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- [00:05]
Headley Thomas
My name is Headley Thomas. Sick to Death is based on my book of the same name and it's the True Story of Dr. Jayant Patel's Lies and manipulation and the herculean effort it took to finally stop him. We've used voice actors throughout this series and on occasion the real people from the story have read their words for us. It is brought to you by me and the Australian. Chapter 29 make or break 18 march 2005. The two lane road from Bundaberg to Seaside Bergarra was one Tony Hoffman had travelled often. Its red dirt shoulders give way to waving fields of sugar cane, strawberry plantations, acres of beans and roadside produce stalls with hand lettered signs. The nurse noticed none of these as she gripped the wheel of her burgundy red Nissan Pulsar and sped through a storm and fierce rain to Rob Messenger's office. Hoffman was going outside the secretive Queensland health system by approaching a local parliamentarian. She didn't know if he could be trusted. She didn't know if he would believe her. Her anxiety mounted as the familiar scenery flew by. She felt sadness, anger, fear and tension. After Jayan Patel's boastful announcement that his contract at the hospital had been extended, Hoffman and the nurses who supported her felt helpless. She had made up her mind to ring messenger to set up an appointment. Afterwards, reflecting on what she had briefly told him in that first tentative telephone conversation, she feared that Rob messenger would believe she was unhinged. She confided her plan to Karen Fox.
- [02:21]
Tony Hoffman
Telling her, you know, I'm ringing him up and saying patients are dying at the hospital and he's probably thinking this woman's crazy, this can't be happening. But it is happening.
- [02:33]
Headley Thomas
Messenger's staff had gone home by the time Tony hoffman arrived about 5:30pm at Shop 7, Bagara Plaza. Her makeup was streaked by tears. He sat her down with a mini recorder, his preferred tool when receiving sensitive complaints from constituents or sources. You could never be too careful in the cut and thrust of Queensland politics.
- [03:00]
Rob Messenger
Can I get you to state your name, please?
- [03:03]
Headley Thomas
Messenger started like a copper conducting a record of interview with a criminal. Except his delivery was gentle and patient.
- [03:11]
Tony Hoffman
Tony Hoffman.
- [03:13]
Rob Messenger
Tony, do you want to claim whistleblower status?
- [03:16]
Headley Thomas
Messenger hoped that the nurse would seek the limited protection afforded to public servants making a serious disclosure to a local politician.
- [03:26]
Tony Hoffman
Yes.
- [03:27]
Rob Messenger
Have you come to me because you believe that Dr. Patel is incompetent in killing people?
- [03:32]
Tony Hoffman
Yes. Yes I do.
- [03:35]
Headley Thomas
There it was done. She would not turn back now. For the next 90 minutes, Hoffman let Messenger know the Entire dreadful story. Messenger asked her if she was fearful.
- [03:48]
Tony Hoffman
She replied, I guess I'm more distressed than scared because I've watched patients die. I feel that every time I see him walk in the unit, I feel sick because I just think, who's he going to kill now? What's he going to do now? And we all feel like that. All of the nurses feel like that. They feel physically ill when he walks in because they just know that he's going to try and interfere with something, operate on someone, cause more of a problem and a complication, or stop a transfer which has been arranged. He says he trained in the United States. We did a search on the net because there's a site there that you can look up physician's qualifications. And it says that he trained in India in 1973 and that he has a general qualification. He continually tells us all sorts of things, like he's been a trauma surgeon for 25 years and that he's been a cardiothoracic surgeon for about 15 years. He seems to have a new qualification every time he talks about it, but we've not seen any of that. He also stated he studied medicine when he was only 15 years old. So, you know, like, we sort of don't believe very much what he says because, you know, it's just impossible.
- [05:03]
Headley Thomas
Messenger wanted to know about the culture of the hospital. He had his views about how a moribund or incompetent management might be impotent to act against a dangerous doctor. Those views were about to be strongly reinforced.
- [05:19]
Tony Hoffman
I think of all the places I've worked in, I've never worked in a place like this. There's bullying, intimidation. You can't trust that anybody is going to tell the truth. The nurses hold the hospital together, and there's some great doctors, but these few people hold the hospital together, and the district manager takes the credit for it.
- [05:41]
Headley Thomas
Messenger's quietly effective interviewing style had been honed as a commentator behind the microphone in the local ABC radio studios.
- [05:51]
Rob Messenger
You say in some of that literature that I've read, Dr. Patel insists on.
- [05:56]
Headley Thomas
Keeping patients longer than what the unit is equipped to keep. Can you explain that?
- [06:02]
Tony Hoffman
Well, as I said, we only keep patients for 24 to 48 hours. We do try and keep them for longer, and we often do keep them for longer, and we substitute our staffing with overtime. But Dr. Patel refused to transfer his patients to Brisbane. He said he wasn't going to practice medicine like that, and he would go up to Dr. Keating and throw a tantrum and say he was leaving or resigning or just refused to transfer them out. Sometimes we would have a bed in Brisbane for a patient, especially if they were quite sick, and then Dr. Patel would stop the transfer and then we would lose the bed because Brisbane would need the bed for someone else. So he consistently would interfere and stop the patients from being transferred to Brisbane, which caused enormous problems for us as nurses. I mean, we were continually putting people on overtime. It blew out our budget for the first time in four years because we had patients. We kept patients for so long. And the thing is, the patients weren't getting the care that they needed anyway because he's not a good doctor. The complication rate was so high that all these patients all had huge complications that weren't being addressed properly. What we've tried to do through Queensland Health is go through the right channels and address this properly, but it doesn't seem to have worked. I've come to you because, I guess as a last resort, because we didn't know what else to do. I mean, I'm here not only as a representative for my own concerns, but I'm here representing the concerns of a lot of people who are too scared to come. We've been told that we're not allowed to come and see you. We literally are at the point where we are just about throwing ourselves over the top of the patients to protect them from this man, you know, and this is just crazy. It's just ridiculous. This is 2005. This should not be happening. You know, we've got this code of conduct that exists in Queensland Health, and we're supposed to have all these things that protect us and the patients in place and nothing's working. And that's why I guess I'm here. I'm asking you, who has nothing to do with the hospital whatsoever, to try and do something to save these patients from this man. We don't know what to do or where to go. Like, who else can we tell? You know, we joked about it the other day and said, what else can we do? Strip naked and hang from the tree outside the Red Rooster and scream out to Bundaberg, this is what's happening at the hospital. So this is what I hope that he gets stood down while there's a proper investigation done.
- [08:50]
Headley Thomas
It was dark outside, still pouring with rain. It was almost 7:30pm messenger had everything he needed. It was sensational, more powerful than any of the information brought to him in the past by people wronged by the hospital where his mother had given birth to him, where his mother died. There was Something else, perhaps serendipity. Whatever it was a year to the day since his maiden speech in state Parliament when he pledged to campaign on health, he had ended the speech with a comment about evil prospering while good men remained silent. Now he wanted to shout the Battell disaster from the rooftops. And he reassured Hoffman. The desperate woman, a lifetime Labor Party loyalist who had not voted for messenger and had never supported his National Party, looked a wreck from worry and sleeplessness.
- [09:50]
Rob Messenger
Ok, we'll leave it there.
- [09:52]
Headley Thomas
I know what to do. Hoffman eyed the dark rain streaked windows and sighed as she prepared to go back out into the storm. Chapter 30 Political Football 19 to 22 March 2005 in a booming electorate that few expected him to hold after his surprise 2004 triumph, Rob messenger was run off his feet. The needs and expectations of working class families and sea change retirees were constant. He and his constituents were fortunate. Messenger had great stamina, patience, a methodical personality and dedicated staff. He had been shaken by the intensity of the secret meeting with Tony Hoffman and her shocking revelations. The documentation she handed to him was extensive and worrying. It corroborated her emotive story. He had been told by too many staff and patients that Bundaberg Base Hospital was a house of horrors. He had witnessed his own mother's battle with cancer there. He intuitively knew Hoffman was right, but he had to play it safe. A bad call now could stall his political career within his own beleaguered National Party. One or two colleagues envied his increasing popularity. They would not mind seeing him trip up. His speeches and press releases highlighting the problems at the hospital were routinely used against him by the Labor Party's Nesa Cunningham, the the elected representative for the adjoining seat for hammering the local hospital and revealing its ills. He was regularly accused of demoralising the staff and worsening the problems. If he publicly took on the director of surgery, he would be picking his biggest fight yet. It was conceivable that the man would resign. Messinger knew this. Who would be around to repair the worn out knees, perform the colonoscopies, cut away the cancer? And if Patel were not as bad as Hoffman claimed, the community would be up in arms. If messenger forced an innocent surgeon out of the hospital, the politician's head would be on the chopping block and the voters would lop it off pronto. After asking his staff to transcribe the record of his interview with Tony Hoffman, he went to the country town of Calliope and then to Gladstone on the coast for National Party business. By Sunday evening, when he checked for email, every word of his conversation with Hoffman two days prior was at his fingertips. He read it again on his computer screen, shaking his head at the seriousness of it all. As he scrolled the text, he spoke to Mike Horan, the reliable parliamentarian from Toowoomba, west of Brisbane. Horan had been a health minister in a former coalition government. He listened intently to Rob Messenger's version of the meeting with Hoffman. Mike Horan gravely told the young understudy he had a duty to act with urgency before meeting his political colleagues. To explain the bombshell and work out a strategy on how best to drop it, messenger called Dr. Martin Straughn, a highly qualified physician in Bundaberg. Strawn was known to messenger in the confidential October 2004 memo which Tony Hoffman had written to Peter Lecht setting out the concerns over Patel. She specifically related one of her conversations with Straughan. It followed the death of Des Bramwich. Rob messenger read the passage in the memo again.
- [14:00]
Tony Hoffman
The day after the patient's death, when I thought he had safely been Transferred to Brisbane, Dr. Straughan came to talk to me in the office and found me very distressed. He offered to talk to some of the other doctors and get back to me as a representative of the AMA in Bundaberg. He did this. He stated, there is widespread concern, but at the moment no one is willing to stick their neck out. He urged me to keep stats on my concerns.
- [14:30]
Headley Thomas
Messenger dialled Straun's number. It was a confidential query, messenger explained to the doctor before candidly revealing how he had received statements and information about Patel and the serious concerns over his competence. He asked Straughan, a dry humoured Seventh Day Adventist who disliked unhealthy habits like smoking and drinking, about the chain smoking, wine loving, incompetent surgeon. Did other doctors at the hospital or the visiting medical officers who had contact with Patel and his patients share the concerns about the director of surgery? Rob messenger wanted to know. Martin Straughan replied, yes, I know about Dr. Patel. We think he's going to resign in June and we'd like this matter to go away quietly. However, if this man was to stay on for another 12 months, we'd have serious concerns. The response floored Rob messenger, knowing that the matters were under review by Queensland Health. Dr. Martin Straughan, a former secretary and president of the Bundaberg and District Local Medical association, urged the politician not to go public with the issue. If messenger outed Patel, Straughn added Every patient who had been operated on by the director of surgery would be anxious. Messenger found this attitude hard to comprehend and later he would be furious. Martin Straughn was effectively corroborating the story about Patel being dangerous. Messenger did not know what was worse, the confirmation or the reluctance of the doctors to act. He decided to smash their protective nexus. If nobody said anything and Patel left quietly, he would wreak more damage at the next hospital he went to. Rob messenger became excited and a little apprehensive as his opportunity to go public with the scandal loomed. He planned to rely on parliamentary privilege, the protection afforded elected politicians. It permitted him to speak without fear of legal retribution. It was a permanent immunity. He would get his chance soon. On 22 March, state parliament would convene for the seventh sitting day of 2005. Messenger began rehearsing his questions. The plan he had developed in the political party room would be a double act to reinforce the seriousness of the issue and lend support. The party's shadow Health minister, Stewart Copeland, would join in. In that way, it would be harder for the media or the minister to write it off as the baseless outpourings of an inexperienced politician suffering relevance deprivation syndrome. The day began unpromisingly for messenger as he took his seat on the opposition benches, waited for the moment of truth and mentally reworked his speech. He was jolted to attention. At 9:30am, the speaker of Parliament, Ray Hollis, went to his grand chair. The journalists in the gallery above milled around with notepads as media officers handed out press releases and briefing notes. But already one of the Beatty government's more experienced head kickers was on his feet, accusing Rob messenger of lying. Robert shorten, the Minister for Public Works, housing and Racing, put the boot in. The issue turned on claims of bungling over the installation of air conditioners in a Bundaberg public school. Messenger had raised it in Parliament a fortnight earlier and now Rob shorten was questioning his honesty.
- [18:35]
Gordon Nuttall
It is important that honourable members in.
- [18:37]
Headley Thomas
This Parliament reflect accurately the facts and.
- [18:40]
Gordon Nuttall
Not mislead the House.
- [18:43]
Headley Thomas
If it was a pre emptive attack, with the specific aim of undermining Messenger's credibility before he went public with Patel, it meant something had leaked. It would indicate a plot or a setup. The parliamentary session that morning featured the usual verbal fisticuffs between members of the opposition and those of the Beatty government. Emergency Services Minister Chris Cummins was wounded. Cummins, one of the lightweights in Cabinet, was exposed by National Party leader Lawrence Springborg for trying to dodge payment of parking fines. Liddy Clark, the former ABC play school presenter who had been sacked after a brief stint as Indigenous Affairs Minister was resented Springbok for describing her as less than truthful. She called him an absolute grub. Beattie sang the praises of the smart state of Queensland. And he trumpeted that Queensland's public hospital waiting times for elective surgery were the best in Australia. Health Minister Gordon Nuttall pledged improvements at the crisis torn John Tong Centre where thousands of forensic samples needed urgently by police and the courts were awaiting scrutiny by too few overworked scientists. It was a story I had been writing after a helpful leak from the embattled staff there. Rob Messinger tensed as Stuart Copeland stood and spoke. My question is to the Minister for Health. I refer to the fact finding process conducted by Dr. Fitzgerald, the chief Health Officer, into serious allegations made about the clinical and surgical competence of Dr. Patel, a surgeon operating at Bundaberg Base Hospital. The allegations involve approximately 14 patients who have suffered serious post operative complications, including death following surgery performed by Dr. Patel. As the findings of the process have not been released publicly to date and to ensure that first class patient care is provided at Bundaberg Base Hospital, will the Minister now release these findings? Will the Minister have the allegations independently investigated? Will Dr. Patel be stood aside while he is under investigation? Health Minister Nuttall, who had no idea what Stuart Copeland was talking about, tried a stalling tactic in relation to the.
- [21:17]
Gordon Nuttall
Issues raised by the Honourable Member. They are matters for the Medical Board. I am not aware of the issues raised by the Honourable Member. I am more than happy as the Minister responsible to investigate those matters. I will meet with the CEO of the Medical Board today and speak with him about those issues. I am more than happy to give the Member the details of what I find out from the CEO of the Medical Board.
- [21:42]
Headley Thomas
Mike Horan, a parliamentary ally to messenger, exploded. You should have known about this. There were deaths, a 100% strike rate. By noon, Rob messenger was ready for his speaking part on Patel. He wanted to make sure nobody misunderstood.
- [22:01]
Rob Messenger
The significance for the protection of patients at the Bundaberg Base Hospital Intensive Care Unit and the wellbeing of the medical staff. I make public and table a letter from the nurse Unit manager of the Bundaberg Base Hospital icu. This letter alleges serious concerns relating to the behaviour and the clinical competence of Dr. Patel, an overseas trained surgeon working at the Bundaberg Base Hospital icu. The letter, submitted to the management of the Bundaberg Base Hospital on or around 22 October 2004 lists the cases of approximately 14 former patients of the Bundaberg Base Hospital ICU who the writer believed required formal investigations. I am astounded that the Minister for Health, as witnessed by his reply this morning to a question without notice from the shadow Health Minister, was ignorant of the investigation.
- [22:59]
Headley Thomas
Messenger began reading aloud paragraphs of Hoffman's October 2004 letter to Peter Leck. He emphasised how Dr. Patel was feared by nursing and medical staff as very powerful and that anyone who tried to alert the authorities about their concerns would lose their jobs. Messenger issued a plea to Gordon Nuttall to release the findings of Chief Health Officer Jerry Fitzgerald's clinical audit report and start a thorough review of the entire hospital and its administration.
- [23:34]
Rob Messenger
I challenged the Minister to guarantee that all staff members who choose to give evidence be afforded full whistleblower status and that they be protected from any vindictive administrative action. Penning the results of this investigation, the Minister must immediately stand aside and suspend from work surgeon Dr. Patel and senior administrative staff Peter Leck and Dr. Darren Keating. The staff of the Bundaberg Base Hospital ICU are desperate.
- [24:03]
Headley Thomas
After Rob messenger sat down, the Liberal leader Bob Quinn lamented a government that does nothing to address emerging problems until those problems become full blown blown crises. Health, according to Bob Quinn, was one of those crises. Malcolm Cole, the Courier Mail's political correspondent, was on the telephone in the parliamentary press gallery. He half heard the attack launched by Rob messenger, whose credibility was yet to be proved to some of the journalists covering politics. We'll need to file on this, malcolm said to his colleague Rosemary Hodges. She too had heard the attack. Odgers doubted the veracity of the story. Still, the Courier Mail was the paper of record. She decided to write a few paragraphs. Behind the scenes, the political machinery began to move. By the time Rob messenger had finished his parliamentary spray, Gordon Nuttall was close to having a ministerial meltdown for being left out of the loop by his top departmental staff. He furiously ordered his staff to find the Chief Health Officer and demand answers fast. So much for the policy of no surprises. Gordon Nuttall seethed as he relived the embarrassment of being ambushed by Stuart Copeland and Rob Messenger.
- [25:27]
Gordon Nuttall
He demanded, what is going on at Bundaberg Hospital?
- [25:32]
Headley Thomas
Paul Dal Alba, the senior departmental liaison officer, telephoned Jerry Fitzgerald and explained the questions that had been asked in Parliament. At 10:53am Dal Alba emailed the Chief Health Officer. Mr. Copeland stated that you are investigating post operative complications and asked if the Minister would release the report and suspend Dr. Patel. Can you please provide some dot points by return email to allow the Director General to verbally brief the Minister this afternoon. We may then need to organise a Parliamentary question time brief for tomorrow so the Minister can respond to the question in Parliament. Dal Alba was ordered to summon Fitzgerald to a 6pm meeting with Gordon Nuttall at room A37 in Parliament House. Glenda Viner will meet you at the main entrance to Parliament House. Dal Alba asked David Potter, the media manager for Gordon Nuttall, to transmit the parliamentary Hansard transcript and the statements tabled by messenger to Queensland Health's two media managers, Lisa Shiltz and Phil Nickerson. Peter Lech was also to receive the material. Paranoid about the probable media interest, Dal Alba then briefed Schiltz, Nickerson and another public relations flac, Paul Michaels. Due to the nature of the statements made, it is likely that media attention will result. The Director General has advised that Queensland Health response should be along the following lines. District Manager has sought assistance in evaluating the appropriateness of surgical services at Bundaberg. This review is underway and Queensland Health will consider recommendations when complete. In his naturally disarming manner, Chief Health Officer Jerry Fitzgerald explained to Steve Buckland, the Director General of Queensland Health, the background to the Bundaberg audit and its preliminary indications of Patel's competence. The Chief Health Officer told Buckland, he's.
- [27:33]
Jerry Fitzgerald
Not as good as some, but he's not as bad as others.
- [27:37]
Headley Thomas
Fitzgerald, who was waiting on comparative figures for wound breakdowns, complications and organ injuries, confirmed that Jayant Patel had a high infection rate and attempted too many complex procedures. He hoped to finalise his report in the next 48 hours. Already, however, Jerry Fitzgerald should have been alarmed by some of the findings. One stood out. Too many patients had suffered bile duct injuries after routine surgery by Patel. The procedure, laparoscopic cholecystectomy, involves the removal of the gallbladder via tubes inserted through small incisions in the abdominal wall wall. It is a common and uncomplicated operation for people in pain from gallstones. Before Patel arrived at the hospital, the rate of bile duct injury was zero. Over the ensuing 18 months, Patel's patients appeared to have suffered bile duct injuries at an alarming rate, 28 times the national average. For someone supposedly as experienced and senior as the Director of Surgery, it was horrendous. At his desk, Jerry Fitzgerald produced a document for the Minister, Gordon Nuttall, to rely on if he were asked more questions by Rob Messenger. The first part of the document was confidential and not for public release.
- [29:09]
Jerry Fitzgerald
It told Nuttall, procedures have been performed at Bundaberg which are beyond the capacity and facilities of the Bundaberg Hospital. The significant issue regarding the competency of Dr. Patel appears to relate to his preparedness to take on cases which are beyond the capacity of the Bundaberg Hospital and possibly beyond his personal capacity. There is no evidence that his general surgical skills are inappropriate or incompetent.
- [29:39]
Headley Thomas
The Chief Health Officer prepared the second part of the document for public release under the heading Suggested Response. He helpfully provided a page of points setting them out so they would sound like Nuttall's handiwork should he read the page in Parliament. To fend off messenger, it stated, I.
- [30:01]
Gordon Nuttall
Have now been informed of concerns raised by staff at the Bundaberg Hospital in regard to some general surgical services provided at the hospital. The Chief Health Officer, Dr. Jerry Fitzgerald, has undertaken a review of clinical outcomes at the hospital and is currently finalising his report. Dr. Fitzgerald has identified a number of issues of concern at the hospital and will be making recommendations in regard to those concerns. There is insufficient evidence at this time to take any particular action against any individual and to suspend anyone would be unjust and inappropriate. The Bundaberg Hospital has taken certain action to limit the scope of some general surgery performed at the hospital which should address the majority of issues raised by staff. The report will also make recommendations regarding the management of staff conflict at the hospital. However, the report has also identified that there is a relatively high satisfaction amongst patients and that waiting times for elective surgery have been reduced considerably in recent times. Junior staff have been very complimentary in regard to the teaching and guidance provided to them. However, Dr. Fitzgerald has raised concerns about the clinical judgment exercised by one member of staff and will be referring these concerns to the Medical Board for consideration.
- [31:26]
Headley Thomas
Later in the day. After his documents had been emailed to Dal Alba, the Chief Health Officer briefed Gordon Nuttall personally. Back in the office I watched the 6pm TV news which featured the silliness of Chris Cummins in his efforts to evade parking fines. My colleagues Des Houghton and Jamie Walker, watching with me in the office, made jokes at Cummins expense. Rob Messenger's revelations went unnoticed. Paul Dal Alba knew the Bundaberg News Mail would run the Patel story. Peter Lech told him the Newsmails reporter had a copy of the document Hoffman had compiled in October 2004 when she detailed the Patel concerns and the bad outcomes for patients. Chapter 31 Natural Justice 23 March 2005 Bundaberg's news mail had a splash headline on its front page Truck Off Bridge. The news report described how a 56 year old man who survived a five metre fall in his truck and then two hours trapped in the cabin was very, very lucky. Rob messenger had tipped off the News Mail's Dan Nancarrow about the Jayant Patel allegations. The young reporter's two articles were relegated to page five under the heading Taking an in depth look at issues of interest to people in our area. Peter Leck had told Nancarrow, it is.
- [33:12]
Peter Leck
Important Dr. Patel receives natural justice and is given the opportunity to respond to.
- [33:16]
Headley Thomas
Any allegations that have been made in the Courier Mail. The story barely rated a mention, just a brief summary under the heading Fast news. Blink and you would have missed it. I saw the item while scanning the newspaper at home. When I went to work and logged onto the Parliamentary website, I felt distinctly uneasy. I pointed the item out to the CourierMAL's news editor, Graham Lloyd. I told him that I believed we had seriously underplaced the story. I said, look at the allegations. An incompetent surgeon whose patients are dying. It all came out in Parliament. I told Graham Lloyd of my earlier contact with a concerned nurse. I explained how I had wanted to launch a proper investigation when a yellow A4 envelope containing several statements arrived a few weeks earlier. But I had been unable to see my way clear of other stories. Lloyd knew what to do. He said he would ask Ryan Heffernan, a tenacious newsroom colleague, to follow the story. In the meantime, when Gordon Nuttall spoke in State Parliament at 10.20am, he went on the front foot, describing Rob messenger as totally irresponsible for airing the Patel matters. While Jerry Fitzgerald's clinical audit was incomplete, Rob messenger, according to Health Minister Nuttall, had circumvented all natural justice processes to vilify a health professional.
- [34:55]
Gordon Nuttall
I can tell the House that some of the allegations made by the member for Burnett are not only inaccurate, but could also be considered deliberately misleading. Should any issues be raised regarding the professional performance of an individual clinician as a result of the clinical audit into surgical services, these will be referred to the Medical Board to be investigated. I am advised that at the conclusion of the audit of surgical services, the Director General will refer any outstanding issues which are appropriate to the powers and function of the Medical Board. To that board.
- [35:32]
Headley Thomas
The incomplete response from Nuttall omitted Fitzgerald's own advice that he had formed concerns over Patel's clinical judgment. Despite everything the nurses had told Jerry Fitzgerald, despite the figures showing the remarkable complication rates, despite the failure of the Bundaberg Hospital administration to ensure that Patel had been credentialed the director of surgery was still safe. He was still operating, still being given the benefit of the doubt. When Tony Hoffman saw Dr. Martin Straughan in the intensive care unit, he told her, you'll be lucky to keep your job after this. As the hospital seethed with rumours, Martin Straughan also visited Peter Leck. Divulging the telephone call he had received from Rob Messenger, Strawn told Leck that no doctor would have stooped so low in leaking details about a fellow medical practitioner to a parliamentarian. The clear implication was that the culprit must be a nurse. Straughn, who already suspected Hoffman, also tipped off Leck about something. Rob messenger had indicated that the information was leaked to him by a nurse. Dr. Patel, who had been briefed by Leck about the outcry in distant Brisbane, passed Hoffman in the corridor and stared straight ahead. He was full of swagger and confidence as he walked to the operating theatre to wield the scalpel again. One of his patients that day would suffer an avoidable complication. Gail Alma considered Patel's rhinoceros thick hide. She would have had a grudging respect for the man, so stoic in the face of adversity, had she not already decided he was a psychopathic narcissist. With Linda Mulligan away on holidays, the acting Director of nursing, Diane Walls, was in the hot seat. She called a meeting of the staff of the intensive care unit. Tony Hoffman had devoured the brief reports in the News Mail and fretted over the lack of attention by the Courier Mail. When she heard of the upcoming meeting, she felt her worries and fears easing. Hoffman had a message for the other.
- [37:58]
Tony Hoffman
Nurses were going to be supported now. Everything will be fine.
- [38:04]
Headley Thomas
She called in those nurses who were on days off. Hoffman wanted all who had joined her in raising concerns to come in to receive the support from management. After Hoffman and nurses Karen Jenner, Jan Marks, Karen Fox and Vivian Tapiolis went to the tea room in icu, Diane Walls arrived with Peter Leck. The district manager was visibly furious as he waved around documentation and spoke of the severe consequences of leaks. The nurses believed that the papers he held were sections of the Health Services act and the Code of Conduct setting out the penalty of two years imprisonment for staff who leaked information. The official jargon states, in the course.
- [38:54]
Tony Hoffman
Of their work, health Service staff come in contact with information that must be kept confidential at all times. All employees are reminded that irresponsible discussion of any matters regarding the Health Services facilities staff and most importantly, the patients is regarded as an offence.
- [39:18]
Peter Leck
I'm appalled.
- [39:20]
Headley Thomas
Lech repeatedly condemned the handover of statements to Rob messenger, saying very high sources had confirmed that it came from an ICU staffer.
- [39:32]
Peter Leck
I have good information as to who this person is.
- [39:35]
Headley Thomas
Peter Leck added that the leaker had brought shame to the hospital. Tony Hoffman was paralysed with shock and felt fear. She had only told one person, Karen Fox, about her meeting with Rob Messenger. Lex claim to know the source was almost as worrying as his failure to address the issues of patients dying unnecessarily. How did politicians operate? Hoffman wondered. Was it all a big game? Did they just rat on their sources? When Leck claimed that the airing of the Patel issues had caused a rift between the medical and nursing staff, Karen Jenner was astonished. In her two years as a nurse at the hospital, she had not met Leck until now. She could not recall him visiting the ICU. Shortly before the 1:30pm meeting, she had been told by Jan Marks that the Patel story was on the radio. Hoffman had warned several nurses that the media might try to contact those nurses whose names were on the document tabled in Parliament. Karen Jenner, who hurriedly read the news mail before going to the tea room, figured that Leck had come to give advice on dealing with any journalists who might call for comment. She expected his backing, not a barrage of vitriol. There was no chance to ask him question questions or put another side of the story. Immediately after the outburst, he got up and left. Karen Jenner said at the time.
- [41:15]
Rob Messenger
How dare he speak to us like that?
- [41:18]
Headley Thomas
Diane Walls, who had no prior knowledge of the complaints and the depth of feeling in the intensive care unit over Patel, told the nurses that management had spoken. Let it go now, she said. At 2.30pm, Peter Lek fronted another meeting in the conference room outside the executive offices. He berated the more senior nurses. This time, Robyn Pollock, the nurse in charge of the renal unit, learned by email that attendance was mandatory. She was a few minutes late when she arrived. Lec was admonishing her colleagues. Pollock wanted to say that if management had handled this matter appropriately and dealt with the complaints about Patel back when they were made, we wouldn't be in this position now. But Peter Lek's anger was intimidating for her. He said the leaker was a nurse. One of the nurses asked, are you sure? How do you know that? Peter Lek replied, I have it from.
- [42:23]
Peter Leck
A reliable source, but it is not just one source. I have two or three people that can verify it was a nurse.
- [42:30]
Headley Thomas
Nurse Gail Alma Bridled at the accusatory tone in Lec's furious diatribe, she resented being blamed over the leak and she felt powerless to defend herself and her colleagues. She feared a nurse would be made a scapegoat for the leak when the bigger issue was the lethal incompetence of a surgeon. What sort of mixed up management shot the messenger and ignored the message? Are you going to track this person down? One of the nurses asked Lec. Leck said something about that not being his immediate priority. At the end of the tirade, he stormed out. The afternoon was filled with tension. To the nurses, Patel appeared unmoved. But the surgeon seized the opportunity to confront Lec and demanded his complete backing. Lech could see that Patel was incensed at the questioning of his competence. Unless you send a letter of support to the Bundaberg News Mill in relation to my work, I will resign. The Director of Surgery pledged to quit within 24 hours if he did not see signs of rock solid backing from management. Patel spoke about launching legal action against everyone involved in what he saw as a plot to oust him. When Lek could get a word in, he tried to placate Patel by apologising. Despite his grave concerns about the surgeon's incompetence, Lec was worried about the need to continue working through the waiting lists. Later, Leck gave an explanation to the senior departmental liaison officer, Paul Dal Alba.
- [44:16]
Peter Leck
He acknowledges the support provided so far by myself, the Minister and others, but want some further backing. I'm advised that Dr. Patel is the only general surgeon who will be in Bundaberg over the coming Easter weekend. His departure at this time would be critical to service delivery.
- [44:33]
Headley Thomas
Lech told his colleague that he found only one patient letter of complaint relating to Dr. Battelle from a family whose father was treated mainly by another surgeon. Peter Lech sent to Paul Dal Alba a draft of the letter that he would soon dispatch to the News Mail.
- [44:52]
Peter Leck
I refer to the article of March 23rd concerning allegations made against Dr. J Patel. The fact that a number of allegations have been made public without completion of a review process designed to ensure the application of natural justice is reprehensible. At this time I have received no advice indicating that the allegations have been substantiated. A range of systems are in place to monitor patient safety and the community can be assured that we are constantly working to improve our service delivery. Dr. Patel is an industrious surgeon who has spent many years working to improve the lives of ordinary people in both the United States and Australia. He deserves a Fair go. Peter Lech, District Manager, Bundaberg Health Service District.
- [45:35]
Headley Thomas
A little while later, Leck went to the evening meeting of the District Health Council, which was part of a Queensland health public relations exercise, to pretend it was interested in in the input of handpicked community members. Its chairman, Viv Chase, who was cranky and in poor health with diabetes, received a nominal $500 a year to attend meetings. Viv Chase no longer wielded much influence, certainly nothing like when he was the local mayor. But this evening he was prepared to take a stand. Rob messenger was at it again, running down the local hospital. Chase knew little about what was really going on in the hospital. Peter Lecht simply did not bother briefing him on the sensitive issues. In his ignorance of the situation, Viv Chase had become sick and tired of the constant carping by Messenger. As Joan Dooley, Leck's secretary, took the minutes of the meeting, Lec gave an overview of of the Patel issues. One of the members, Dr. Denise Powell, the president of the local medical association, briefed everyone on the media interest, including TV follow ups. Dr. Powell stressed that the local medical community was standing behind Patel. There was no mistaking the mood of the meeting. Whatever the significance of the allegations, the patients ran a poor second to the interests of Battelle. The meeting gave Pal the green light to speak to Rob Messenger. Perhaps a chat could reassure the maverick parliamentarian or quieten him down. And everyone on the District Health council was in favour of providing a letter of support to Patel. Chapter 32 damage control 24 March 2005 Beryl Crosby is the type of down to earth person described by TV reporters and producers as great talent. Although unknown in the media world, she had a story that might make or break a ratings night for the Nine Network. A Current Affair in its perennial war with Severns. Today tonight, her story and picture on the front page of the News Mail and on an inside page of the Courier Mail had excited Paul Ransley, Queensland chief of A Current Affair. The News Mail had reported it like this.
- [48:17]
Tony Hoffman
Beryl Crosby was organising her own funeral when she found out being diagnosed with cancer had been a medical mistake. Mrs. Crosby claims the doctor responsible was Jayant Patel, the man at the centre of malpractice allegations read out in State Parliament by member for Burnett, Rob Messenger. This week I thought it was a.
- [48:39]
Headley Thomas
One off case, Errol Crosby said.
- [48:42]
Tony Hoffman
I hope by not taking action back then I didn't add to anyone else's grief.
- [48:47]
Headley Thomas
Paul Ransley, a former investigative journalist with the Sunday program, hoped the morbidly Fascinating story would beat whatever Today Tonight might serve up. Its sharp new producer, Karen Cooper was closing the gap in the ratings. Paul held an early morning phone conference with his counterparts in Sydney. They liked the angle. It was one one of those back from the dead stories with universal appeal. Ransley asked his veteran foot in the door reporter David Margan and a crew to rush to Bundaberg and interview Crosby. Crosby seemed excited as she did her first TV walk.
- [49:30]
Tony Hoffman
Oh my God, it's like a friggin movie.
- [49:33]
Headley Thomas
The crew needed footage of her strolling, spelling the roses. It was part of the package. Beryl Crosby's transition from obscurity to public limelight had happened quickly. It started after her daughter saw the first day of local headlines about Patel. She called her mum and told her to buy the newspaper. Beryl sat transfixed as she read the brief stories. She wondered if her own brush with Patel was relevant. A sales representative who was between jobs. She plucked up the courage to call Rob Messenger's office at Bagara and she explained how Patel had treated her. She was told to expect a call from Messinger, who was still in Brisbane attending state parliament. When Beryl Crosby explained how Patel had misdiagnosed cancer, messenger cried. He still grieved for his mother. Just recalling her death at the hospital after a fight with cancer reduced him to tears. It was the moment Crosby decided that Rob messenger was a good man. She felt she could trust him.
- [50:48]
Rob Messenger
When I come back up, I would love to come and see you.
- [50:51]
Headley Thomas
You should get a damn good lawyer.
- [50:53]
Rob Messenger
And sue them for everything they've got.
- [50:57]
Headley Thomas
Messenger was a pragmatist. He knew that Crosby's story would help to validate some of the concerns about Patel. It might also ease the pressure he was under for naming Patel in Parliament. He asked Crosby if she would do some media. He wanted her to tell her story to the newspaper and TV reporters. He offered to make the arrangements. A short time later, the crew from the News Mail arrived on Crosby's doorstep. My colleague Ryan Heffernan from the Courier Mail had also telephoned Beryl Crosby. And that was just the start of the media interest. The print articles were like bait for the follow ups by A Current Affair. And Today, tonight, the pressure on Patel, on his bosses in Bundaberg and the bureaucracy in Brisbane mounted with each new headline. Patel had it out with Peter Leck, again accusing the district manager of failing to rally robust support. Patel walked off in a rage.
- [52:03]
Peter Leck
Dr. Patel has just resigned, effective immediately.
- [52:07]
Headley Thomas
Leck wrote to Dan Bergin, the Queensland Health Zonal manager, and to Paul Michaels, one of their media advisors, just after lunch.
- [52:17]
Peter Leck
He has indicated that he plans to take legal action against a variety of staff and as well as Queensland Health for failing to stop the leak of confidential information and for not providing definitive support in relation to the allegations. There are no general surgeons in Bundaberg, privately or publicly as from 8am this morning, except Dr. Patel.
- [52:39]
Headley Thomas
As the media scrambled to reach Bundaberg, Jerry Fitzgerald, having received the data he needed to verify Patel's off the scale rate of complications, gave his final report to the Director General of Queensland Health, Dr. Steve Buckland. They met to talk about it. The clinical audit dealt with carnage on a grand scale, yet it was written in such a way that the reader might not be immediately alarmed. Fitzgerald's report began like this.
- [53:12]
Jerry Fitzgerald
Bundaberg is a progressive, modern city with a population of 44,670, where residents are catered for with excellent shopping, medical services, education facilities and a diversity of recreational pursuits and experiences, including the coral isles, coast and country.
- [53:33]
Headley Thomas
On page seven, the report states, in.
- [53:36]
Jerry Fitzgerald
General, staff have enjoyed their work at Bundaberg Hospital and only recently have issues arisen which have caused concern. However, as well as raising concerns, some staff made complimentary comments about the Divisional Director's commitment to teaching and mentoring of junior medical staff. In addition, there has been a significant improvement in efficiency, especially in the operating theatre and in meeting elective surgery targets, with significant reductions in waiting times for surgery.
- [54:10]
Headley Thomas
Dr. Fitzgerald compiled the report with regard to what was known as a no blame protocol. Dr. Patel's name did not even appear in the report. He was referred to by title, with comments such as, the Director of Surgery.
- [54:26]
Jerry Fitzgerald
Has high standards and this has led to some degree of conflict with staff.
- [54:32]
Headley Thomas
Only by reading between the lines and analysing the figures on complications at the back of the report would it have been possible to ascertain the seriousness of the matter. But as the report remained under a strict veil of secrecy, none of the patients or staff of the hospital would know. Steve Buckland, however, received an additional piece of advice. Dr. Fitzgerald had attached a confidential memorandum to the report and the memorandum was alarming for Buckland's eyes only.
- [55:08]
Jerry Fitzgerald
It stated, in February this year, I was asked to undertake a clinical audit of general surgical services at Bundaberg Hospital. As you are aware, the events which triggered this audit have now been the subject of questions in Parliament. The report of the clinical audit is now complete and I have attached a copy to this memorandum. There are issues which I need to bring to your attention. There is evidence that the Director of Surgery at Bundaberg Hospital has a significantly higher surgical complication rate than the peer group rate. In addition, he appears to have undertaken types of surgery which in my view are beyond the capability of Bundaberg Hospital and possibly beyond his own skills and experience. Although his surgical competence has not been examined in detail, I believe his judgment both in undertaking these procedures and also delaying the transfer of patients to a higher level facility is below that which is expected by Queensland Health. I would recommend that these matters should be examined by the Medical Board and have written to the executive officer, Mr. Jim O. Dempsey, bringing the matter to his attention. The audit report also identified that there has been a failure of systems at the hospital which has led to a delay in the resolution of these matters. The Credentials and Clinical Privileges Committee has not appropriately considered or credentialed the doctor concerned. The executive management team at the hospital does not appear to have responded in a timely or effective manner to the concerns raised by staff, some of which were raised over 12 months ago. While the report makes a number of recommendations for system improvements, I would recommend that some discussion should occur with the hospital management reminding them of their responsibilities to put such systems in place and ensure they respond appropriately to reasonable clinical quality concerns. Dr. Jerry Fitzgerald, Chief Health Officer, 24th.
- [57:17]
Headley Thomas
Of March 2005, Fitzgerald wrote also to the Medical Board's head, Jim O. Dempsey.
- [57:25]
Jerry Fitzgerald
I wish to formally bring to your attention and seek assessment of the performance of Dr. Jayant Patel, who is the Director of Surgery at Bundaberg Hospital.
- [57:35]
Headley Thomas
Fitzgerald advised the Medical Board of evidence that the outcomes of complex operations performed by Patel were relatively poor, with at.
- [57:45]
Jerry Fitzgerald
Least two of the patients dying in the immediate post operative period. In addition, data produced during the audit demonstrated a significantly higher rate of complications than the peer group average. However, we have not been able to exclude the impact of differential severity on this complication rate.
- [58:08]
Headley Thomas
But Dr. Fitzgerald did not send his report to the Medical Board, nor did he send it to Peter Leck in Bundaberg. And despite the preliminary findings, neither Buckland nor Fitzgerald considered suspending Patel based on what he knew at that time. Steve Buckland, the man in overall charge of all the hospitals and staff in Queensland Health, would not have permitted Patel to come near him with a scalpel. But Buckland's priority was to keep Patel operating. When Buckland spoke to Leck in the late afternoon, Patel was still threatening to sue everyone, including his employer. Patel also knew that without him, there would be no surgeon on duty over the Easter break, when thousands of families would be on the roads. There were always smashes broken and twisted limbs, damaged organs. Hospital staff would be run off their feet and the nightly news could be counted on to grimly update the road toll each evening. It was the hospital's most critical time of need. By threatening to refuse to work unless certain conditions were met, Patel put Lec, who was not coping well under the pressure, into a state of dread. In his time of need, Patel was also being flattered by fellow doctors who rushed to defend him. Dr. Keys Nydem wrote a public declaration of support.
- [59:45]
Tony Hoffman
I would have no hesitation of having this highly qualified surgeon operate on any.
- [59:50]
Headley Thomas
Member of my family or myself. Nydham regarded the primary role of newspapers to be the publisher of comics and his letters. Furious with the nurses, Kees Neidem, who was in the chair as acting director of medical services when Patel was first employed at the hospital, said he was vacillating between sadness and disgust over the public shaming. As president of the local medical association, Dr. Denise Powell was urged to show her support for Patel, and she said the organisation felt he had made a positive contribution to the community. In Brisbane, the big guns lined up against Messenger. They had the politician in their sights. Dr. David Malloy, President of the Australian Medical Association's Queensland branch, said Patel had spent many years training and practicing in the United States. Dr. Malloy said there is every probability that there was no negligence involved in the surgeon's practice. And the issue before the Medical Board mostly relates to the scope of surgery being completed in a country centre. The opposition has acted irresponsibly by accusing a Bundaberg surgeon of professional incompetence in the interests of cheap political gain and.
- [61:13]
Rob Messenger
Perverting the course of justice.
- [61:16]
Headley Thomas
At 5:25pm, the relentless rob messenger launched another broadside in State Parliament against Gordon Nuttall, accusing the Minister of instructing his department to run Queensland Health with the pretend I am a mushroom approach.
- [61:34]
Rob Messenger
If we listen to the Minister, everything is rosy and fine with the Bundaberg Hospital. There are no shonky surgeons, no access block, no shortage of beds and no mental health crisis. And nurses and hospital employees are not being bullied or vilified by the administration. But the facts of the matter are quite different. I repeat my call that not Only should surgeon Dr. Patel be suspended, administrators Mr. Peter Lech and Dr. Darren Keating should also be suspended. They have lost the confidence of the staff and the patients of the Bundaberg Hospital. The Minister can trust me not to hide the reality of what is happening in our wards and operating theatres.
- [62:16]
Headley Thomas
In an angry aside not recorded by the reporters of Parliament's proceedings. Gordon Nuttall shouted at Messinger across the.
- [62:25]
Gordon Nuttall
Chamber, I hope you're satisfied that he's resigned. You are responsible for the lack of a surgeon in Bundaberg.
- [62:33]
Headley Thomas
Over the Easter break, Peter Leck dashed off an email to Steve Buckland to update him on Patel's latest demands. He had changed his mind about quitting and was weighing a new offer of a four month contract from 1 April 2005. His current contract would finish in six days on 31 March. In his email, Lex said, I offered.
- [62:59]
Peter Leck
Support by suggesting he take a few days leave to consider his position and the future. Dr. Patel indicated that he'd been doing that and was prepared to return to work tomorrow if he was offered a contract of $1,500 to $2,000 a day. He wants something close to $2,000 from the first of April through to July. He also wants the organisation to fully support him, but was no longer explicit in his demand that we back him in relation to all the procedures he has undertaken in Bundaberg.
- [63:29]
Headley Thomas
Buckland's day was worsening. The story on A Current Affair had given the Patel fiasco a national profile. It suggested the surgeon was about to quit. Messenger's latest attack had made Nuttall even angrier and the PR flaks were under pressure. The loss of a patient's life was of far less concern to the organisation than damaging headlines. According to Queensland Health's little known risk Matrix, a policy developed by a senior bureaucrat strictly for internal use. An adverse clinical incident is weighted as major if someone dies. But publicity that significantly damages the organisation's reputation, however, has a heavier weighting of extreme. Apart from Bundaberg Hospital, Steve Buckland had another problem. It was my story that day in the Courier Mail, disclosing how Queensland Health staff at the John Tong forensic laboratories were being threatened with imprisonment over the speak about serious testing problems and maladministration. Nuttall went on morning radio to attempt damage control and he expressed surprise at the suggestions that his organisation, Queensland Health, was secretive. Although no patient's details were disclosed, the DNA scientists had been warned by senior staff that an internal investigation would be followed by a police probe which could lead to criminal charges. They were told to get independent legal advice and prepare for questioning. The crackdown terrified Tony Hoffman. Queensland Health issued a bland statement saying it was usual practice to investigate any unauthorised release of confidential documents, as such actions are breaches of the code of conduct. Meanwhile, Buckland told LEC that the surgical service had to be supported over the Easter break. They needed to keep Patel operating, Buckland said. I think he should work over Easter and we would look at his contract from April 1st during next week. The offer of $2,000 per day is unacceptable and would never be supported. Patel, larger than life, was out for dinner at a popular restaurant overlooking the ocean at Bagara. With its stylish timber fittings and furniture and a vast menu, Casey's was a local favourite. Patel loudly talked up his surgical skills. His dinner companion, Dr. Aisha Curtis, a bright young intern on secondment from the Martyr Hospital in Brisbane, wanted the ground to swallow her up. Two months earlier, Patel's sexual advances almost caused her to quit her stint in Bundaberg. Curtis was sure she had not misinterpreted Patel's crude repertoire. The man had said he wanted to marry her and start a new life before the tolling of any wedding bells. He promised to write glowing reports about her surgical performance, but there was a catch. He wanted sexual favours in the meantime. When he had come on strongly in January, Curtis was worried about how to reject Patel without offending him and jeopardizing her career. She quietly sought advice and Support from Judy O', Connor, the medical education officer, and Dr. Keys Neidem. Curtis decided that she would politely decline Patel's suggestion, and she toughed it out. After Rob messenger had slammed Patel in Parliament, Curtis heard rumours that he was going to quit and return to the United States. She felt sorry for him and accepted his offer of dinner, but she soon regretted it. Patel was coming on stronger than ever. Over a couple of glasses of wine, he was offering further inducements. The next morning, Dr. Aisha Curtis decided to terminate her contract early. She did not want to wait to find out if Patel was staying or leaving. Sick to Death is written and presented by me, Headley Thomas, the Australian's national Chief Correspondent. Clare 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 Kristin Amyot, Production management by Stephanie Coombs Artwork by Sean Callanan. Thanks to Ryan Osland, Matthew Condon, Corinna Berger, Ellie Dudley, David Murray, Dominique McDermott, Zach Skulander and all our family, friends and colleagues who helped in this series and contributed voice, acting and special thanks to Tony Hoffman and Rob Messenger. Subscribers to the Australian hear new episodes of Sick to death first@sicktodeathpodcast.com and on Apple Podcasts. You can get exclusive access to photographs, videos, timelines and more at the website.