Toni Hoffman (3:51)

Brammach was the last straw. They may come back and say he would have died anyway, but that isn't the point. It was about Dr. Patel interfering in the process that would have got the patient to Brisbane in time for him to have the best chance.

Headley Thomas (4:10)

Hoffman reminded Leck of how she had gone to him eight months earlier with her concerns about Dr. Patel's behaviour and how she and Dr. John Joyner had warned Dr. Keating about the dangers of the esophagectomies. In mid-2003, she repeated other disturbing clues to Patel's incompetence, including evidence of the harm caused to patients in the renal unit because of his injury ineptitude. With the placement of catheters, Hoffman gave the district manager an ultimatum. Unless there was a rigorous and independent audit of the outcomes for Patel's patients, she would be forced to take further steps. As she told Leck, I'm quite happy.

Toni Hoffman (4:56)

To be proven wrong.

Headley Thomas (4:58)

In an email to Peter Lek two days later, she documented the details of unnecessary suffering by a dozen of Patel's patients.

Toni Hoffman (5:08)

I spoke with Dr. Dieter Behrens and informed him the nursing staff were going to report their concerns with Dr. Patel to an official source. He stated he would support us by telling the truth, but he was concerned he would lose his job and Dr. Patel would be the one left behind. It is widely believed among the medical and nursing staff that Dr. Patel is very powerful, that he was wholeheartedly supported by Peter Lek and Darren Keating and was untouchable. Anyone who tried to alert the authorities about their concerns would lose their jobs. This perception was indeed perpetrated by Dr. Patel on a daily basis. Many of the principal house officers have expressed their concern, Dr. Alex Davis and Dr. David Rison, but were unsure of what to do because of the widespread belief Dr. Patel was protected by executive.

Headley Thomas (6:05)

On the day Leck received hoffman's written report, Dr. Keating and Dr. Miak had an angry row over Patel's competence. But still nothing was done to restrict any of Patel's work. The surgical wards were full of patients. They were still being led into theatre like lambs to a slaughter. Leck briefly considered suspending Patel on full pay, but Patel was much too valuable to the hospital and the campaign to reduce the waiting lists for surgery. Leck bought time. He decided to test Hoffman's serious allegations. Leck and Keating interviewed Dr. Dieter Behrens, one of the anaesthetists who questioned Patel's competence and judgment in undertaking some operations. Dr. Behrens bluntly described Patel as dishonest about his mistakes and so rigid he refused to consider alternative and safe clinical options for the patients. Dr. David Rissohn, a relatively junior doctor, revealed that he had concerns about the number of postoperative complications and infections. Patel's dismantling of one of the reporting mechanisms meant that the surgical audit process was a bad joke. When Dr. Rison had previously raised a wound dehiscence, Patel tried to change the definition of dehiscence. Patel had said we should be careful.

Dr. Jayant Patel (7:39)

What we call wound dehiscence and what we class wound dehiscence.

Headley Thomas (7:44)

The Director of Surgery was trying to minimise the number of complications being recorded. The next doctor to be interviewed was Martin Straughan had nothing to lose for speaking his mind. He was a visiting medical officer who helped out at the hospital when he had time away from his full time job elsewhere. He described Patel's misdiagnosis of a woman upon whom the Director of Surgery was determined to perform an extremely complex Whipple's procedure. She died several days later. Martin Straughan was convinced that Patel believed he was invincible. A Johnny come lately as the doctor called Patel, but with aggressive trays who was strongly supported by management to take a scalpel to the waiting lists. Dr. Straughan also emphasised the dangerous vacuum into which Patel had arrived. The Director of surgery, who saw himself as a self declared expert from the first world to help the third world of Bundaberg, had been permitted to operate without any form of peer review. Keating and Leck did not bother asking Dr. Meak, the most qualified and experienced specialist in the district. But in early November 2004 Dr. Meak handed the to Keating another scathing indictment of Dr. Patel. It was a letter written by Dr. Jason Jenkins, a vascular surgeon at the Royal Brisbane Hospital who was held in high regard for his specialist skills and integrity. He sent it to Dr. Miak and to Patel. Only rarely would doctors blast colleagues in writing over the care of patients. But Dr. Jenkins was enraged after he examined Marilyn Daisy on the 1st of November for her diabetes problems. When he saw Marilyn Daisy, Dr. Jenkins asked the question, when did you get that done? Dr. Jenkins asked when he saw the bandage on her below knee amputation six weeks ago.

Dr. Jason Jenkins (10:01)

Do you mind if I have a look at it? Has it not healed yet?

Headley Thomas (10:06)

It was clear that not only had the wound not healed, the sutures were still in Daisy's amputation stump six weeks later. There was also an area of gangrene.

Dr. Jason Jenkins (10:20)

So have you seen the surgeon since the operation? What's he going to do about this? Did he offer you a chance of saving your leg?

Toni Hoffman (10:28)

I haven't seen the surgeon since the procedure. No, they just said that I need my leg off.

Headley Thomas (10:34)

Patel had not offered Daisy the option of trying to save her leg with a bypass operation. In his letter, Jenkins wrote, these sutures.

Dr. Jason Jenkins (10:46)

Were heavily buried within the tissue and very difficult and painful to remove. I find it mind boggling that someone could leave sutures in for for this long. It shows a complete lack of understanding of diabetic disease and how to perform an operation. I have suggested to her that when she comes to Brisbane that she will require a debridement of this stump and if it fails to heal, then she may require an above knee amputation. I think if procedures can't be performed appropriate with the Bundaberg Hospital, then they should not be performed at all.

Headley Thomas (11:24)

In the months before Daisy sought help in Brisbane, Jenkins had noted a disturbing pattern in patients who underwent vascular surgery by Patel. Jenkins quickly determined that the director of surgery was doing more harm than good. He was astounded when Dr. Peter Miak told him how he had tried to stop Patel, but to no avail. Patel would go and find patients in the wards and operate without MIAC knowing. Before writing the letter, Jenkins telephoned Patel and threatened to report him to the Medical Board if he kept doing vascular work.

Dr. Jason Jenkins (12:03)

Look, you know, if you keep doing this, then there are going to be consequences.

Headley Thomas (12:08)

But Patel was unmoved. For as long as the hospital let him do such operations, he had no intention of stopping. Peter Miack gave Dr. Keating the written complaint on the same day that the Health Practitioners Tribunal in Brisbane was delivering its own verdict. The wheels of justice had turned slowly for Elise Neville, her parents and Dr. Andrew Donovan, who was pleading guilty to unsatisfactory professional conduct to save himself and his family further trauma and crippling legal fees. In her findings, District Court Judge Debbie.

Judge Debbie Richards (12:51)

Richards wrote, the tragedy has had an enormous impact on the Neville family and no doubt others who knew and loved young Elise. Dr. Donovan must have been fatigued by the hours he was working. It seems extraordinary in this day and age that anyone, let alone someone in a position of such responsibility, should be asked to work such long hours. One does not need medical evidence to know that anyone who's in the 20th hour of a continuous duty must have reduced capacity to assess the situation when it presents itself. If this tragedy leads to nothing else, it should lead to the abolition of such brutally long shift hours.

Headley Thomas (13:29)

Judge Richards concluded that Andrew Donnerman's treatment of Elyse was deficient in a number of respects.

Judge Debbie Richards (13:37)

She she ruled his interpretation of the history and physical findings based on limited examination and his lack of appreciation of the parents concerns were wrong and errors of judgement which eventually denied Elise the chance of survival. Accordingly, the tribunal concurs with the board's submissions that stringent conditions should be placed on Dr. Donnerman's continuing right to practice.

Headley Thomas (14:02)

The disciplinary orders compelled Dr. Andrew Donneman to work in a supervised position for 12 months with ongoing assessment and reporting of his competence to assess patients. After the delivery of the judgment, I walked to a nearby cafe to talk to Gerard and Lorraine. They still had unfinished business. Gerard pledged the system was yet to reform itself. When the pain in Trevor Holter's stomach had become too much, he went to see his GP, Dr. Ken Hornsby. At 54, Halter regarded himself as being in reasonably good shape. As fit as a mallee bull, he half jokingly boasted. But the pain was constant. Even Holter, a part time race caller who rolled beer kegs around the club where he did odd jobs, had to concede he needed help. Dr. Hornsby wrote a referral letter for him to attend the outpatient's department at Bundaberg Hospital. Trevor Holter had gallstones. Fortunately, he learned that the condition was easily remedied. Jayant Patel spoke to him.

Dr. Jayant Patel (15:21)

You're probably better off having your gallbladder out because you don't really need it and so you may as well have it out. I do four to five a week and there's nothing to it.

Headley Thomas (15:29)

It's keyhole surgery, the routine corrective procedure. Laparoscopic cholecystectomy was on a par with having your tonsils out. Trevor Holter learned that he would need to stay just one night in the hospital. After the operation he awoke in agony. He spent the next seven weeks in hospital. Two of those weeks were in the intensive care unit. As he fought for his life, his children were told his lungs had collapsed, his liver had failed and he contracted pneumonia and septicemia. Then his heart went. He was finally transferred by helicopter to Brisbane on the 4th of December for life saving treatment. All from a routine gallbladder operation bungled by by Dr. Patel. Months later, Holter was still in pain and undergoing corrective surgery. Chapter 25 the Bloodletting December 2004. When Judi and Jerry Kemps looked back on their lives and the fruits of a close marriage of 50 years, they felt blessed. They were wed on the 23rd of October 1954, in St Patrick's Cathedral in Melbourne, Judy had given birth to three healthy and happy children, Jackie, John and Bernie. They had relaxed into the gentle pace and tranquillity of Bundaberg. After a stint overseas, they set up a photographic studio and continued to raise their three children. The couple remained active as they aged. They went bushwalking together and enjoyed regular tennis and golf. Kemps was one of those fortunate people who never had a sick day in his life. But by 2002, his health began to deteriorate. His blood pressure was erratic, he got gout, he suffered back pain. When he received a letter from Queensland Health offering a free check up, an appointment was made at the local Burham street medical practice. The tests on his urine sample pointed to a problem. As they ate lunch 10 days later, Judy told her husband.

Judge Debbie Richards (18:03)

You look yellow. You look anaemic to me.

Headley Thomas (18:08)

By the 6th of December, further tests at Bundaberg Hospital should showed that Kemp's was bleeding internally. The endoscope had identified a large malignant tumour about 4cm in size in the lower esophagus. The CT scans showed that the cancer had spread beyond the esophagus. There were shadows on both lungs. There were enlarged lymph nodes where the trachea splits into the left and right main branches. Dr. Dorwood Smallburger was adamant that Kemps needed to go to Brisbane for keyhole surgery. Nothing too radical was proposed. The cancer was such that the patient might have just 12 months to live. Under the circumstances, Dr. Smallburger wanted to ensure Gerry Kemps received the best care and quality of life possible for the time he had left. He did not contemplate an esophagectomy. Even for a highly competent surgeon, such a complex procedure was far too risky. But with the presence of secondary cancers, it was also pointless. Dr. Smallburger decided that the best course of action was a stent to make it easier for Gerry Kemps to swallow his food. The protocol for a transfer of a patient from Bundaberg to another hospital's surgical department required the decision to be signed off by a surgeon in Bundaberg. Unfortunately for Jerry Kemps, he was seen by Jayan Patel. The safe and conservative course was suddenly turned on its head by the Director of Surgery. Patel told the couple that the keyhole surgery recommended by Dr. Smallburger was just patch up work and that what he really needed was an esophagectomy. Patel explained how he would remove part of the stomach and part of the esophagus and Join what was left. Back together again. No problems.

Dr. Jayant Patel (20:19)

It is a big operation, but it is nothing because I have done hundreds of them.

Headley Thomas (20:24)

His confidence was contagious. Neither Kemps nor his wife was given any reason to doubt Patel. Theatre nurse Damian Gadds went to work early to start preparing for the operation on Jerry Kemp's. But there was a problem. The intensive care unit already had two patients on ventilators. They would be unable to cope with Jerry. Nurse Gadz called Dr. Dieter Behrens, who agreed the operation should be postponed. But when Gads reached Jayant Patel on his mobile telephone, the Director of surgery was furious.

Dr. Jayant Patel (21:04)

That brain dead patient should have been.

Headley Thomas (21:06)

Switched off last night at 8pm the day before, Patel had told a nurse to call Dr. John Joyner and ask him to turn off the life support keeping a critically ill woman, Robyn Turton, 63, alive. Turtin had slipped in the bath and hit her head on Saturday, suffering a cerebral bleed. Her family was aware that her prospects were poor. Her death would free up an ICU bed and Patel wanted it for Jerry Kemp's. But Joiner flatly refused. He was offended at the indecent haste to end the life of a woman who had not yet undergone formal brain death tests. Although it was probable from the CT scans that she was brain dead, Dr. Joyner prudently decided to wait. Patel had little time for Dr. Joyner, the anaesthetist who 18 months earlier had expressed concern to management about the risks of performing esophagectomies in a small hospital with a limited icu. As Patel did his ward rounds on Monday morning, he badmouthed Dr. Joyner. Patel told Martin Brennan, one of the.

Dr. Jayant Patel (22:27)

Nurses, I have a theatre case to do.

Headley Thomas (22:30)

The theatre nurse was astonished at Patel's cavalier approach to ending Turton's life before the necessary brain death tests had been done. Martin Brennan did not trust Dr. Patel. He had heard the surgeon intimidate and bully the nurses and threaten to harm their careers. Patel had created a climate of fear in the operating theatre and in the intensive care unit. All the nurses doubted that they would be backed by management in a showdown, as Patel often boasted of his influence over Darren Keating.

Dr. Jayant Patel (23:07)

I can get what I want from Darren as I've just made this hospital 500,000.

Headley Thomas (23:13)

Patel stormed into Dr. Martin Carter's office and denounced Dr. Joyner. He pressured Carter to end Robin Turton's life and free up a bed for the esophagectomy. Nurse Vivian Tapiolis witnessed Patel's insistence on the withdrawal of life support For Turton, whose children were in the waiting room at the ICU. As Patel pressed Dr. Carter to make a decision. After a review of the charts, Tapiolis and the two doctors spoke to the family about ending Turton's life. Patel walked back into the ICU with a spring in his step.

Dr. Jayant Patel (23:54)

Now I can perform the oesophagectomy.

Headley Thomas (23:57)

Dr. Carter switched off life support at 8.55am on Monday. Despite the absence of the formal brain death tests, Carter decided that there was sufficient clinical evidence to show Turtin had suffered massive and irreparable brain damage. He wrote, in view of the dreadful prognosis this lady has, and following discussion with family, ventilator support is to be withdrawn. Importantly for Patel, he now had a spare bed. At 9.52am on Monday 20 December, less than an hour after the death of Robin Turton, the operation on Jerry Kemp's began. Patel was flanked in theatre by the anaesthetist, Dr. Dieter Behrens, two principal house officers, Dr. Sanjeeva Carrier Wassam and Dr. Anthony Athanasiov, and the nurses, Dr. Kariowassam had spent much of his time at the hospital as Patel's shadow. They got along well. Patel was only too happy to explain the complexities of surgery to his eager apprentice. Together they used to undertake what Patel would call a blitz. In one week there would be a swag of colonoscopy procedures. In another week there would be a run of gallbladder operations. It was part of Patel's ongoing assault on the waiting lists and it kept him in management's good books. Kariy Wasam often heard Patel boasting about how successful he had been in reducing the lists and establishing rapport with Keating. The esophagectomy appeared to go well at first, but Gerry Kemps's abdomen needed to be opened to permit access to the oesophagus and the stomach. Suddenly, however, he became unstable. With plunging blood pressure and a rising pulse rate, Kemps was turned onto his side for the thoracotomy part, the opening of the chest cavity. As Patel resected the tumour in the chest, the blood continued to pour freely into the drain. The heavy bleeding in the abdominal cavity was obvious to everyone. Dr. Behrens was worried. Apart from the blood loss, he could see that the director of surgery lacked the skill to be attempting such an operation. Patel's roughness around the heart and the vessels was all too obvious. Nor did he appear interested in the monitoring being done by Dr. Behrens of blood pressure and other vital signs. Behrens was shocked. It was as if Patel could not acknowledge a major problem. Unless the blood stopped flowing, Kemps would surely die. Nurse Damien Gaz raised the alarm. Dr. Patel, the belovac drain is over half full with no vacuum and is still draining freely.

Dr. Jayant Patel (27:09)

That's what drains are for. Demian.

Headley Thomas (27:12)

To the amazement of Dr. Behrens and the theatre nurses, who were alarmed by the obvious and heavy bleeding, Patel gave instructions for Kemps to go to the icu. From that moment, it was inevitable that he would not survive. At 2pm, Patel called Judy at her home.

Dr. Jayant Patel (27:33)

He told her it was a great success. We have got it all. There's a little bit of bleeding there, but that's nothing.

Headley Thomas (27:42)

When Judy went to the intensive care unit soon afterwards, she saw a nurse frantically pumping blood into her husband's body. Jerry Kemps received more than 30 bags of blood altogether. His abdomen was distended as bright blood drained away. Three nurses were needed at his bedside for fluid management and one ran back and forth from the blood bank for products and to page the doctors. Dr. Behrens was using large quantities of a drug to maintain blood pressure and support the heart. Another nurse took Judy aside and told her, Jerry is a very sick man and he is on life support. Judy, joined by her son John, went over to his bedside and and gave Jerry a kiss. I love you, she said. He tried to sit up. At 5pm, Judy was told of the need for another operation.

Dr. Jayant Patel (28:45)

I have to take him back into theatre again. It can only be the spleen. I'll take it out because he doesn't need it anyway.

Headley Thomas (28:52)

But Patel had begun another operation on a different patient, which led to another complication. Kemps was not taken back into theatre until after 6.30pm the situation was critical when Dr. David Rison, who had not been involved in the esophagectomy, came to theatre to help. Dr. Rison was surprised to see Dr. Sanjeeva Kariow Assam, a junior doctor, identifying problems and tactfully pointing them out to Patel, who seemed out of his depth and at a loss to pinpoint the torrential bleeding. Patel reopened Jerry's abdominal cavity and the chest cavity as scout nurse Janelle Law's tasks included finding sutures, sponges and anything else that might be needed for the operation. Janelle lost track of the amount of blood spilling from camps on the operation operating table, but she counted 75 large sponges and 15 gauze squares to absorb the blood. It was everywhere. As the nurses moved around theatre, they left footsteps of blood on the floor.

Dr. Jayant Patel (30:07)

This man's going to die. He's going to die on the table. I can't do anything. Get the family. Get the family.

Headley Thomas (30:15)

Janelle Law watched Patel becoming more agitated, defending his surgery and saying that the bleeding had nothing to do with him.

Dr. Jayant Patel (30:24)

This isn't my fault. This has nothing to do with my surgery. This isn't my fault.

Headley Thomas (30:30)

But Patel also had a rare moment of insight. He was shaken by the demise of Jerry Kemps. He said in the operating theatre, maybe they're right.

Dr. Jayant Patel (30:43)

Maybe we shouldn't be doing esophagectomies. Maybe I should start thinking about not doing these type of procedures anymore.

Headley Thomas (30:50)

Janelle Law opened the theater door for Patel to go outside to talk to Judy and her two sons. Patel was covered in his patient's blood.

Dr. Jayant Patel (31:01)

I've taken the spleen out, but it was all right. I had a look at the lungs and they were all right. So the bleeding must have come from the heart. I can't do anything about it, but he will be lucky to last the night.

Headley Thomas (31:13)

Patel repeatedly told the shocked Kemp's family that his surgery was perfect. The longest night in Judy's life was spent with her dying husband in Tony Hoffman's intensive care unit. Jerry's demise was inevitable. The equipment supporting him was gradually removed. Judy noticed something else. The nursing staff seemed strangely uncomfortable around her. Their body language was defensive. They avoided eye contact. Jerry kemps died at 9.20am on 21 December 2004. Dr. Patel had notched up another lucrative procedure for Bundaberg Base Hospital, which received its financial bonus irrespective of whether the patient survived the operation. And the intensive care unit bed was vacant again. Already, Dr. Athanasioff, given the task of filling in the death certificate, was discouraged by Patel from referring the case to the coroner.

Dr. Jayant Patel (32:27)

We know the cause of death. It was due to a bleed in the aorta.

Headley Thomas (32:32)

The theatre staff were furious with Patel. Dr. Behrens was alarmed. He could not understand why Patel would send a bleeding patient to the intensive care unit. Nor could he understand Patel's inability, hours later to discover the source of the bleeding. Dr. Behrens and Dr. Martin Carter agreed the death should be reported for formal autopsy. The coroner's act refers to a death being reportable where it was not reasonably expected to be the outcome of a health procedure. But by the time the two anaesthetists had come to this view, it was too late. A notice in the Bundaberg News Mail showed that Kemps was being buried in a few hours. Dr. Behrens was struck by the lack of interest from Dr. Darren Keating when it came to investigating. Even when Dr. Carter explained his concerns about the survival rates of Patel's patients, nurses Janelle Law and Damien Gads decided to make a formal complaint. They believed Dr. Patel had killed Kemps. In the afternoon after Kempster's death, Peter Leck saw a note blandly advising the outcome of the complex procedure performed by the Director of surgery. Leck asked Dr. Keating a question.

Peter Leck (34:01)

The esophagectomy concerns me somewhat. Have any of these patients survived?

Headley Thomas (34:22)

Chapter 26 Life and Limb late December 2004 to January 2005. Shannon Mobs fell spectacularly from his friend's trail bike at 10am on 23 December, the day Judi Kemps farewelled her husband at his funeral in Bundaberg. The teenager had struck a tree stump hidden by long grass on a winding track at Woodgate, south of Bundaberg. The 15 year old was flown by helicopter to Bundaberg Hospital after his friend sped 10 kilometres along the track to raise the alarm. By the time he was in the operating theatre for life saving surgery by Jayan Patel, the boy had lost a massive amount of blood from a deep slash in his groin and a lacerated femoral vein in his thigh. His condition was so perilous that the boy was initially transfused with blood that did not match his type, but at least it kept him alive. After the first operation Patel emerged from theatre to reassure mobs mother Karen Oriel. The surgeon talked about himself for the first 10 minutes, falsely claiming that he had been in charge of the trauma and emergency ward of a New York hospital for a decade. Karen Oriel was relieved when the Director of surgery told her he had stopped the bleeding. He assured her that her son was fine and would make a complete recovery, all thanks to Patel's vascular surgery. Over the next 12 hours Dr. Patel performed another two operations on Shannon Mobbs. Despite the initial life saving surgery and then serious complications demanding more major surgery, Dr. Patel told the other doctors and Karen Oriel that there was no need to transfer the boy to Brisbane. Patel left the hospital on Boxing Day to fly to the United States for annual leave, but not before instructing the medical staff to keep the boy in the surgical ward. He had extracted something from Darren Keating on Christmas Eve. It was another Dear J letter. It set out the terms of a four year extension of his current contract. Keating wrote, I would like to offer.

Dr. Darren Keating (36:59)

My congratulations on your ongoing appointment and hope that your work with the Bundaberg Health Service District will continue to be both beneficial and rewarding.

Headley Thomas (37:10)

The many serious issues raised by Tony Hoffman were yet to be formally investigated. She was at home mourning the death of her grandmother at 98, preparing for the funeral in Sydney and worrying about the condition of young Shannon Mobs. Although Tony was supposed to be on annual leave and entertaining her parents, her sister Marie and husband Matthew and their two kids, she could not let go of the problems with Patel. She stayed in touch with the hospital by telephone and repeatedly urged the nurses in the intensive care unit to do what they could to influence the transfer of Shannon.

Toni Hoffman (37:50)

You've got to get that boy to Brisbane.

Headley Thomas (37:54)

Tony's brother in law Matthew was also worried. He could see the high levels of stress that she was under when she was supposed to be on holidays. Tony showed him the lengthy letter of complaint she had written and spoke to him about her pleas for a clinical audit. He told her that at least you will be able to sleep at night. But Hoffman was finding sleep difficult. For most of the nine days Shannon Mobbs remained in the hospital. There was no pulse in his left foot. The foot was dying. Contrary to the claims Patel had made in the notes about repairing Mobs femoral vein he had simply tied it off after Dr. Patel went on holidays handing over to Dr. Jim Gaffield. The boy was in excruciating pain with a fractured pelvis, huge muscle tears in his thigh, raging temperatures, sepsis and gangrene. It took until 1 January and a snap decision by an appalled Dr. David Rissohn on his return from leave for Mobs to be airlifted to the Royal Brisbane Hospital. There Dr. Mark Ray diagnosed him on New Year's Day as the sickest 15 year old he had ever seen. Dr. Ray could smell the septic and grossly infected leg from the other side of the emergency department. He did not expect Mobs to survive the night. If he did survive he would need more surgery to amputate his leg through the knee. The operation by Dr. Jason Jenkins and Dr. Ray showed that both ends of the femoral vein had been suture ligated. Instead of being reconstructed. Blood had been going to Shannon's limb through the femoral artery but it could not drain away through the femoral vein. This had led to gross swelling and a range of serious life threatening implications. Patients Dr. Steve Rashford, who organised the emergency airlift and the two Brisbane surgeons Jenkins and Ray were disgusted by the care Mobs had received in Bundaberg. There was no excuse for the failure to send him to Brisbane after the initial surgery. They believed that the athletic 2 metre tall boy who wanted to be a professional basketball might have kept his leg if he had been transferred immediately after the major operation. On the 4th of January, Michelle Hunter, the nurse who had alerted the doctors to Shannon's shocking condition on New Year's Eve, resolved to do something. She had come to the conclusion that Patel was a serial danger. She had never seen so many instances, instances of wound dehiscence and the Internet search she had done months earlier was still on her mind. Patel's treatment of Shannon Mobbs, the tying off of his femoral vein, which effectively destroyed his leg, persuaded Michelle Hunter to act. She went to see Tony Hoffman, who was back from Christmas leave. But the nurse in charge of the ICU had still not heard anything from Peter Lek or Darren Keating about an investigation. Despite her increasingly detailed and grave complaints made during 2004, Hunter decided to make her own complaint. She considered going directly to the Health Rights Commission. First, she sent a memo to Linda Mulligan setting out her concerns over the mob's case.

Linda Mulligan (41:45)

My concerns are with the surgeon that performed his initial three operations. I'm concerned that if the patient had been transferred to Brisbane initially, he may not have lost his leg or be in such a grave condition. I would like his treatment at the hospital investigated as I fear his health and wellbeing has now been compromised by inadequate substandard treatment by the medical team.

Headley Thomas (42:09)

There was a similar expression of concern from Dr. Rashford in Brisbane, who wrote to the most senior administrators in Queensland Health and he copied his memo to Peter Leck and Darren Keating. Pressure was mounting. But Dr. Keating, who wanted Patel to return from holidays to a new four year contract, produced a report stating that no external probe was necessary. Linda Mulligan was now starting to worry. From the beginning, she had downplayed Tony Hoffman's concerns. She believed that the nurse and the top surgeon simply loathed each other and that Hoffman's complaints were motivated by emotional rather than clinical issues. But on 7 January, three distraught nurses from the operating theatre, Katrina Zwolak, Damien Gadz and Janelle Law, had decided to unite in an unprecedented complaint. They went to Mulligan and they told her that Patel was a shocking surgeon whose patients were dying unnecessarily. Katrina and Janelle were weeping as they told of the falsification of patients records by Patel and of how staff had felt powerless because of his claims to have management in his pocket. Linda Mulligan immediately tipped Leck off about this dramatic new development. She told him they displayed different degrees.

Linda Mulligan (43:39)

Of Emotion to the point of one stating that the whole issue is keeping them from sleeping.

Headley Thomas (43:45)

All of Tony Hoffman's claims were being corroborated and still a clinical audit of Patel's work was not begun. Chapter 27 Executive Decisions the 13 to 14 January 2005. Peter Lek was showing the first signs of acute panic. By the time Jayan Patel had returned to work in early January, Lec worried about his own failure to conduct any sort of review of Patel. Despite a trail of dead and maimed patients and a string of complaints, he had broken his own promise to Hoffman to have the concerns properly checked. He had not even told her what he was doing. Peter Leck had dithered. He had been indecisive, weak and interminably slow. On 13 January, Leck raised the concerns for the first time with the Acting Director General of Health, Dr. John Scott.

Peter Leck (44:56)

I was just wanting to flag that I actually do have some concerns about the outcome of some of Dr. Patel's surgery.

Headley Thomas (45:03)

He also told Scott about the nurse's fears over injuries and deaths, adding that Dr. Darren Keating believed that the concerns.

Peter Leck (45:12)

Were completely driven by the personality conflict. However, he has now expressed some concern, although he still believes most of the issues are personality driven.

Headley Thomas (45:21)

He was silent about the backing of Hoffman's concerns by the three doctors, doctors Dr. Martin Carter, Dr. David Rissohn and Dr. Dieter Behrens who had been interviewed. Keating was angry that it had come to this. He did not like confrontations with Patel, particularly as he had exceeded the surgery targets and made Keating and the hospital look good. But the ICU and theatre staff were close to rebellion. Something had to give. Keating told Lec.

Dr. Darren Keating (45:57)

Look, we need to make sure that Dr. Patel is aware of the investigation and give him as much information as possible.

Headley Thomas (46:04)

In a meeting in LEC's office on 13 January, Patel was told for the first time about the complaints concerning his handling of Shannon mobs as well as other patients. Patel was told that there would be an investigation and that in the meantime he could continue doing surgery, just not cases requiring admission to the icu. Patel scoffed at the notion that his surgery was below standard. But for the third time in his career he faced a thorough investigation with potentially grave findings. He was indignant.

Dr. Jayant Patel (46:44)

I will be considering my position.

Headley Thomas (46:47)

The next day. Patel told Dr. Keating that he would not be taking up the four year contract after 1 April, but he had no plans to leave Australia. Patel still believed that he could remain as a surgeon on a special contract despite the trouble he would Be in if the easily discovered details of his past came to light, he chose not to flee. At least not yet. He told Keating, I would like to.

Dr. Jayant Patel (47:16)

Thank you for your support over the past two years. My stay at Bundaberg has been challenging at times, but mostly enjoyable and rewarding.

Headley Thomas (47:24)

Keating replied with a glowing appraisal of Patel's troubled time at the hospital, thanking.

Dr. Darren Keating (47:30)

Him for his sustained commitment, ongoing enthusiasm and strong work ethic. I have greatly valued your advice, insight and support over the last two years and I wish you well in the future in. In whatever endeavours you may take.

Headley Thomas (47:46)

Patel kept Keating's note for his curriculum vitae. It was the sort of adulation not dissimilar to the praise bestowed by his peers in New York State and Oregon when he had been in trouble. Seeking further reassurance and comfort, Patel turned to the junior surgeons, Dr. Anthony Athanasiov and Dr. Sanjeeva Karriawassam. They were upset at the story told by their mentor, the man who had bought their meals and passed on his surgical prowess. They teamed up with three other junior doctors to lobby on Patel's behalf. In a note to Dr. Keating, they.

Dr. Anthony Athanasiov (48:28)

Dr. Patel is now in a position whereby he feels it is not in his best interest to stay at Bundaberg, and we believe the hospital should consider this very carefully. Dr. Patel's approach to his work is nothing short of admirable. He is dedicated, hard working, efficient and knowledgeable. His efforts to ensure his patients receive the best care go above and beyond the call of his duties. He consistently goes out of his way to provide timely, expert management for a wide variety of surgical problems. In summary, we are concerned about the circumstances surrounding Dr. Patel's departure and we believe his leaving will be a great loss for the hospital and and also for the Bundaberg community.

Headley Thomas (49:10)

By the end of January, Keating had hatched a devious plan. He was annoyed that impertinent nursing staff had dashed his hopes of retaining Jayan Patel as the Director of surgery until 2009. Dr. Keating decided to flex his management muscle, pandered to Patel and put the nurses back in their place. All with one big decision. In early February, he offered Patel a senior surgical role with a daily rate of $1,150, a significant enhancement on his existing $200,000 a year package. Keating had also given the medical board another glowing appraisal of Patel's work.

Dr. Darren Keating (49:56)

Dr. Patel is a very committed and enthusiastic clinician who has continued to be a very effective member of staff and director of surgery. He has a very strong work ethic which is a model for others.

Headley Thomas (50:11)

Keating told the board that there were nil significant areas for improvement in Patel's performance and he rated the surgeon's performance as excellent. Keating had paved the way for the four year extension offered previously. He wrote to the Department of Immigration and confirmed that the hospital planned to employ Patel until 2009. Patel was elated as he boasted to nurse Janelle Law in the operating theatre during an endoscopy procedure, they're going to.

Dr. Jayant Patel (50:46)

Pay me as as much for three months as what I get in a year.

Headley Thomas (50:49)

The nurse was appalled. She had been looking forward to seeing the back of Patel and all the problems he brought to the hospital. Now it seemed he was to be showered with money and kept on. Chapter 28 the investigation February to March 2005 Jerry Fitzgerald spread the email printouts, memos, reports and letters across his desk at Queensland Health headquarters in Charlotte Street, Brisbane. The Chief Health Officer of Queensland had given himself an unenviable assignment a clinical audit of the Jayant Patel's surgical outcomes. The documentary material was the first part of the puzzle. Dr. Fitzgerald had already been advised by Peter Lech that there were personality differences between Patel and his principal accuser Tony Hoffman. Fitzgerald also knew how valuable Patel was to Bundaberg Hospital. The surgeon's role in slicing through the waiting lists had been repeatedly stressed by Leck. Mindful of the sensitivities of the people involved, Fitzgerald made plans to visit Bundaberg to interview Patel as well as the nursing and medical staff. He wrote to Peter Leck, at this.

Dr. Jerry Fitzgerald (52:22)

Point we will be simply collecting information and not seeking to validate or evaluate any any particular concerns raised. Would you mind asking Dr. Patel if he can spare some time to meet with me to discuss any concern he may have? Dr. Patel is definitely entitled under the principles of natural justice to be confronted with the details of the complaints made against him. He may decline to meet with me until he has had the opportunity to respond to the complaints. I hope he does not do so. Our main intent is to find the facts and to seek a resolution asap.

Headley Thomas (53:07)

Anyone else who risked being exposed as a clinical fraud would have skipped overseas on the eve of an investigation by the Chief Health Officer. But not Jayant Patel. His ego and self belief refused to entertain the idea that he might be found out. Patel also knew that the hospital still desperately needed him. On 8 February, Keating had all but pleaded for Patel and other staff to work harder on those waiting lists. The hospital was 92 operations behind its target. Kidding, wrote A memo to senior staff.

Dr. Darren Keating (53:47)

Should the target not be achieved, Bundaberg Health Service District will not get another chance to upgrade the target and hence lose flexibility and significant dollars. Therefore, it is imperative that everyone continue to pull together and maximise elective surgery throughput until 30 June. All cancellations should be minimal. With these cases pushed through as much as possible.

Headley Thomas (54:14)

In the executive meeting room on the 14th of February, Fitzgerald and a Brisbane colleague, Sue Jenkins, began working their way through a list of about 30 nurses and doctors. Some of the interviews lasted just 15 minutes. Others went for over an hour. The nurse, Karen Jenner, wondered how seriously the investigation was being taken.

Toni Hoffman (54:38)

This is not an investigation of Dr. Patel. This is us gathering information to find out whether or not it is important to have an investigation into Dr. Patel.

Headley Thomas (54:48)

When Patel strolled in, he acted as if he did not have a care in the world. He had spared about 25 minutes for the Chief health officer, who immediately identified an arrogance bordering on megalomania. Patel's self confidence was almost pathological. It was a personality that Fitzgerald, a naturally shy and disarming man, could not easily understand. Patel proceeded to boast about how much surgical experience he had in the United States. He repeatedly spoke of his expertise in complex procedures. He was clearly agitated at the scrutiny being applied to his work. But he brushed it off as the product of flaws in other people.

Dr. Jayant Patel (55:36)

He told Fitzgerald, nurses have been complaining about doctors for centuries. Some of them are lazy. They don't want to work hard.

Headley Thomas (55:44)

Patel offered an olive branch.

Dr. Jayant Patel (55:47)

Well, if you don't want to do these procedures anymore, we won't do them here.

Headley Thomas (55:52)

After hearing from Dr. Peter Miak and several nurses about the catheter problems and the lack of hygiene, Fitzgerald, too was doubting the competence of the director of surgery at the Bundaberg Base Hospital. But was the hospital better off with Patel than with no senior surgeon at all? When Fitzgerald asked Tony Hoffman this question, she was certain of the answer. She told him that the patients would be much better off if Patel were immediately suspended. As she told the chief health officer.

Toni Hoffman (56:27)

We don't like this guy, but that's not the issue. The issue is he's doing these things here and it's harming people.

Dr. Jerry Fitzgerald (56:36)

He replied, well, we can't do anything because nothing's been proved at this stage.

Headley Thomas (56:42)

Hoffman was crestfallen. She wondered, what on earth can we possibly do to stop this man? Fitzgerald asked Aaron Keating, what do the patients feel?

Dr. Jerry Fitzgerald (56:54)

What's the level of patient satisfaction? Have there been any complaints against Dr. Patel by patients?

Headley Thomas (57:01)

Keating had a folder of complaints, but he assured Fitzgerald that there were none. Patel had given an undertaking to stop doing the esophagectomies and other complex surgery needing intensive care unit support. But he was still causing serious damage. Three days before Fitzgerald's arrival at the hospital, Jenny White was the scrub nurse for a procedure to remove part of the cancerous bowel of a patient, Jean Stewart Sutherland. Patel cut the healthy part of her bowel. If he noticed his error, he did not acknowledge it until a junior doctor pointed it out. Nurse White shook her head in disbelief. How Patel could have overlooked the 4 centimeter cut was unfathomable. When the patient returned to theatre in late February, because of the inevitable complications from the earlier incompetence, Jenny White saw the terrible state of the bowel. It was leaking. More than one litre of bile stained fluid needed to be drained. There was also a gross infection. The blood from the carotid artery of Harry Petrahilos spurted in a fine but steady stream. It happened suddenly when one of the doctors in the coronary unit tried to put a central line into his neck, missing the vein but piercing the artery. Because arterial pressure is greater than venous pressure, Petrahilos began losing blood fast. He was already in poor shape. He had suffered a heart attack and was also battling severe kidney failure, which made him anaemic. He took blood thinning substances for a condition called atrial fibrillation and irregularity of the heart. He had one more disadvantage. Petrahilos was a Jehovah's Witness, which meant he would not be a candidate for blood transfusion. His delicate condition and complications meant he had to be handled with extreme care. Any operation was a grave danger because of the potential for Petrahelos to bleed to death. When Jayant Patel saw the commotion on 4th March and asked what was going on, a nurse explained that Petra Hellos was one of Dr. Peter Miak's patients.

Dr. Jayant Patel (59:33)

Patel replied, okay, I won't touch him then.

Headley Thomas (59:38)

The rift between Dr. Miak and Dr. Patel had only widened in the years since the Director of Medicine banned the Director of Surgery from handling certain patients. Dr. Mihak had made it clear in his interview with Dr. Jerry Fitzgerald in February that Patel was dangerous and incompetent. Miak had even taken the unusual step several months earlier of asking to see Patel's personnel file and cv. He flicked through it in a couple of minutes, expecting to find a red flag pointing to the incompetence of the man. But it seemed in order. Peter Miak had walked back to the Ward perplexed. But Patel could not walk away. He told the theatre nurses to prepare for an operation. Patel wanted to operate on the punctured artery of Petrahelos. The nursing and junior medical staff were immediately alarmed. Someone called Dr. Miak and asked him to come to the ICU urgently. He walked into a bizarre and tense situation. Dr. Patel, all scrubbed up in his surgical gear, was intent on taking Petrahelos into theatre. The nurses were pleading with their eyes and body language to prevent another death. Miac gave an instruction to one of the doctors.

Dr. Jerry Fitzgerald (61:01)

Just put pressure on it.

Headley Thomas (61:03)

Patel loudly insisted on an operation to put a couple of stitches in the carotid artery. It was a delicate procedure under ideal conditions, but in the hands of Patel, it promised to be a disaster. Dr. Miak refused to budge. He believed that there was absolutely no chance the man would survive the operation that Patel seemed determined to perform.

Dr. Jerry Fitzgerald (61:28)

He told Patel, look, the carotid doesn't need fixing. His priorities are his heart, his anaemia, his everything else.

Headley Thomas (61:37)

Miak knew that by maintaining pressure on the small hole in the carotid, the bleeding would eventually stop. He gave firm instructions to a junior doctor. But he still had to silence Patel, who was angry and embarrassed.

Dr. Jerry Fitzgerald (61:53)

Look, this man is not going to theatre and that's the end of it. He's going to Brisbane.

Headley Thomas (61:58)

Tony Hoffman watched the drama with mounting alarm. Why had it come to this? She had prayed that an investigation by the chief health officer would result in decisive and immediate action. But instead, Patel was still wreaking havoc, still boasting about the renewal of his contract and his massive salary boost. Miac instructed Hoffman, whatever you do, don't.

Dr. Jerry Fitzgerald (62:24)

Leave this patient's bedside. And if Dr. Patel goes near him, telephone me immediately.

Headley Thomas (62:30)

As Hoffman stayed by Petrahilos to await the royal flying doctor for an emergency flight to Brisbane, a leader of the Jehovah's Witness Church in Bundaberg came to the intensive care unit. Tony Hoffman already knew from contacts close to the church that Patel had ingratiated himself with the flock. She had been suspicious when first told of the charm offensive. Now, one of the men who knew Petrahilos as well as Patel was in the intensive care unit. He asked if Dr. Patel was available. Hoffman was in a panic. If she put a call through to Patel, the patient's fate would be sealed. Hoffman knew how persuasive Patel could be. He would tell the church elder that an operation to repair Petrahilos carotid artery was absolutely imperative. And he would prevail upon the elder to demand that the operation Bipertel should go ahead. Tony Hoffman decided that she could not let that happen. She told the Elder, Dr. Patel isn't.

Toni Hoffman (63:36)

Here at the moment, but the patient is going to be fine.

Headley Thomas (63:40)

Ten days later, Dr. Martin Straughan decided to use an endoscope to examine the stomach of Joan Cameron, who had been admitted to the medical ward with vomiting and bleeding. Strawn discovered an obstruction in the second part of her duodenum. He strongly suspected it was a secondary tumour, which would require further investigation and possibly surgery in Brisbane. In the corridor outside the theatre, Patel asked Strawn about the finding. Patel told him, oh, well, that will.

Dr. Jayant Patel (64:15)

Be a primary tumor in the duodenum. The patient needs an operation to remove it and I'll put the patient in the surgical ward and I'll do it early next week.

Headley Thomas (64:23)

Dr. Straughan suspected that Patel was wrong and would attempt more complex surgery. After opening the patient up, he was determined to prevent Patel from operating. But how? When Joan Cameron developed a chest infection a few days later, Straughan seized the opportunity to remove the patient from Patel's grasp. He spoke to Dr. Miac, Dr. Martin Carter and Tony Hoffman about a plan to hide the patient in the icu, a safe refuge since Patel no longer ventured there. From the icu, Joan Cameron could be quietly transferred to Brisbane. They were all in agreement. Behind Patel's back at the time, Strawn regarded it as outrageous behaviour to have to resort to a ruse to keep an injury ill patient away from the director of surgery. He was also worried about how Patel might retaliate when he found out. But the bizarre episode had made a more profound impression on Tony Hoffman. Her mind was made up now. She had to fully expose Patel and worry about the consequences later. 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 Samaglou and Neil Sutherland. Our producer is Kristen Amias. Production management by Stephanie Coombs. Artwork by Sean Callanan. Thanks to Ryan Osland, Matthew Conditions, Corinna Berger, Ellie Dudley, David Murray, Dominique McDermott, Zach Schoolander 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@s sicktodeathpodcast.com and on Apple Podcasts. You can get exclusive access to photographs, videos, timelines and more at the website.