Elie Khoury took action against fellow doctor David Kirwan in the Supreme Court over emails and oral statements he claimed were defamatory.

That in turn led to contempt of court proceedings against Dr Khoury and his partner, Jessica Nowell, over the disclosure of subpoenaed documents.

It was revealed in written findings on Friday that the costs in the contempt proceedings alone, not including the defamation action, totalled an estimated $529,635.

Dr Kirwan estimated his costs in the contempt action, which concerned emails being wrongfully forwarded on, were $299,000.

Justice John Dixon said while it was common for hard-fought legal contests to incur large legal fees, "this is a surprising and extraordinarily high claim".

Dr Khoury claimed in the defamation action that Dr Kirwan had implied he was a "serial killer".

In his statement of claim, Dr Khoury said Dr Kirwan had told others "he's killed another one" in reference to a patient.

He said it was implied he was unfit to practise as an orthopaedic surgeon and "had killed more than one of his patients", and implied he was a rogue surgeon.

The case was settled out of court and Dr Kirwan issued an apology.

It's unclear what, if any, financial terms, were reached between the parties.

"You allege that I defamed you by making statements which imputed that you killed or harmed some of your patients deliberately or recklessly and that you are unfit to practise as an orthopaedic surgeon," Dr Kirwan had said in his apology.

"I withdraw any such imputation unreservedly and if you or anyone else understood my statements in that way, I retract the statements and sincerely apologise to you and your family for the professional and personal damage that such an imputation would have undoubtedly caused.

"I also acknowledge that there are no restrictions on your registration and the Medical Council of New South Wales has determined that your professional performance is satisfactory in that it is at the standard reasonably expected of a practitioner of an equivalent level of training or experience."

Justice Dixon has now fined Dr Khoury $5000 for the contempt of court.

Justice Dixon on Friday said no fine would be imposed on his partner for her role in the contempt.

The Supreme Court, in a brief finding lasting minutes, heard the couple would have to pay some of the costs in the matter.

Justice Dixon noted the importance of protecting the confidentiality of documents produced to the court.

Dr Khoury and Ms Nowell must pay some of the costs incurred by Dr Kirwan, and Dr Jeremy Kolt.

Dr Kolt's emails had been forwarded on by Dr Khoury and Ms Nowell.

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