolutely sure their patients understand the ramifications of surgery to alter normal, healthy tissue. If it can be proven that a patient was not fully informed of an adverse outcome, or that he was deceived in a court of law, patients need to be awarded damages. And, if they are left in a situation where doctors can get away with performing surgery on healthy, non-consenting individuals, patients are being defrauded, it should be of no surprise if patients decide to take matters into his own hands as this one did.

One often hears that the complications of male circumcision are "next to none," but this is only what is said. In 2012, the American Academy of Pediatrics conducted an extensive review of the whole of medical literature regarding the topic of male circumcision and concluded that the medical benefits are "not enough" to recommend the procedure for all infants. Furthermore, they concluded that "the true incidence of complications after circumcision remain unknown.", and it must be asked "Why?" It must be asked, in a reality where the true incidence of complications after circumcision are unknown, how is it even possible that parents and patients can be making informed decisions? When patients and/or their parents sign a consent form, what does it actually mean? Well, in this story we see a glimpse.

When there are adverse effects, medical organizations are loathe to acknowledge them and treat them as if they didn't exist. Doctors and hospitals would rather say it's "mental" than to admit that a problem is due to the procedure they're making money from. 

Doctors and hospitals keep deferring and passing the buck, hoping the problem goes away. Often the only recourse patients have is to give up and suffer in silence, or, in worse case scenarios, act out as the young man did in this story. The problems are ignored, and thus the lie that "the risks of circumcision are minimal" continues to be repeated.

Again, I'm not saying it was justified to kill this doctor, but when a young man is left with half sensitivity in his penis gone, the sensation of having a beehive at the end of his penis all day, and doctors and hospitals minimizing his problem and gaslighting him by telling him his problems have nothing to do with the procedure that obviously gave him his problems, calling him a "schizophrenic mental case," what recourse does a young man have? Who is holding doctors who get away with medical fraud accountable?

This isn't the first case of a man unhappy with his circumcision. There are countless stories of men confronting doctors who circumcised them, only to be told that "it's all in their head," only a few of which actually make headlines. Tragically, it took a murder for this man's problems to make headlines. How many other men suffer in silence?

Two cases come to mind:

The above two stories can be accessed here and here.

"But that's only two," some might say. Yes. Two that made the news. As demonstrated here, others suffer in silence, being gas lit into believing their pain and and anguish has nothing to do with the fact one of the most sensitive parts of their penises has been sliced off.
Finally, the Global Survey of Circumcision Harm is another testament to this fact.

The bottom line is, while this doctor's murder and this patient's suicide were tragedies, medical organizations need to acknowledge that circumcision can and does result in adverse outcomes, patients need to be fully informed before being asked to sign a consent form, and fraudulent doctors who profit from non-medical procedures on healthy, non-consenting individuals need to be held accountable.