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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.
- [00:39]
Chapter 7 the Web December 2002 to March 2003.
- [00:50]
Jayan Patel knew little about New Zealand and even less about Kaitaia, a small township in the country's far north. Its hospital, a modest 28 bed public facility, needed a doctor for a relatively undemanding position. There would be no surgery. It was a massive step down from the senior surgical positions that Dr. Patel had held in Portland, Oregon until resigning in disgrace in 2001.
- [01:22]
At Kaitaia, the successful candidate would be mostly involved in pre and post operative care of the patients. On rare occasions, Patel may have been needed in the operating theatre, but only to assist a surgeon. On 10 December 2002, he wrote, this.
- [01:43]
Dr. Jayant Patel
Is exactly the position I am looking for. A responsible practice in a small community.
- [01:49]
Hedley Thomas
His enthusiasm was obvious. Although the position involved a move to the other side of the world, Patel said he would be available to travel in just three weeks.
- [02:00]
Dr. Jayant Patel
Please call me if you can if there is any interest.
- [02:03]
Hedley Thomas
For months Patel had been searching the Internet looking for work. He was bored. He had been humiliated in the Oregon medical community. He needed to go somewhere foreign, a country and a hospital where he would be welcomed and pampered, where the doctors and nurses had no knowledge of his past.
- [02:26]
He had registered with an Australian medical recruitment company, Wavelength Consulting, which pledged in its mission statement, we will always provide.
- [02:35]
Dr. Sally Ehlers
Our clients with first class candidates, our candidates with first class opportunities and both with unbeatable service. We will do so ethically and with the best interests of the candidate, client and wider community in mind.
- [02:52]
Hedley Thomas
Its website was busy with job descriptions and easy to navigate. Its staff responded promptly to his emails and queries. The company, which had a paid up Capital of $2, was owned by Dr. John Bethel and Claire Paunceford in Sydney. They headhunted overseas health professionals and matched them with vacancies in hospitals and private clinics throughout Australia and New Zealand.
- [03:20]
The company earned a commission from each placement. A chronic shortage of doctors and the constant bidding up of salaries by increasingly desperate employers had created a lucrative market. Dr. Bethel found that he could make more money from his Internet based business than he could earn by practicing medicine. But the hospital at Kaitaia in New Zealand would have to make do without Dr. Patel. He was flattered when a Wavelength staff member told him he would be too senior for this post. Instead, Dr. Bethel had something else up his sleeve. A position as the senior medical officer at the Bundaberg Base Hospital had become available. Patel was again brimming with enthusiasm. He spoke to Bethel on the telephone and followed up in writing.
- [04:14]
Dr. Jayant Patel
I had good training and experience with the majority aspect of general and pediatric surgery, including laparoscopic procedures, trauma surgery, including vascular emergencies. I have excellent surgical experience and am very comfortable with the responsibility. I'm getting a few offers within the us. However, my first priority is overseas work.
- [04:34]
Hedley Thomas
Patel explained that he was near retirement and financially secure, with a daughter in medical school and his wife Kishoree, still practicing as a doctor. He told Bethel that he wanted an altogether different work and life experience. He wanted an adventure. Bethel liked what he heard. Dr. Patel had held a position as a staff surgeon with the same major organisation in Oregon for 12 years and he had headed a surgery residency program which involved teaching and mentoring junior surgeons. A number of articles he wrote jointly with other surgeons had been published in journals. And unlike some of the doctors who promoted their skills through the website, Dr. Patel was not overly demanding. Dr. Bethel briefed Dr. Keys Neidem, Bundaberg Hospital's acting Director of medical services, about Dr. Patel. He would expect relocation expenses and accommodation, but does not need a big house. He needs a place to get a good cup of coffee in the morning. Patel sent glowing references from three of his US referees Dr. Peter Feldman, Dr. Bawar Singh and Dr. Nora Dantas. Each of the references was written on Kaiser permanente letterhead. Here's Dr. Feldman. I've known Dr. Jayant Patel ever since he came to work at Kaiser permanente in Portland, Oregon. I have many good things to say about Dr. Patel. He has been a wonderful colleague over the years and has been a very hard worker. In addition to having a very busy surgical practice, he was very active on hospital committees and in other administrative forums. He has a well above average interest in his work and a well above average knowledge of surgery. Here's Dr. Singh.
- [06:30]
Dr. Sanjeev Sharma
As a former chief and staff anesthesiologist, I have had the opportunity of working with Dr. Patel on numerous occasions, both in elective and emergency situations. His balanced judgment, surgical skills and decisive steps, especially in the management of high risk complex procedures, has always been appreciated by US anesthesiologists and other members of the Oregon team. Dr. Patel's professional expertise, passion and energy for Quality patient care coupled with ethical and best practices advocacy won him the vote of his colleagues for a Distinguished physician award in 1995. These qualities undoubtedly will be an integral part of Dr. Jay Patel's professional career, irrespective of the place of his practice.
- [07:19]
Hedley Thomas
And here's Dr. Dantas I worked with.
- [07:23]
Dr. Sally Ehlers
Him closely at our intensive care unit and saw him care for the most difficult surgical cases at our hospital. I saw the good results. The nursing staff had good things to say about his surgical skills, his compassionate care and his relationship with the nursing and medical staff. My countless patients that he took care of for the last 10 years were very satisfied of his results and his skills. And I can say categorically that no one ever gave me a negative feedback about him, which I always get as a primary care physician when patients come back to me.
- [07:56]
Hedley Thomas
Patel's other testimonials were also superb. Dr. Edward Areniello was chief of surgery at the Kaiser Permanente Group's Bez Kaiser Hospital when he hired Patel in 1989. According to Aranelo, from the time he.
- [08:16]
Dr. Sanjeev Sharma
Started, he dove into the work with full vigor. He generally did about 120 cases of pediatric surgery per year, in addition to a full load of General Surgery. Dr. Patel had excellent results with no serious problems or complications. As far as general surgery is concerned, he took on the easy cases and more often the more difficult, challenging and risky cases. He achieved remarkable results and successes. Insofar as patients are concerned, they keep coming back to him, they trust him and he delivers the best care he can.
- [08:57]
Hedley Thomas
When Dr. Bethel called Dr. Feldman and Dr. Singh, they both continued the praise. Neither mentioned the most relevant chapter in their former colleague's career, his record of botch ups and disciplinary action. Although Dr. Feldman gave a cryptic clue when he said that Patel sometimes took on complex cases handed to him by colleagues and found it hard to say no.
- [09:25]
Dr. Bethel voiced one minor concern. It was that Dr. Patel had not worked for almost 18 months. According to his curriculum vitae. In a subsequent CV sent by Patel, the date on which he claimed to have left Kaiser Permanente in Portland had been changed from 2001 to 2002, but the change went unnoticed. On Christmas Eve, Dr. Patel received an early present, a letter of appointment as senior medical officer at Bundaberg Base Hospital. He promptly signed and returned the document. His starting date was confirmed as 1st April 2003. Before he farewelled his wife, Kashoree, his daughter and friends in Oregon. There was a pile of paperwork and red tape to be dealt with. Patel needed a rubber stamp from the Medical Board of Queensland to say he was a properly credentialed doctor. Although the board had a statutory duty to register doctors and protect the public from charlatans, its procedures were negligently lax. The board performed no independent checks of the references or credentials of incoming doctors. Their fellow physicians were above suspicion. In Patel's case. The board simply required a document from the Oregon Board of Medical Examiners certifying that he was properly registered and had not been disciplined. Patel gave an assurance to Susie Tors, one of the Wavelength staff handling his file, in January.
- [11:10]
Dr. Jayant Patel
I will fax you the letter and put the original in the mail.
- [11:14]
Hedley Thomas
Tors forwarded the documents from Dr. Patel to Ainslie McMullen, an officer with the Medical Board of Queensland. Neither Tors nor McMullen noticed that the certificate from Oregon hinted at a potentially serious problem. In black and white, it said standing public order on file, see attached. But there was nothing attached. The documents setting out the details of Patel's negligence and his disciplinary history had been removed. One of the Medical Board forms requires doctors to declare whether their registration overseas has been the subject of any condition, suspension, undertaking or cancellation. Patel, in his response, wrote no.
- [12:02]
McMullen processed the file, one of hundreds she had handled for the board. Wavelength would receive $13,924 for its efforts in recruiting Dr. Patel. His travel plans were locked in by the administrative staff at Bundaberg Hospital. He was scheduled to arrive in Brisbane on a Qantas flight on 31 March, go to a 12.30pm meeting with a Medical Board representative at Forestry House in the city and then head back to the airport for a 3.30pm flight to Bundaberg. He wrote to the hospital's Lynn McKean, who is taking care of his travel and accommodation.
- [12:44]
Dr. Jayant Patel
I'm looking forward to meeting all of you and having a very productive year.
- [12:48]
Hedley Thomas
She had booked him into one of the nicer beachside apartments in Miller street, Bagara, a 15 minute drive from the hospital. It offered a superb view of sand, volcanic rocks and sea.
- [13:03]
We are all so looking forward to your arrival and I know you all have an enjoyable year.
- [13:11]
Chapter 8 flashback a vicious cycle.
- [13:19]
It was May 1993 and Jayan Patel, smiling warmly, uttered his umpteenth self serving sentence in the 20 minutes that he and Dr. Sally Ehlers had been seated together.
- [13:32]
Dr. Jayant Patel
Congratulations. You've got the job. I make my decisions quickly.
- [13:38]
Hedley Thomas
At 29 and newly separated from her husband, the father of her four year old son, Sally Ehlers found the interview disturbing. She had the job. But already she was concerned about the underlying ambitions of her new boss.
- [13:54]
She wanted the position as a second year resident in an integrated surgical residency program run by Emanuel Hospital and Health Centre and Kaiser foundation hospitals in Portland, Oregon. She guessed that Dr. Patel, the program director, had hired her because of her attractive appearance, age and gender, not because of the strength of her impressive curriculum vitae. Driving home, Dr. Ehlers replayed in her mind the clues to Patel's less than subtle antics, and she recalled his repeated references to his age. He had boasted several times that he was only 39. He and his wife, Kishoree, a competent physician, had bought a mansion in Beaverton, an expensive suburb in Northeast Portland, two years earlier for $420,000 US but Patel's partner since medical college in India, rarely came up in conversation.
- [14:57]
His ego was colossal. Aside from himself, Patel had little to talk about. He stressed how much he had achieved and how clever he was. The young surgical residents who looked up to Patel had voted him Teacher of the year in 1991 and 1992. He was determined to educate Sally Ehlers and school her in the intricacies of a wonderful subject. Himself, he boasted how he had embarked on an extraordinarily successful journey in surgery, and he was still, as he put it, so young. He wanted Eliz to nod and fawn in obsequious approval and flatter him with tributes to his stellar career. Patel, who shamelessly complimented himself, had turned a job interview into a flawless self appraisal, and Dr. Sally Ehlers concluded that he wanted her to understand something else. Their age difference was trivial. The 10 years separating the chain smoking and overweight surgeon from his fit understudy was no barrier to a relationship outside the operating theatre, he insisted. But it was another clumsy lie, another hopeless misrepresentation. At that time, Patel was not 39. He had just turned 43. It would take another seven years for regulators in Portland to ban Patel from a wide range of surgery. But the number of patients who were dying or suffering in pain due to his negligence was growing. Even before Dr. Ehlers received her letter of appointment, every time his scalpel slipped and nicked an artery or vein or vital organ, Patel lacerated the quality of life of a patient in Oregon. In at least a handful of cases, the ones that stood out for the glaring ineptitude or because the families demanded answers, his blade was an instrument of death, and some of his colleagues had begun to express disquiet. But before Sally Ehlers had seen him operate or surveyed the dreadful complications in the patients. She was busy discouraging his advances. He spoke to her in the car park a month after their first meeting.
- [17:22]
Dr. Jayant Patel
You may never get to have drinks with your program director again. What you really need is a boyfriend.
- [17:28]
Hedley Thomas
Sally ehlers replied.
- [17:30]
Dr. Sally Ehlers
Well, Dr. Patel, I have a boyfriend, and you know that. You've met him.
- [17:35]
Hedley Thomas
She had been seeing another Dr. Atul Thacker. Patel knew about their blossoming relationship because Sally had introduced them at an annual resident graduation dinner. Dr. Thacker was ethnic Indian, although the similarities with Patel ended there. He had grown up in the United States. He had graduated from the medical school at University of California, Los Angeles, or ucla, and he was a resident at Oregon Health and Science University. He was popular and he was younger. When Patel again tried to start a relationship with Dr. Ehlers, she told him Thacker was a serious boyfriend. Patel's demeanour changed immediately for the worse. Other young female doctors felt uncomfortable around Dr. Patel. As participants in the Emanuel residency program, they lived in adjoining accommodation. Patel would barge into the women's area without knocking, surprising the residents in various states of undress after a shower or while changing clothes. He had no place being there. For the next three years. Patel prevented Elis from performing complex and challenging surgery in educational conferences. He was hostile and shouted her down when she offered answers. He singled her out for nastier sides and made her feel inferior around the other resident surgeons. Those surgeons in Patel's good books, those he dominated and groomed for his clique, they clamoured and competed for his attention. But Ehlers wanted none of it. She suspected that Patel would have been reasonable towards her if it were not for Thacker's ethnicity. The handsome, younger ethnic Indian unwittingly highlighted Patel's shortcomings. On 12 January 1995, Patel sent her a formal letter accusing her of being being argumentative, alienating nursing staff, manipulating the people around her, resisting constructive criticism, and having little insight into her conduct. It was classic self projection. Ehlers had been highly regarded and received outstanding marks before and after her contact with Patel, but he had decided to teach her a lesson. His letter to her went on to.
- [20:03]
Dr. Jayant Patel
State, your performance in your surgical residency at Emanuel has remained unsatisfactory. This is primarily because of your attitude and behavior. You are being perceived as argumentative, disrespectful, dogmatic and arrogant. Being disrespectful, especially to the attending staff, is an unacceptable behavior in their surgical residency program. I am placing you on probation immediately. If you desire, we will be very happy to arrange for counseling, depending on the Evaluations. At the end of your probationary term, you will either be removed from probation and allowed to continue, or be subject to disciplinary actions, including removal, or repeat.
- [20:44]
Hedley Thomas
Patel should have been more worried about his own failures in theatre. The corridor gossip at the Bess Kaiser Medical Centre was spreading like a virus, with several doctors outside Battelle's influence questioning the competence of the staff surgeon. Patel's knowledge of surgery was good. He was clearly an intelligent man. But in many procedures, particularly those involving painstaking and tedious work over several hours, his sloppiness was remarkable. Some of the doctors had a theory. They believed his addiction to smoking was a large part of the problem. Craving the nicotine of a cigarette when he should have been meticulously manoeuvring his scalpel around delicate organs, he would, they suggested, lose focus and nerve. He would rush the procedures, take shortcuts, leave theatre before the job was done and stride outside to light up. Sometimes his patients paid with their lives or their organs. But still none of his colleagues who harboured these concerns went to the authorities. By late 1995, a restructuring of the hospital setup led to Patel being reassigned to work with more experienced surgeons for the first time. Until then, he had been top of the heap. He thrived on conflict and had reinforced perceptions of his aggressive nature by chastising another surgeon and questioning his expertise. But now better surgeons were seeing his handiwork.
- [22:25]
Although Jayan Patel had made a lot of money for the Kaiser Permanent Group, the legal actions brought by the victims of his incompetence were increasingly expensive. Ranila Tepe, 18, was suffering abdominal pain and a family history of polyposis, a predisposition to colon cancer, when she went to see Patel. As her father and her uncle had died at an early age of colon cancer, Ronyla was at similar risk. Despite knowing the family history, Patel ordered the wrong diagnostic test for the young woman. The limited scope of the test meant its results were inconclusive, and Patel assured Ronyla that she was fine. The failure to examine her entire colon meant that polyps already present went undetected. Her death at 20 of colon cancer devastated her young husband, who was left to raise an infant son. The only consolation was financial. Kaiser Permanente settled the case for us. $1.4 million. The hospital group also paid out to the family of Leitriss Fairchild, who died two months after Patel removed part of her stomach. The surgical wound cut collapsed in a hideous mess, leading to serious complications and death.
- [23:52]
Kaiser settled this one for $375,000.
- [23:59]
Throughout 1995, there were more deaths, injuries and payouts and a trio of shocking cases. Gerald Tucker, who bled to death that cost $900,000. Helen Brooks, whose ureter was accidentally cut. That was a confidential settlement. And another confidential settlement in relation to Susan Tomberlin, whose femoral vein was cut.
- [24:28]
One of the younger surgeons tasked with assisting Patel, Dr. Sanjeev Sharma, would later tell Susan Goldsmith, a senior investigative journalist at the Oregonian newspaper, of his efforts in the operating room to help Helen Brook. He tried alerting Patel to his mistake. I tried very hard to get him to realize there was a problem. After the surgery, I spoke up about Mrs. Brooks to Patel, and he said, it's okay, it's okay. Susan Tomblin discovered how she had been unnecessarily injured when a nurse told her that the operation went terribly wrong.
- [25:07]
Dr. Sally Ehlers
When I saw another doctor, he said I was a walking time bomb from this. They said this could kill you if a piece of this blood clot gets loose. When I mentioned that to Dr. Patel, he screamed at me like I was a 2 year old. Told me I wasn't to talk to anybody about what happened.
- [25:25]
Hedley Thomas
The hospital's managers and lawyers elected to keep the litigation and the payouts a secret from Oregon's regulatory body, the board of medical examiners. In mid-1996, in the months after the closure of the Bess kaiser Medical Centre, Dr. Sally Ehlers went to a weekly meeting of doctors at another hospital, Providence St. Vincent, to compare notes on problem surgeries. That's where Sally Ehlers disclosed the case of Duane Fecan, whose large intestine was removed by Patel. It was the wrong decision. Feaken suffered a string of serious complications and needed several operations over a few years to rectify the damage. His wounds had also fallen apart. His poor outcomes mortified Sally Ehlers. At the age of 14, she had been diagnosed with Hodgkin's disease. She was a cancer survivor, and doctors had told her incorrectly at 18, that she was infertile. Her experiences gave her a unique understanding of the mental and physical pain suffered by patients. She knew that Patel, her former teacher, was dishonest and a predator. But she could not figure out why he had rushed Fecan into having the original operation. Duane Fecan had not been afflicted with ulcerative colitis. The young man suffered Crohn's disease, a fact established from the pathology report. It was as if Patel, whose boastfulness was legendary, wanted to do the most complex procedures for his own benefit. A distressed doctor, Ehlers had been to see Patel to discuss his invasive operations and the complications that had ruined Duane Fecan's quality of life. She told him, I have seen the.
- [27:22]
Dr. Sally Ehlers
Pathology report and it shows Crohn's disease.
- [27:25]
Hedley Thomas
But the senior surgeon shrugged it off.
- [27:29]
Dr. Jayant Patel
Oh, I'm going to talk to the pathologist. I will get that straightened out.
- [27:34]
Hedley Thomas
When Dr. Ehlers, safely out of Patel's clutches, went to the Morbidity and mortality meeting at Providence St. Vincent in mid-1996 and described Fecan's clinical history, including his most recent major operation weeks earlier and an intra abdominal abscess, the other surgeons were unusually somber. They had been wary of Patel before Dr. Elis spoke, but now, after hearing about the pointlessness of Feekin's misery, they were worried.
- [28:08]
Dr. Roger Alberti, chief of surgery at the Providence St. Vincent Medical Centre, found that other surgeons doing the same surgery as Patel were having much better outcomes. In the same year, Patel was threatened with disciplinary action by the regulatory authority in Washington state for seeking registration there and lying to conceal an earlier chapter in his disciplinary history. By late 1997, several other surgeons employed by the Kaiser Permanente Group were voicing concern. When the group's chiefs ordered a clinical audit of 79 of his operations, the findings were worse than they had feared. Several patients had bled to death because veins or arteries or organs were nicked in surgery, and a worryingly high number of patients had suffered dehiscence. Their wounds literally fell apart due to negligent technique. In 1998, when the results of the clinical audit were in, Kaiser Permanente managers filed a confidential adverse action report with the US National Practitioner Databank. The patients Patel had operated on for the preceding decade remained unaware of the serious and adverse findings regarding his competence. Patel's surgical work in hospitals operated by the Kaiser Permanente Group was severely restricted. For the first time in late June 1998, a new framework established uniquely for.
- [29:42]
Dr. Sally Ehlers
Him required mandatory second opinions before undertaking.
- [29:47]
Hedley Thomas
All complicated surgical cases.
- [29:49]
Dr. Sally Ehlers
Chart reviews proctoring attendance of surgical meetings.
- [29:54]
Hedley Thomas
In the two years between Sally Ehlers first voicing her long held concerns in 1996 and the conclusion of the clinical audit in 1998, at least four patients died in circumstances where death should not have occurred.
- [30:11]
Numerous others were unnecessarily injured. After hearing finally about the Patel cases, the Oregon Board of Medical Examiners, which registers practitioners to work and decides on disciplinary or regulatory action where the public may be at risk, held its own investigation. On 22 September 1998, Patel admitted to the board's investigative committee that he had made serious surgical errors. Patel agreed to a range of formal restrictions on his surgery, and he undertook to obtain second opinions before considering operations that were not straightforward. It took two more years for the board's restrictions and the formal findings of gross or repeated acts of negligence to become a matter of public record. By 2001, as gossip and revelations about Patel's negligence went around Oregon's medical community, the surgeon had become a public embarrassment to the Kaiser Permanente Group. His colleagues had presented him with an Award in 1995, naming him Distinguished Physician of the Year, but in June 2001 he resigned to avoid being fired. In the same year he was also struck off the role of practitioners in New York State, having also lied to the medical authorities there about his disciplinary history. Patel, desperate to return to the operating theatre, was being thwarted at every turn.
- [31:49]
He was incompetent when he came to Bundaberg in 2003, but his incompetence was compounded by another factor. By April 2003 he had not picked up a scalpel for several years. He was much more deadly than he had ever been.
- [32:18]
Chapter 9 A New Career March to June 2003.
- [32:25]
Jayan Patel was keen to see his new workplace after the Qantas flight from Brisbane touched down late in the afternoon of the 31st of March. Although tired from the travel, he was also excited. His charm and effusive friendliness rubbed off on Dr. Keys Nydem, the acting director of medical Services, who showed him around the Bundaberg Hospital on Bourbong Street. Patel made light of his long journey as he cut a sway through the administration offices, shaking hands with senior and junior staff. He read the Queensland Health Code of Conduct, and he provided a sample of his signature signature for the official registry. Hours earlier in Brisbane, he had been to the offices of the Medical Board and met one of its members, Dr. John Waller. It involved little more than a friendly greeting and a glance at the file. Dr. Waller, overlooking the clue to the disciplinary action in Oregon, ticked yes next to the criterion of Certificate of Good Standing. The next morning, when Dr. Patel arrived at Bundaberg Hospital for the start of his first working day as a senior medical officer, or smo, the town was having a collective laugh. It was April Fool's Day. Patients, nurses, and doctors at the hospital amused each other with practical jokes and harmless gags. The Bundaberg News Mail was in on the fun, reporting how rail lines at Quay street had suddenly been removed. One reader failed to see the funny side after going to inspect the public works only to find nothing had changed.
- [34:12]
On that day, Patel was formally endorsed by the Medical Board. It granted him Registration certificate number 1030-4500, providing authorisation to practise as a senior.
- [34:27]
Dr. Sally Ehlers
Medical officer in surgery at Bundaberg Base Hospital or any other public hospital authorised by the Medical Superintendent on a temporary basis.
- [34:37]
Hedley Thomas
The Dear Dr. Patel letter sent by the regulator on 1 April, states, in.
- [34:43]
Dr. Sally Ehlers
Bold font, it is advised that you are not registered as a specialist.
- [34:49]
Hedley Thomas
This meant he had to be supervised. As Patel had come to Bundaberg to perform surgery, the Medical Board carelessly assumed the hospital already had a director of surgery. In other words, a highly qualified specialist who had been vetted and credentialed by the Royal Australasian College of surgeons to scrutinise Dr. Patel's work and identify any problems. But there was one major hitch. The last Director of Surgery, Dr. Sam Baker, had quit in disgust months earlier. Dr. Keyes Nydem, overawed by Patel, was embarrassed that a senior American surgeon with apparently immaculate qualifications was a mere senior medical officer in a regional Queensland hospital. A week later, Dr. Nydem, temporarily in charge of the hospital where he had done his internship a quarter century earlier, made an executive decision to promote Dr. Patel to the position of Director of Surgery. Dr. Neidem was breaking the rules with his premature move to flatter and elevate an untested surgeon he barely knew. It was the worst decision he had made in his professional life.
- [36:08]
In the year he had reluctantly been in charge of the hospital, Dr. Nydam felt like a military chief who, when he asked for generals, had been given majors. Now that he had a bona fide general, when all he had asked for was a major, Nydham wanted to look after him. Nydam had long taken the view that people who worked in public health were either missionaries or idiots. He put Patel in the former category. He asked a question of Georgie Rose, the hospital's human resources manager.
- [36:42]
Dr. Sanjeev Sharma
Are we paying Jay Patel a director's allowance? If not, could we do so, please, as he is the director of surgery.
- [36:52]
Hedley Thomas
When Jenny White, the senior nurse in charge of the operating theatres, met Patel, he laughed as he told her he had been given the director position. Jenny White was surprised nobody had assessed Patel's surgical technique. If it was anything like his personality, hot and cold, ranging from brash, domineering and rough to charming and obsequious, the staff and patients were in for a wild ride.
- [37:22]
Another American surgeon, Dr. Jim Gaffield, was due to start at the hospital by the end of the month. Nurse White wondered why Dr. Gaffield had not been considered for the position of Director of Surgery.
- [37:36]
Dr. Jayant Patel
Well, it must be because I got here first.
- [37:40]
Hedley Thomas
In mid April, Bundaberg Hospital greeted Dr. Darren Keating as the new Director of Medical Services to occupy on a permanent basis the position that keys Nydem had been unhappily filling. Patel, already well ensconced, warm to the reserved former Australian Defence Force doctor who arrived with his young family from a small regional public hospital in Western Australia. Dr. Keating had never managed a hospital. He displayed unusual trades for an executive. When staff came to see him in his office, he would invariably continue writing whatever letter or report he had in of front front of him. Sometimes he would not bother looking up. Doctors and nurses would leave his office shaking their head at his manner. Dr. Keating chose to remain isolated from most of the staff. He was rarely seen in the intensive care unit, the wards or in medical meetings. Dr. Keating was aloof. It came across as arrogance, but it could have been shyness and a lack of of confidence. His limited and general clinical experience meant he was hopelessly out of his depth around specialists. Dr. Martin Straughan, a visiting medical officer, decided that Dr. Keating preferred to remain bunkered in his office lest he encounter complaints and Keys Nydem would later conclude.
- [39:07]
Dr. Sanjeev Sharma
If he was standing against the grey wall, you wouldn't even know that he was there.
- [39:13]
Hedley Thomas
But right from the start, Dr. Keating gave undivided attention to Jayant Patel. If it were not for Patel's remarkable gusto and his enthusiasm for surgery, the hospital's waiting lists would lengthen. And that would invite even closer scrutiny of Keating's management from more senior bureaucrats in Brisbane.
- [39:35]
Before anyone unnecessarily began to die or suffer injury at Bundaberg Hospital, there were red flags. Warnings that Patel's competence did not equal his confidence. He was too eager to operate, too gung ho. His judgment was questionable. When surgical errors were made, he fought to prevent patients being rushed to better equipped hospitals in Brisbane, even when their complications were life threatening and beyond the capacity of the regional hospital. Patel told management, it always looks right.
- [40:12]
Dr. Jayant Patel
If we do the procedures where we also are capable of dealing with the complications.
- [40:17]
Hedley Thomas
It was a theme Patel hammered relentlessly at Bundaberg. In the beginning, the nurses put it down to his US training. But there were too many mishaps. There were too many squandered chances to improve a patient's prospects. It took a while for Patel's other motive in obstructing transfers to dawn on the nurses. He opposed the transfers because the damage he had caused to the patients could be identified by other surgeons.
- [40:50]
With cancer on the inside upper section of his ear, Peter Dal Gleesh spoke to Patel in April about having it removed. Patel was shown the position and had the added benefit of the notes of the family doctor. On 20 May, Patel confidently went to work on the ear and he declared the procedure a success. But he had operated on the wrong part of the ear. Have you ever had your ear operated on, let alone the wrong place altogether? Dalglish put the question to Peter Leck, the hospital's manager. To say it is painful would be an understatement. Indeed, the cancer is still there. Dr. Darren Keating spoke to Patel, who refused to accept that he had removed healthy tissue and overlooked the cancerous part.
- [41:42]
Paul Jones went in for a procedure on his right scrotum known as an epididymectomy. It was to have been performed, performed under a general anaesthetic. To his great surprise, Jones received an entirely different procedure. Instead of examining his private parts, Patel performed a gastroscopy. He pushed a scope down Jones throat and esophagus to investigate his stomach.
- [42:10]
Nurse Jenny White witnessed an episode she likened to something out of the MASH comedy series. Set in a field hospital during the Korean War, there had been a traffic accident about 15 kilometres from the hospital. White received a frantic phone call from Patel, who was in a panic.
- [42:29]
Dr. Jayant Patel
I've got to go out to this accident site and I am going to need equipment to amputate limbs.
- [42:34]
Hedley Thomas
White was already wary of Patel. What's he going to do? She wondered. She collected equipment. He would need a battery operated power source, a large plastic container of blades and saws and packs full of swabs and sutures. Shortly afterwards, the lift doors opened and she watched Patel rush out with two principal house officers, two interns and two medical students in tow. All were in their surgical scrubs. Patel was still frantic.
- [43:06]
Dr. Jayant Patel
Where's the equipment? Where's the equipment?
- [43:09]
Hedley Thomas
White replied.
- [43:11]
Dr. Sally Ehlers
Look, I have it all here in a trolley.
- [43:14]
Hedley Thomas
The entourage swarmed back into the lift.
- [43:16]
Dr. Sally Ehlers
You're in the wrong lift.
- [43:18]
Hedley Thomas
One lift was programmed to go up and the other to go down. Patel was shouting at the staff and urging them to hurry while white was yelling.
- [43:26]
Dr. Sally Ehlers
Dr. Patel, Dr. Patel, you're in the wrong lift.
- [43:29]
Hedley Thomas
He ignored the nurse and she watched the doors close. The lift went up and then went down so they could pile out and get into the right lift.
- [43:40]
As it turned out, Patel had no role to play in the accident. The passengers were freed by ambulance officers without the need to cut off limbs. When Jenny White reflected on the incident. Afterwards, she realized that Patel had not even notified an anaesthetist to provide pain relief for the victims should amputation be needed.
- [44:02]
From the moment he arrived in Bundaberg, Patel strove to make himself invaluable to his new employer, Queensland Health, and the managers of the hospital in Burbong Street. Nobody in Australia knew about the bloodletting in Oregon, nor, Patel decided, did anyone need to know. Instead, Patel had discovered something about the Queensland public health care system. He planned to turn it to his advantage.
- [44:31]
By working hard and performing as many operations as humanly possible. Patel would cut the waiting lists for surgery. The waiting lists were pointed to by the media, the politicians and the patients as proof of either maladministration or well oiled efficiency. By meeting the targets in surgery, Patel would make the hospital look good. He would give Peter Leck an opportunity to be lauded rather than lambasted by his bosses in Brisbane and by the Labor Party's local parliamentarian, Nita Cunningham. In turn, Patel would make himself the most valued clinician in the district. With hard work he could be so prolific the hospital's new director of medical services would come to to view him as indispensable. Their success would be tied to him. They would come to need him more than he needed them. Patel also knew that his zeal would be financially attractive to the hospital because in the end, it always came down to money. The formula used by Queensland Health to fund the hospitals was deliberately structured to reward volume and and complexity of operations. The more, the merrier, the riskier, the better. The cash flow depended on numbers, not outcomes. And when the hospitals did not meet the numbers, their funding shrank. By doing more operations and more complex operations, Patel would generate rivers of cash for the hospital. He would also generate rivers of blood from the patients. In the process, Patel would set out to prove he really could perform brilliant surgery. He wanted to re credential himself. He looked forward to complex operations such as esophagectomies, operations his United States peers had forbidden him from ever trying again.
- [46:50]
Chapter 10 life and death april, june 2003.
- [46:59]
James Edward Phillips, 46, signed his life away on 10 May 2003. Next to a handwritten asterisk on a consent form. It also bore the name and signature of the man who escorted him to a premature death. On the day he signed, Phillips brimmed with optimism and hope. He liked the look and confidence of Bundaberg Hospital's new director of surgery, Dr. Jayan Patel. Even if the operation being proposed was difficult to pronounce and harder to spell. Esophagectomy. An operation so complicated and risky it should only be attempted at major hospitals by the most adept specialists, preferably gastroenterologists. To maintain proficiency, a surgeon had to perform a minimum of 30 such operations a year. It is an operation needing specialised and well resourced intensive care unit backup. There is only one certainty. After an esophagectomy, the patient will need close monitoring. For a long time in a well equipped hospital, esophagectomies were well beyond the limited scope of the operating theatre and the adjacent ICU on the first floor of the Bundaberg Hospital. The operations were also hopelessly outside the expertise of Patel. His lamentable skills were at their negligent best when he was regularly performing far less complicated operations in hospitals in Portland, Oregon. There, his recklessness, rough handling, clumsy techniques and poor judgement had cost his employer millions of dollars in confidential settlements for wrongful death and wrongful harm. James Phillips knew none of these additional risks when he signed on for an operation he hoped would cut out a small, small lesion in his oesophagus, the tube linking his throat with his stomach. The lesion was blocking part of Phillips oesophagus and making it difficult for him to swallow food. Under Patel's plan, it would be removed. He hoped it would prolong his life by several years. The generic consent form required patients to.
- [49:19]
Dr. Sally Ehlers
Acknowledge the the doctor has explained my medical condition and the proposed procedure. I understand the risks of the procedure, including the risks that are specific to me and the likely outcomes. The doctor has explained my prognosis and the risks of not having the procedure. I understand that no guarantee has been made that the procedure will improve the condition and that the procedure may make my condition worse. On the basis of the above statements, I request to have the procedure on the same form.
- [49:50]
Hedley Thomas
Patel set out his plan strategy. He would make an incision in the abdomen. He would also make an incision on either the left side of the neck or the left side of the chest. He would slice through the tissue of the upper part of the stomach and the lower part of the esophagus. It was a difficult manoeuvre, but what came next was even harder. Patel would need literally to pull Phillips stomach up and attempt a connection to whatever was left of his oesophagus. A fortnight earlier, Phillips, whose serious kidney problems requiring constant dialysis made him a regular visitor to the hospital, had seen Dr. Mark Appleyard for an examination of his oesophagus. Dr. Appleyard put a flexible viewing tube into Phillips's mouth and carefully inserted it all the way to the duodenum, the first stage of the small intestine. Appleyard located a nodule, which he noted had a concerning appearance. It crumbled easily. It also bled easily on touching. Appleyard wrote the following in the patient's notes. I am concerned about the esophageal nodule. Fortunately for Phillips, he had been in the safe hands of Dr. Peter Meak, a highly regarded renal specialist in charge of the renal unit, who was also the director of medicine. Peter Meak had supervised the ongoing dialysis. Phillips was a favourite patient of nurses in the renal unit. He rarely complained, despite his serious kidney issues, the constant dialysis and his poor overall health. The biopsy results after Appleyard's examination were discouraging. When the five pieces of pale, tan and brownish tissue measuring up to four millimetres were analysed, they showed evidence of invasive adenocarcinoma. In other words, a cancer in cells lining the walls of his esophagus. Dr. Miak had asked Dr. Patel for an opinion. The surgeon recommended an esophagectomy, but Dr. Miak was against it. He believed that Phillips was much too frail. Major surgery would be extremely dangerous in someone as ill as Phillips. Dr. Meak worried the man would die on the operating table.
- [52:32]
On 19 May, Dr. Patel fast tracked Phillips into theatre without Dr. Miac's knowledge.
- [52:40]
A little after 10am, Dr. Patel began to make the incisions. He cut and removed the diseased tissue and pulled up the stomach. Phillips, still under a general anaesthetic, went downhill fast. His vital signs were were rapidly deteriorating. For the last 45 minutes of his operation, there was no recordable blood pressure to keep him alive and his blood circulating. He received massive doses of inotropic drugs to make his heart beat more strongly. Even the adrenaline in the drugs was of little benefit. By mid afternoon, Dr. Patel had put down his instrument instruments and Phillips was wheeled into the intensive care unit in an extremely unstable condition. His pupils were fixed and dilated, indicating brain death. A renal vein used to take blood away from the kidney had become blocked. The blockage was almost inevitable. The charts for Phillips, who had not been offered an esophagectomy by specialists in Brisbane despite their greater expertise, showed the artery was functioning at just 70%. An esophagectomy would almost guarantee thrombosis. And it did. For much of the operation, Phillips was in the operating theatre with no dialysis access and a soaring potassium level, a precursor to Cardiac arrest. While Patel cut, pulled, pulled and stitched, Phillips's heart had given up. His brain was starved of oxygen. At bed five, near the window of the intensive care unit, its most senior nurse, Tony Hoffman, ensured that everything possible was being done for Phillips. During the wait for his arrival at the icu, she had been told by one of the nurses that the operation had gone badly. When she saw Mr. Phillips lying on his back in a white gown with a covering blanket shortly after 3pm, Hoffman knew instinctively that he was highly unlikely to survive. Dr. Alison Macready, the anesthetist who had been in theatre with Patel, told Hoffman something as they checked the ventilating equipment to ensure it was inflating the man's lungs. It is an expensive way to die, Dr. MacReady said. @ this early stage, nurse Tony Hoffman knew little about the brash director of surgery. Tony had been on holidays when he toured the hospital and met the key staff. On his first working day, one April, already seven weeks into his contract, there was gossip on the wards about his flirtatious behaviour with younger nurses. Tony Hoffman was broad minded. After nursing for more than 20 years in hospitals in Australia, Saudi Arabia and London, she was no longer surprised by the delusions of some doctors who assumed they were God's gift to the nurses, or perhaps that the nurses were God's gift to them. She also knew from experience in much larger hospitals that esophagectomies challenged everyone the patient, the surgical team and ICU staff. She wondered why such an ill patient had been subjected to the operation.
- [56:11]
Hoffman was in good company. Dr. Peter Miack, the person most familiar with the multiple health problems plaguing Phillips, agreed. Miack's position was unequivocal. I do not believe that this man should have ever gone to theatre. There was no urgency about it. There was no immediate acute problem in this man. There was the major problem with his cancer of the oesophagus, but there was nothing acute that demanded that he be operated on straight away. As Tony Hoffman watched the monitors, she questioned why Patel had been allowed to attempt it and why he had risked it with a patient as weak as Phillips. The nurses from the renal unit were distressed. Their bond with Phillips included his mum, who waited anxiously in the ICU relatives room and the downstairs cafeteria for any news.
- [57:05]
When the nurses told her that Phillips condition was very poor, his mother went to see Patel. Up to that point, Dr. Patel had been telling her the exact opposite. Furious at being questioned, Dr. Patel stormed into the ICU to confront Tony Hoffman. And he let rip with a furious.
- [57:27]
Dr. Jayant Patel
Tirade. It's embarrassing for this to happen. You should have notified me first about the patient's condition getting.
- [57:32]
Hedley Thomas
Worse. She found the criticisms confusing. Phillips was at death's door. That much had been obvious before he went to the icu. His perilous condition had not changed. Drugs were keeping him alive, yet Dr. Patel insisted that he was doing.
- [57:52]
Dr. Sally Ehlers
Fine. The patient was not stable and we're not going to lie to the.
- [57:57]
Hedley Thomas
Relatives. I don't see how you can say he's stable.
- [58:02]
Patel took his complaint up with Dr. Darren Keating, who had arrived to be the new Director of Medical services a fortnight after Patel started.
- [58:13]
After Hoffman and the Director of nursing, Glenys Goodman, met Keating to talk about the problems, he tried to mediate the conflict. Dr. Keating suggested to Nurse Hoffman that she sit down with Dr. Patel to explain the ICU's constraints and the need to work together as a team. Hoffman wondered at the time why it was up to her to explain such fundamental issues to the hospital's most senior practicing clinician. Surely this was a task for Dr. Keating. Soon afterwards, Hoffman and Patel spoke in her office about the dispute. She tried to explain the staffing and equipment limitations of Bundaberg's intensive care unit. We can't keep patients for more than 48 hours. The patients need to be transferred.
- [59:05]
Dr. Sally Ehlers
To the larger hospitals in.
- [59:06]
Hedley Thomas
Brisbane. Dr. Patel bridled at the idea of losing his patients to a larger hospital where they would come under the care of.
- [59:15]
Dr. Jayant Patel
Specialists. I refuse to practice medicine like this. I will refuse to transfer my patients.
- [59:21]
Hedley Thomas
Out. He refused to speak to Hoffman again. James Edward Phillips passed away at 10.15pm on 21 May 2003 in his bed at the intensive care unit. He had never regained consciousness. Patel had tackled a challenging, trouble prone esophagectomy which other surgeons would not have contemplated. It should have been no surprise to Dr. Battelle when James Phillips succumbed.
- [59:59]
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 Leek with assistance from Leah Samaglu and Neil Sutherland. Our producer is Kristin Amias. Production management by Stephanie Coombs. Artwork by Sean Callanan. Thanks to Ryan Osland, Matthew Condon, Corinna Berger, Ellie Dudley, David Murray, Dominique McDermott, Zach Schoolander and all our family, friends and colleagues who helped in this 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 the website.