A (3:55)

I suppose it's surely incumbent upon the authorities around that story to make sure it never happens again. Because what we see in Sick to Death is a number of people. Jayant Patel in particular obviously stands out, who has glowing references, even though he actually has a past history of malfeasance, of putting patients in danger, of, you know, he actually has a terrible work history, but he can roll up to Queensland Health with glowing reviews from previous colleagues.

B (4:27)

That's right. And I think what we learned is that if you are a doctor who is so bad that you're hurting or potentially killing patients with your appalling surgical technique, the effort that an investigative authority needs to take to prove that is quite large and costly. And so if the doctor getting wind of a complaint just leaves, resigns from his job, leaves that particular jurisdiction, that state, or. Or even goes to another country, then there isn't, in his absence or her absence, any impetus for the authority charged with investigating this to do anything about it. They'll just say, well, he's left. We don't need to deal with this anymore. But then, even though they may have serious complaints on their files that they haven't yet properly got to the bottom of, there isn't a system whereby they follow the doctor where he went to and then alert the authority in that country. We see so and so has turned up. Before he left, we had some grave concerns. Here are the files that we collated. You might want to have a close look at him. He left before we could do much about it. That kind of thing doesn't occur. And in the case of Patel, where he had been through a regulatory process and he was rubbed out in the United States, he had senior doctors writing glowing references which do not give any clue to the appalling disciplinary findings against him.

A (6:13)

When I was listening to that, I wondered again. I suppose I'm thinking very conspiratorially at the moment, but I wondered, are they doing that to help him go? As in, good, get out of our hospital, I'll write you a letter. I don't care where you go, just don't be our problem anymore.

B (6:29)

Yeah, maybe. I mean, I tried to interview at least one of those referees. I know that a colleague, Tuck Thompson, who went to the United States at the same time that Paul Barry then from 60 Minutes was trying to talk to Patel. Tuck also attempted to interview at least one of the referees, and Tuck told me the response he got was, you know, how dare you come to us and ask us to explain ourselves? Who do you think you are? So very weird kind of situation, like you would hope that doctors who know that a colleague is under severe disciplinary scrutiny and has been the subject of damning findings would either decline to give a reference or just give it truthfully. But is the fear of litigation, for example, so great that they think, well, we won't mention the real truth here, we'll try and, you know, write around it and sugarcoat this in a way that means that he gets out of our jurisdiction. And there's another one, and I suppose

A (7:50)

I never thought of something you just alluded to then, which is that any. Any suggestion of guilt, any suggestion of knowledge, can put people at risk of litigation and put institutions like hospitals at risk of huge amounts of money in litigation. So there's so much watching your own back and all of that here, isn't there?

B (8:12)

Yeah. And the bureaucrats are often overly concerned about the political response, so the Minister's office and the Minister's chief of staff and the Minister's advisors can just strike fear and lead to the public servants cutting corners or going along with a strategy so as not to embarrass the Minister.

A (8:41)

Nothing loses votes like people are dying in your hospitals and you're the head of that department.

B (8:47)

Yeah. Imagine being the Minister for Health and having to address a press conference where journalists are saying, minister, do you take responsibility for the hiring of. Of a fake psychiatrist from the former USSR who had a criminal record and no qualifications whatsoever, and you employed him, how did this happen on your watch? I mean, those are tough questions. So if you can avoid those questions, avoid the scandal ever coming out by just when you hear that he's been employed and shouldn't have been getting rid of him quietly and there's no referral for disciplinary action, move on and hopefully it'll go away.

A (9:33)

The other thing that the Minister and the state government is part of, if not in charge of, is what you call the economic rationalisation of the Health Department of hospitals. And anyone who's had anything to do with hospitals in the last couple of years will know that we're now called clients, we're not called patients. And there is a real. You can feel it in the air. In some ways, it feels like a hotel they want. The bed's full, not under full, not over full, because that's Sort of maximum profit making. It's run like that, isn't it? Which also creates a pressure.

B (10:08)

Yeah. And I think because of extraordinary advances in medical research and technology and the capacity to allow us to live longer, to overcome what were once terminal soon illnesses, there's a public expectation that we can have so much more too. And I know this from experience, from people close to me. There is an overburdening of public hospitals, for example, just, you know, the emergency department. You know, Michelle, I don't know about your experience, but when I was growing up, emergency was the place you'd go to if you'd accidentally, you know, half cut off your arm with the chainsaw while pruning a tree. Or you went to emergency when you were hit by a car, like your child swallowed poison, you were at emergency. You didn't go to emergency because you had a twinge in your back or you had a headache and you thought it might be a tumor, like that is not an emergency consultation. That's when you went to go and see a doctor. But when doctors said, well, we can't keep bulk billing, we've got to charge you. And when people, I think lazily thought, I'll just treat emergency like my GP's office, the emergency department became this kind of place that was a bit of a free for all. And I think because of the extraordinary demand on really good nurses and doctors and consultants in those emergency departments, as a result of patients not needing emergency care, patients who do need it are having to wait. There's ramping that is causing the system to jam up. It probably needs a brave policymaker politician to make some tough decisions about ensuring that people who are not in the grip of a medical emergency do not get through the door.

A (12:19)

You make the point as well that there was sort of a perfect storm in Queensland at the time. We're talking about the early 2000s, where there was a shortage of doctors, there was a growth in population, as you mentioned, not only a growth in population, but we're living longer because we have a great standard of living in Australia in general. So. But with longer living comes more health concerns. Unfortunately, we're still old no matter how long we're gonna live for.

B (12:44)

Right.

A (12:44)

So we still have those things pop up. So we ended up. Well, Queensland ended up. I don't know if this is a national situation, but Queensland ended up relying on foreign trained doctors and overworking them at that. Tell us about that, that situation. Was it national? Was it. Was it just Queensland?

B (13:02)

No, it was. It was certainly national. I think because of Queensland being a very decentralized state with, you know, regional towns and then smaller towns over a very vast area. The necessity for medical care and then the reliance on overseas trained doctors must have been greater than say, you know, a much smaller state such as Victoria or Tasmania. So the overseas trained doctors, you know, were essential. And you know, many of them, most of them are no doubt exceptionally good. They're, they're highly skilled. But partly because of the urgency with which the system needed overseas trained doctors, partly because of the incompetence of the screening authority, they dropped the ball in terms of properly vetting the doctors they were allowing in. Hence you got people who weren't even doctors. You could have doctors who are not at the top of their game. We know hundreds of journalists. Some of them you'd say, well, a grade. Some of them, you know, not so much, but they'll get by. And the same for doctors. Not all doctors are going to be the A graders who are able to diagnose the problem, you know, in a couple of heartbeats. But you would hope that they're all actually qualified doctors. What we discovered is that a number of the so called overseas trained doctors, and I've only mentioned, you know, the example of Berg so far and of course Patel having been rubbed out. But there were others who were complete imposters. They were not doctors and yet they were employed to be doctors in a first world health system.

A (14:59)

We're not talking about, you know, the 20s or the 50s where there's no, you know, where communications are so much clunkier and all those issues. This is very recent and there will

B (15:09)

be across Australia undoubtedly. I am absolutely certain of this right now, people practising as qualified medical practitioners who are not qualified.

A (15:24)

And you made the point that, yes, it feels a little bit icky because it feels racist to say something. This is how sensitive we are in Australia now to say, listen, the proliferation of overseas trained doctors is a problem.

B (15:41)

I still remember when it was raised with me by Dr. Ingrid Tall, who I had gone to see because she was the Queensland head of the Australian Medical Association. And I was asked by my editor in the early 2000s to start investigating and preparing a series of stories on health in Queensland. And I didn't really know where to start because it's such a big topic. So I thought, well, I'll go to the person who represents the doctors of Queensland and try to get an understanding of the culture of the public health system and how things are working in the bush and whether there's insufficient Staffing, whether the bureaucracy is too onerous. I didn't know what I'd get out of it. But it was one of those meetings I needed to did to have to try to understand what was going on. And Ingrid, a bit tentatively started to talk to me about the concerns that she was aware of from the other doctors who would report to her of the overseas trained doctors. And she said, look, it's a tricky one because we're not racism and we welcome overseas trained doctors if they're qualified. And he wasn't suggesting at that point because I don't think she had any inkling of it that some of them were not even doctors. She was just talking about medical practitioners who'd come in from several third world countries who had medical qualifications but who were not of a standard that would be acceptable if they were being properly vetted by Australian colleges. And so I thought, well, it's not racist, it's about evidence and proper care. And I started investigating what she was talking about and came up with some really concerning examples, spoke to very reasonable, measured senior surgeons and they produced more evidence of the things that were going on. And I think they started to realize that they had been too timid, too concerned about, I guess, political correctness, about racism and the accusation that could so readily be thrown at them that they were being quiet.

A (18:11)

You made me think about all the great Indian doctors and healthcare professionals who are working, living in Australia now and how devastating an impact this must have had on, by the time this entire story worked its way out about Jay and Patel, how, how their lives must have changed the way that patients looked at them, treated them. Yeah, it must have been an absolute nightmare. It's probably ongoing, I suppose.

B (18:34)

I'm sure it was. And the story of Jayant Patel would have unleashed the genuine hardcore redneck racists to abuse a number of people who were brown skinned from other countries or had grown up and been educated in Australia, possibly born in Australia, but because they were brown skinned and had a name that was not Anglo Saxon, they would have copped it in the neck. And that was very, very sad. It wouldn't have happened though, if the regulatory system had been tighter, had been competent so that imposters and people who weren't up to it didn't get through. And the people who were not up to it, the overseas trained doctors who didn't have the skills to be in the roles they were in, they just needed to be retrained or given extra tuition in Australia to ensure that they would get there.

A (19:41)

If you move Here from anywhere in the world, I think. And you've driven forklifts in your own country. When you get to Australia, you still got to get your forklift license, your Australian one.

B (19:50)

Yeah.

A (19:50)

You know, like it's, it's, it's unfathomable that people could slip through the net in this profession, in this area, when it's so important.

B (19:58)

Yeah. And the areas of need, particularly rural areas, were more vulnerable because the Australian trained doctors didn't want to work there. They wanted to work close to family and the social networks and the cities, Brisbane, Sydney, Melbourne, Adelaide, they were all going to be the first preference for Australian trained doctors. So the rural areas were desperate for doctors and that's why overseas trained doctors were streamed into those places. And because they were away from the cities, they had less supervision. They didn't have the benefit of being able to talk to an experienced doctor, colleague to say, look, I'm struggling a little bit with this, can you help me? They're often on their own. As a newly arrived overseas trained doctor,

A (21:12)

If you'd like to talk to someone about abuse that's taken place in your life, no matter how long ago it happened, your GP is always a good place to start. If that's not going to work for you, you can contact 1-800-Respect on 1-800-737-732 or via their website, 1-800respect.org au or you can call Lifeline's 24 hour phone counselling service on 13 hours and 14 seconds. We know that Jayant Patel was not the kind of guy who was ever going to ask for assistance anyway. So, I mean, so he goes to Bundaberg Hospital, that's where he ends up. And they are thrilled, thrilled beyond thrilled to have him because he presents as a very experienced, very well trained surgeon. He's, he's come from two American hospitals and as we mentioned, he's brought glowing references with him. However, by the time he gets to Bundaberg, for reasons that he doesn't really disclose, doesn't talk about, he hasn't actually performed surgery in a couple of years at all. And he walks in there and he's just charging around like a bull in a china shop organising surgeries on people. And I didn't know this, I should have known this, that Bundaberg, that size of hospital, the protocol is really for major surgeries and things like that to get patients straight to Brisbane, you know, it's not built for that. It's not built for big, difficult surgeries and recovery from those, even if the surgeon's great.

B (22:39)

That's right. The Bundaberg Hospital was, you know, relatively well equipped until very complex surgery or serious complications developed. And then there would be the retrieval team coming in and taking the patient to tertiary hospitals, the Royal Brisbane Hospital, the Princess Alexandra and the Prince Charles. And those hospitals in Brisbane had better trained surgeons and doctors, more of them, and they had facilities that could look after those complex patients and give them a better chance. But Dr. Patel was determined to do the complex operations in Bundaberg, procedures like esophagectomies. And because of the way the system was geared, if those kinds of complex surgeries were undertaken in the regional hospitals, the budget for those hospitals would be bettered. So if you're the administrator running that hospital and you've got a surgeon who's very keen to do complex surgeries and to do a lot of surgery to increase the volume, then the amount of money that that hospital can be provided by the Queensland health hierarchy is larger. So it takes the pressure off an administrator when there's more money coming in. So all of a sudden, you have a terrible scenario. A surgeon who shouldn't have been holding a scalpel, who was told he shouldn't practice, he couldn't practice. He was barred from surgery in the US after very serious findings against him and detailed forensic investigation into the outcomes for his patients. He turns up, he then wants to perform all these very complex surgeries. He isn't vetted before they make him the director of surgery because he wasn't originally appointed to be the director of surgery, but someone made a very poor decision that they just give him that title and give him all of the responsibility that went with it. And then he just set about operating on as many people as he could. He was a workaholic, he was prolific. And then the terrible outcome started to occur. Now, it continued for two years. And in that two years, the hospital was in chaos. The nursing staff were traumatized because they were dealing with the aftermath of these operations.

A (25:24)

I remember a part of Sick to Death where Tony Hoffman, she, for me and for a lot of people listening to hers is the face that pops into our mind because she became the face of this. She said, I thought this was breathtaking. She said, it got to the point where we nurses were virtually throwing ourselves over the top of patients to keep him off them. She said that when he walked into the hospital, she felt sick because she felt. She thought, who is he gonna kill today? Because by that stage, she had tried through every proper channel to bring attention to the Fact that just statistically, his numbers were through the roof. Suddenly, the number of fatalities they had in the hospital, the number of patients who weren't making it out of the hospital and out of surgery, warranted someone to look at it, even if they didn't believe, even if they thought it was a personality clash and she and he just didn't like each other. The data was the data. The numbers were the numbers, you know, and no one would agree.

B (26:27)

That's right. The nurses were actively scheming to try to keep patients away from Dr. Patel. Several of the doctors were concerned, too, and they told Tony that they didn't want Patel to ever operate on them or members of their family if they had, you know, a car accident or needed sudden surgery. You know, they. They were just adamant that he wouldn't be the surgeon and, and. And made that rule.

A (27:01)

You know, I mean, we're saying, you know, on one hand, he chose to do surgeries that really the hospital wasn't equipped for. But the mistakes that he made were just so sloppy. He's doing things like flushing someone's bowel backwards so the contents of their bowel ends up in their mouth. He's constantly nicking people's nicking the wrong organs, basically, bowels and everything else. Is he. So he's clumsy while he's performing surgery. What about his hygiene? Oh, these poor nurses saying he would go from patient to patient, touching their wounds, no gloves, and not washing his hands in between patients. This just rudimentary stuff.

B (27:42)

I know, and it's a horror story in that regard. Like, you think, how did it go on for two years? Like, how did he continue? But the other thing that I found, and I still can't quite grasp, is Jaya Patel turns up at that hospital, and he's the only one who knows that he has this appalling record that is a matter in the United States, a public record. It wasn't a secretive kind of process that he went through, probably wasn't on the front pages of newspapers when he was being investigated and disciplined over the deaths and injuries to a number of his patients in Portland, Oregon. But if he went looking for it, he must have thought someone could find my history. And so why would you sort of put a target on your back by being so confrontational with the nurses, by insisting on doing more of this surgery? And then near the end of his two years there, he becomes aware that the nurses have gone outside the system, they're making formal complaints about him, and they've even gone to the local member of Parliament, who stood up in the Queensland Parliament in Brisbane and named Dr. Patel as the person who's become a public menace in this major regional hospital. You would think then that you would be running for the airport and trying to get on the first flight to the United States because the game's up. But he didn't. He wanted to stay on and tried to negotiate a more lucrative salary for himself.

A (29:32)

He remained arrogant. He remained. He was constantly telling them of his achievements, his specialities. He was constantly, I think, claiming accreditation that he didn't really have, saying that he was this kind of surgeon and that kind of surgeon, which I don't believe he was. What do you. Was there ever a kind of a diagnosis of his personality, of what kind of person this is?

B (29:57)

I remember talking to a psychiatrist about, you know, what made someone like that tick. And, you know, they describe someone who is deeply narcissistic with, you know, very, very little insight, nil insight into their own performance and failures. But I think that even narcissistic people have a keen sense of self preservation.

A (30:19)

Yeah.

B (30:20)

Yeah. Like they're cunning to the extent that if they think that they're being cornered, even though they may keep deluding themselves that they're perfect and have done nothing wrong, but they don't want to be cornered, so they'll work out the escape route. He didn't do that. So there was something very abnormal going on. I remember when I visited the town of Jamnagar in Gujarat province in India, and I did visit India and spent quite a bit of time trying to talk to and getting great cooperation from Patel's college classmates because he had done his medical training in India, he'd grown up in Jamnagar, and I even was able to do a lengthy interview with his main teacher, the college professor at the MP Shah Medical College. They had followed the scandal as it was unfolding through 2005. And I was there in late 05, and so they were aware of it from the reports that were appearing online, and they very generously shared their recollections of Jaya Patel because they had seen him on visits. He would come back, and by then he was living in the United States, and he'd been living in New York, and he'd be practicing there. And then he moved to the west coast to live in Portland, and he would come back to this hometown pretty dusty, obviously, incredibly. Or much, much poorer place than where he had chosen to live and practice in the United States. And they, until the stories were coming out, all believed that he must have been one of the most wonderful success stories from their hometown. There was this great admiration for what he had done, he and his wife Kishore. And so when the news was. Was coming out about his past and they read for the first time, they learned for the first time of the disciplinary actions that had been taken against him in the United States. It must have been a lot to take in. But what they shared was that when he was their fellow student, when he was being trained, he never had any doubt about his own actions and decisions in surgery and in theory, and when he would be challenged, he always rejected the idea that he had done something wrong or made a poor diagnosis. It was something he just couldn't countenance. And there was this unanimous, even though I interviewed these people separately, theme coming out, that he believed that he was close to perfection and he would get angry if he would be questioned about something that he had done wrong.

A (33:18)

It's fascinating, isn't it? Because as we said, the numbers are the numbers, mate. This isn't an abstract scenario where you can believe you're doing a great job when you're not, because people are dying. And surely he would know from his own knowledge of medicine without other people telling him, that bloke should not have died. He died because of the surgery. He died because of your poor hygiene. When it comes to. Like his patients, wounds popped open in a way that was unheard of. Other specialists said, I've never seen that in my career. And it's happened to a dozen of his patients.

B (33:55)

I interviewed one man who had been rendered impotent from surgery. I interviewed him in Portland, Oregon. He was one of the patients who was part of the proceeding, and his life was changed forever. As a young man, he went in for procedure that no doubt wasn't straightforward, but it should not have ended like that. There were so many stories like that, but he was a survivor. And he could not comprehend how Patel, having gone through that process in the United States, was then able to reinvent himself as a director of surgery and continue hurting people in Australia.

A (34:39)

In the end, there was a great zeitgeist. Thank God, wasn't there? Because in the end, there's you at the Courier Mail and your boss has said, hedley, go and have a look at Queensland Health. There's a lot of not one thing. There's a lot of weird stuff going on over there, and it's dysfunctional. But the government's putting a lot of effort into trying to make it seem functional and improving. Part of that was reducing the waiting times for surgery, which also Then helped Patel to shine in Bundaberg. Cause he was like, I'll do heaps of them, I love it. So he's knocking down the waiting times, but his patients aren't surviving. So that's happening with you. We've got Tony Hoffman, the nurse in Bundaberg, who, by the way, the Department of Health in Queensland was really not very subtle in its threats against whistleblowers, wasn't it? It was made very clear to them that complaining, certainly complaining outside of. Of the hospital, in the department, as you've mentioned earlier, was possibly a sackable offence, if not illegal.

B (35:43)

Jailable. Jailable, yeah, yeah, yeah. They tried to put great fear into the nurses and they repeated that when it was obvious that the nurses were becoming highly anxious about Patel's conduct. And to try to discourage further disclosures, the nurses were read the riot act again about speaking out again. This is so much about bureaucrats and politicians acting in their own interests rather than the interests of public safety. And we see this time and again in systems, the minister who's really only a temporary caretaker in a role, a political appointee who's going to possibly win the next election, possibly lose it, and then someone else will come in. But the personality type of a lot of politicians leads to their own political staff becoming control freak apparatchiks who then, you know, attempt to ensure that senior public servants who should know better are cowed and turned into, yes, people with a bent to covering up the bad news that could reflect poorly on the minister. It's so often the case that this is about, in trying to make the political head of the portfolio free of media and public criticism that could harm his or her career and have an impact on the party. And both sides are guilty of it from probably across Australia. There's no difference.

A (37:36)

So the zeitgeist is finally building. These poor nurses are finally being listened to. They found someone in Rob messenger who was the. The Member of Parliament politician for the National Party. I say that with surprise in my voice because as a Queenslander, I was kind of. I thought that was great. That was. You know, this guy's almost broken ranks in a way. He's just a different fish, isn't he, this bloke?

B (38:00)

Yeah. And Tony Hoffman says she is, you know, a lifetime labor voter and supporter. She's not a gnat and her local Member of Parliament is Rob messenger than that. But she went to him secretly and shared with him the information that gave him the platform to be able to stand up in Parliament and reveal things. She went to him, because his government, sorry, his party was in opposition. It wasn't in government. And Tony understood that if she'd gone to the politician, for example, Nita Cunningham, who was another local member, but the labor member, so her side was in government, Tony suspected that nothing would get done because they wouldn't want to rock the boat, they wouldn't want to have a political scandal or problem. So she went to the opposition because

A (39:01)

they're on the side of the equation that's saying, don't let this out.

B (39:06)

Yeah.

A (39:06)

And you're reminding me, someone else told me before with some kind of criminal matter, something that they wanted help with, that they realized you got to go to the opposition because they're not going to try and bury it. On the contrary, they're the ones who want it to become a huge media story and become a huge issue. Yes, of course. Of course. What was that? The breakthrough, the when. When messenger got up in Parliament and named Giant Patel, was that when the rest of us heard about him and.

B (39:41)

Well, it was stage one of, you know, a chain of events that led to the breakthrough. So Tony. Tony went to see Rob and Rob, and there's an amazing recording, the original recording of Tony's disclosures to Rob. He had the good sense to, with her permission, to do what we're doing now and just record the conversation for audio. And we've actually played a big chunk of it in one of the bonus episodes of the Sick to Death podcast series, so that people can hear the genuine concern in Tony's voice and Rob's soothing reassurance that he's going to take this seriously and do something about it. And. And it's a remarkable piece of audio. But Rob then does a bit more work on it and then makes his speech in Parliament, raising concerns and asking the government for answers. And that leads to this flurry of action in the Minister's office. And the then minister, Gordon Nuttall, was furious because he'd been blindsided by something and made to look silly by the National Party bumpkin as he saw Rob Messenger. And he then got his political advisors and the Chief Health officer to give him some advice. And while all that was going on, I was feeling like I needed to wade back into Queensland health and the issue, because I had been contacted by Tony Hoffman by email. She'd written to me very privately as a response to the stories that I'd done on Elise Neville and her tragic death and how the health system had failed Elise's parents and failed Elise. I'd heard about the case of Elise. And I wanted to know more about it. And I went down to the registry of the courts where you could read the files relating to disciplinary matters and understand from the documents that were filed, you know, lengthy affidavits and so on, you know, what was going on. And these included witness statements and the medical records and so on. And when I started reading about Elisa's case, this terrible, terrible tragedy involving beautiful young girl who's on holidays with her mom and dad, her sister and brother and, and how she had been in a holiday apartment with her family during the night. She rolls the wrong way out of the top bunk and lands on the hard floor and hits her head. That then leads to a really serious, very small bleed in her brain that could have been stopped and the pressure relieved if she had received proper medical treatment. But when she was taken to hospital by her parents, she didn't get the sort of care that she should have got. And by the time it was discovered what was really going on, it was too late. The soft tissue of her brain with the bleed effectively herniates against the hard bones of your skull and causes irreparable brain damage. And she died. And several things went wrong. The nurses who were on duty were not properly concerned about dealing in a professional way with Elise and her parents when they came in. And the doctor who was on duty was not a young doctor, but he was a relatively inexperienced doctor. So he'd decided to study medicine later in life and he had been working well, I think is criminally reckless and irresponsible. A 24 hour shift, not because he wanted to. It wasn't his fault that he was doing that. That's what Queensland Health directed their doctors to do in some of these public hospitals. So he was at the 19 hour mark of a 24 hour shift when he was asked to consult and assess. Elyse Neville. I don't know what you're like after most sleep for 19 hours, but I'm hopeless. I imagine I would be. Well, I know I would be angry, I would be missing things.

A (44:31)

Well, you reminded us that there's, you know, studies into sleep deprivation and how effects are similar to having consumed a certain amount of alcohol and things like that. So, yeah, it seems an extraordinary policy for a health department to have to overwork doctors as a matter of policy.

B (44:50)

Well, you're turning doctors into dangers to the public. They're not going to be a help, they're going to be a threat to people if they haven't had sleep, if they are so fatigued. And that's why pilots are not allowed fly the aircraft if they haven't had sufficient sleep, is why there are several of them on long haul flights. One's having a sleep while the other one's up front crazy. And Tony was deeply moved by that story. I'd written a very lengthy feature article and she'd written to me about Dr. Patel. She hadn't named him, she just talked about a surgeon in Bundaberg who was causing a huge amount of concern. And I'd had a bit of a follow up with her. And I said, look, I want to look at this when I get back into reporting on health. I'll be back in touch with you. And then other stories came up and there are other interruptions. And then I read about Rob Messenger's performance in state parliament and I thought, well, this is what this is about. This is what Tony Hoffman emailed me about not too long ago. So I contacted Tony and could she come and see me? And it turned out she was going to be in Brisbane on a course at the hospital down the road, the Royal Brisbane. I could see it from my desk in the old Queensland newspapers building in Bowen Hills. And so she came in with her friend and they both signed in, they're both nurses. And they signed into the visitors book that we had in the old foyer there under false names because they were paranoid about going outside the system. And I led them through to the cafe that we had and sat down and took many pages of notes. And I realized that I needed to go to Bundaberg next, that I couldn't write, you know, the story without seeing more nurses, trying to meet some patients, trying to get a better feel for it some. Several days later I made arrangements to fly to Bundaberg and I did a bit of work through the day trying to talk to patients and just scoping out the hospital. And then I made an appointment for Tony to meet me with some of the other nurses at Tony's house in Bundaberg. It was a secret meeting and it was going to be after everyone had finished work. So in the evening I said that I would bring takeaway curries for everybody. And I'm a huge fan of a curry, so there's a bit of self interest there. So I went to the Curry bazaar, which was Dr. Patel's favorite restaurant. And he knew the staff and the owners there and he was there most nights. And I remember when I was picking up the order just, you know, surreptitiously saying, oh, I've seen some publicity about you know, your local director of surgery, you know, and I was fishing, and obviously I didn't say who I was. And. And Pam, who. Who was the owner, said, oh, yes, wonderful man, Dr. Patel. I don't believe anything that that's being said about him. He's one of our very best customers. And I said, okay. And. And then I went to Tony's place and we sat, and while they were around the table with me and I was taking notes, my hand was aching by the end of the night. And there was this turning point, Shel, where I feel like I had one of the most important penny drop moments of my career. And it was right near the end when the takeaway containers were being packed up and thrown away, and I was soon going to be driving the hire car back to this awful motel in Borbong Street. And one of the nurses just kind of randomly said, of course he didn't become a bad surgeon overnight. And you know when you hear something but you haven't quite understood the underlying significance of it, but you know there's something there, you just have to tease it out. I just stopped and said, what do you mean exactly? He didn't become a bad surgeon overnight? And of course, what she meant, which is what she explained, was that he's a surgeon in his 50s. He's been practicing surgery for many years. He's always been a bad surgeon. And so I then talked to her about how, therefore, there must be, you know, a trail of patient wreckage where he's worked previously. And she said, yeah, there will be. Absolutely there will be. Because, you know, he wasn't a brilliant surgeon who became a bad surgeon.

A (49:32)

And these habits that we've discussed, these poor hygiene habits, this sloppiness. Yeah, that's not sudden stuff.

B (49:38)

Yeah. And that was like an epiphany that meant it wasn't just because of the crummy motel room and the bad bed. I couldn't sleep properly that night. I was tossing and turning because all I could think was rushing back to Brisbane to try to research Dr. Patel's background before he came to Australia. I wanted to work out where he had worked before and what had happened in those places where he had practiced surgery. And back then, 2005, I must have had one of those pretty cheap Nokias. Smartphones were not a thing, and I didn't have Internet on my laptop. If I even took a laptop. I probably just took notebooks to Bundaberg. So I had to go back to Brisbane and either go straight home from the airport or to the office and get on a desktop computer to use Google to start that process. So I went to the office and I started just googling Dr. Jayant Patel, disciplinary, using keywords like that. And it became obvious with the first search that he had this terrible disciplinary history that had always been online and should have been discovered when he first applied two years earlier. And there it was on the screen. And then you had this terrible fear that something so obvious can't be true. This must be another Patel. You know, how could they have failed to check this and discovered this? But what I didn't discover until months later when it came out, as a result of the excellent investigative work by the public inquiry and the subpoenas that were issued that one of the senior doctors who was running the hospital in Bundaberg, Darren Keating, and who had been defending Patel and not responding to Tony Hoffman's concerns for the two years he had himself. Days earlier, days before my search, he had done the similar search and had a oh shit moment and discovered it.

A (51:55)

Wow, I can't imagine the size of that oh shit moment. That is almost feel sorry for him. That's such an awful scenario. God. So it seemed. I just remember I was working in radio in Brisbane at the time. And so I just remember suddenly Jayant Patel was just everything, every story, everything and more and more cases, people, victims coming out, talking about, as I say, Tony Hoffman in the media everywhere. So when did it end? How did it end? Was it. It felt sudden to me.

B (52:28)

Yeah. So he, by the time that Google search was done and everyone realized this is what we're dealing with, he had left Australia and he was back in Portland, Oregon. And he must have, you know, pretty soon realized that in Australia journalists in the media were onto him.

A (52:53)

Was this a period where he was like on holiday or something? So it was the end of his initial contract and he was negotiating to renew the contract and they were desperately trying to get him to resign, right?

B (53:05)

Yeah, they wanted him to resign. He put in a proposal that he be paid an exorbitant amount. And the director general said, well, we're not going to pay that. And so then he just left. And so the Queensland government provided him with a one way business class fare back to Portland and he returned. And when the Google search occurred and it was early evening in the office and then we had this mad scramble to get the stories published, who to get them written and then into the paper again. The stories weren't immediately online. They didn't, we actually didn't have much of an online Presence at the Courier Mail then. And so I got home late at night, you know, still probably days, but running on adrenaline from, you know, the events that had unfolded, and contacted our colleague in Los Angeles, Nick Papps, and with his partner flew to Portland, Oregon from LA and went to Patel's home because I had the address, it was in the disciplinary documents. And so he was able to try to talk to Patel and photograph him at his front door before Patel even realized that there was a story coming, because the time difference and publication lag

A (54:23)

and so on, and he was feeling victorious, wasn't he? He knew the nurses hated him, he knew there was people at Bundaberg Hospital who didn't like him, who, whatever, disapproved of him, but he thought he'd defeated all of them. He thought that he was so respected by the hierarchy, by the management, that none of these people were a worry to him.

B (54:45)

Yeah, that's right. And then two very accomplished journalists in Alison Caldwell from the ABC, I think she was working for Radio national in 2005, and Jane Hodgkinson, who was with the Nine Network in Brisbane. They tracked down his phone number in Portland, Oregon and rang him, as the stories were. And the issue was exploding in Queensland and they believed that they were interviewing Patel's brother and this man was talking about what a brilliant doctor his brother was and he didn't need to work, he was very wealthy and one of the most skilled and credentialed doctors you could ever meet. But it was actually Patel talking about himself. So then we had this period where the health system came under intense scrutiny over months of public hearings, you know, lawyers representing the health system, the administrators, patients with a very senior barrister at the time, Tony Morris QC as the inquiry head, and then Jeff Davies, the retired judge taking over the inquiry.

A (56:00)

A lot of victims didn't, probably didn't perceive themselves as victims of wrongdoing, did they? And families would have thought that's a terrible thing that happened to us, but it happens. It happens so rarely in Australia. We're lucky we've got a great health system. We were just unlucky that he didn't survive the operation or whatever. So I guess this would have been a moment where they realised they were actually part of something huge and terrible.

B (56:25)

That's right. And there was some terrible outcomes and then trying to process that and then you're in the public glare and you don't know whether the injuries that you fear have been caused could be life threatening to your loved one, to yourself, your child. So there was a lot to unpack. And Patel stayed away from the inquiry. He was invited back and he refused to return. And then the inquiry recommended he be charged over deaths of, I think about 15 or 16 patients and injuries to many more. And then there was a period where Patel was staying away from Australia for obvious reasons. Queensland authorities wanted him, or said publicly they wanted him back. And I discovered through very good sources that Patel's lawyers had gone to the government, to the DPP and said, well, he will come back and it doesn't need to be a long, drawn out battle for his extradition. He's prepared to come back and he knows he's going to be charged when he returns. And he just wants to ensure that there's some procedures in place to protect him and a respectful arrangement. But Queensland was facing a state election and the government didn't want him to come back at that time because it would remind everyone who hadn't had Patel news for a good year or so that this disaster on Labor's watch was back in the news cycle. And so they were told, no, we're not accepting that. We'll take our chances with a multi year extradition battle. And it was just another example of what I thought was just appalling politics and the whole thing.

A (58:25)

Oh, I know the cost of it. Obviously it would have cost a lot more to go through the extradition hearing when you've got a fugitive who's offering to come back. It's unbelievable.

B (58:34)

This is a part of the story that I'm researching and writing now, because when my book came out, and this is what the podcast is based on, that book, it came out in early 2007, late 2006, bearing in mind the saga was unfolding through 2005. So when the book came out, Patel was still in the United States, the extradition hadn't started, police were still investigating. And. And so I am now really, for the first time, immersing myself in the whole prosecution of Patel and what followed. Because I left journalism for a couple of years in early 2008 and went and worked for what we call the dark side, you know, in comms, corporate comms.

A (59:23)

All right, yeah.

B (59:24)

So while I was away, his prosecution was ensuing and what we know happened, and I'll just give the executive summary, is he was charged over the deaths of several of his patients, so manslaughter charges, and there were some other charges relating to that. He was also charged with fraud because you shouldn't have been practicing here in the first place. He lied to get the job and the financial gourds that came with it. And he was convicted by a Supreme Court jury over the manslaughter and these other matters. The fraud was left to another, I think, the District Court to deal with. So that wasn't part of the Supreme Court case. And then he appealed the convictions, and the Queensland Court of Appeal rejected his appeal and said, no, the conviction stand. Then he appealed to the High Court. The High Court said, well, we're going to quash these convictions because you suffered a miscarriage of justice when the prosecution changed direction very abruptly during your manslaughter trial. And so the High Court being the final arbiter of the law in Australia and cases, its ruling meant that the Queensland DPP had to sort of go back to square one and start again with possibly a retrial. At the same time, you had patients who were frail or. And dying witnesses who were dropping off. And the upshot was that Patel left Australia with his manslaughter convictions having been quashed, but he pleaded guilty to the fraud. And then, you know, because of the time served, because he had been in prison for several years after the original conviction, he was then told, leave and you won't be able to return. And I don't believe he's ever going to practice again. He wouldn't have practiced afterwards because the Oregonian Authority said, you can't practice. One of my colleagues, Ellie Dudley, who was on second in the United States, she went and saw him. He's still in the same home in Portland, Oregon. And he said, oh, it's history. I've forgotten all about it. I don't want to, you know, revisit that. You know, you sort of think, how. How do you sort of reconcile if you're Jaya Patel, the things you've done and the outcomes and the infamy and the shame you brought upon your own family and, you know, in his village in the town in. In Jamnagar, he must still be person with a high degree of notoriety. You know, it's not something you easily walk away from. It would have brought shame upon that place.

A (62:21)

He seems to be of some particular personality type where he does believe in himself, you know, so obviously that makes way for lots of recovery. From his perspective, if he does believe that he is a great surgeon, that shit happens essentially when you lose patience. The brutality of his way of thinking, I think, was demonstrated most clearly in the story where he was lobbying to have a lady's life support cut off because he wanted the bed. Just thought, well, she's going to Die anyway, so can we just cut her off so I can put this other bloke in that bed?

B (62:57)

And I think that he was also well aware that the referral of the patients that he had harmed, the referral of those patients to Brisbane could result in him being discovered earlier. And so that's why he really wanted to hold onto them in Brisbane. He didn't like them being taken away. And he said, oh, no, I need to keep caring for my patients.

A (63:22)

Well, congratulations again. I mean, the work that you do and have done is enormous. I mean, you've got an incredible body of work. But I'm so glad you brought this, this project to podcasting, because it is an old one of yours, frankly. I know that it's evolving and that you're still working on it, but I really like that you talk a bit about your personal life and about your family and this. I think that context is really helpful for a lot of reasons for you to talk about the shooting that happened at your home and how it's also really interesting when, when people write their stories, I think with this much hindsight that you can put together all these pieces, this led to that, led to this, led to that in your own life and also in the unfurling of this story.

B (64:12)

Yeah, I agree. You go through periods of your career and you think, well, that story, you know, 20 years ago, that, that's, that was interesting and that's behind me. And you know, that was, well, remember that and remember this. But you sort of, you forget so much. And I'm really glad that I wrote this book way back then and that although the book had pretty good circulation for an Australian book in 2006, seven, it sold okay. And it was my first book, I was really proud of it. But then once the book came out, that was it. And now we have the options of audio. And I just had this idea that if we got a fully voice acted and narrated story, the story sick to death. Basically the exact book that I wrote, but just turned into a podcast series and then updated. Well, it may be interesting to many listeners, but it also might remind people of the risks and the need to always be prepared to question the system and challenge what you're told. Because I don't think that things have necessarily revolutionized in terms of positive reform. I'm sure that some of the terrible things that were discovered when we lifted up the bonnet and went through the public hearings of the health inquiry and saw so much more that was wrong, that those things don't just get fixed and we move on, there'll still be issues.

A (65:57)

Absolutely, yeah. This is what I mean about you unlocking fears. In my mind, it's just because I am very trusty. I mean, I've just made fun of my mum for being trusting of doctors, but I suppose I am. I suppose I just go, whatever, Whatever you reckon. I don't know. You're the boss. You know what you're doing. And I wonder how much of that is my faith in the system. There was only one thing I disagreed with you about, and that was when you said that you think Australians expect reasonable care, medical care, and I thought, no, Hedley, I think we expect excellent medical care. That's our expectation. It's part of our privilege in this country. Yeah. We assume we're going to get excellent care. It never occurs to us that anything like this could happen. So as. As relevant now as ever, I think, and great to listen to it. Great to hear your lovely voice and your actors and everything like that. You've got a real signature style when it comes to audio.

B (66:49)

Oh, thank you. Yeah. I'm indebted to Jasper Leake, who has produced the music and mixed everything and done a great job of that. Yeah.

A (66:58)

Thank you so much, Hedley. It's always a pleasure to talk to you.

B (67:00)

My privilege. Thank

A (67:05)

you. Thanks for joining us on Australian True Crime. If you would like any more information about anything you've heard on the show today, or support numbers, just check out the show notes.

B (67:19)

The producers of this podcast recognise the traditional owners of the land on which it's recorded. They pay respect to the Aboriginal elders past, present and those emerging.