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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 39 Strange Meetings 3:50pm 7 April 2005 Tony Hoffman giggled nervously in the foyer of the old orange brick Queensland Newspapers building near the top of Campbell Street, Bowen Hills. She had come from a conference in, of all places, the Clinical Practice Improvement Centre at the nearby Royal Brisbane and Women's Hospital. I could see the massive complex from my desk. The fortunate timing of the conference in Brisbane meant that she had an opportunity to meet me while many of her colleagues in Bundaberg were feeling severely bruised by Gordon Nuttall and Dr. Steve Buckland.
- [01:24]
Tony Hoffman
Karen is here to give me backup.
- [01:26]
Headley Thomas
Hoffman explained, introducing her friend and colleague Karen Fox.
- [01:32]
Tony Hoffman
She doesn't trust journalists and she thinks I'm mad for meeting you.
- [01:36]
Headley Thomas
The blunt honesty moments after meeting at the front counter was a good start. As a precaution, Hoffman elected to sign the visitors book as Jane English. Her friend signed in as Sue James. They liked their assumed names. It was a relief to leave my desk. My previous meeting with an elderly man who had been battling his local council for a decade over the use of an asbestos linked product in road bays near his home was heavy going. His story had potential, but I doubted it would get a run unless there were people who could say I'm dying of mesothelioma now because my incompetent counsel put this lethal staff near my home despite the obvious risks. That's because stories warning of safety risks paled beside stories in which the result of unsafe practice was at once obvious. I walked Hoffman around to the staff cafe, pointing out departments on the way. She seemed keen to talk about anything, perhaps just to lower her anxiety levels. Her friend eyed me suspiciously and refused to utter a word. Can you tell me about the complaints involving the surgeon? I asked. Hoffman began talking in a rushing torrent of names, dates and medical terms. It was a struggle to keep up. And then she went faster. Her nervousness was driving her to try to spit out the entire two year debacle in a few frantic minutes. As Sky News blared on the overhead TV and her friend stared daggers at me. Something had to give. I started to wonder about her state of mind. Clearly she was deeply agitated. Clumsily, I tried to calm her down, but it sounded more like a rebuke. Tony, can we do this slowly, one fact at a time, please? I'm starting from a long way behind. She paused and began again.
- [03:41]
Tony Hoffman
There were so many botch ups with the patients. And it continued on and on until this one big incident. The straw that broke the camel's back. And it took five months after that complaint. The nurses from the renal unit complained, the infectious control nurses complained. In between all this, we would be having the patients with complications coming into the intensive care. And pretty much on a daily basis we would have a patient in ICU with some stuff up because of what he had done. Since this all came out in Parliament, the doctors have stood up and defended him. And they were the ones who two days before had been trying to get us to defend and protect their patients. All we were trying to do was to stop him from operating on patients and harming them. He would tell us he was a cardiac, thoracic and trauma specialist. When we looked him up on the web, he just had an MBBS from a university in Pakistan. He thought that he could do everything. Even the acting Director of Medicine, Dr. Kay Snydem, sent a letter saying he had full faith in him and would allow him to operate on his children. Peter Leck has got up and said he was appalled that it had been leaked and that it was not due process. But where was the due process for the patients? The district manager stood up for the hospital. Nydems stood up for the doctors, but the nurses were gagged. Nobody stood up for the nurses. Gerry Fitzgerald, when he interviewed me, did not even have a copy of the complaint. He'd not read it. His report is with the Director General now. A physician was hiding a patient in the intensive care so Patel could not get to him. And this was just recently. We literally were throwing ourselves across the patients to stop him from getting to them. After all that we were seeing, this guy got employee of the month. We were seeing this guy being rewarded while we lied to families and protected patients and felt sick about what was happening. We've been crying for months. Patel had 100% complication rate with catheters. Every one of his patients got infections. He used to lie in the patient's notes. One was on 100% oxygen and and being kept alive with medication. And Patel wrote that he was stable in his notes. The nephrologist refused to let him operate on his patients. The hospital knew that this was going on because they had set up an alternative way for their fistulas and vas catheters to be put in.
- [06:25]
Headley Thomas
Hoffman's account was shocking. We spoke about Patel's claim of earning the hospital an extra $500,000 a year.
- [06:34]
Tony Hoffman
To meet the budget and surgical targets. Hospitals have to do a certain amount of surgery. Hospitals make money from surgical procedures. Because he was churning through the surgery, he was making them money.
- [06:48]
Headley Thomas
Where is he now? I asked.
- [06:51]
Tony Hoffman
We've been told that Patel has left for good. Martin Carter, the director of Intensive Care and Anesthesia, he called him all the names under the sun. He called him Dr. Death. But when the chips were down, they supported him. The doctors called for the whistleblower to be identified and made an example of. I was told that they perceived the nurses have all the power and that they could be next. Some of the patients really liked him because he talked a lot. He was incompetent and he had a God complex. He was not malicious. He just did not realise how incompetent he was. The system has failed us. It does not allow us to be taken seriously.
- [07:36]
Headley Thomas
At that moment, Hoffman's mobile phone began to ring. She apologised and reached into her handbag. As she listened, her face lost colour and she balled her free hand into a fist. The caller was Gail Aylmer at the hospital.
- [07:53]
Tony Hoffman
I can't believe it, they said.
- [07:54]
Headley Thomas
What?
- [07:55]
Tony Hoffman
No.
- [07:57]
Headley Thomas
Hoffman ended the phone conversation. The composure she had worked hard to maintain in our interview was gone. She dabbed her eyes.
- [08:06]
Tony Hoffman
The Director General and Gordon Nuttall were just there and they said that seeing as it was leaked, they're not going to release the report. They had nothing to say to vindicate the nurses.
- [08:19]
Headley Thomas
The chance call to Hoffman's mobile clinched it for me. The visit by Nuttall and Buckland to the hospital was unusual and to the best of my knowledge, had not been foreshadowed in media releases. If the essence of the stern talk by Nuttall and Buckland had been conveyed accurately to Hoffman, it was, I suspected, a crude attempt to contain the Patel problem while waving a big stick at any staff who might have been involved in the allegations being aired. It felt like the start of a cover up. I told Hoffman the issue of Patel's competence might take ages to investigate. But the meeting today gives me an opportunity to put the story back on the agenda. I'll call Gordon Nuttall's office and find out why they are trying to shut this down. We walked back to the foyer and resolved to stay in touch. Hoffman and Fox were booked on the last Qantas flight back to Bundaberg. Dan Bergin, one of the managers for Queensland Health, remained angry about the leaking. He emailed Peter lech shortly after 5pm as Steve Buckland stewed over the Patel negligence revelations.
- [09:35]
Rob Messenger
Peter is there a process going on.
- [09:37]
Headley Thomas
Involving internal audit to investigate this? Lech, still in the dark on Patel's United States secret, was uncertain how to manage the problem.
- [09:47]
Peter Leck
I must admit that I'm not entirely sure where to go from here. In the meeting with the staff today, the DG advised that we would not have a witch hunt and that we needed to move on from this incident. Bottom line is that regardless of whether an investigation is held or not, I don't believe the culprit who leaked this information will be found. While on one hand I would like to send a strong message to the person or persons concerned that they are on very dangerous ground, I am concerned that such an investigation could prove very destructive, resulting in nurses and doctors going after one another. Perhaps we have the audit team come up and deliver some training sessions around the code of conduct and deliver some firm and scary messages. I would welcome your advice, especially if the Director General's office is expecting action in a particular way. Peter.
- [10:39]
Headley Thomas
Chapter 40 fluke 6pm 7th April 2005 News coming out of left field late in the day is always more difficult to place in any newspaper, as the story has not been the subject of a briefing in editorial conferences, it has to knock something else out to get in. Unless it is momentous and urgent, perhaps an aircraft crash or a political upheaval, its prospects of a good run are poor. Such stories are often held for the next day, and that can kill them slowly. Stories held over can appear stale despite not having been run. Something else invariably comes along to compete for the print space in the newspaper. Sometimes on a slow news day or when the best laid plans go awry because the promised stories have failed to materialize. The late and unexpected ones are hailed as saviours, but most of the time they are a nuisance. The night editor has to change course and rebuild pages in the face of an unforgiving deadline. I was keen to publish the story about Gordon Nuttall and Steve Buckland going to Bundaberg and telling staff nothing would be done about Jayant Patel. It was breaking news. It had been presented to me on a platter. A few minutes after showing Tony Hoffman and Karen Fox out of the building, I saw Graham Lloyd, the news editor. Perfect. After I explained the story, Lloyd suggested postponing it, mate, it's pretty tight.
- [12:18]
David Potter
The paper's full. Do it as part of your bigger.
- [12:21]
Headley Thomas
Yarn for Saturday and it'll get a much better run. After working closely with Lloydy for six years, I had enormous respect for his judgment and advice. We had jointly delivered some powerful scoops from the newspaper's features section when he was in charge of it. Although disappointed that Nuttall and Buckland would be off the hook for the moment, I figured it might make my scheduled lunch with the minister the next day less uncomfortable. One of Gordon Nuttall's closest friends, Brendan McEnery, had called me earlier in the week to confirm the low key meeting at the Hellenic Club in South Brisbane when he first set it up. McEnery, whom I knew through a mutual contact, explained that Nuttall wanted to develop a working relationship with a few senior journalists. Nuttall had big plans for Queensland Health. The private lunch at the Hellenic Club would give him an opportunity away from his minders and advisers to set out its future. I went back to my desk for my car keys as David Fagan, the editor, wandered over. He was unhappy.
- [13:30]
Gordon Nuttall
What a shocking day. We haven't got one story worthy of putting on the front page. You haven't got anything in your back pocket, have you?
- [13:37]
Headley Thomas
He asked me. In the past six years at the Courier Mail, neither Fagin nor his predecessor, Chris Mitchell, had come to me to ask for a story. Late in the day they were too busy. For a start, they relied on their staff to talk about the big fish in a news editorial conference after the reporters had reeled them in, for David Fagin to come into our section, sometimes known as Writer's Block or Poet's Corner. He must have been desperate. He was looking for a splash, the major story for the front page. I've got a great yarn, I told him, relating the suspected cover up in Bundaberg and the meeting I had just had in the cafe. All I need is confirmation from Gordon Nuttall's office. I've got heaps of background. The doctor has left Queensland. Do you want me to write it as the Splash? Fagan was non committal.
- [14:34]
Gordon Nuttall
Possibly. Write it as soon as you can and we'll take a close look at it.
- [14:38]
Headley Thomas
I called David Potter's mobile phone, but it was turned off. The media advisor was still in the air, en route from Bundaberg to Brisbane. He would hear my message on landing. The next call was to Cameron Milner, Potter's public relations sidekick, in Nuttall's office. He's on the plane, milner said of Nuttall.
- [14:59]
David Potter
He went to open the Springshaw Community Centre and on the way back he dropped into the Bundaberg Hospital. He spoke with staff before doing a tour.
- [15:07]
Headley Thomas
The conversation became farcical when I asked about Gerry Fitzgerald's clinical audit and report into Patel's surgery at the hospital.
- [15:16]
David Potter
It's not a report into Dr. Patel, he said. It's a clinical audit to look at the range of services and surgery done at the hospital to determine whether appropriate surgery is being done there. The complaints about Patel were about particular types of surgery he was carrying out.
- [15:34]
Headley Thomas
Having heard at length from Hoffman about the surgeon's incompetence, the deaths attributed to him, the work of Fitzgerald and the surprise visit that afternoon by Nuttall and Buckland, I responded aggressively to the spin from Milner. It was nonsense to suggest that Patel's competence was not under scrutiny. Why did these people always twist the truth? For a few minutes we went back and forth arguing about the clinical review. Milner stuck stubbornly to the script. When I questioned him about what had triggered the review, given that it was not a routine matter, he dropped his guard.
- [16:15]
David Potter
It was prompted by the complaints arising from surgery being conducted by Dr. Patel.
- [16:21]
Headley Thomas
Finally, we were getting somewhere. I asked Milner to tell Nuttall and Potter to contact me urgently. My next call was to the mobile telephone of Dr. John Scott, the Deputy Director General of Queensland Health. As I did not have a contact number for Jerry Fitzgerald and it would be at least 30 minutes before I heard from either Potter or Nuttall, perhaps John Scott could shed some light on what was unfolding. I wanted to see or hear about the report, which Hoffman had told me Fitzgerald had already completed. How did the report's completion square with what Buckland and Nuttall had apparently told the meeting in Bundaberg earlier? That the denial of natural justice and Patel's departure meant it would not be finalised. Dr. Scott knew little about the report by Fitzgerald.
- [17:17]
David Potter
He said, here we are looking at an individual and there's a range of things, including natural justice, that you have to consider when thinking about release. This is the chief Health officer doing a review of a particular person's conduct.
- [17:33]
Headley Thomas
Exasperated at being told nothing, I began hitting the keyboard to write the story Fagin wanted. I could write the bones of it and add flesh. Upon hearing from Nuttall's side, I called a medical source and explained the issues. He became angry at his employer's cover up culture. Potter returned my call at 6:30pm I told him I was preparing a story about the meeting. A few hours earlier at the hospital and I asked him to have Nuttall call me. Potter rang back and said Nuttall would not be available. I didn't know if Potter had been told about the lunch planned with Nuttall for the next day. Maybe there had been a deliberate decision by his boss not to brief him, but I decided against using the engagement as leverage. It incensed me that the Minister would not speak for himself about the meeting in Bundaberg. Why doesn't he have the ticker to talk about the meeting? I asked. Potter, the likeable and efficient media adviser, a former Courier Mail colleague with whom I had worked on a number of stories, ignored the barbs. For the record, he told me Nuttall had not seen the report, the department had not seen the report and the.
- [18:53]
David Potter
Minister does not now expect to get.
- [18:55]
Headley Thomas
A report, Potter told me, because it.
- [18:57]
David Potter
Can'T be completed without going back to Dr. Patel. Obviously we can't go back to him because he's packed up and gone. Due process was not followed. We have said we are very disappointed about that.
- [19:10]
Headley Thomas
After goading Potter again about Nuttall's timidity, he agreed to double check. He called back to advise me that Nuttall would definitely not be calling me. When I wrote the story, I led it with the news of the visit, how Nuttall and Buckland had admonished staff and told them there would be no report. Kim Sweetman, the Chief of Staff, looked at the filed copy shortly after 7pm and she asked me about a single line in the story. It stated that the nurses were asked to hide patients from Patel. So the nurses were literally trying to hide patients from him in the wards. Sweden asked. She seized on the angle and elevated it to the top of the draft. The mental imagery was too powerful. David Fagan liked the story, but in his walkabout in the newsroom he had found another relating to the Beatty government's failure to address the dangers of asbestos in hundreds of public schools. My report led page three beneath the headline Nurses hid patients in in wards from Dr. Death. But it contained an embarrassing error in the first paragraph. I had failed to properly check on Patel's background. He was from India, not Pakistan. This is what my story stated.
- [20:37]
Narrator/Reporter
Nurses at Bundaberg Base Hospital were asked to hide patients so they would not be treated by a Pakistan trained doctor. Dubbed Dr. Death by colleagues. The doctor, who has fled the country since the beginning of an investigation into his work at the public hospital, has been accused of gross incompetence linked to the deaths of at least 14 patients. But health Minister Gordon Nuttall will keep secret a report detailing evidence about the deaths and a trail of serious injuries suffered by patients at Bundaberg Base Hospital. The report by Chief Health Officer Gerry Fitzgerald includes evidence gained from interviews with doctors and nurses at the hospital. Queensland Health sources describe the doctor hired more than two years ago under the controversial Overseas Trained Doctors scheme as dangerous and incompetent. They say his actions have been extremely harmful and in some cases lethal to more than 14 patients and were an indictment of the health system for its failure to respond to complaints two years ago. Patients who have been harmed and the relatives of those who have died are demanding an explanation from Queensland Health about the doctor's proficiency and conduct. The Courier Mail has been told of how at least one specialist at the hospital was so concerned he pleaded with nurses to hide his patients in various wards to prevent them from being seen by the doctor. But Mr. Nuttall and Director General Dr. Steve Buckland yesterday went to Bundaberg Base Hospital to tell a confidential staff meeting that the evidence gathered by Queensland Health in relation to the doctor's conduct would not be made available. They admonished staff for leaking some of the evidence, which embarrassed Mr. Nuttall because it was revealed in State Parliament last month before he was aware that an investigation by his own chief health officer was underway. The doctor, whose Queensland Medical Board registration lapsed last week, quit his job and left Australia at Easter days after the concerns were made public.
- [22:46]
Headley Thomas
Accompanied by a file photograph of Gordon Nuttall. The story continued with a quote from my medical source about how it was an outrageous cop out that the doctor's departure had been used by Queensland Health to end its investigation and pull down the shutters. It included the accusations made in State Parliament and a reference to the Queensland Health report that I had been leaked in late 2003, warning that a growing number of overseas trained doctors rushed into the public hospitals lacked medical competence and capability and put patients at risk. The adrenaline was still flowing when I left the office. On the way home, I dropped into a bar for a beer with my colleague Des Houghton, who had been writing about the Beatty government's secret state culture. Des was fascinated by the Bundaberg Hospital story. He reckoned there had to be much more to it. Steve Buckland left the taxpayer owned aircraft and headed home, as Darren Keating had done the night before in Bundaberg. Buckland went to his home computer to search for details about Jayant Patel's United States registration. It took him some time after he located the relevant sites in Oregon and New York state and then navigated the options until the truth about Patel's incompetence appeared. He made printouts. Buckland called Jerry Fitzgerald at home and told him of the stunning findings. They agreed that Fitzgerald should tell the medical board as a matter of urgency. Buckler knew he had to deliver the political dynamite to Gordon Nuttall, too. He decided to wait a day. More time would help him develop a strategy which might, if they were fortunate, limit the damage. If Patel's secret past leaked before everyone was back in a position of control, the damage could be incalculable. Chapter 41 put it in writing 8 April 2005 Brisbane's Gung Ho Morning radio journalist Steve Austin for 612 ABC introduced the story with gusto. The line about nurses hiding the patients had grabbed his attention. His producer tracked Rob messenger down in Sydney and quickly put him on the air. Austin, relating the Courier Mail's Page three lead story, asked messenger if he felt vindicated now. The novice Bundaberg mp, whose bosses in Brisbane had instructed their media advisor, Darren Davies, to begin priming other media outlets to have another crack at the story, said he had never doubted the concerns about Jayant Patel. I'm supposed to be having lunch with Nuttall today, I told Ruth as the radio program played out at home. It'll be an interesting conversation after the yarn today. I bet he doesn't front up. My mobile phone would not stop ringing. Darren Davies reckoned that Dr. David Malloy, the president of the Australian Medical Association's Queensland branch, should be asked if he still stood by Patel. I wanted to talk to Malloy about whether he would support the release of the report by Dr. Jerry Fitzgerald, the chief health officer, or the establishment of a more exacting audit. Dr. Malloy began to put some distance between himself and Patel.
- [26:30]
Rob Messenger
He told me, I have not defended the doctor. Dr. Patel is not a member of the AMA and I did not feel compelled to defend him. We have been constantly arguing for better transparency in the health system, and part of the tension between Queensland Health and the medical organisations and the doctors they employ is over truth. It is in the public interest that the truth is told here. If there is a bad doctor in the system, we have to wear that. We strongly support the findings being made public. Covering up this stuff is not in the public interest. The fact that the doctor has left town already is not a reason to not have these issues addressed. This is a serious inquiry. It is a serious issue and in the public interest that the findings be made public. Twenty kilometres from Brisbane, the public health system runs on overseas trained doctors.
- [27:20]
Headley Thomas
Given the dreadful publicity that usually accompanies ham fisted cover up attempts, I was puzzled by Gordon Nuttall's strategy in the staff dining room at Bundaberg Hospital the day before. Surely he did not think all the staff would suddenly go quiet. What was his motive? I asked David Malloy.
- [27:41]
Rob Messenger
He doesn't want to undermine public confidence in the system that supplies hundreds of doctors to try to bury. This is just so wrong. I'm concerned about the public interest aspects of this for the people of Bundaberg, for overseas trained doctors and the health system.
- [27:56]
Headley Thomas
Dennis Atkins was blessed with finely tuned political antennae, in part the result of his years working for a former labor government in Queensland before returning to journalism at the Courier Mail. Atkins reckoned the story was a cracker. He urged me to pursue it. Darren Davies called again from the opposition's office. The police are looking now at criminal negligence. He wanted me to interview messenger when I reached him in Sydney. He told me how Tess and Mark Bramwich had been to the police to ask for a criminal investigation over the treatment received by Destination. She supplied death certificates and all the information she has. I heard firsthand the devastation in their lives. I am still feeling angry. I have told my staff to write to the Medical board and am asking them to investigate this matter and I referred them to the previous correspondence. I have also written to the Health Rights Commission. We would like to see the report and if there is nothing to hide and nothing has gone wrong, they shouldn't need to keep it secret. Messenger said Tess and Mark Bramwich were among some 50 locals wanting action. There'll be a public meeting at the Brothers Club on Thursday. My next contact was with Mark Bramwich to confirm his visit to the police.
- [29:21]
Rob Messenger
We just want all the help we can get.
- [29:23]
Headley Thomas
Dad didn't die because of the accident. He died because of what happened in the hospital.
- [29:28]
Rob Messenger
We can't bring dad back, but other.
- [29:30]
Headley Thomas
People in Bundaberg might benefit. Tess told me Dr. Patel needs to.
- [29:35]
Tony Hoffman
Answer a lot of questions that we have.
- [29:39]
Headley Thomas
The next call I made was to one of my original contacts from late 2003, Dr. Chris Blenkin, who had told me about the debacle over the Fiji trained doctors being falsely passed off as orthopaedic surgeons at Harvey Bay Hospital. He had seen the paper that morning.
- [29:58]
Dr. Chris Blenkin
It's terrible. They're trying to bury it. The only justification is that the findings are so bad it could cause an extraordinary loss of confidence in the public system. If it's seen to be a cover up that will lead to a loss of confidence.
- [30:12]
Headley Thomas
Blinken understood the dynamics immediately.
- [30:17]
Dr. Chris Blenkin
They should have some form of public inquiry into how he came to be there in the first place and whether mistakes were made in the appointment process. They need to appoint investigators through the College of Surgeons to perform a full audit into his surgery, as has been done for the overseas trained doctors at Harvey Bay Hospital. The patient files, notes and statements will all be there. There is such a smell about this that it is terribly important to maintain public confidence. An open inquiry should be performed before leaving the office.
- [30:47]
Headley Thomas
To meet Gordon nuttall, I wanted Dr. Peter Woodruff on the record. A vice president of the Royal Australasian College of Surgeons, Dr. Woodruff worked for Queensland Health as a vascular surgeon at the Princess Alexandra Hospital. I quickly briefed him on the issue and the circumstances, what should happen.
- [31:09]
David Potter
Dr. Woodruff replied, there's no question that it has to be fully investigated and the public made aware of the findings. There is no justification for not releasing it if there are complaints about surgical standards. As the body vested with responsibility and a track record for striving to maintain standards, the college would happily investigate any perceived deficiencies and surgical outcomes. We should be a party to anything that smacks of substandard surgery in this country so we can address it and correct it.
- [31:42]
Headley Thomas
If Queensland Health came under enough public pressure over the report that it was refusing to disclose, I believed that its leaders would crumble and relent. By the time Brendan McEnery had called to say he was coming to pick me up from the Courier Mail for the lunch meeting with Gordon Nuttall, I had more than enough in my notepad to form the basis for a strong follow up story in the Saturday paper. Michael Demiguero reckoned he had seen it all. A career public servant, he began as a junior clerk in the Mines Department. For the past 17 years, he had been Deputy Registrar of the Medical Board. Even if he were ambitious, the prospects of career advancement were limited. He knew the job backwards. He developed and perused much of the paperwork, briefed perfunctory committee meetings and gave many of the doctors streaming into Queensland from overseas a legal rubber stamp to permit them to practice. But on Friday, the Medical Board's Executive officer, Jim O. Dempsey, who had been tipped off by Jerry Fitzgerald, asked Demi Garou to drop everything. He was instructed to investigate Jayan Patel's registration, hear history in the United States. In particular, Jim O. Dempsey wanted to know anything about past disciplinary issues. Michael Demi Garou performed his own Internet search and retrieved the data from the Oregon Board of Medical Examiner's website. It stunned him. It was inexcusable. When he went to Patel's complete file, he realized the truth. Travesty. Immediately, he and his staff had overlooked a crucial notation. It states standing public order on file. Demi Garou turned the file over. There was nothing attached. It had been omitted. The clue to the existence of disciplinary action and the documents setting out what Patel had been disciplined for had been overlooked by by the medical board staff. Had they followed up the clue or investigated Patel's background with a few clicks on the Internet, the surgeon's incompetence in the US would have been plain. They would have seen another notation.
- [34:12]
Narrator/Reporter
It says an amended stipulated order was entered on 12th September 2000. The order restricted licensee from performing surgeries involving the pancreas, liver resections and ilioanal reconstructions.
- [34:30]
Headley Thomas
Demi Garou went to the website of the New York State Office of the Professions. Its information was more damning, more succinct.
- [34:40]
Narrator/Reporter
Effective date 5102001 Action License Surrender misconduct description. The physician did not contest the charge, having been disciplined by the Oregon State Board of Medical Examiners for negligence involving surgical patients.
- [34:58]
Headley Thomas
A bureaucrat to his bootstraps. Demi Guerrero began producing a report. O Dempsey wanted a complete written explanation for this debacle. Under the heading Learnings, Demiguero would write, an incident such as this provides an opportunity to reflect on the effectiveness of procedures in place and to consider any changes which might ensure the circumstances which arose in this case cannot reoccur. Chapter 42 the Backlash 8 April 2005 Tony Hoffman went to work three hours later than usual after her long day at the conference in Brisbane, a secret visit with Karen Fox to the offices of the Courier Mail, the flight back to Bundaberg, and another night of sleepless worry. She was glad to be starting at 11am it was a small mercy. Tony remained fearful. The article about the visit by Steve Buckland and the minister, Gordon Nuttall, and the provocative headline about the nurses hiding patients from Jayant Patel were the subject of gossip and speculation among staff in the wards. Darren Keating kept his head down. He had told only his wife and the director General, Steve Buckland and Jennifer Kirby, a colleague and friend at the hospital, about the results of his Google search. The they each had as much to lose as he did. Peter Leck remained ignorant of the discovery. Diane Walls, the acting director of nursing, called a meeting of about 15 senior nurses. After Hoffman arrived in the seminar room on the Third floor. Walls, who had cut the article from the newspaper, vented her anger over the latest blaze of publicity. I. I'm appalled, she said. Walls told the nurses that anonymous sources were clearly trying to create unnecessary mischief and mayhem. She suspected someone in the meeting. A few of the nurses there were also angry over the leak. They felt threatened. Hoffman believed that Walls had fingered her as the prime suspect. In Hoffman favour, however, was her absence from Bundaberg. During the dressing down delivered by Steve Buckland and Gordon Nuttall. Tony called out to Walls from the back of the room.
- [37:35]
Tony Hoffman
Why is it appalling? It's all true, Gail.
- [37:39]
Headley Thomas
Alma had made a point of moving off to one side of the room. She very deliberately made herself a highly visible study of concentration. She had a pretty good idea that Hoffman was behind the article in the Courier Mail. In past months, when Tony had confided some of the actions she was taking to stop Patel operating, Aylmer half jokingly told her friend and colleague that she needed to see a psychiatrist.
- [38:06]
Narrator/Reporter
You're certifiable, she would say.
- [38:10]
Headley Thomas
But Diane Walls had not been joking in her efforts to persuade Hoffman to have counselling for mental stress. We're all really worried about you, Tony.
- [38:20]
Tony Hoffman
Peter Lek is especially worried about you. Please seek some help.
- [38:25]
Headley Thomas
Hoffman was going mad. She was mad with management for its inertia and its blinkered approach to Patel. Aylmer held up the article in the meeting.
- [38:35]
Narrator/Reporter
I don't know about this.
- [38:37]
Headley Thomas
The other nurses looked at her. She emanated authority and credibility. She was about to throw Hoffman a lifeline.
- [38:45]
Narrator/Reporter
I've read it closely and I reckon the information in it has come from a doctor. It reads like something from a doctor, not a nurse.
- [38:54]
Headley Thomas
Everyone bought it. They agreed a doctor was behind the leak. Hoffman sighed with relief. The meeting ended. Chapter 43 Mind Games 8 April 2005 the Hellenic Club, in a time worn building on Russell street in South Brisbane, is a favorite meeting place for all the Greek community's senior citizens and their sons. Its old tables on the outdoor patio sit uneasily on cracked tiles overlooking a neglected garden and driveway. The club has none of the refinement of the riverside restaurants favoured by politicians and business leaders. Despite its authentic and remarkable food, friendly staff and casual atmosphere, it is the last place you would expect to find a cabinet minister. For Gordon Nuttall, it was the perfect venue for a low key chat with a journalist who had become one of his government's thorns. Leo Kelleher, the Premier's Director General, still wanted my guts for garters for exposing the freedom of information fiasco and the remarkable appointment two months earlier of Kathy Taylor. By meeting with me, Gordon Nuttall was fraternising with the enemy at an outside table. As the Greek regulars savoured souvlaki and ribbed each other over card games, Nuttall and I talked. My estimation of him rose because he had fronted after being stitched up in that day's newspaper. At least he was not precious. After a tentative introduction, he spoke about the challenges confronting Queensland health. As he sipped a beer, he stressed the brutal reality a finite amount of money and an infinite number of costly medical procedures. He came across as a realist, being as honest as he dared about a system. Under strain, we exchanged ideas and anecdotes. He told me of his respect for some of my colleagues and his contempt for others. At one stage, he asked why I was labouring at the Courier Mail and wanted to know why I had not moved elsewhere, like into a more lucrative job in government. He was ambitious. When I asked him about taking on what was arguably the toughest job in Cabinet, Gordon Nuttall laughed. Despite health being a huge promotion from the industrial relations portfolio portfolio, none of his colleagues had wanted it. He decided that they were wimps. If he made a good fist of health, he would prove his credentials as a premiership contender. None of the logs around the Cabinet table could see the potential of health and how a competent chief might soar in the portfolio. That's how he saw it. For all his ambition, Nuttall was not an insider. Premier Peter Beattie was wary of him. The Deputy Premier and Treasurer, Terry McEnroth and the Racing Minister, Robert Schwarten, had little time for him. He had succeeded in bringing in anti smoking measures which infuriated the major clubs and threatened to dent the revenues from poker machines. McEnroth had opposed the proposals. The bottom line for treasury was a loss. The bean counters did not factor in the future savings from improving the health of individuals. Nuttall spoke highly of Education Minister Anna Bligh, who was struggling to limit fallout from the tardy handling of the issue of asbestos in schools. And he praised Attorney General Rod Welford, who had been damaged by legal bungles and speculation over his conduct at a Christmas party. Nuttall was also close to a former Deputy Premier, Jim Elder, who had quit over a vote rorting scandal. I had the unfortunate assignment of confronting Elder at his home. With the evidence of the rorts precipitating his sudden resignation, Nuttall relied on Jim Elder's wife, Lisa Shilts, for advice on media management. She had been his ministerial media advisor until transferring to the most senior media management role in the department. Answering to Steve Buckland, I suspected that both Schiltz and Elder were not among my fans. Nuttall's big picture analysis of health was interesting for its honesty, but it did not advance the issue. I wanted to drive. I broached the Bundaberg story. I told Nuttall that I believed it had legs. His response baffled and angered me.
- [43:59]
Gordon Nuttall
Nuttall said, I have to be fair to the doctor. He has not received natural justice.
- [44:06]
Headley Thomas
He asked me what I thought about the predicament and I replied, you've got a doctor who has forfeited his right to natural justice by leaving and now you've got a hospital with a lot of angry staff who think you are covering it up. How does Dr. Patel leaving Australia somehow prevent a thorough investigation or the release of the report? Surely you owe more to the staff and the patients than you do to Patel. If Patel turns out to have been a major problem, you are going to have to carry the can for him. I'm going to Bundaberg first thing Monday morning to try to find out exactly what has been going on there. But Nuttall kept returning to the natural justice issue, which seemed to me either a red herring or an idea someone else, perhaps Buckland, had pressed and exaggerated. Natural justice never worried politicians when it came to launching attacks in Parliament on perceived enemies. Why was it suddenly so concerning now? My mobile phone rang. It was Rob messenger, calling with more information. He was determined to remain integral to the story that he had kicked off in Parliament on 22 March. I did not tell him why. I couldn't chat. Nuttall seemed to grasp the need for a strategy. The meeting with Bundaberg staff the day before had rattled him. Realising the issue was not going away and might become a serious problem, he groped for a remedy, a circuit breaker. He seized it when I told him I had spoken to Dr. Peter Woodruff minutes before coming to the lunch. I told him about Woodruff's comments about the need for the College of Surgeons to be involved in any audit of Patel's surgery. Nuttall was oblivious to the 2003 report by one of his senior advisors, Dr. Dennis Lennox. Its warnings about the dangers inherent in the Medical Board of Queensland's abysmal screening of overseas trained doctors, a number of whom lacked competence, had been front page news before Nuttall's appointment. Nuttall asked me to repeat the full name of the report and its author. He made a note of it. I explained how the report had been published in the courier mail in November 2003, a few months before he took on the portfolio, and how its warnings and recommendations were backed up by respected practitioners such as Dr. Chris Blenkin of the Australian Orthopaedics association and Dr. Anne Kolb, President of the Royal Australasian College of Surgeons. Nuttall told me he would ask his department for a copy when I began writing in a mini notebook. Nuttall chose his words carefully.
- [47:00]
Gordon Nuttall
These are matters of great concern to me. I understand that patients and families have concerns as well as staff. We're trying to be open and accountable. There is nothing in Fitzgerald's report that we want to hide. But we are in a dilemma. I have a person here not able to respond because he's left. We are obviously concerned about both the patients and the families and that's why we need to talk with the Chief Health Officer to address those concerns.
- [47:29]
Headley Thomas
When I asked about Dr. Woodruff's offer, Nuttall replied, I'm happy to meet with.
- [47:35]
Gordon Nuttall
The college and talk about the issue. I'm not opposed to it. If that's the offer, I will talk to the Chief Health Officer. What he indicated to me was that there were concerns enough for him to refer the doctor to the Queensland Medical Board. Now, if it can be sustained that these allegations were made two years ago, we need to have a really good look at the operations of the Bundaberg Base hospital because I'm not happy that it's taken that long to be brought to my attention.
- [48:04]
Headley Thomas
The interview and the lunch over Brendan McHenry fixed up the bill and drove me back to the office. I had everything I needed for the following day's story. It was headlined police opened file on Dr. Death's alleged killing. This is what my story stated.
- [48:22]
Narrator/Reporter
A police probe into the alleged unlawful killing of a Bundaberg Base hospital patient began yesterday as the dead man's grieving widow and son demanded full disclosure from Health Minister Gordon nuttall. Des Bramage, 56, was one of at least 14 patients whose treatment by the overseas trained Dr. Jayant Patel alarmed hospital doctors and staff, prompting a top level investigation by Queensland health health professionals and heads of the Australian Medical association and the Royal Royal Australasian College of Surgeons called on Queensland Health to openly deal with the preliminary findings of Chief Health Officer Dr. Jerry Fitzgerald. Their calls came as Mr. Nuttall revealed he was told by Dr. Fitzgerald that the issues surrounding Dr. Patel were serious and warranted referral and further inquiry by the Medical Board of Queensland, which prosecutes.
- [49:21]
Headley Thomas
Doctors, the article continues, and it included quotes from Mark Bramwich, Dr. David Malloy Nuttall and Dr. Woodruff. For the second time in as many days, the minister's photograph ran as a single column picture, this time with a prescient caption. It said, trying Times. Chapter 44 Strategy 9 to 10 April 2005 Peter Woodruff slept soundly in the master bedroom of his motor Cruiser Annabelle. The 23 metre white hull Beauty was gently rising on the tide at its manly mooring when the leading vascular surgeon's mobile phone began bleeping about 6am his wife Maria woke him up. The phone was upstairs on the counter near the kitchen. Calls so early usually meant bad news, thought Woodruff as he walked up the polished teak steps. Was it a clinical crisis at the Princess Alexandra Hospital or an accident involving someone in his family? He had purchased Annabelle shortly after the September 11th catastrophe at the World Trade Centre. He and Maria tried to escape to the boat most weekends and they often succeeded in luring their eldest daughter Samantha, her husband Roger Traves, a leading lawyer, and their little ones for day trips to the beach at Peel Island. Since Peter and Maria's children had grown up and moved away, the family home at Chelmer, overlooking the Brisbane river, had lost some of its appeal. But Annabelle turned heads on Moreton Bay. She was the perfect sanctuary after battles with administrators at the Princess Alexandra Hospital. The early morning caller was Deb Podbury, a bane of Woodruff's professional life. He suspected he was about to be reprimanded. A tough Queensland health district manager with a reputation for toeing the corporate line and taking the clinicians to task, Podbury had attempted to rein in Woodruff in the past. His well intentioned contact with journalists had caused alarm during one memorable made for television event by Premier Peter Beattie to the Princess Alexandra Hospital. Woodruff beat the premier at his own game. As the cameras rolled and the self proclaimed political media tart talked up the hospital's capabilities, Woodruff told him the reality. There were too few beds, severely limited funding. Patients were not receiving timely treatment. From a public relations perspective, this was dreadful for Beattie. Damning the evening news played it up. It was the sort of spectacle that the bureaucrats who probably regarded the satirical yes Minister program as a serious documentary never forgot. Deb Podbury's tone and the hour of the call put Woodruff on guard. When she sounded sorry for disturbing his sleep, he relaxed.
- [52:35]
Rob Messenger
Have you read this morning's paper, she asked him.
- [52:39]
Headley Thomas
Woodruff, who was yet to see Saturday's edition of the Courier Mail, wondered what it said. No, I haven't, he replied. There's a rogue doctor and the minister is going to have an inquiry into it. Your name has been suggested as an investigator. She was friendly, asking if he would have any objection to receiving a call from Gordon Nuttall.
- [53:02]
David Potter
Of course not.
- [53:03]
Headley Thomas
You will possibly hear from him or his department in the near future. About 20 minutes later, Nuttall called. Woodruff found the early morning activity a little hard to follow.
- [53:15]
Gordon Nuttall
I would like you to join a team to review the issues at Bundaberg base hospital involving Dr. Patel, Nuttall told him.
- [53:23]
David Potter
No problem at all, Minister. We have had rogue doctors before. This shit should be pretty straightforward.
- [53:28]
Gordon Nuttall
No, this is serious. Very serious.
- [53:32]
Headley Thomas
After the call, Woodruff went to a nearby shop to buy the paper. When he read the article, he still couldn't understand why Nuttall and Podbury seemed so worried. At the same time. My enthusiasm for the story was now tempered with concern. The College of Surgeons wanted to be involved. The minister had begun to take it seriously, and the Australian Medical association also now urged a thorough review. What if the investigations determined that things were not nearly as bad as Tony Hoffman had claimed? I spoke to her that Saturday morning and I said, if what you are saying is right, I reckon there's a good chance it will come out. My qualified comments angered Tony. She replied crossly.
- [54:22]
Tony Hoffman
You still doubt me, don't you? You're not convinced yet. I promise you it's much worse than people think. It's shocking.
- [54:31]
Headley Thomas
I was on my mobile phone at the Rockley markets while Ruth and the children shopped for fruit. A leaflet for the local Subway sandwich outlet became my notepaper as Hoffman vented her anger.
- [54:44]
Tony Hoffman
Queensland Health spends a lot of money teaching us about risk management and putting us through courses on open disclosure. And then when we need to disclose, the system fails. People went in for simple operations and came out missing a spleen. Doctors and administrators don't know how bad it has been. It's the ICU nurses who have had to go in each day and look after his complications and who had to lie to patients about what had gone wrong. He was still performing surgery until the end on the day it was raised in state Parliament. He was operating that night and didn't seem at all concerned. He would ingratiate himself by buying the alcohol at parties and gifts for the other staff. There are lies in the death certificates. We don't know the full extent of it.
- [55:37]
Headley Thomas
Her impassioned account bolstered my confidence and I felt guilty for doubting her. My plan was to head into the office to pick up the files I would need for the two night visit to Bundaberg. The latest story had provoked some strong reaction on my office computer. An email from Darren Davies flagged a doorstop media conference. National Shadow Minister for Health Stuart Copeland will be available at Parliament House for commentary on the Bundaberg Hospital issue and mental health escapees from 11:30am or whenever required today. But it was the email that had popped in at 12:26pm From David Potter, the media advisor for Gordon Nuttall, that piqued my interest. Head this is a release from MIN for yesterday. MIN has asked Jerry Fitzgerald to call you, so I've given Jerry your number. Cheers Pottery the media release that David attached to the email was fascinating.
- [56:35]
Narrator/Reporter
04-09-2005 Minister announces Bundaberg Hospital Services review Health Minister Gordon Nuttall today announced a comprehensive review of safety and quality at the Bundaberg Base Hospital. Mr. Nuttall said he has also been informed by Independent Chief Health Officer Dr. Gerry Fitzgerald that issues regarding a doctor from the Bundaberg Hospital had been referred to the Queensland Medical Board, Mr. Nuttall said. In light of allegations, a full and comprehensive investigation of all clinical services will be carried out by a panel including Royal Australasian College of Surgeons Vice President Professor Peter Woodruff. All appointees will be given investigative powers under the Health act by the Director General. The panel will report their findings to Dr. Fitzgerald. The report will be made publicly available. Dr. Fitzgerald's recent conducted audit of clinical services at the hospital showed issues of concern about individual patient outcomes. I would reiterate what I have said this week, that the correct process of investigating concerns at the hospital was circumvented by the naming of the doctor in the State Parliament by the Member for Burnet. When concerns were first raised with my department and with Queensland Health, immediate action was taken through the audit by Dr. Fitzgerald. But clearly we must do more. My major priority as Health Minister must be the welfare of patients and staff. The Medical Board investigation will ensure that any issues relating to the doctor concerned are thoroughly examined. I need an absolute guarantee of quality and safety at the Bundaberg Hospital to maintain not only my confidence but but most importantly that of the public. Patients and staff who have aired their concerns deserve answers and if needed, action, Mr. Nuttall said.
- [58:36]
Headley Thomas
My only regret was the timing of its release. It fell right into the lap of the Sunday Mail newspaper. I emailed Tony Hoffman and forwarded to her the media release about the clinical review. I wrote Tony, I came into work today to get some files and this was on my email. The truth is coming out. You will be fine. When I rang Potter, he said that Nuttall and the Chief Health officer, Jerry Fitzgerald, had just done a media conference to talk about the review. I learned that Fitzgerald had been mowing the lawn at home when he received the call to come in and and lend support to Nuttall. Chapter 45. Now they're talking. 10-4-2005. The 17th hole at Indrapilli Golf Course is a long dog legged par four with an elevated green. Making it onto the putting surface in two shots is a rare feat. My mobile phone was ringing and vibrating in my trouser pocket. The swing disintegrated along with a deep divot which advanced farther than the ball. It was a dreadful misfire.
- [59:56]
Jerry Fitzgerald
Hello? It's Jerry Fitzgerald, the Chief Health Officer. I'm sorry for interrupting a Sunday.
- [60:03]
Headley Thomas
As Potter had promised, the Chief Health Officer was calling about the review. He and Nuttall had announced it the day before. The Sunday Mail's Darrell Giles went to the media conference along with the TV journalists. It made a brief story. Jerry Fitzgerald, one of a few senior Queensland health people who already knew about Patel's US background, explained that he was happy to respond to questions about his audit at Bundaberg Base Hospital. When I returned home from the golf course and called him for a formal interview. He was friendly and open. He did not volunteer any clues to the highly sensitive revelation of the Oregon and New York disciplinary action. Patiently and methodically, Fitzgerald told me about his clinical audit.
- [60:56]
Jerry Fitzgerald
What we found came in two broad categories. Firstly, issues relating to the scope of practice he would tend to do. Complex procedures that were outside the scope of a hospital the size of Bundaberg, very complex operations that should have been done somewhere else. And as a result of that, in these complex cases, even in the best of hands, there's a high complication rate. But certainly doing them at Bundaberg without the support, the complication rate appears to be higher than anyone would be happy with. Secondly, there's the complication rate in general. We've got comparative data. It's evident that he has a higher complication rate in certain aspects. We measure infection rates, rate of wound breakdown and damage to another organ during an operation. Certainly there were some higher complication rates. The hospital, being a small country hospital, did not have the systems and structures in place to detect this earlier.
- [61:54]
Headley Thomas
Fitzgerald's answers did not tally with what I understood Tony Hoffman and the other nurses had detected. I asked about their disclosures and complaints. I believe that if Fitzgerald backed Hoffman in print, she would be less likely to suffer retribution. Jerry Fitzgerald responded, I'm aware that there.
- [62:16]
Jerry Fitzgerald
Was some informal raising of the issues. I'm not sure if that was raised in a written way. Certainly the people who raised them were concerned that they raised them and concerned that not too much had happened. I have to pay tribute to the staff up there. They were brave and persistent in their complaints and in raising their concerns. The information they have brought to us is factual in what it says. They were honest about it. I do not have any reason to doubt them.
- [62:43]
Headley Thomas
He said he had about six cardboard boxes filled with files relating to the 14 patients pinpointed by Hoffman.
- [62:52]
Jerry Fitzgerald
We did not have enough information to confront Dr. Patel on all of those cases. We interviewed Dr. Patel and asked him what was going on. He did speak about a higher level of wound breakdown and he suggested these were not really his fault. He thought that it was largely a conflict with the people in intensive care. They did not understand him or support him and there was a personality conflict even talking to him. It's probable that he does not see himself as a bad man and he believed what he was doing was possibly in the interests of those patients.
- [63:28]
Headley Thomas
I asked about Patel's background and credentials. The Chief Health Officer, who had known since the previous Thursday of the serious concern over Patel's restrictions, did not miss a beat.
- [63:41]
Jerry Fitzgerald
I have a copy of his CV. All CVs are very broad in their description. I have not read one yet that says I'm no good.
- [63:57]
Headley Thomas
Sick to Death is written and presented by me, Headley Thomas, the Australian's national Chief Correspondent. Claire Harvey is the Australian's Editorial Director. Audio editing, production and music have been done by Jasper Leake with assistance from Leah Samaglou and Neil Sutherland. Our producer is Kristen Amias, production management by Stephanie Coombs, Artwork by Sean Callanan. Thanks to Ryan Osland, Matthew Condon, Corinna Berger, Ellie Dudley, David Murray, Dominique McDermott, Zach Schoolander and all our family, friends and colleagues who helped in this 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 free photographs, videos, timelines and more at the website.