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- [00:05]
Hedley Thomas
My name is Hedley Thomas. Sick to Death is based on my book of the same name, and it's the true story of Dr. Jayant Patel's lies and manipulation and the herculean effort it took to finally stop him. We've used voice actors throughout this series and on occasion the real people from the story have read their words for us. It is brought to you by me and the Australian. Chapter 46 Sugar Town, 11 April 2005 it is known as a DE or a Distant inter engagement and depending on how well you are perceived by the editor to have been working, the DE can be a reward, perhaps even a junket to an exotic island where the most onerous task is to appear attentive as a guide provides helpful facts for a travel story. Another kind of DE is stressful work dropping in on a community, usually after a tragedy. There might be a rough car trip over rutted roads after a wobbly flight in a light aircraft, a scramble to interview the locals, the injured and the relatives and friends of the dead. Sometimes they want to talk, but the intrusion on their grief is awful. The trip to Bundaberg shaped as something in between. Patricia Holloway, the Courier Mail's travel organiser, had set up the Monday morning Qantas flight, the hire car and the motel accommodation for two nights. There would be interviews with the injured and bereaved, but I expected they wanted to talk. I read the Courier Mail on the flight. The story I had filed from home after the interview with Jerry Fitzgerald ran as a Page four lead. Page four was an ordinary space in a Monday paper, but I was glad to keep the issue alive. It had to maintain momentum. I had called Toni Hoffman after my conversation with Fitzgerald because I wanted to tell her about his praise for the nurses. She was beginning to feel positive. My father had been following the story with increasing interest. He emailed me shortly before the flight to Bundaberg. Good to see you have started an inquiry into the activities of our man from Pakistan, he wrote. I winced again at being reminded of my earlier mistake about Patel's nationality. Dad read the newspapers closely. He was always poised to pounce on the print media or the ABC for anything that could be seen as left wing bias. A twice decorated former Royal Australian Air Force pilot, he had flown dangerous missions into jungles in Vietnam. He led squadrons in Australia and the Middle east before resigning to go into commercial aviation. He was my hero as a boy and he remained a steadying influence. Our political views were then poles apart, but we agreed on the vital importance of a free media. We also agreed on the threats posed by the dishonesty and secrecy which was pervading parts of the Beatty government. Dad was cranky with one of my colleagues who had written a weekend article on a military helicopter accident. Dad reckoned it was, in his words, rubbish, with a pile of codswallop thrown. Thrown in for balance. It was an irresponsible piece and ought not to have been published, he said. On the other hand, it was a fine example of how misreporting can mould opinion. Which leads me to my point. The truth, pal. Always the truth. The last time I had been to Bundaberg was in late June 2000, after fire had destroyed a backpackers hostel in the nearby town of Childers. Robert Long, who was an itinerant fruit packer with a grudge against the hostel operators and some of its occupants, had lit a match in a bin in the downstairs lounge fronting the main road one chilly night. When the volunteer firefighters combed the ruins of the historic building after the flames were finally extinguished, they counted 15 bodies. The victims were young, exuberant and hopeful travellers. Some died in their sleep. Others, who realised their peril, were unable to escape the smoke and heat because of bars on the windows. Unforgivably, the fire alarm system had been turned off within minutes of landing and shutting the engines down. We wandered around a community in shock. The tragedy and the trespassing on the grief of the 69 survivors and the families of victims had a profound impact on me and my colleagues. The Courier Mail's reporting team of Justine Nolan, Paula Donovan, Amanda Watt and myself filed dozens of stories in the first few days. Despite his sensitivity with a camera, photographer Anthony Wheat was abused and physically assaulted by one traumatised survivor. It was a sobering reminder of the fine line we walked between the public's need for news and an individual's right to privacy. Some of Bundaberg's retailers had asked the survivors to come to town for free clothing, backpacks and other kit. A bus was put on to ensure everyone arrived in Bundaberg safely. After a shopping expedition in which no money changed hands, the survivors and the journalists returned to Childers, our closest contact with the local community. Our source for factual material about the rescuers, the police investigation, the suspect and even the shopping trip came via a woman called Kathy Heidrich and her husband Wayne. They owned and put together the newspaper called the Isis Town and Country. It was a weekly which was dedicated to local news. Everyone trusted Kathy and Wayne and they were generous to us with their news Tips after arriving In Bundaberg on 11 April 2005, I called Kathy. She would know about the surgeon Patel and the problems at Bundaberg Base Hospital. I figured. We agreed to meet for lunch the next day. My plan was to meet Tony Hoffman after nightfall. It left me six hours to make calls, visit the hospital in Bundaberg and drive to the seaside at Bagara to drop in on the bold politician Rob messenger, for whom my respect was growing. Although I had told Gordon Nuttall and Jerry Fitzgerald of my Bundaberg plan, it was my intention to keep a low profile while in town. There would be no dramatic attempts to doorstop hospital managers such as Darren Keating or Peter Leck to pose questions that they would, I suspected, be under strict instructions to ignore. After parking outside a private clinic on Bourbong Street, I was struck by the provincial feel and dilapidated condition of the hospital and its grounds. There were dying weeds ringing a faded concrete helipad a short walk from a dejected main entrance. I left my notepad in the hire car for all that the staff and patients knew as I confidently pressed the elevator button, stopped to read the notices on the board, and checked out the older wing of the hospital with its suite of executive officers, far removed in every sense from where the doctors and nurses improved or saved countless lives. I was one of them. Nobody challenged me. Outside the intensive care unit, I peered around corridors and into wards. After about 20 minutes I left for the drive to Bagara with the renewal of its seafront esplanade, a swathe of holiday accommodation, more buildings still coming out of the ground, and restaurants promising all day breakfasts and bottomless cups of coffee. Bergara, on the Coral coast, had become one of Queensland's newest magnets for tourists. It was also where Patel had chosen to live. I introduced myself to Rob Messenger's media advisor, Melinda Bradford, who told me the boss was still out of town. Bradford, who was aged just 20, had her hands full. A middle aged man, perhaps a constituent, sat transfixed as she offered advice. He seemed infinitely more interested in her than in the obscure, a problem he had brought to the office in a news agency. I bought the Bundaberg News Mail to check whether their reporters were still on the case. They had a story about Nuttall's backflip in establishing the review. I mentioned the controversy to the newsagent while passing over 90 cents. I was just fishing. If she knew Patel as a customer, she might say so. Perhaps he spent $100 a day on instant lottery tickets. Maybe he subscribed to Home Beautiful magazine. It was all grist for the mill. I don't know him, she said sharply. Bradford agreed to photocopy a handful of articles and a few written complaints from some of the people who had been to messenger since his stand in state parliament. She gave me names and phone numbers. There was Ian Fleming, Beryl Crosby and Nelson Cox. They had all been patients of Patel, she explained. And there was Ian Brown. He was their Brisbane based solicitor, a personal injury expert from Carter Kapner. Lawyers. I knew the firm, having worked closely with one of their solicitors, Judy Teitzel, While reporting in 2001 on property marketeering and rip offs. Judy Teitzel had been targeting some of the people I was investigating and writing about. She launched legal actions to claim damages for their misleading and deceptive conduct by swapping intelligence. We both came out in front. I did not know Ian Brown, but I figured that he would welcome the Courier Mail's interest. Publicity was free advertising for his law firm, two Patel clients who had suffered or who thought they might win some money. The usually symbiotic relationship between lawyers and journalists thrived on these understandings. We relied on the victims for their story. The lawyers relied on the victims for the money they could bring into the firm. The victims relied on the journalists and the lawyers to promote their case. I was in the car reading the local newspaper and scanning the material copied by Bradford when Hoffman called my mobile phone. The onus was on her to set the evening meeting up. She offered her home and told me the address.
- [11:33]
Tony Hoffman
I think a few other nurses will be coming to talk to you. I told them you were bringing the food.
- [11:39]
Hedley Thomas
Earlier, I had offered to buy dinner, a range of curries. Hoffman said the best ones came from the Indian Curry Bazaar, Patel's favourite restaurant and the venue for his farewell party. She giggled at the delicious irony and I agreed to ring in the order. Returning to the motel, I put in a call to the Bundaberg base hospital and asked to speak to Keating. Although I was certain that he would not come to the phone or call me back, I needed to ensure he had been given the opportunity. I contacted the local Channel 7 News reporter who had covered the visit of the Bramwich family to the local police. She was too busy to meet me for a chat about the story and she doubted anyone from the hospital would talk to me on the record. My next call was to Mark Bramwich, a quietly spoken bloke who just missed his dad.
- [12:34]
Rob Messenger
Before this, everyone, including myself, bagged politicians. But if it wasn't for Rob messenger, none of this would have come about. I really think he's trying to help us.
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Hedley Thomas
He told me Bramage had witnessed the accident which pinned his father, Dez, beneath the caravan one day in July 2004 in the town of Agnes Water. Dez had appeared to be doing well when Mark visited him in the hospital.
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Rob Messenger
We went in there and he was stabilised, sitting up in bed and having a sip of coffee and talking. No worries at all. And that was the next day. He was just normal. He was thanking God that he had got out of the situation. I went home and started doing some work and then the missus said, you'd better come back. He's taken a turn for the worse. I got there at nighttime. He wasn't conscious. We were up there until he died.
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Hedley Thomas
Ramij recalled Patel saying, you had better pray because he has only a 10% chance of surviving.
- [13:38]
Rob Messenger
I didn't know what to think. In a way it was sad, but in a way it was also up front. It was arrogant in the way he said it. The nurses were crying. I'll never forget that. They could see something wasn't right.
- [13:53]
Hedley Thomas
After thanking Bramwich for his time, I called the solicitor Ian Brown in Brisbane to clear the path for a meeting with his clients in Bundaberg. Brown and I talked about Queensland Health's decision to announce the clinical review. A few days earlier, Gordon Nuttall and Steve Buckland had firmly told the staff of the hospital that there would be no completed report and no finalised investigation. Now a major inquiry was under way. Privately, I suspected that Nuttall had heeded at least some of my advice at our lunch. But I did not know how much he really knew about Patel. Brown told me. Oh, it all seems very rushed.
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Rob Messenger
It could be a response to the.
- [14:39]
Hedley Thomas
Thursday public meeting that Beryl Crosby is driving. She's one of the patients. In the space of two days, we've fielded a dozen people interested in making claims. The hospital staff are concerned about going to the meeting because they fear the hospital will send spies. We are still worried that Queensland Health is going to do a whitewash on this. Ian Brown told me that Beryl Crosby was keen to set up a patient support group. There's nothing better than shared experiences. Cynically, I thought it was also a clever strategy adopted by personal injury law firms. It meant as many potential claimants as possible were brought together with a minimum of fuss and expense. The administrative head of the Bundaberg Hospital, Peter Leck, was feeling foolish. His earlier backing of Jayan Patel was backfiring. Now, after all the fuss. It seemed to Leck that the hierarchy was less concerned about the natural justice. He was confused. The report Dr. Jerry Fitzgerald had sent to Peter Leck on 7 April was far from a clean bill of health for the former director of surgery. And Steve Buckland, the Director General, had to have known it when he visited the hospital that day. So why, Pinalek wondered, the angry condemnation of the staff at the time? And then the weekend backflip. Leck still had no idea about how incompetent Patel had been. Nor did Leck know anything about Patel's lethal negligence in the United States. Fitzgerald, Buckland, Darren Keating and the medical board were holding that information back. It was too damning for them all. Fitzgerald had been asked to go to Bundaberg to meet the staff on 13 April and brief them on his findings. But he had not been asked to tell the staff about the discovery of Patel's United States history. Those findings were still a secret. Peter Lecht thought it best for Jerry Fitzgerald to meet first with the staff from the intensive care unit prior to a general staff meeting at either lunchtime or afternoon tea time. Leck wrote to Fitzgerald, this will allow.
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Rob Messenger
For those staff who express their concerns to feel a little special in talking to you prior to a wider audience. Would be grateful if you confirmed that you are happy to meet with the families of some patients who, before we make the offer, the ones getting most publicity are the Brammaches crushed by caravan case currently subject to coronial inquiry. And Beryl Crosby. You did not review this case, but she has complained that she was wrongly diagnosed with cancer and has had lots of media attention.
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Hedley Thomas
Fitzgerald replied that he was happy to meet the families if that would be helpful.
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Jerry Fitzgerald
We should also meet with the local press and the minister asked that I try and give Nita Cunningham a briefing on the situation as well. That would need to be done discreetly, Fitzgerald said.
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Hedley Thomas
If any politician deserved a briefing from the Chief Health Officer, it was Rob Messinger. His outspokenness in Parliament had lifted the lid. But Messinger was from the wrong political party. Nita Cunningham, who had done nothing but spout propaganda, was the first political cab off the rank. That's because she was the Labor Party's representative. Leck asked Joan Dooley to arrange a very discreet meeting between Fitzgerald and Cunningham.
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Rob Messenger
Would be grateful if you could make confidential arrangements, Lec said.
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Hedley Thomas
Chapter 47 the penny drops evening 11 April 2005 behind the counter at the Indian Curry Bazaar, the restaurant's owner, Pam Samra, her fingers and Wrists dazzling with gold rings and bracelets, smiled. She motioned me to a seat to wait for the takeaway meals. It won't be long, she said. At a table strewn with magazines and newspapers, the Bundaberg News Mail from the previous Saturday stood out. The local paper had done its biggest story yet on Jayant Patel. Its front page declared Families to sue over Dr. Death. The letters page, a potpourri of opinions, included a curt man from Nita Cunningham, the labor member for Bundaberg, who was still criticising Rob messenger for revealing the complaints against Patel.
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Pam Samra
It is not proper for a member of Parliament to rush in and defame a doctor before he has had the benefit of natural justice. But to do it in Parliament, to defame someone so badly under the cowardly protection of parliamentary privilege has disgusted us all. Since then, as a direct result of the member for Burnet's prolonged and vicious attacks, this surgeon has left a hospital. Many sick people will now face having their surgery postponed or being sent to another hospital in Brisbane or Harvey Bay to have this work done. And of course, the waiting times in Bundaberg will blow out. Meanwhile, the hospital has to find a replacement. It is encouraging to see that my disgust, that is lack of responsibility, is being shared by so many health professionals throughout our district.
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Hedley Thomas
Knowing that Patel had been one of the restaurant's best customers, I held up the newspaper's front page to use as a pretext for a seemingly innocent query. The story about this surgeon at the hospital has stirred up a lot of trouble. It's all over the papers, I said to Pam Samra.
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Pam Samra
He's a lovely man.
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Tony Hoffman
He used to come here all the time.
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Pam Samra
He made a few enemies because he was very talented. So some of the people he worked with at the hospital became jealous. I don't believe the things they've said about him. I heard from others there that it's all wrong. It's terrible.
- [20:57]
Hedley Thomas
He had to leave, she replied to me. Tony Hoffman's directions were precise, but somewhere it went bad. I was late, hopelessly lost, speeding crazily and throwing the hire car into violent turns as plastic containers of curry bumped and leaked on the front passenger seat. And then I almost crashed near the railway line. Even with a map and directions, I couldn't find her street, just a few minutes from town. When I used the mobile phone to ask for help, she sounded exasperated. I wondered if she shared my thoughts. What sort of investigative journalist can't find a clearly marked street? Tony's small weatherboard home, aglow with candles, ornate frames around pictures of loved ones. Exotic trinkets, antique furniture, hangings and ornaments from the Middle east and Asia had an immediate calming effect. As nurses Karen Jenner and Karen Fox introduced themselves, Hoffman set plates and cutlery around the kitchen table and opened a bottle of wine. There were two other nurses there and they asked to be given made up names. I'm calling them Jody, Gerda and Rita Black. I don't think I was followed here, I told them feebly. After telling Tony what Pam Samra at the Indian Curry Bazaar had said about Patel, I suddenly felt sick. Pam knew that Tony had telephoned the order for the currys, which I had picked up and paid for with a credit card bearing my full name. If the restaurant's owner read the Courier Mail and noticed my byline, she would realise the connection. And if she spoke about it to one of Patel's friends, I feared that hospital management would have the evidence it needed to go after Hoffman. I confessed and apologised for my carelessness. I should have paid cash for the meal. Hoffman and her colleagues had taken a big risk in meeting me under a veil of secrecy. I hoped it would not bring them more grief. Between mouthfuls of Rogan Josh garlic naan and chicken tandoori, we spoke of cardiac arrest, perforations of the bowel and pus oozing infections. Hoffman had been through the charts during her shift that day to see the number of Patel's patients who had suffered serious complications, infections, wound breakdowns and death since September. The exercise had made her more depressed.
- [23:37]
Tony Hoffman
She told me, there's 14 more. Dr. Martin Carter is the one who should have stopped Patel earlier. I said to him that he should be ashamed of himself, that he had left it all to the nurses. And he said he realised that now and should have done more. The doctors cling together. They would not stand up and be counted. The doctors are commenting now. Well, none of us are safe anymore. In ICU you build up a special rapport with the families. You become surrogate families. They trust you. You see the patients at their sickest.
- [24:14]
Hedley Thomas
Rita Black seemed naturally more reserved than the other nurses because of her quiet demeanour. Her descriptions of some of Patel's procedures carried a lot of force. It was very difficult for nursing staff to complain about the doctors, she explained, adding that Patel's antics were like something out of a movie. Karen Jenner was more direct, still furious about the attempt by Gordon Nuttall and Steve Buckland to shut down the inquiry. Karen seethed over management's mishandling of a surgeon she regarded as a Dangerous menace. Patel blew his trumpet so hard for himself in the hospital that he made it seem he was untouchable. Jodi Gerda was blunt and brutally direct about Patel's incompetence. She had also tried to figure out what made him tick. Hours after Rob Messinger spoke about Patel in State Parliament, Jodi Gerda had watched the surgeon going around the ward as if it was any other day. His blind self belief was abnormal. Karen Fox, who had been with Hoffman when we first met at the Courier Mail's Brisbane office, became upset talking about the death of Des Bramwich. She had been there for his final minutes and she heard Patel's heartless comments to Tess and the rest of the family. She had seen people die before, but never as violently as Bramwich. With a surgeon standing over him, stabbing his chest repeatedly with a long needle. The stories of negligence, death and cover up tumbled out. A man who died after Patel persuaded him to let him perform an esophagectomy instead of going to Brisbane to have it done. A man whose bowel was perforated in surgery. On the evening of Messenger's revelations in Parliament, they told how Patel's 100% complication rate with the insertion of catheters for renal dialysis prompted the hospital to bypass him and have the procedures done. Privately, they described Patel's obsession with performing surgery even when the patients were not in his care. They spoke about the lopping of gangrenous toes with no pain relief, the delusional perception of his abilities, how he opened his wallet to shower gifts on the staff he regarded as supporters, how he would keep his patients in Bundaberg even when their deteriorating conditions were life threatening. Why did he keep his patients? I asked naively.
- [26:53]
Pam Samra
Because if they went to Brisbane, the.
- [26:55]
Hedley Thomas
Complications would be obvious, said Black.
- [26:59]
Pam Samra
In the public coffee shop, he held.
- [27:00]
Hedley Thomas
Court comparing us to the Third World.
- [27:03]
Tony Hoffman
And referring to our substandard equipment, said Gerda.
- [27:07]
Hedley Thomas
Hoffman chimed in, he worked long hours.
- [27:11]
Tony Hoffman
I don't think he had a life outside. On weekends when he was not on call, he would turn up and in that time he would cause more mischief, telling the ICU staff that I did not support him and asking them whose team they were on. He wanted to be on every committee and every panel and people thought that because he talked a lot he was good. We worried about what monsters he was creating from the younger doctors. There were a lot of people who knew a lot and did nothing. And I think that's part of the culture of medicine that has to change as well. The doctors protecting doctors Away from the.
- [27:49]
Hedley Thomas
Tragic accounts of those patients who died or were severely injured, the four nurses found humour. They laughed about the night his $200 Gucci shoes were stolen from theatre. They recalled his aftershave, so pungent the nurses knew where he was and how to avoid him. And they recalled his relentless flirting. At the end of a five way conversation which filled a dozen pages of notes, we stood in Hoffman's lounge room and began to say goodbye. It was after 10:30pm Ming, her pint sized Lhasa apso dog, and Sammy, the Maltese terrier, were barking crazily. Karen Jenner said something matter of factly. You know he didn't become a bad surgeon overnight. What do you mean? I asked. Well, he's in his mid-50s. He's worked as a surgeon for about 30 years. You don't suddenly go bad as a surgeon. He must have always been a bad surgeon. So there has to be a trail of wreckage everywhere he's worked. Her words jolted me like a sharp elbow to the face. What she had said was so fundamentally sensible and logical. It meant an examination of Patel's US background was at least as important as his legacy in Bundaberg. On the drive back to the motel on Bourbong Street, I decided to leave Bundaberg as soon as possible. There was a new priority. I wanted to return to Brisbane to run checks on Patel's employment in the United States. Karen Jenner's comment and the appalling horror stories kept me up most of the night thinking about the possibilities. Chapter 48 close and personal 12-4-2005 as the earliest available flight back to Brisbane would not leave until 2pm I still had time to meet some patients at the home of Beryl Crosby's parents on the outskirts of Bundaberg. For the second time in as many days, I became hopelessly lost and arrived late. Crosby radiated genuine warmth and friendliness. She led me around the house to a backyard sitting area where Nelson Cox, an elderly man who had once been a handy boxer, sat with his doting wife, Harriet, and Ian Fleming, a former police officer. Of everyone there, Crosby's father, who had never laid eyes on Patel, looked the most unwell. He had a thick cough and difficulty speaking. Crosby's mother made sure everyone had a drink and a biscuit.
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Nelson Cox
I just went in for a gallbladder removal. I was as fit as a fiddle.
- [30:48]
Hedley Thomas
Said Cox, keen to get the ball rolling.
- [30:52]
Nelson Cox
That was on 25th October 2004. The outcome there was a mess up in the operation and I had to Go back into surgery again that night.
- [31:02]
Hedley Thomas
Mrs. Cox piped up.
- [31:04]
Pam Samra
The surgical nurse said we what happened in there should not have happened.
- [31:09]
Nelson Cox
That night I underwent another surgical procedure to fix the damage and then I was moved to the ICU for a day and a half. It was black and rotten. They were taking four or five litres twice a day out of me. I was that sick. Nil by mouth for 16 days. Dr. Patel did the first and the second procedure. Something was done or cut that shouldn't have been done or cut. All Patel said to me after five or six days was, you were very lucky that you were fit and a good sportsman. He did the third procedure as well. That was a cut to put a drain in and get it all out of my gut. My stomach had swollen up so much. I was up there for more than three weeks. I thought I would only be there overnight.
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Hedley Thomas
Cox lifted his shirt. He carried hardly any fat on his wiry frame, but his abdomen was horribly distended. A bulge the size of one of the local mangoes jutted out. There was angry scarring.
- [32:07]
Nelson Cox
I reckoned there was something wrong from the start, but he was the doctor and he was that nice to me. He can't even put a staple in. The nurses would say to me by gee, you had a hard time in surgery. You went through a lot. After the third operation, he did not want to see me again. I had to go back for check ups. I asked a couple of times for him. He was still seeing patients, but not me.
- [32:30]
Hedley Thomas
I asked about Patel's personality from interviews at Tony Hoffman's house the night before and now with the patients in the backyard. Patel sounded like a man who believed he was flawless.
- [32:43]
Pam Samra
Crosby said he had a lovely manner. We really believed in him because he was so positive until something went wrong and he didn't want to know you. I told him I love you when I was going under anaesthetic. He was so nice to me. He made you feel that you could have faith in him. He told me that no matter what, he was going to buy me some time. He was a lovely man. After things went wrong, he never saw any of us. He screamed at me. He passed the buck. Everyone knows someone who had a problem a lot took the attitude that there's no point. It was never the case that the doctors and nurses were not doing their jobs properly. They were wonderful, but they were gagged and forced to stand by while people were being hurt. Leck and Dr. Keating should be held accountable along with the hospital board. They listened to reports and did not Stop him. Messenger was the linchpin.
- [33:30]
Hedley Thomas
He deserves a medal, chimed in Cox. Fleming, who had been listening patiently as Crosby and Cox described their experiences, now spoke.
- [33:42]
Ian Fleming
He made you feel that you and he would go through it together. Once it was apparent there was a complication, he became abrupt, rude and arrogant and wiped his hands of you. Complications in surgery are a fact of life, but the high complication rate he had goes back to when he started at the hospital. It was covered up. He was of an age where you expected. He had 20 to 30 years of experience and qualifications and ability and competency. I didn't know his experience and I didn't know anyone else was suffering. He's delusional because he would convey a sense of absolute mastery of the subject. He was very fluent and well spoken, and I think he hoodwinked and befuddled the executives and administration at the hospital. I think the culture in the hospital maintains an atmosphere of suppression and repression. I have nothing but the highest praise for the nurses and staff there. Except for Patel.
- [34:38]
Hedley Thomas
Crosby took some telephone calls. She was torn. Ian Brown, her solicitor, had advised her not to meet the Queensland health staff or Dr. Jerry Fitzgerald, who were due to arrive in Bundaberg the next day. Brown was unable to go to the meeting and he was playing it safe. We spoke about the pros and cons. Crosby feared that she was out of her depth in her role as an advocate for the patients, dealing with journalists, lawyers, lawyers and soon the chief health officer. She had never been a political player in her uncomplicated life in Bundaberg. Crosby did not know or care which side of politics Peter Beattie, the premier, represented. The slings and arrows of political theatre held no interest for her. She had a heart of gold and a capacity to keep giving to everyone around her. When she learned of Patel's efforts, errors and complications, Crosby's first concern was for those who might have escaped his attentions had she pressed her complaint. I told her that I thought there was nothing to lose in going to meetings with senior Queensland health staff who might hopefully shed light on Patel and his legacy. Gordon Nuttall's backflip and Jerry Fitzgerald's apparent openness were encouraging signs. Information was almost always power. After leaving, I sped back to Borbong street to meet Kathy Heidrich for a chat over lunch. She too knew one of Patel's patients, a woman from Childers who had died after surgery by Patel. She had been one of the town's stalwarts in the immediate aftermath of the blaze at the hostel. She had made herself available at all hours to give the survivors a shoulder to cry on food, drink and clothing. Over a cappuccino and a toasted sandwich, Kathy told me that the popular woman's demise was a great loss. Chapter 49 the bombshell 12 April 2005 for a few moments at the arrivals terminal at Brisbane Airport, I considered going straight home in a taxi to Ruth and the kids. It was already after 4pm I was tired. I had barely slept. It seemed unlikely I would get much work done at my desk at the office in the late afternoon. But the doubts over Patel's background kept niggling at me. I had a sense there was something more. It was stronger than a hunch. So much of the doublespeak of the politicians, bureaucrats and spin doctors did not add up. And there was Karen Jenner's haunting comment about the trail of human wreckage elsewhere. I went directly to the office. There were 14 messages on my voicemail. One from an irate Pakistani doctor furious that I had misreported Patel's nationality, one from someone in Mount Isa seeking someone to investigate his feud with the bank. There were several hang ups. A couple of friends calling for a chat, my doubles partner for Tuesday night tennis asking if I would be available in an hour, and an overseas trained medical practitioner, Dr. Jean Singh that's not her real name had left three increasingly anxious messages. There were too many emails to read. The last One was from Dr. Singh.
- [38:19]
Tony Hoffman
My tears are for the 14 patients and their families.
- [38:22]
Hedley Thomas
My tears are also for the poor.
- [38:24]
Tony Hoffman
Doctor whose life and reputation are now in shreds. Certainly lives could have been saved by more appropriately actionable systems. And maybe a doctor could have been.
- [38:34]
Pam Samra
Helped to modify his practice to the.
- [38:36]
Tony Hoffman
High standards of care, integrity and compassion the medical profession stands for.
- [38:42]
Hedley Thomas
The other email of interest came from Stuart Copeland, the opposition's health spokesman, who declared Gordon Nuttall unfit to be health minister. Why did the minister's office initially try and bury the findings of an investigation claiming Dr. Patel had fled the country and there was no point in pursuing the matter? What else is he trying to hide in relation to this sad and shameful cover up that has clearly cost patients lives? I returned to the online quest for clues to Patel's past. Were there other victims? Was there anything to hide? A decade ago, such a quest would have meant waking up half the night to telephone a faceless stranger in an office on the other side of the world in the forlorn hope that the information would be made available to a journalist. But the Internet had changed everything. When organisations, including the registration bodies for medical practitioners, realised they could save time and money money by making the data freely available to visitors in cyberspace, there were fewer boundaries. A couple of double clicks could transport a journalist from Brisbane or a patient from Bundaberg into an online drawer of files setting out the disciplinary history, if indeed there was any, of a surgeon in the United States. After unsuccessfully trying a few variations of Jayant Patel in search engines used by doctors, I went to Google and typed his name. I had done an identical search a few days earlier and nothing of interest came up. But this time, a little after 5pm, when Google presented me with dozens of pages of hits, I saw a reference to a Dr. Jayant Patel halfway down the first screen. One word, disciplinary stood out. Double clicking on the link brought a New York state office of the profession's website to the screen. There was the distinctive logo for a PDF file next to the words Jay Aunt M Patel. When I opened the PDF file, I felt the hair on the back of my neck stand up. The documentation was damning, perhaps too damning to be true. There were copies of correspondence between the Board's lawyers and in New York City and Patel at his home in Oregon. His home address was published. His signature was there at the foot of several of the letters. The text detailed his negligence. There was a ruling that he be struck off for gross and repeated acts of negligence in surgery. The detail unfolding on the screen mesmerised me. Surely, I thought, this can't be the same Patel. I began to doubt the information. I doubted myself. I had to be mistaken. Surely he would not have been registered by the Medical Board of Queensland without a background check. But then I recalled the Board's track record of utter incompetence, its naivety and complete lack of rigour in verifying the credentials of overseas trained doctors. When I wrote about the problems and the warnings in late 2003 had caused me and health professionals to be gravely concerned with the Medical Board, anything was possible. The Board conducted fewer checks for doctors wanting to come from overseas than vets applying to treat animals. Stunned at the potential enormity of the discovery, I printed the pages and went to the equivalent site for the Oregon Board of Medical Examiners. Its built in search engine allows visitors to type the surname of a medical practitioner to check for disciplinary or competence issues. When I clicked with the mouse, it returned more information on Patel, more pages to print. The printer seemed to take forever to disgorge the documents. They were queued up behind page proofs of horse racing guides, court lists and other essential elements of the newspaper, but they seemed so banal as I paced back and forth. When the paper finally crawled out of the printer, I walked over to Graham Lloyd, who was leaning against a bench covered with bound files of month old newspapers. He was planning the placement of stories for the following day's edition. Mate, you are not going to believe what a Google search on Dr. Patel has turned up, I said. What have you got? He asked. It looks like he's been struck off in the United States for dodgy surgery. I mean, it all looks right, but I can't believe it. There must be some mistake.
- [43:31]
Nelson Cox
What?
- [43:31]
Hedley Thomas
Those stupid fucking idiots, he said. In six years, I had never seen Lloyd, one of the most intelligent journalists in the industry, lose his cool. He might have looked like a well dressed hippie, but he rarely believed conspiracy theories. He blamed incompetence first and foremost. I showed him the documents fresh from the printer. What do you reckon? I asked. We looked faintly ridiculous. Two grown men jabbing at pieces of paper, one swearing and wildly waving his arms. Stephen Seeley, the deputy editor, stopped to see what was going on. I told him hurriedly about the discovery. It looks right, I said. I haven't been able to confirm yet that it's the same Patel, but what are the chances of another negligent surgeon called Jayant Patel coming from Oregon? Sealy shook his head. Well, you'd better start making the calls, he said. He urged me to get cracking on the confirmation. He turned to the backbench to explain to the night editor, Rory Gibson, and his deputy, Neil Maynard, the contingency plan to remake the front page in the event of the story being true. Soon there would be a newsroom clamour for images of Patel's patients in Bundaberg, patients I had visited earlier that day without a photographer. Over at my desk, Graham Lloyd restored calm. He methodically analysed the documents from the two medical registration boards. They were clearly dealing with the same surgeon. But was he our surgeon? Lloyd correctly synthesised the details. He was disciplined first in Oregon in 2000, he said, so they banned him from doing surgery there. Then he's tried to obtain registration in New York State and he hasn't told them about his Oregon problems. When they found out, they've struck him off altogether. He's agreed to go along with that as a kind of plea bargain to avoid a greater punishment. We were still no closer to determining whether he was Bundaberg's Jayant Patel when I telephoned Jerry Fitzgerald. It was shortly before 6pm Time was against me. The strategy I had decided to follow involved a few simple queries. I planned to ask Fitzgerald to confirm Patel's home address or his US physician licence number. Figuring that the Chief Health Officer had access to Patel's file during the clinical audit. I hoped the details would be readily available to Jerry. I would not volunteer what I had found. The cryptic approach fell apart. I had delivered it clumsily. Fitzgerald told me he did not have the basic information that I sought.
- [46:24]
Jerry Fitzgerald
We have his CV showing his address, care of the Bundaberg Base Hospital and it says he was staff surgeon at Kaiser permanente in Portland, Oregon, October 89 to September 02 and clinical associate professor, Department of Surgery, Oregon Health Science University.
- [46:44]
Hedley Thomas
I changed tack, Jerry. I probably should have explained this at the start. I'm ringing because I've just done a Google search on Jayant Patel. It's come back showing him being struck off in New York State. He was also banned from doing surgery in Oregon. But there could be many doctors in the US with that name. I need to check if it is the same Patel. Naively, I believed that Jerry Fitzgerald had no knowledge of what I was talking about. Oh, really?
- [47:16]
Jerry Fitzgerald
I wonder if it's the same bloke. Probably is. There wouldn't be too many in Portland, Oregon. He got a Certificate of Good Standing from Portland, Oregon before he came here. They have to produce a Certificate of Good Standing when they come.
- [47:30]
Hedley Thomas
Fitzgerald let on nothing as I asked about these certificates and how they were verified.
- [47:36]
Jerry Fitzgerald
We rely on the medical board from where they have come from. If they can't produce the certificate, then we make further inquiries.
- [47:45]
Hedley Thomas
I read to Fitzgerald extracts from the correspondence. When I asked him if he was hearing about this for the first time, he said he was. But although I did not know it at the time, I was preaching to the converted. Fitzgerald had known about Patel since the previous Thursday. I asked again if he had anything I could use to match Bundaberg's now infamous surgeon with the Patel thrown up by the Google search.
- [48:13]
Jerry Fitzgerald
We don't have his date of birth. It sounds like it's him, but he still appears to be registered in Oregon. What I'm intrigued about is the relationship over what's happened in New York and Oregon. It sounds like the New York board has done a deal with him.
- [48:28]
Hedley Thomas
At the time, I was struck by Fitzgerald's immediate acceptance that it was the same Patel. It was out of character. Senior public servants are always overly cautious. Doctors are the last to assume the worst about their colleagues, or at least the last to share their views with those outside the club. At the time, I did not comprehend Fitzgerald's apparent confidence that it was the same Patel. He suggested that I contact Jim O. Dempsey at the medical board and ask him for the information about Patel's home address and US licence number. In previous exchanges with O Dempsey, I had put down the phone, infuriated by his lack of candour. We had invariably exchanged strong words. I doubted tonight would play out any differently. As Chief Health Officer, you'll have more luck than me, I said. Could you please ring him, explain the situation and ask him to contact me urgently? Tony Hoffman was at home when I called her. In the meantime, do you have any documents signed by Dr. Patel? I asked. I've found something and I need to compare his signature with it as soon as possible. Ill have a look, she said. Within 30 minutes, she had sent me a handful of emails. The attachments were documents bearing his signature. It was a lucky break. Hoffman had feared that the administration would deliberately lose the medical file for Des Bramwich, so she had copied it and taken it home. Amongst the paperwork were documents bearing Patel's signature. She scanned and emailed the messy swirl as JPEG files. It looked very much like the signature on the letters. It was close, but not conclusive. I asked if she knew anything definite of a New York connection or the medical college he had attended in India.
- [50:31]
Tony Hoffman
He talked about his time in New York and Portland, Oregon.
- [50:35]
Hedley Thomas
She said Hoffman went on the Internet herself and called back later to say that he had graduated from the University of Saurashtra in 1973.
- [50:47]
Tony Hoffman
Peter Leck lost the plot at the hospital today, she added, he had to be escorted from the premises. Someone said he's behaving like an orangutan. Everyone in the executive now is really very afraid.
- [51:01]
Hedley Thomas
The editor, David Fagan, wanted an urgent briefing on everything we had. Lloyd and I sat in his office and showed him the material. The Oregon and New York documents, the signatures. And I read to him my notes of the interview with Fitzgerald. I think we've got enough to publish. It looks good to me.
- [51:21]
Rob Messenger
If it were not for the signatures, we'd fall short. They are pretty close.
- [51:27]
Hedley Thomas
Fagin was more confident than me. What if we were wrong? I cringed at the thought of the consequences. The ABC's Media Watch would have a field day. As we talked in Fagin's office, my mobile phone rang. It was O. Dempsey. He had stepped out of a scheduled monthly meeting of the Medical board at Forestry House in Brisbane. I figured he would have been well briefed. By Fitzgerald, a fellow board member who was at the meeting. But he asked me what I was calling about. The question surprised me. Surely he knew. I told O. Dempsey what I had told Fitzgerald and that I needed details to confirm whether Patel from Bundaberg was the same person uncovered in the Google search. He said he had been in a meeting and would need to go away again to check Patel's personnel file.
- [52:18]
Jim O. Dempsey
I think it's likely, given he came from Oregon.
- [52:23]
Hedley Thomas
Like Fitzgerald, the executive officer of the medical board was being casually optimistic about something gravely serious. It was out of character. After ending the brief exchange with me, O. Dempsey made an urgent call in a desperate bid to minimise the probable damage. He knew the game was almost up when he telephoned one of Dr. Steve Buckland's advisors, Jill Fingster, on her mobile phone. Pfingst was on a road trip in Atherton in North Queensland with Buckland, Nuttall and one of the other advisors, Cameron Milner. They had been to Atherton Hospital after a visit to the indigenous community at Yarrabah. O. Dempsey, by now severely rattled, tipped off Pfingst, explaining that I had done an Internet search and discovered what they already knew about Patel and his disciplinary history. Gordon Nuttall winced. The worst secret was about to get out when O. Dempsey called back fewer than 30 minutes later. He asked me what address I had for Patel. I repeated the house number of the mansion in Northwest Bluegrass place, Oregon. We also compared the date of birth.
- [53:38]
Jim O. Dempsey
It matches, he said. We have that date of birth in 1950 and that address.
- [53:45]
Hedley Thomas
It was now conclusive. I told him the license number of the Patel on the Google search. He confirmed it was the same number in the personnel file of the former director of surgery. I was incredulous. Jim, this is unbelievable. It means that he should never have been registered here in Queensland. O. Dempsey was ready with an explanation, and he delivered it smoothly.
- [54:11]
Jim O. Dempsey
He provided the board with a false statutory declaration and he removed part of his Certificate of Good Standing prior to providing it to the board on my review. That appears to be what has happened. I've asked my staff to undertake a full review. There was a reference to an attachment on the Certificate of Good Standing. We did not receive it. If we had received it, it's still likely that we would not have had a sustainable priority to refuse his registration totally. We may have had to put conditions on his license. They would not have addressed the issues in Bundaberg. The issues in Bundaberg were around the types of operations he was doing.
- [54:49]
Hedley Thomas
The justifications did not make sense to me. But there was no time to argue. A deadline loomed and there was much to write. It dawned on me that O Dempsey's explanation meant he already knew about Patel. O Dempsey's routine of asking what I was calling about going back for the file, asking me what I needed to confirm it was a charade. I asked him when he discovered the fraud. He responded.
- [55:17]
Jim O. Dempsey
I got a review of the file over the weekend. We have been aware of the issues from Oregon and I was awaiting confirmation from Oregon. I'm not aware that the Chief Health Officer was aware of it. I am awaiting a brief from my staff member which is in draft form. He's looking at what went wrong. Can I stress there have been no findings against Dr. Patel. There's been a surgical audit that raised issues with Dr. Patel. The medical Board is extremely concerned about this one off incident. We are so concerned that I've instructed my staff tomorrow to commence a full review of every current overseas trained doctor registrant to ensure that their certificates of good standing are accurate.
- [56:00]
Hedley Thomas
I questioned O Dempsey closely on the timing of his knowledge. The answers to who knew what and when were essential.
- [56:09]
Jim O. Dempsey
I looked at the Dr. Patel file on Friday. I saw the note regarding the attachment. I instructed a senior Medical Board officer to find out what it was and get the details from Oregon. We advised the Minister's office today on the basis of getting formal information back. I merely briefed the Director General's liaison person.
- [56:29]
Hedley Thomas
I asked him repeatedly when precisely he spoke to the Minister's office. I said that the findings about Patel's previous incompetence were startling and that surely he could remember at what time that same day he had advised the Minister's office. But he insisted he could not recall. He rejected my suggestion that there had been a shockingly negligent lapse by the Medical Board with tragic consequences.
- [56:56]
Jim O. Dempsey
Absolutely not. We have one incident of what would appear to be fraudulent activity by a doctor and an error in processing. Here we rely on the certificate of good standing from the jurisdiction. We rely on the certificate rather than searches of the web. If we have a certificate of good standing that says they are OK, they are OK.
- [57:19]
Hedley Thomas
It was immediately clear that the warnings of late 2003 about the lax screening of overseas trained doctors had not been heeded by the Medical Board, which was little more than a rubber stamp. If doctors or complete imposters were capable of fraud or handy at desktop publishing, they might get away with the unlawful killing of patients. And maybe Patel had. Hoffman must have been sitting next to the phone. She was on tenterhooks when she answered it on the first ring. We've got him, I said. I explained the events of the previous two hours. She cried. Hoffman felt immense and indescribable relief. She had been completely vindicated, but she was also disgusted and furious. How, she asked me, could her bosses and the board be so reckless? And at what terrible cost for the patients and the nurses? David Fagan wanted a maximum display in the newspaper. The rush for pictures became frantic. The Bundaberg News Mail refused when we asked if we could buy one of their pictures of Des Bramwich, Mark or Tess. The News Mail had no idea of the story about to explode in their backyard. Our photographer in Harvey Bay, John Wilson, rushed to the Bramwich home to shoot a few frames and email them back. Back before deadline it was imperative to publish such extraordinary news as quickly and as prominently as possible. A little after 7pm I began writing the main splash under the banner headline. Why didn't they check? The story began like this. The surgeon dubbed Dr. Death by colleagues at Bundaberg Base Hospital had been found guilty of gross negligence in the US and forced to hand in his practicing certificate less than two years before coming to Australia. A Google search of public registers by the Courier Mail revealed yesterday that Dr. Jayant Patel, an Indian trained practitioner, had been cited over serious problems with his surgery in New York State and Oregon. Stephen Seeley made an astute decision to throw out the feature slated for page 13 and replace it with a lengthy read on the Patel case as well as the page one splash story. He needed a 1500 word inside story by 9pm before leaving the office. I needed to respond to my Source from late 2003. Dr. Marsh Godsall, who had first first explained to me the concerns over the proficiency and vetting of overseas trained doctors, was following the Patel stories. Marsh had emailed me the previous day, pointing out, the Bundaberg saga is an extension of what we discussed in 2003. Situation has not changed. My reply a few minutes before 10pm must have seemed somewhat cryptic. I wrote, I've been thinking of you these past few days and recalling what we tried to achieve in late 2003. The news in Wednesday's Courier Mail will blow your mind. Or maybe it won't, given your warnings, but it could also finally produce the sort of positive reforms you've been seeking. When I finally made it home and recounted the saga to ruth, it was 11pm The Courier Mail's first editions were being printed. There was a window of about six hours before they would hit the streets and unleash waves of shock and anger. The story was still missing something its most important character Patel. From home, I called our correspondent in Los Angeles, Nick Papps, who was waking up in another time zone. I explained the story, telling perhaps he could take an early flight and be on Patel's doorstep in Portland, Oregon before the Curie Mail's revelations were read or understood by anyone else. This was an era before there was instant news from the Internet. Pabst and his partner, a photographer, fought the rush hour to the airport.
- [61:51]
Pam Samra
Foreign.
- [61:57]
Hedley Thomas
Sick to Death is written and presented by me, Headley Thomas, the Australian's national Chief Correspondent. Claire Harvey is the Australian's Editorial Director. Audio editing, production and music have been done by Jasper Leake with assistance from Leah Samaglu and Neil Sutherland. Our producer is Kristin Amyers. Production management by Stephanie Coombs Artwork by Sean Callanan. Thanks to Ryan Osland, Matthew Condon, Corinna Berger, Ellie Dudley, David Murray, Dominique McDermott, Zach Skulander and all our family, friends and colleagues who helped in this series and contributed voice, acting and special thanks to Tony Hoffman and Rob Messenger. Subscribers to the Australian hear new episodes of Sick to death first@sicktodeathpodcast.com and on Apple Podcasts. You can get exclusive access to photographs, videos, timelines and more at the.
- [63:10]
Rob Messenger
SA.