A (8:18)

There are also serious concerns about overseas trained doctors.

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My response was at first dismissive. The issue smacked of racism. To my knowledge, it had not been raised publicly as a serious problem in the past. Tall pressed her point.

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No, it is a serious issue. Some of our members have good information about it. I can put you in touch with Dr. Marsh Godsall. He knows it better than anyone.

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Dr. Godsall, who practiced in Central Queensland, knew my wife Ruth's father, Dr. Ian Mathewson, who practiced in Mackay. When I returned to my office in Bowen Hills, another family related medical contact from Mackay promised to help me crack the waiting lists fiasco.

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Waiting lists are manipulated by administrators to put themselves in the best light. You have heard the saying. Lies, damn lies and statistics.

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Over the weekend I researched the subject of medical negligence and extracted part of a judgment by Lord Denning, an eminent judge of the House of Lords in Britain. From a famous case, Roe v. Minister of Health, the relevant passage read, it is so easy to be wise after the event and to condemn as negligence that which was only a misadventure. We ought always to be on our guard against it, especially in cases against hospitals and doctors. Medical science has conferred great benefits on mankind, but these benefits are attended by considerable risks. Every surgical operation is attended by risks. We cannot take the benefits without taking the risks. Every advance in technique is also attended by risks. Doctors, like the rest of us, have

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to learn by experience.

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And experience often teaches in a hard way. After the weekend Dr. Godsall contacted me to emphasise the concerns about overseas trained doctors. He told me that the single biggest issue in the public health system was Queensland's dependency on them.

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We are also concerned that appropriate qualifications, including language skills, are not being ensured. This means the public is potentially and increasingly at risk from doctors with less than the skills required to work here, though they may be adequate in the environment in which they were trained and who do not have the communication ability which is expected from those selected for Australian medical schools. This, in turn means the public purse is exposed to litigation.

B (11:03)

Godsall mentioned a report by Bob Birrell, a Melbourne academic. I found it on the Internet. The report was alarming. Having at first been less than enthusiastic, I knew now that an investigation of the overseas trained doctors, or otd, had real potential. It might be the backbone of the series. Dr. Godsall also hinted that Queensland Health knew all too well about the dangers. One of its senior advisors, Dr. Dennis Lennox, had produced an important report. Dr. Godsall suggested that the report had been deliberately smothered. As my interest soared, I told Godsall that the story would become a priority. I was determined to see the report by Dr. Lennox. Dr. Godsall told me, I do not

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think that many appreciate the situation or are aware of it. For example, you seemed incredulous this morning when I told you of the lack of vetting of the skills and qualifications

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Godsall kept giving over several days. He sent me emails and he telephoned with new snippets of information.

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I send you this to help put things in perspective for you, as if you are not living with these things on a daily basis. It is very easy to misinterpret or be misled. I'm telling everybody they can speak to you on and off the record and you will respect their request. Those with Queensland Health positions feel threatened because of the retribution that can be their lot.

B (12:40)

He offered names and telephone numbers of other doctors with insight into the issue. He urged me to investigate a death at a hospital in Charters Towers. He suggested I talk to a pharmacist in Mackay. He he mentioned a GP in Bundaberg who had employed doctors from overseas. And he hinted again at this explosive secret report, adding, if qh try to

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snow you, it'll be difficult to get people to speak because of the code of conduct.

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After interviewing two overseas trained doctors, I could see the story being a potential blockbuster. These doctors were stunned at the lack of screening of their qualifications and their competence. I told Godsall they reflect your concerns. I wrote to him. No doubt the spin from Queensland Health will be that if the system is working so poorly, why are there no or few complaints? And why no adverse outcomes? I think that if your contacts can point to some events in which an overseas trained doctor's conduct has produced a bigger problem, it would lend more credibility to the issue. I also tried to impress on Dr. Godsall that a story involving clinicians merely expressing concern would have little or no impact. If he and his colleagues wanted to change the situation. They needed to think about cause and effect. They needed to reveal cases involving negligent clinical conduct with adverse consequences for patients. The word went around sections of the medical community. After a few days, I was urged to talk to Dr. Chris Blenkin, a leading orthopaedic surgeon and the president of the Australian Orthopaedics Association's Queensland branch. Although his brother Max was a senior journalist in Canberra, Dr. Blenkin's professional contact with journalists had been limited before he heard from me, but he spoke frankly and strongly. He cited a crisis at the public hospital in Harvey Bay, about 300 kilometres north of Brisbane, involving two Fiji trained doctors being held out as consultants in orthopaedic surgery. Neither had done the training demanded of Australian surgeons, nor had they been assessed or accredited by peers. Since their arrival at the hospital, they had not been properly supervised. Inevitably, their lack of competence had raised concerns in the medical field. Orthopods, as they are known, are often the butt of jokes. If cardiac surgery is a fine art, orthopaedic surgery is roadside labouring. It can quite literally involve a hammer, nails and brute force. When I pressed Blenkin on the Harvey Bay situation, he promised to check into it more thoroughly. He called me a few days later and said he was sincerely worried. The dangers at the hospital, he explained, were unacceptable. He detailed two of the most recent adverse outcomes in Harvey Bay. A femur that exploded because the pin was nailed in wrongly and a hip fractured on the operating table.

A (16:03)

You have to see it to believe it. It highlights the problems that occur when we drop standards. You are better off with no one than someone who is bad. Because it is possible to do so much damage. The community expects a reasonable standard. But the damage done far outweighs any benefit in providing a service. Who knows why the medical superintendent and the district manager have gone down this path? They probably think a doctor is a doctor.

B (16:30)

I decided it was imperative I talk to a number of doctors in different fields and in different parts of Queensland. I didn't want the story to lack credibility for a failure to gauge a variety of views in atherton, north Queensland Dr. Bruce Cameron told me that a large number of doctors coming from overseas were simply unsuitable without significant upskilling. He told me that there may be some situations where no doctor is safer than a bad doctor. Dr. Drew Speight, a GP at Bundaberg's Burnett Medical Centre, described the need to introduce a formal program of screening and mentoring. He said to me, I don't want to sound racist. We welcome these people here in a situation where there is a shortage of Australian doctors, but we need to ensure they have the skills. Dr. David Malloy, who would become the next Australian Medical Association Queensland president, called for systems to measure the experience and skills of overseas trained doctors.

A (17:38)

As the health system tightens with the emphasis on meeting budgets, nobody is available to evaluate the doctors when they hit the hospitals. Our natural inclination is to protect the medical system, but the fact is, where there are language problems and people are asked to work above their level, the potential for adverse outcomes has to be so much greater. Everyone knew this was a bit of a powder keg. I think we have been afraid to approach it because of a fear of being seen as elitist and racist.

B (18:07)

Anxious for the two Fiji trained doctors to have an opportunity to comment, I telephoned one. He rejected the concerns and told of the community's gratitude for their work. We are not specialists. We are not saying that our qualifications mean we should be recognised as specialists. I don't think I have a lack of experience. Within a few days of hearing for the first time about the issue, I received a fax from a confidential source. Somebody had sent me the July 2003 report by Dr. Dennis Lennox, the senior Queensland Health Workforce Advisor. It ran for 18 pages and seemed complete. But for a signature I turned to the executive summary which said what I already knew. A chronic shortage of Australian graduates had resulted in an increasingly heavy reliance on overseas trained doctors. My faith in Dr. Godsall rose as I read the warnings. Evidence is increasing of increased risk of OTD recruits being insufficiently assessed and prepared

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for practice in Queensland.

B (19:21)

Under pressure of recruitment of such increasingly large numbers of OTDs. Some recent experience of overseas trained doctors

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without the competence or capability for medical practice in Queensland presages adverse outcomes for

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patients, employees, community and medical profession. Dr. Lennox had done his homework. He mapped out a policy and tactical response embracing a comprehensive assessment and management process, bridging courses for doctors not up to scratch, Australian Medical Council examinations and fellowship of the relevant medical colleges. Lennox wrote that these options would ensure that doctors from overseas were appropriately qualified.

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It also protects the community from incompetent

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medical practice and consequent adverse outcomes. The report was the smoking gun of this story. It evinced evidence that Queensland Health knew of the concerns because they had been distilled and emphasised by one of its managers. I felt even more strongly about the seriousness of the story, but I decided not to show my hand too soon. On 21st October I wrote to my former colleague from the Courier Mail, Steve Rouse, who managed communications for the then Health Minister, Wendy Edmond. As a seasoned political reporter before crossing to what we call the dark side, Rous was one of the better advisors in the Beatty government's army of spinners. He was also my main point of contact for the series I had been asked to produce. I explained to Steve Rouse some of the issues I wanted dealt with in interviews with Wendy Edmond, the Minister and her Director General, Dr. Rob Stable. I told him that I sought information to address the claims of clinicians and patients that the waiting lists are misleading because they don't indicate the waiting time for the appointments for assessments for surgery. I also flagged my interest in the bigger picture issues. I wrote, for example, what the community might want or expect versus what it is prepared to pay for and the increasing tensions arising out of strife of interest with what clinicians would like to do for patients versus administrators who are responsible for the budgets. The secrecy issues being raised constantly by the doctors and nurses concerned me. I emailed Steve Rouse about it. I wrote A number of clinicians claim that when they identify serious issues relating to public health, the problems are denied or not addressed seriously. They claim, as Cairns doctors claimed earlier this year, that only by speaking out can they alert the public to what is really going on, but they risk their jobs by doing so. They say that this puts them in an impossible situation. Can you address this, please, with reference to the code of conduct, why it restricts the doctors from whistleblowing and why, in Queensland Health's view, the doctors are no different from any other public servant when it comes to highlighting internal issues. On the matter of overseas trained doctors, I decided not to disclose that I had already been leaked the sensitive Dennis Lennox report. Instead, I asked for information that addresses the number of overseas trained doctors in Queensland in both the private and public sector, the extent to which the system relies on them and the due diligence undertaken to ensure they're sufficiently skilled. I asked does the Minister believe that the current arrangements are adequate or is she concerned that doctors without appropriate experience or skills are slipping into an undermanned sector because of the chronic shortage? What can be done to ensure that adverse outcomes are minimised. Steve Rouse confirmed my appointments for interviews or briefings with the Director General, Dr. Rob Stable, his probable successor, Dr. Steve Buckland and Minister Wendy Edmond for Monday 27 October. Files and folders stuffed with documents about Queensland Health covered the kitchen table as I worked the telephone and read again the Lennox report on overseas doctors. When it came time to go to the 19th floor of the Queensland Health building in Charlotte street on the afternoon of 27th October, I was well prepared. In just a few days, Rob Stable, who took most of the questions while Buckland listened and occasionally added something, would be out of the top job in Queensland Health. He was leaving for a new role in the private sector, heading up Bond University on the Gold Coast. Dr. Stable told me, we have some very good overseas trained doctors in this state, but we are finding that where we need to recruit them, some don't have the same degree of language skills. The pool of Australian medicine has not kept pace with the demand. The market has changed and we do everything practical, interviewing them, checking references, giving clinical scenarios. We have this situation where we have to provide services, we have hurdles in place. It's been reported to us that their communication skills have not been very good, but we have noticed this ourselves with the applicants. This is a no win. The politicians don't accept that we can't have doctors. Is no service better than taking the risk that one or two cases per year of the 600 we get in the public system in Queensland are not up to scratch? Dr. Buckland seemed perplexed. We are not in the business of causing harm and seeing adverse outcomes. My meeting with Wendy Edmond covered a range of topics. She downplayed the problems facing health generally. There would always be people, she told me, who were like Chicken Little, talking about the sky falling in. It was her way of saying that the public health system system was in good shape despite the regular reports from clinicians and patients to the contrary. A few hours after meeting Stable, Buckland and Edmund, I sent a note asking further questions about the situation at Harvey Bay. Was it the only public hospital at which the qualifications of overseas trained doctors were not recognised by the the respective colleges? I asked also, can you copy to me a report by Queensland Health's Dr. Dennis Lennox earlier this year into issues arising from overseas doctors? Kate o', Donnell, who handled Queensland Health's official responses to some of our queries,

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told me this report has no official status and was not accepted or endorsed by Queensland Health executive Dr. Buckland and

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the Medical Board of Queensland had received Dr. Lennox's report. They had read it and they had buried it. Chapter 16 discredit November 2003. The last patient left Dr. Ross Cartmill's waiting room on Wickham Terrace above the lights of the city's office building sometime after 7pm A urologist with a successful private practice, Cartmill was also a visiting medical officer, meaning he gave some of his time for relatively minimal financial return to look after patients and to mentor junior doctors in Brisbane's public hospitals. For many specialists like Cartmill, the motive for doing part time work in the public system was altruistic. They were giving something back to hospitals which had been their training ground years earlier. But Dr. Cartmill was now gravely worried about the performance and sustainability of public health care. I took notes as he vented his spleen. The first fact the community needs to understand is that doctors are afraid they'll be sacked if they talk openly about what is actually happening in public hospitals. The second fact is that if doctors could talk openly, Queenslanders would hear that their public health system is chronically underfunded and suffers from an acute lack of staff and beds. It means people who need surgery wait much longer than they should and some people never get operations that would change their lives. The doctors and medical staff are frustrated because they feel unable to tell the community the whole story. The culture prevents people from hearing about the deficiencies. The doctors are told they must report their concerns internally. But we've reached the point where we believe that reporting upwards will not make any difference anymore. Every so often when someone breaks ranks, there's a crackdown and severe reprimand. I had been hearing similar complaints from some of the most senior clinicians in Queensland. Many were fearful that they might be seen meeting me. We went to unusual lengths to avoid detection as they told me about a corporate culture that stamped violently on whistleblowers. One of Queensland's top specialists wanted to provide evidence of a clinical disaster in a hospital. But he insisted on a secret rendezvous in a car in a back street. Six months earlier, Health Minister Wendy Edmond had turned on doctors in the North Queensland city of Cairns after they protested publicly about cuts in the services at the hospital. Wendy Edmond made a statement to state parliament in May 2003.

A (29:37)

There will always be some whinges and I will meet with the wingers and talk to them.

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The doctors who had funded advertisements in the Cairns Post to make their point, were threatened with disciplinary action and dismissal. On 3rd November 2003, I reported this in the Courier Mail. If Only half the concerns about the clinical standards of some of the overseas doctors imported into Australia in the past few years are true. It would have serious ramifications for patients and the profession. Senior medical specialists, rural GPs and doctors in the public hospital system believe that the failure of registration boards and the state and federal governments in checking the competence of imported overseas doctors could end up costing the community dearly. I knew that many health professionals were also angry that the government, led by Premier Peter, continued to promote itself for supposedly reducing the waiting times for surgery in hospitals. As the Health Minister, Wendy Edmond and Premier Beattie lauded themselves for achieving their best ever results for elective surgery, the clinicians insisted that the claims were a gross misrepresentation of the truth. Doctors were sure that an independent or audit of the results would prove that the public was being told lies. I looked at the situation overseas and elsewhere in Australia. In the United Kingdom, the National Audit Office had identified what it called deliberate manipulation or misstatement of the figures in public hospitals in nine major districts in New South Wales. The Independent Commission Against Corruption was bringing charges after the discovery that a number of major public hospitals had falsified and misrepresented waiting list data. I mentioned the concerns to Queensland's Auditor General, Len Scanlon, and sent him data, but he showed little interest in investigating. On 17th November, my interview with Dr. Cartmill was published in the Courier Mail with an article about about the alleged manipulation by Queensland Health of waiting list data. In Queensland, documents taken by the politicians to Cabinet remain exempt from disclosure. For 30 years this law has been routinely exploited by politicians who have thwarted freedom of information applications and concealed sensitive documents from public scrutiny by taking those documents into Cabinet. Health Minister Edmund had taken waiting list data to Cabinet, ensuring their concealment for 30 years. She sent me a statement which said

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Queensland waiting times for elective surgery are not misleading.

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Another prominent article I wrote revealed how patients needing urgent surgery had been left disfigured by aggressive cancers after operations were cancelled because of a lack of intensive care beds in hospitals. The next day I wrote about a leaked memo. It was written by Dr. Phil Kaye, an emergency department head, who was furious that administrators had decided to close the gynaecology unit in one of Queensland's largest hospitals. Our articles, part of the Couriermail series on the health system, were causing top level angst. Minister Wendy Edmonds efforts to keep health off the front page had failed. Her staff feared the series might do significant harm to the image of the Beatty government. Just a few months out from the February 2004 state election, the Courier Mail's editor, David Fagan, received an angry letter from Hendrick Gout, Queensland Health's executive manager for media and communications. Gout began by expressing what he called

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his sincere concern about the ethics and behaviour of Headley Thomas over the past few days.

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He described me as an unprincipled, unprofessional, unscrupulous journalist. In the 18 November message, Gout said,

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either the Minister's office is lying or one of your own reporters has a Pinocchio nose. Headley is making a practice of this.

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After examining my actions and double checking the facts of the stories, I realized that Dr. Cartmeill and the other doctors were right. The culture of fear and loathing in Queensland Health was thriving. It was an organisation with serious fundamental shortcomings which were being camouflaged by glossy prime and aggressive shoot the messenger strategies. It was little wonder that many clinicians were afraid to tell the truth. A number of the doctors, professional administrators and former health chiefs had made a persuasive public case that the health system was in crisis. They were adamant that the public was being conned into believing that it had one of the finest systems in the world. In fact, spending on health in Queensland was the lowest per capita in Australia. The underfunding of more than $1 billion a year had produced huge gaps. Doctors and health professionals had little incentive to remain in a system which treated them and their patients so poorly. The drain of experienced professionals, cutbacks on beds in hospitals, the rationing of care and the punishment of administrators who did not churn through waiting lists while making budget had set Queensland Health up for a painful fall. When Dr. Steve Buckland sought the top job as director General a few months after the Courier Mail series, he wrote a confidential letter acknowledging that Queensland Health's focus on fiscal school management had suppressed its ability. In his job application, he wrote, this has also resulted in a disaffected workforce, a lack of innovative problem solving, strained relationships with other government agencies and a lack of public confidence in the system's capability. Publicly, however, the message from Queensland Health and its political sponsors was the exact opposite. Opposite. This podcast is made possible by subscribers to the Australian and our principal sponsor, Harvey Norman. Since late 2017, when I started pursuing Chris Dawson for the 1982 murder of his wife, Lynn, Harvey Norman has been a loyal backer. It began with the teacher's pet, and Harvey Norman and its CEO Katie Page's support has continued for over eight years. I'm proud to have had their backing on all of mine and the Australians investigative podcasts, the Night Driver, Shandy's Story, Shandy's Legacy, the Teacher's Trial, the Teacher's Accuser, Bronwyn and most recently, the Sick to Death Podcast. For more information on this podcast, go to theaustralian.com. Chapter 17 starting over. Long before the first European explorers ventured almost 400km north of Brisbane to identify future settlements and farming opportunities, a local Aboriginal tribe known as the Bunda had the area to themselves. The government Assistant surveyor, James Charles Burnett, visited in the 1840s but failed to appreciate the potential of the rich volcanic soil. The oversight meant that the Bunda people were left alone for another two decades. The first white settlers, Brothers John and Gavin Stewart, arrived on Christmas Day 1866 and began to raise the hardwoods. They were followed by European migrants keen to exploit the fertile black soil and the readily available water source of the Burnett River. Their success attracted industry and commerce. The settlement started to thrive as the German word for town was berg. The area was named Bundaberg. It owed its burgeoning prosperity to sugarcane and the toil of outsiders. Dark skinned Kanakas brought to work as bonded slaves in the cane fields for a meager wage, a roof over their heads and food, they were indeed censured for three years. To the plantation owners, the conditions were invariably dreadful. In 1881, when the General Hospital opened beside the Burnet river, it comprised four rooms, a cottage and a separate ward for the Kanakas. The following year dozens of labourers from Ceylon, now Sri Lanka, arrived in bundle Bundaberg under work contracts. But the demand for cheap labour was still unmet. The Bundaberg and Districts Historical Museum reported

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For the next 30 years, Melanesian and Polynesian islanders provided almost the complete field labour for cane plantations and farms. At one stage, 3,000 lived in the district.

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Bundaberg is famous for its rum, a product of its sugar cane and a record breaking aviator, bert Hinkler. In February 1928 he flew from England to Australia in 15 days, an extraordinary feat at the time. The son of a local mill worker, his achievement lifted the town's spirits. The sugarcane plantations were still thriving when Jayant Patel arrived in 2003 and Bundaberg still relied heavily on imported labour. But now the most valuable imports were overseas trained doctors. A medical workforce crisis, serious throughout Australia, but dire in regional Queensland due to inferior salaries and conditions, meant that the overseas doctors were the backbone of the public hospital on Bourbong Street. Although the doctors coming from third World countries were financially better off in Australia, they were easily exploited. Their employers knew that the foreign doctors could be forced to return to their own countries if their working visas were not renewed. Unlike Australian doctors, who could change jobs after a dispute with management, the overseas trained doctors were at a distinct disadvantage. It made some of them more willing to follow orders and less likely to ask difficult questions. Jayant Patel had little time for Bundaberg's history and its natural attractions the outlying resort islands, the beaches and the largest mainland turtle hatchery in Australia. Unlike his predecessors, Dr. Charles Nankevel and Dr. Sam Baker, Patel delighted in being overburdened with surgical work. He spent most of his time at the hospital. But whereas most of the other overseas trained doctors were submissive, Patel displayed bravado. He worked hard and he exerted his influence over management. One of his confidants was Pam Samra, whom he saw at least four times a week at her restaurant, the Indian Curry Bazaar, near the Sugarland shopping centre in Tackle Van Street. They chatted freely and often about his career, his life in the United States and his efforts at the hospital. She was alarmed to hear from him one day that he had not slept for 30 hours because of the continuous work. She told him, those hours are ridiculous.

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You shouldn't be doing that. What are you working so hard for? Take a break.

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Patel replied, there are no.

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No other doctors to do the work. I've been asking for backup for months. Nobody listens to me. But then I've been paid $40,000 in bonuses for getting through the waiting lists.

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In truth, Patel had been arriving at the hospital before the other doctors so that he could beat them to the patients. He was creating work for himself. If Dr. Martin Carter arrived at 7:30am, Patel would be there the next day at 7:00am If Carter responded by coming in at 7:00am, Patel trumped him with a 6:30am start. Carter gave up. At this rate, he would have been lying in wait for the surgeon and coming to work at midnight. Patel was intrigued by the circumstances of Pam Samra and her husband, Jindi. In accordance with the custom and tradition of India's Punjab state, their marriage was arranged despite Pam having been born and raised in Australia. It was a happy and prosperous union. Patel lied to the married father.

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I have no kids. I've never been married. The only woman in my life is my mother in India.

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He told how he visited the old woman at the ancestral home in Jamnagar as often as possible. He sent funds to make her privileged life more comfortable.

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Why doesn't she move to America?

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Asked Samra. But Patel said his mother would be unhappy in the United States. Away from her friends and relatives. Patel dressed smartly, often in a suit and tie. He tipped generously, usually rounding a $35 bill for his takeaway meals to $50. He ordered only vegetarian dishes and told her he was vegetarian. Samra heard from others, though, that he ate meat elsewhere. Although he was occasionally arrogant, Samra nevertheless enjoyed their chats. Nobody else in the town spent as much on food at the Curry Bazaar as Dr. Patel. He was their best customer. At least once a week after work, he would bring a group of nurses or student doctors to the upstairs dining area. He enjoyed the company of Dr. Jim Gaffield, who had also arrived from the United States, and the young Dr. Anthony Athanasiov, an Australian graduate. Patel usually paid for the groups he brought to the restaurant. Pam Samra suspected that he was lonely. She regarded him as a hopeless flirt. He often had a hand on the lower back of one of the nurses. Although he would make the occasional proposition, the physical contact was never so overt that it led to a rebuke. When he was not entertaining the medical and nursing staff, he wanted to talk to Samra about her life. She wondered if he was attracted to her. Patel's two bedroom apartment in Sapphire Lodge at Bagara was tidy but never clean. The cigarettes he chain smoked had left a pungent smell. The bathroom and toilet were always dirty. On one occasion, Carol Elliot, the owner's sister, went to the apartment to do some cleaning. As part of an ongoing arrangement, the sheets needed washing. She removed Patel's things from the machine to do another load. He walked in and began screaming and abusing the shocked woman in front of her to grandchildren. Patel was enraged. His tirade could be heard up and down Miller Street. Who took my washing out of here? It should have been obvious to him that Elliot had removed a few towels.

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You have no business. I'm a very important doctor. I'm the head doctor at the base hospital.

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How dare you. Don't worry about it. You just go to the hospital and I will make sure the towels go on the line to dry. The incident, the encounter had upset her grandson. Elliot was worried that it would influence the boy's view of dark skinned people. Why did that black man scream at you, Koran? He's not a nice man. Not all people that colour are like him. When Patel's wife, Kishore and daughter came to visit from the US he kept them away from the restaurant. He had told others that he was single. Elliot felt sorry for Kishore, a medical practitioner in Portland. During a chance meeting, Patel introduced his daughter and beamed with pride as he praised her as the family's next doctor. She would be graduating soon from medical school. But Patel scarcely acknowledged his wife, the demure woman beside him. Elliot walked away, away, wondering what made him tick. Chapter 18 Doctor's Germs late 2003 to early 2004 Joanne Turner hovered over the patients in the renal unit at Bundaberg Hospital and waited for a tube to visibly redden, a telltale sign of blood being drawn from the internal jugular just above the heart's right atrium. Everything looked satisfactory. The catheters with tubes burrowing into the chest, the two patients whose blood needed regular cleansing. The haemodialysis machine which would return the blood with fewer impurities and provide the patients with a lease of life. Turner frowned. The catheters, which had been surgically implanted by Jayan Patel, were not working. They appeared to be blocked. Effective haemodialysis with a permacath type catheter required a blood flow rate of more than 200ml a min, but Turner could not obtain a drop. Patel arrived in the renal unit within minutes of being paged. When Turner explained the difficulty that she was experiencing, the surgeon erupted. Flush it, sister. Just get in there and flush it. Turner was immediately uneasy. She knew it was unsafe to flush the catheter until the removal of the heparin lock, a dose of an anticoagulant drug called heparin, which stops blood from clotting at the end of the catheter. A low pressure injection of saline from a syringe is used to flush a catheter, but only after the removal of the heparin lock. She had set up two sterile trays, one for each patient. Patel had neither washed his hands nor put on sterile gloves. When he took the bung from the end of the catheter connected to the first patient. He picked up the sterile syringe and tried unsuccessfully to take blood from the line. To Turner's alarm, he then moved with the same syringe to the other patient. Turner had never seen anything like it. Strict infection control measures in hospitals were critical in the renal unit, where the chronic disease suppressed the patient's immune systems, the catheters were perfect conduits for blood. They were also perfect conduits for bacteria. Pointing to the other sterile tray, she said, this is the patient's setup. But how did you tactfully tell the director of surgery that his modus operandi was wrong and might be lethal? Turner did her best. Aren't you going to wash your hands. She urged him to put on the sterile gloves.

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Sister, I don't have Jones.

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She thought at first that he was joking. Nobody would seriously believe such a comment, least of all a doctor. But Patel neither smiled nor corrected himself.

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I'm doing you a favour.

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The look on his face told Turner that he was annoyed at her attempts to insist on the gloves. He performed the procedure on the second patient with his bare hands. Lynette Yeoman, one of the other nurses working the early shift, watched, dumbfounded. She wondered how someone with so much experience could fail to appreciate the serious risk he posed to the ill patients. A third nurse, Carolyn Waters, walked off in disgust. At the end of the shift, the nurses spoke to their manager, Robyn Pollock. When Patel first arrived at the hospital, he had little to do with the renal unit. But this had changed when he started inserting catheters in August. During his regular stops in Pollock's office, he invariably turned the conversation from the patient's to her personal life. The visits were usually uncomfortable for Pollock. She asked her staff to telephone if Patel stayed in her office more than a few minutes. The ruse usually worked. Pollock had another reason to feel uncomfortable. She had been concerned for some weeks about complications with catheters implanted by Patel. Four patients had had peritoneal dialysis catheters placed by Patell one in August, two in September and one in October, and each had suffered unnecessarily. In three of the patients, there were chronic infections at the exit sites. The fourth patient, whose catheter did not drain or flow properly, needed surgical intervention. Some of the catheters had moved internally and ended up in the wrong position. After the nurses explained the events of the morning and Patel's handling of the patients, Pollock was aghast. Fearing that a patient might die, she raised the issues with Gail Aylmer, the nurse responsible for infection control. Aylmer, who had previously tried to tackle the wound dehiscence problems, arranged a meeting with Dr. Darren Keating two days later. Lindsay Druce was also worried. The clinical nurse had returned from maternity leave to find a rash of problems in the renal unit. It seemed to Druce that many of the problems were due to Patel's positioning of the catheters. Every one was either facing up or sideways. This meant that when the patients showered and moved around, it was inevitable that fluids and grit would collect in the catheters. As the fluids and debris could not drain or fall away from the exit site, the risks of infection from organisms thriving in the moist, warm environment soared. When Aylmer And Pollock went to see Darren Keating on 27 November. He wanted facts and figures, not anecdotal feedback. They repeated Patel's bizarre comment about not having germs. Keating asked how often infections were occurring and how many cases involved Patel.

A (53:55)

You know, if I really need to go further with this, I need data

B (53:59)

to support what you're saying. When he spoke to Patel after the meeting with the nurses, the surgeon was was affronted. He denied that there had been problems. He told Keating the nurses were wrong and he stopped coming by Pollock's office. As far as Keating was concerned, the work ethic of Patel and the great strides he was already making in reducing the waiting list for surgery made him indispensable. Despite the growing concerns of the staff who had been to Keating. He lauded Patel in a 2 December 2003 performance report.

A (54:38)

Dr. Patel effectively utilizes his broad knowledge, skill and experience in general surgery to

B (54:44)

provide high quality of patient care.

A (54:47)

He is a willing and enthusiastic leader. He also brings understanding of clinical management subjects to appropriate forums.

B (54:56)

Keating chose the heading performance better than expected to give Patel a tick in nine out of 11 areas, including his clinical skills, knowledge base, judgment, communication, teamwork and professional responsibility. After just eight months in the job, Patel had his boss wrapped around his little finger. But Dr. Peter Miak, the nephrologist in charge of the renal unit, was rapidly losing confidence in Patel. By late 2000, the catheter problems, coupled with several other factors. Patel's insistence that he could perform any procedure and the almost inevitable complications had made Peter Miak increasingly wary. Some of Patel's procedures were just cruel. When Philip Knopp, a patient suffering kidney failure, needed an operation in August to draw fluid away from his heart, it was decided that Patel would do a pericardial window, a procedure that involved cutting a hole in the chest to insert a drain. The build up of fluid threatened to squeeze Nop's heart and cause it to fail. Although a fine needle had been used to draw the bloody fluid from the pericardial sac, Mihak realised that it would take the removal of a little bit of the pericardium to eradicate the problem. Miak hardly ever went to theatre, but he decided to watch Patel's handiwork on Nopp. Miac winced. Nop was screaming and moaning and clearly felt excruciating pain. Dr. Patel had elected to do the invasive operation without anaesthetic, contrary to normal practice. When Peter Miack tried to transfer his patients south away from Patel for the catheter procedures, he was told by A doctor at the Royal Brisbane Hospital. We are not going to do it here. We don't have the time. We don't have the capacity. He asked Dr. Jim Gaffield, the plastic surgeon who had arrived from the United States soon after Patel, for help. Look, this is not the sort of thing I'm used to. I prefer not to do them. Robin Pollock had another idea. She reached out to Brian Graham, who worked for a company with a contract to supply renal products to the hospitals. The company, Baxter Healthcare, was offering programs to train staff. Pollock had told Graham about the run of complications with catheters implanted on Patel's patients. She knew Patel was not interested in hearing from the nurses. Perhaps he would respond, though, to an offer from Graham to provide support or education on placement technique. Brian Graham met Patel in the renal unit and explained the program. Patel pounced.

A (57:58)

Well, you can fly me to Brisbane. You can wine and dine me. You can put me up somewhere nice and then I might listen to what you have to say.

B (58:06)

Graham decided that Dr. Patel was a lost cause. On 16 December, Eric Nagle returned to the hospital for surgery to correct a catheter placement that Patel had bungled when inserting it the previous month. Because it had not been tunnelled correctly during the first operation, the catheter was facing sideways instead of downwards. Internally, it had flipped up under Nagel's liver. An X ray showed the internal part of the catheter had migrated, resulting in impeded drainage. For the much needed haemodialysis to work, Nagel's old catheter needed to be removed and replaced with a new one. Nagel and his wife Linda, were reassured on the eve of surgery. They believed that it would be a routine procedure conducted under a general anaesthetic. In the operating theatre, they knew nothing of the nurses concerns over Dr. Patel. Nor did they know about Dr. Peter Miack's misgivings. Lindsay Drooce watched Nagel being wheeled off to theatre. It was the last time she saw him. A guide wire used by Dr. Patel poked a hole through the main blood vessel going to Nagle's heart. The bleeding took place inside his pericardial sac. Nagel's blood pressure dropped suddenly as Patel and Dr. Martin Carter, the top anaesthetist, tried frantically to rectify the situation. Nagel suffered a heart attack. His thoracic vein was punctured. He bled to death. None of the distraught nurses in the renal unit could recall anyone else ever dying during the placement of a catheter. When Nagel's widow returned Returned days later for an explanation, anything that might help her understand why a supposedly routine procedure had killed her husband. The nurses were at a loss. For Peter Miak, it was the last straw. He decided that Patel would not perform any more catheter operations on his patients.

A (60:19)

If I have to send them to Brisbane, so be it.

B (60:23)

Before going on extended leave in January, Peter Miak told a replacement nephrologist, Dr. Martin Knapp, keep Dr. Patel away from the renal patients. Druce completed her report on complications from catheter placements. It showed the patell had a 100% failure rate, six catheter placements and multiple complications. All of the patients were adversely affected. One was dead. With Peter Miack overseas and Brisbane refusing to receive Bundaberg's patients, Pollock became desperate. She had seen yet another complication arising from Patel's handiwork. She, Andreus went to see Patrick Martin, the acting director of nursing, to explain the problems, the directive from MEAC and the uncertain future for patients needing catheters. Patrick Martin had little time for Dr. Patel. There was something amiss, something about the surgeon's personality that made Martin wary. He took the nurse's concerns to Darren Keating. But Keating said, if the nurses want

A (61:39)

to play with the big boys, then they need to provide the evidence and bring it on.

B (61:44)

Eventually, Pollock, Druce and Peter Miak found a way to bypass Patel. The patients from the renal unit who needed catheter placements would go to a nearby private hospital where another surgeon performed the operations. There were no more problems. But even this highly unusual arrangement did not result in the surgeon's clinical expertise being reviewed or questioned by management. Tony Hoffman went to see Bundaberg Hospital district manager Peter Leck at the end of February 2004 to tell him about the concerns over Patel.

A (62:22)

I just want to make you aware

B (62:25)

she gave LEC a document headed intensive care unit issues with ventilated patients. The document dealt with the worries about esophagectomies, the refusal of Patel to transfer his patients to larger and better equipped hospitals, and the compromising of their care. In the document, Hoffman warned, on several

A (62:47)

occasions when Dr. Patel's patients have been in the ICU, he has refused to transfer his patient to Brisbane even when the patients have deteriorated and have been in ICU for much longer than 24 to 48 hours. Dr. Patel has repeatedly threatened to resign, not put any elective surgery in ICU and go straight to Peter Leck.

B (63:12)

Tony hoffman added that Dr. Patel boasted that his efforts so far had earned half a million dollars for the hospital. Keating was short tempered when Peter Leck asked him about the issues.

A (63:25)

If this keeps going, Dr. Patel will leave.

B (63:29)

Peter Leck, who mislaid his copy of the document a short time later, told Hoffman that if she wanted to do something about it, she would need to come and see him, lodge a formal complaint and let the matter be progressed through official channels. Hoffman asked Peter Leck not to do anything about Patel just yet. She wanted another chance to resolve it. With Dr. Martin Carter's help, the hospital administrators had become not just highly dependent on Patel, they were also saving money. Keating had encouraged him to apply for a half time position as an Associate professor in Surgery at the University of Queensland School of Medicine. The criteria called for demonstrated expert knowledge and clinical experience in one or more of the surgical disciplines. When Keating sat on the three person selection panel with a physician, Dr. Lou Davies, and a senior lecturer in surgery, Dr. Peter Bohr, the decision was unanimous. In late 2003, Patel was appointed and given the authority to teach full time students. His salary and other benefits from this role of more than $80,000 a year were remitted to the coffers of Bundaberg Hospital. Darren Keating and Peter Lech congratulated themselves on their business and management acumen. The hospital was humming. Sick to Death is written and presented by me Hedley Thomas, the Australians 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 Samaglou and Neil Sutherland. Our producer is Kristen Amias. Production management by Stephanie Coombs. Artwork by Sean Callanan. Thanks to Ryan Osland, Matthew Condon, Karina 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 at Sick

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to Death

B (66:12)

and on Apple Podcasts. You can get exclusive access to photographs, videos, timelines and more at the website. Foreign. This podcast is made possible by subscribers to the Australian and our principal sponsor, Harvey Norman. Harvey Norman has provided unwavering support for my investigative podcast since 2018. For more information on this podcast and on our entire Investigative catalogue, go to theaustralian.com au.