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Speaker 1: My name is Hedley Thomas. Sick to Death is based

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Speaker 1: on my book of the same name, and it's the

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Speaker 1: true story of doctor Jayant Patel's lies and manipulation and

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Speaker 1: the herculean effort it took to finally stop him. We've

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Speaker 1: used voice actors throughout this series, and on occasion the

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Speaker 1: real people from the story have read their words for us.

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Speaker 1: It is brought to you by Me and the Australian

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Speaker 1: Chapter seven the Web December two thousand and two to

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Speaker 1: March two thousand and three. Jayant Patel knew little about

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Speaker 1: New Zealand, and even less about Kaitaia, a small township

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Speaker 1: in the country's far north. Its hospital, a modern twenty

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Speaker 1: eight bed public facility, needed a doctor for a relatively

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Speaker 1: undemanding position. There would be no surgery. It was a

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Speaker 1: massive step down from the senior surgical positions that doctor

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Speaker 1: Patel had held in Portland, Oregon until resigning in disgrace

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Speaker 1: in two thousand and one. At Kaitaia, the successful candidate

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Speaker 1: would be mostly involved in pre and post operative care

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Speaker 1: of the patients. On rare occasions, Pateel may have been

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Speaker 1: needed in the operating theater, but only to assist a surgeon.

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Speaker 1: On ten December two thousand and two, he wrote this.

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Speaker 2: This is exactly the position I'm looking for, a responsible

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Speaker 2: practice in a small community.

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Speaker 1: His enthusiasm was obvious. Although the position involved a move

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Speaker 1: to the other side of the world, Patel said he

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Speaker 1: would be available to travel in just three weeks.

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Speaker 2: He is corgnificain if there is an interest.

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Speaker 1: For months, Patel had been searching the Internet looking for work.

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Speaker 1: He was bored. He had been humiliated in the Oregon

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Speaker 1: medical community. He needed to go somewhere foreign, a country,

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Speaker 1: and a hospital where he would be welcomed and pampered,

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Speaker 1: where the doctors and nurses had no knowledge of his past.

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Speaker 1: He had registered with an Australian medical recruitment company, Wavelength Consulting,

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Speaker 1: which pledged in its mission statement.

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Speaker 3: We will always provide our clients with first class candidates,

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Speaker 3: our candidates with first class opportunities, and both with unbeatable service.

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Speaker 3: We will do so ethically and with the best interests

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Speaker 3: of the candidate, client and wider community in mind.

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Speaker 1: Its website was busy with job descriptions and easy to navigate.

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Speaker 1: Its staff responded promptly to his emails and queries. The company,

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Speaker 1: which had a paid up capital of two dollars. Was

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Speaker 1: owned by doctor John Bethel and Claire Ponsford in Sydney.

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Speaker 1: They headhunted overseas health professionals and matched them with vacancies

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Speaker 1: in hospitals and private clinics throughout Australia and New Zealand.

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Speaker 1: The company earned a commission from each placement. A chronic

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Speaker 1: shortage of doctors and the constant bidding up of salaries

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Speaker 1: by increasingly desperate employers had created a lucrative market. Doctor

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Speaker 1: Bethel found that he could make more money from his

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Speaker 1: internet based business than he could earn by practicing medicine,

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Speaker 1: but the hospital at Katya in New Zealand would have

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Speaker 1: to make do without doctor Patel. He was flattered when

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Speaker 1: a Wavelength staff member told him he would be too

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Speaker 1: senior for this post. Instead, doctor Bethel had something else

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Speaker 1: up his sleeve. A position as the senior medical officer

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Speaker 1: at the Bunderberg Base Hospital had become available. Patel was

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Speaker 1: again brimming with enthusiasm. He spoke to Bethel on the

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Speaker 1: telephone and followed up in writing.

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Speaker 2: I had good training and experience with a majority aspect

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Speaker 2: of general and pediatric surgery, including laparoscopic procedures drama surgery,

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Speaker 2: including vascular emergencies. I have excellent surgical experience and I'm

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Speaker 2: very comfortable with the responsibility. I'm getting a few offers

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Speaker 2: within the US, However, my first priority is overseas work.

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Speaker 1: Patel explained that he was near retirement and financially secure,

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Speaker 1: with a daughter in medical school and his wife KISHOREI,

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Speaker 1: still practicing as a doctor. He told Bethel that he

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Speaker 1: wanted an altogether different work and life experience. He wanted

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Speaker 1: an adventure. Bethel liked what he heard. Doctor Patel had

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Speaker 1: held a position as a staff surgeon with the same

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Speaker 1: major w organization in Oregon for twelve years, and he

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Speaker 1: had headed a surgery residency program which involved teaching and

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Speaker 1: mentoring junior surgeons. A number of articles he wrote jointly

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Speaker 1: with other surgeons had been published in journals, and unlike

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Speaker 1: some of the doctors who promoted their skills through the website,

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Speaker 1: Dr Patel was not overly demanding. Doctor Bethel briefed doctor

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Speaker 1: keyes ndem Thunderberg Hospitals, acting director of Medical Services about

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Speaker 1: doctor Patel.

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Speaker 3: He would expect relocation expenses and accommodation, but does not

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Speaker 3: need a big house.

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Speaker 1: He needs a place to get a good cup of

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Speaker 1: coffee in the morning. Patel sent glowing references from three

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Speaker 1: of his US referees, doctor Peter Feldman, doctor Bawis Singh,

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Speaker 1: and doctor Nora Dantas. Each of the references was written

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Speaker 1: on Kaiser Permanente letterhead. Here's doctor Feldman.

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Speaker 4: I've known doctor Jayant Patel ever since he came to

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Speaker 4: work at Kaiser Permanente in Portland, Oregon. I have many

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Speaker 4: good things to say about doctor Patel. He has been

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Speaker 4: a wonderful colleague over the years and has been a

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Speaker 4: very hard worker. In addition to having a very busy

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Speaker 4: surgical practice, he was very active on hospital committees and

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Speaker 4: in other administrative forums. He is a well above average

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Speaker 4: interest in his work and a well above average knowledge

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Speaker 4: of surgery.

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Speaker 1: He is doctor Singh.

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Speaker 5: As a former chief and staff anesthesiologist, I have had

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Speaker 5: the opportunity of working with doctor Patel on numerous occasions,

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Speaker 5: both in elective and emergency situations. His balanced judgment, surgical

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Speaker 5: skills and decisive steps, especially in the management of high

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Speaker 5: risk complex procedures, has always been appreciated by US anesthesiologists

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Speaker 5: and other members of the Oregon team. Doctor Patel's professional expertise,

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Speaker 5: passion and energy for quality patient care, coupled with ethical

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Speaker 5: and best practices advocacy, won him the vote of his

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Speaker 5: colleagues for a Distinguished Physician award in nineteen ninety five.

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Speaker 5: These qualities undoubtedly will be an integral part of doctor J.

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Speaker 5: Pettel's professional career, irrespective of the place of his practice.

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Speaker 1: And here is doctor Dantas.

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Speaker 6: I worked with him closely at our intensive care unit

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Speaker 6: and saw him care for the most difficult surgical cases

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Speaker 6: at our hospital. I saw the good results. The nursing

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Speaker 6: staff had good things to say about his surgical skills,

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Speaker 6: his compassionate care, and his relationship with the nursing and

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Speaker 6: medical staff. My countless patients that he took care of

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Speaker 6: for the last ten years were very satisfied of his

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Speaker 6: results and his skills. And I can say categorically that

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Speaker 6: no one ever gave me a negative feedback about him,

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Speaker 6: which I always get as a primary care physician when

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Speaker 6: patients come back to me.

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Speaker 1: Patel's other testimonials were also superb. Doctor Edward Arronilo was

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Speaker 1: chief of surgery at the Cause of Permanente Groups bez

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Speaker 1: Cais a hospital when he hired Patel in nineteen eighty nine.

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Speaker 1: According to Aarronilo.

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Speaker 5: From the time he started, he dove into the work

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Speaker 5: with full vigor. He generally did about one hundred and

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Speaker 5: twenty cases of pediatric surgery per year, in addition to

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Speaker 5: a full load of general surgery. Doctor Patel had excellent

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Speaker 5: results with no serious problems or complications. As far as

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Speaker 5: general surgery is concerned. He took on the easy cases

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Speaker 5: and more often the more difficult, challenging and risky cases.

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Speaker 5: He achieved remarkable results and successes. In so far as

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Speaker 5: patients are concerned. They keep coming back to him. They

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Speaker 5: trust him, and he delivers the best care he can.

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Speaker 1: When doctor Bethel called doctor Feldman and Singh, they both

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Speaker 1: continued the praise. Neither mentioned the most relevant chapter in

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Speaker 1: their former colleague's career, his record of botchups and discipline reaction.

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Speaker 1: Although doctor Feldman gave a cryptic clue when he said

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Speaker 1: that Patel sometimes took on complex cases handed to him

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Speaker 1: by colleagues and found it hard to say no. Doctor

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Speaker 1: Bethel voiced one minor concern. It was that doctor Patel

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Speaker 1: had not worked for almost eighteen months. According to his

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Speaker 1: curriculum Vitae In a subsequent CV sent by Patel, the

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Speaker 1: date on which he claimed to have left Kaiser Permanente

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Speaker 1: in Portland had been changed from two thousand and one

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Speaker 1: to two thousand and two, but the change went unnoticed.

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Speaker 1: On Christmas Eve, doctor Patel received an early present a

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Speaker 1: letter of appointment as seen medical officer at Bunderberg Base Hospital.

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Speaker 1: He promptly signed and returned the document. His starting date

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Speaker 1: was confirmed as one April two thousand and three. Before

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Speaker 1: he farewell his wife, Kashoori, his daughter and friends in Oregon,

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Speaker 1: there was a pile of paperwork and red tape to

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Speaker 1: be dealt with. Patel needed a rubber stamp from the

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Speaker 1: Medical Board of Queensland to say he was a properly

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Speaker 1: credential doctor. Although the Board had a statutory duty to

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Speaker 1: register doctors and protect the public from Charlatan's, its procedures

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Speaker 1: were negligently lax. The Board performed no independent checks of

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Speaker 1: the references or credentials of incoming doctors. Their fellow physicians

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Speaker 1: were above suspicion. In Petel's case, the Board simply required

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Speaker 1: a document from the Oregon Board of Medical Examiners certifying

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Speaker 1: that he was properly registered and had not been disciplined.

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Speaker 1: Patel gave an assurance to Susie Taurs, one of the

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Speaker 1: Wavelength staff handling his file, in January, I.

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Speaker 2: Will fax you the letter and put the original in

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Speaker 2: the men.

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Speaker 1: Tours forwarded the documents from doctor Patel to Ainsley McMullan,

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Speaker 1: an officer with the Medical Board of Queensland. Neither Tours.

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Speaker 1: Normcmullen noticed that the certificate from Oregon hinted at a

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Speaker 1: potentially serious problem. In black and white it said standing

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Speaker 1: public order on file Sea attached, but there was nothing attached.

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Speaker 1: The documents setting out the details of Patel's negligence and

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Speaker 1: his disciplinary history had been removed. One of the Medical

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Speaker 1: Board forms requires doctors to declare whether their registration overseas

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Speaker 1: has been the subject of any condition, suspension, undertaking or cancelation. Patel,

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Speaker 1: in his response wrote no. McMullen processed the file, one

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Speaker 1: of one hundreds she had handled for the board. Wavelength

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Speaker 1: would receive thirteen thousand, nine hundred and twenty four dollars

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Speaker 1: for its efforts in recruiting Dr Patel. His travel plans

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Speaker 1: were locked in by the administrative staff at Bunderberg Hospital.

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Speaker 1: He was scheduled to arrive in Brisbane on a Quantus

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Speaker 1: flight on thirty one March, go to a twelve thirty

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Speaker 1: pm meeting with a medical Board representative at Forestry House

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Speaker 1: in the city, and then head back to the airport

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Speaker 1: for a three thirty pm flight to Bunderberg. He wrote

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Speaker 1: to the hospital's Lynn McKean, who was taking care of

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Speaker 1: his travel and accommodation.

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Speaker 2: I'm looking forward to meeting all of you and having

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Speaker 2: a very productive year.

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Speaker 1: She had booked him into one of the nicer beachside

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Speaker 1: apartments in Miller Street, Aagara, a fifteen minute drive from

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Speaker 1: the hospital. It offered a superb view of sand, volcanic

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Speaker 1: rock and sea.

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Speaker 6: We are also looking forward to your arrival and I

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Speaker 6: know you will have an enjoyable year.

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Speaker 1: Chapter eight, Flashback a Vicious Cycle. It was May nineteen

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Speaker 1: ninety three and Jayne Patel, smiling warmly uttered his umpty

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Speaker 1: self serving sentence in the twenty minutes that he and

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Speaker 1: doctor Sally Eelers had been seated together.

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Speaker 2: Congratulations, you've got the job. I make my decisions quickly.

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Speaker 1: At twenty nine, and newly separated from her husband, the

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Speaker 1: father of her four year old son, Sally Eelers found

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Speaker 1: the interview disturbing. She had the job, but already she

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Speaker 1: was concerned about the underlying ambitions of her new boss.

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Speaker 1: She wanted the position as a second year resident in

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Speaker 1: an integrated surgical Residency PROB run by Emmanuel Hospital and

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Speaker 1: Health Center and Kaiser Foundation Hospitals in Portland, Oregon. She

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Speaker 1: guessed that doctor Patel, the program director, had hired her

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Speaker 1: because of her attractive appearance, age, and gender, not because

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Speaker 1: of the strength of her impressive curriculum vitae. Driving home,

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Speaker 1: doctor Eelers replayed in her mind the clues to Petel's

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Speaker 1: less than subtle antics, and she recalled his repeated references

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Speaker 1: to his age. He had boasted several times that he

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Speaker 1: was only thirty nine. He and his wife, Kshoori, a

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Speaker 1: competent physician, had bought a mansion in Beaverton, an expensive

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Speaker 1: suburb in northeast Portland, two years earlier for four hundred

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Speaker 1: and twenty thousand dollars US. But Patel's partner since medical

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Speaker 1: college in India, rarely came up in conversation. His ego

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Speaker 1: was colossal. From himself, Patel had little to talk about.

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Speaker 1: He stressed how much he had achieved and how clever

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Speaker 1: he was. The young surgical residents who looked up to

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Speaker 1: Patel had voted him Teacher of the Year in nineteen

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Speaker 1: ninety one and nineteen ninety two. He was determined to

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Speaker 1: educate Sally Eelers and school her in the intricacies of

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00:15:21,880 --> 00:15:27,320
Speaker 1: a wonderful subject himself. He boasted how he had embarked

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Speaker 1: on an extraordinarily successful journey in surgery and he was, still,

221
00:15:31,720 --> 00:15:35,600
Speaker 1: as he put it, so young. He wanted Elers to

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00:15:35,760 --> 00:15:39,680
Speaker 1: nod and fawn in obsequious approval and flatter him with

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Speaker 1: tributes to his stellar career. Patel, who shamelessly complimented himself,

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00:15:46,200 --> 00:15:49,920
Speaker 1: had turned a job interview into a flawless self appraisal,

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00:15:50,600 --> 00:15:54,280
Speaker 1: and doctor Sally Eelers concluded that he wanted her to

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00:15:54,400 --> 00:16:01,040
Speaker 1: understand something else. Their age difference was trivial. Years. Separating

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00:16:01,080 --> 00:16:05,640
Speaker 1: the chain smoking and overweight surgeon from his fit understudy

228
00:16:05,760 --> 00:16:09,480
Speaker 1: was no barrier to a relationship outside the operating theater,

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00:16:09,880 --> 00:16:15,720
Speaker 1: he insisted. But it was another clumsy lie, another hopeless misrepresentation.

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Speaker 1: At that time, Patel was not thirty nine. He had

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00:16:20,160 --> 00:16:24,640
Speaker 1: just turned forty three. It would take another seven years

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00:16:24,640 --> 00:16:28,080
Speaker 1: for regulators in Portland to ban Patel from a wide

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00:16:28,240 --> 00:16:31,800
Speaker 1: range of surgery, but the number of patients who were

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00:16:31,880 --> 00:16:35,200
Speaker 1: dying or suffering in pain due to his negligence was

235
00:16:35,240 --> 00:16:39,120
Speaker 1: growing even before doctor Eelers received her letter of appointment.

236
00:16:40,360 --> 00:16:43,960
Speaker 1: Every time his scalpels slipped and nicked an artery or

237
00:16:44,120 --> 00:16:48,320
Speaker 1: vain or vital organ, Peateel lacerated the quality of life

238
00:16:48,360 --> 00:16:52,440
Speaker 1: of a patient in Oregon. In at least a handful

239
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Speaker 1: of cases, the ones that stood out for the glaring

240
00:16:55,760 --> 00:17:00,320
Speaker 1: ineptitude or because the family's demanded answers. His blade was

241
00:17:00,440 --> 00:17:04,320
Speaker 1: an instrument of death, and some of his colleagues had

242
00:17:04,359 --> 00:17:09,280
Speaker 1: begun to express disquiet. But before Sally Eelers had seen

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00:17:09,359 --> 00:17:13,240
Speaker 1: him operate or surveyed the dreadful complications in the patients,

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00:17:13,560 --> 00:17:17,600
Speaker 1: she was busy discouraging his advances. He spoke to her

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00:17:17,680 --> 00:17:20,639
Speaker 1: in the car park a month after their first meeting.

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00:17:21,960 --> 00:17:23,920
Speaker 2: You may never get to have drinks with your program

247
00:17:23,960 --> 00:17:26,960
Speaker 2: director again. What do you really need as a boyfriend?

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Speaker 1: Sally Eelers replied, well.

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Speaker 7: Doctor Patel, I have a boyfriend, and you know that

250
00:17:33,000 --> 00:17:34,359
Speaker 7: you've met him.

251
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Speaker 1: She had been seeing another doctor, a tool Thacka. Patel

252
00:17:39,359 --> 00:17:43,200
Speaker 1: knew about their blossoming relationship because Sally had introduced them

253
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Speaker 1: at an annual resident graduation dinner. Doctor Thacker was ethnic Indian,

254
00:17:48,840 --> 00:17:53,280
Speaker 1: although the similarities with Patel ended there. He had grown

255
00:17:53,359 --> 00:17:56,520
Speaker 1: up in the United States. He had graduated from the

256
00:17:56,520 --> 00:18:01,280
Speaker 1: medical school at University of California, Los Angeles or UCLA,

257
00:18:01,600 --> 00:18:05,520
Speaker 1: and he was a resident at Oregon Health and Science University.

258
00:18:06,359 --> 00:18:10,600
Speaker 1: He was popular, and he was younger. When Patel again

259
00:18:10,720 --> 00:18:14,440
Speaker 1: tried to start a relationship with doctor Elers, she told

260
00:18:14,480 --> 00:18:19,880
Speaker 1: him Thaka was a serious boyfriend. Patel's demeanor changed immediately

261
00:18:19,920 --> 00:18:24,679
Speaker 1: for the worse. Other young female doctors felt uncomfortable around

262
00:18:24,720 --> 00:18:29,560
Speaker 1: doctor Patel. As participants in the immanual residency program, they

263
00:18:29,640 --> 00:18:34,160
Speaker 1: lived in adjoining accommodation. Patel would barge into the women's

264
00:18:34,200 --> 00:18:38,119
Speaker 1: area without knocking, surprising the residents in various states of

265
00:18:38,240 --> 00:18:42,680
Speaker 1: undress after a shower or while changing clothes. He had

266
00:18:42,720 --> 00:18:47,040
Speaker 1: no place being there. For the next three years, Patel

267
00:18:47,119 --> 00:18:53,800
Speaker 1: prevented Elers from performing complex and challenging surgery in educational conferences.

268
00:18:53,840 --> 00:18:57,160
Speaker 1: He was hostile and shouted her down when she offered answers.

269
00:18:57,720 --> 00:19:00,920
Speaker 1: He singled her out for nasty asa words and made

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00:19:01,000 --> 00:19:06,240
Speaker 1: her feel inferior around the other resident surgeons, those surgeons

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00:19:06,359 --> 00:19:10,159
Speaker 1: in Patel's good books, those he dominated and groomed for

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00:19:10,200 --> 00:19:14,280
Speaker 1: his clique. They clamored and competed for his attention, but

273
00:19:14,359 --> 00:19:18,400
Speaker 1: ELA's wanted none of it. She suspected that Patel would

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00:19:18,440 --> 00:19:20,960
Speaker 1: have been reasonable towards her if it were not for

275
00:19:21,080 --> 00:19:29,080
Speaker 1: Thacker's ethnicity. The handsome, younger ethnic Indian unwittingly highlighted Patel's shortcomings.

276
00:19:30,160 --> 00:19:34,000
Speaker 1: On twelve January nineteen ninety five, Patel sent her a

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00:19:34,080 --> 00:19:39,040
Speaker 1: formal letter, accusing her of being argumentative, alienating nursing staff,

278
00:19:39,520 --> 00:19:44,240
Speaker 1: manipulating the people around her, resisting constructive criticism, and having

279
00:19:44,400 --> 00:19:49,040
Speaker 1: little insight into her conduct. It was classic self projection.

280
00:19:50,000 --> 00:19:54,480
Speaker 1: ELA's had been highly regarded and received outstanding marks before

281
00:19:54,760 --> 00:19:58,600
Speaker 1: and after her contact with Patel, but he had decided

282
00:19:58,640 --> 00:20:02,320
Speaker 1: to teach her a lesson. His letter to her went

283
00:20:02,400 --> 00:20:03,480
Speaker 1: on to state.

284
00:20:04,440 --> 00:20:08,600
Speaker 2: Your performance in your surgical residency at Emmanuel has remained unsatisfactory.

285
00:20:09,240 --> 00:20:12,639
Speaker 2: This is primarily because of your attitude and behavior. You

286
00:20:12,680 --> 00:20:19,440
Speaker 2: are being perceived as argumentative, disrespectful, dogmatic, and arrogant. Being disrespectful,

287
00:20:19,640 --> 00:20:23,480
Speaker 2: especially to the attending staff, is an unacceptable behavior in

288
00:20:23,520 --> 00:20:24,639
Speaker 2: the surgical residency.

289
00:20:24,680 --> 00:20:25,080
Speaker 1: Program.

290
00:20:25,600 --> 00:20:29,240
Speaker 2: I am blessing you on probation immediately. If you desire,

291
00:20:29,359 --> 00:20:32,560
Speaker 2: we will be very happy to arrange for counseling. Depending

292
00:20:32,600 --> 00:20:35,359
Speaker 2: on the evaluations at the end of your probationary term,

293
00:20:35,800 --> 00:20:38,880
Speaker 2: you will either be removed from probation and allowed to continue,

294
00:20:39,280 --> 00:20:43,760
Speaker 2: or be subject to disciplinary actions, including removal or repeat.

295
00:20:44,520 --> 00:20:47,840
Speaker 1: Patel should have been more worried about his own failures

296
00:20:47,880 --> 00:20:51,840
Speaker 1: in theater. The corridor. Gossip at the best Chise of

297
00:20:51,960 --> 00:20:55,560
Speaker 1: medical center was spreading like a virus, with several doctors

298
00:20:55,600 --> 00:20:59,560
Speaker 1: outside Betel's influence questioning the competence of the staff. Surgeon.

299
00:21:00,359 --> 00:21:04,360
Speaker 1: Patel's knowledge of surgery was good. He was clearly an

300
00:21:04,440 --> 00:21:09,760
Speaker 1: intelligent man, but in many procedures, particularly those involving painstaking

301
00:21:09,880 --> 00:21:14,520
Speaker 1: and tedious work over several hours, his sloppiness was remarkable.

302
00:21:15,760 --> 00:21:19,280
Speaker 1: Some of the doctors had a theory. They believed his

303
00:21:19,359 --> 00:21:22,879
Speaker 1: addiction to smoking was a large part of the problem.

304
00:21:23,280 --> 00:21:26,240
Speaker 1: Craving the nicotine of a cigarette when he should have

305
00:21:26,280 --> 00:21:31,080
Speaker 1: been meticulously maneuvering his scalpel around delicate organs, he would,

306
00:21:31,160 --> 00:21:36,240
Speaker 1: they suggested, lose focus and nerve. He would rush the procedures,

307
00:21:36,440 --> 00:21:40,119
Speaker 1: take shortcuts, leave theater before the job was done and

308
00:21:40,200 --> 00:21:45,119
Speaker 1: stride outside to light up. Sometimes his patients paid with

309
00:21:45,240 --> 00:21:50,159
Speaker 1: their lives or their organs, but still none of his colleagues,

310
00:21:50,200 --> 00:21:54,880
Speaker 1: who harbored these concerns went to the authorities. By late

311
00:21:55,000 --> 00:21:58,679
Speaker 1: nineteen ninety five, a restructuring of the hospital set up

312
00:21:58,760 --> 00:22:02,560
Speaker 1: led to Patel being assigned to work with more experienced

313
00:22:02,560 --> 00:22:06,280
Speaker 1: surgeons for the first time. Until then, he had been

314
00:22:06,400 --> 00:22:09,520
Speaker 1: top of the heap. He thrived on conflict and had

315
00:22:09,560 --> 00:22:14,080
Speaker 1: reinforced perceptions of his aggressive nature by chastising another surgeon

316
00:22:14,440 --> 00:22:20,320
Speaker 1: and questioning his expertise. But now better surgeons were seeing

317
00:22:20,480 --> 00:22:26,959
Speaker 1: his handiwork. Although Jayon Patel had made a lot of

318
00:22:27,000 --> 00:22:31,119
Speaker 1: money for the Kaiser Permanent Group, the legal actions brought

319
00:22:31,200 --> 00:22:36,480
Speaker 1: by the victims of his incompetence were increasingly expensive. Roanila

320
00:22:36,720 --> 00:22:40,840
Speaker 1: T Pei eighteen was suffering abdominal pain and a family

321
00:22:40,960 --> 00:22:45,520
Speaker 1: history of polyposis, a predisposition to colon cancer when she

322
00:22:45,640 --> 00:22:49,480
Speaker 1: went to Sea Patel. As her father and her uncle

323
00:22:49,600 --> 00:22:53,200
Speaker 1: had died at an early age of colon cancer, Ronila

324
00:22:53,359 --> 00:22:57,760
Speaker 1: was at similar risk. Despite knowing the family history, Patel

325
00:22:57,920 --> 00:23:01,639
Speaker 1: ordered the wrong diagnostic test for the young woman. The

326
00:23:01,720 --> 00:23:05,560
Speaker 1: limited scope of the test meant its results were inconclusive,

327
00:23:05,760 --> 00:23:10,720
Speaker 1: and Patel assured Ranila that she was fined. The failure

328
00:23:10,800 --> 00:23:15,080
Speaker 1: to examine her entire colon meant that polyps already present

329
00:23:15,400 --> 00:23:20,720
Speaker 1: went undetected. Her death at twenty of colon cancer devastated

330
00:23:20,720 --> 00:23:24,040
Speaker 1: her young husband, who was left to raise an infant son.

331
00:23:25,480 --> 00:23:30,679
Speaker 1: The only consolation was financial Caizer Permanente settled the case

332
00:23:30,760 --> 00:23:35,879
Speaker 1: for US one point four million dollars. The hospital group

333
00:23:36,000 --> 00:23:39,800
Speaker 1: also paid out to the family of Leitras Fairchild, who

334
00:23:39,840 --> 00:23:43,440
Speaker 1: died two months after Patel removed part of her stomach.

335
00:23:44,200 --> 00:23:48,080
Speaker 1: The surgical wound collapsed in a hideous mess, leading to

336
00:23:48,200 --> 00:23:54,479
Speaker 1: serious complications and death. Kaiser settled this one for US

337
00:23:54,640 --> 00:24:00,600
Speaker 1: three hundred and seventy five thousand dollars. Throughout nineteen nine five,

338
00:24:00,640 --> 00:24:04,480
Speaker 1: there were more deaths, injuries, and payouts, and a trio

339
00:24:04,640 --> 00:24:09,679
Speaker 1: of shocking cases. Gerald Tucker, who bled to death that

340
00:24:09,840 --> 00:24:15,000
Speaker 1: cost US nine hundred thousand dollars. Helen Brooks, whose eureta

341
00:24:15,240 --> 00:24:20,760
Speaker 1: was accidentally cut. That was a confidential settlement, and another

342
00:24:20,840 --> 00:24:25,400
Speaker 1: confidential settlement in relation to Susan Tomblin, whose femeral vein

343
00:24:25,560 --> 00:24:31,600
Speaker 1: was cut. One of the younger surgeons tasked with assisting Patel.

344
00:24:31,960 --> 00:24:36,480
Speaker 1: Doctor Sanjeev Sharma would later tell Susan Goldsmith, a senior

345
00:24:36,600 --> 00:24:40,760
Speaker 1: investigative journalist at the Oregonian newspaper, of his efforts in

346
00:24:40,800 --> 00:24:44,879
Speaker 1: the operating room to help Helen Brooks. He tried alerting

347
00:24:44,960 --> 00:24:46,480
Speaker 1: Patel to his mistake.

348
00:24:47,840 --> 00:24:50,359
Speaker 2: I tried very hard to get him to realize there

349
00:24:50,400 --> 00:24:51,000
Speaker 2: was a problem.

350
00:24:51,119 --> 00:24:54,119
Speaker 1: After the surgery, I spoke up about missus Brooks to

351
00:24:54,119 --> 00:24:59,600
Speaker 1: Patel and he said, it's okay. It's okay. Susan Tombland

352
00:24:59,600 --> 00:25:03,199
Speaker 1: discovered and how she had been unnecessarily injured when a

353
00:25:03,280 --> 00:25:06,280
Speaker 1: nurse told her that the operation went terribly wrong.

354
00:25:07,600 --> 00:25:09,960
Speaker 8: When I saw another doctor, he said, I was a

355
00:25:09,960 --> 00:25:13,280
Speaker 8: walking time bomb from this. They said, this could kill

356
00:25:13,359 --> 00:25:15,400
Speaker 8: you if a piece of this blood clock gets loose.

357
00:25:16,480 --> 00:25:19,520
Speaker 8: When I mentioned that to doctor Patel, he screamed at

358
00:25:19,520 --> 00:25:21,800
Speaker 8: me like I was a two year old Tommy. I

359
00:25:21,880 --> 00:25:23,840
Speaker 8: wasn't to talk to anybody about what happened.

360
00:25:25,040 --> 00:25:28,800
Speaker 1: The hospital's managers and lawyers elected to keep the litigation

361
00:25:29,080 --> 00:25:33,000
Speaker 1: and the payouts a secret from Oregon's regulatory body, the

362
00:25:33,000 --> 00:25:37,840
Speaker 1: Board of Medical Examiners. In mid nineteen ninety six, in

363
00:25:37,880 --> 00:25:41,720
Speaker 1: the months after the closure of the Best Caiser Medical Center,

364
00:25:41,880 --> 00:25:45,600
Speaker 1: doctor Sally Eelers went to a weekly meeting of doctors

365
00:25:45,680 --> 00:25:50,120
Speaker 1: at another hospital, Providence, Saint Vincent, to compare notes on

366
00:25:50,280 --> 00:25:55,000
Speaker 1: problem surgeries. That's where Sally Elers disclosed the case of

367
00:25:55,160 --> 00:26:00,439
Speaker 1: Dwayne Feken, whose large intestine was removed by Patel. It

368
00:26:00,600 --> 00:26:04,800
Speaker 1: was the wrong decision. Facin suffered a string of serious

369
00:26:04,840 --> 00:26:08,960
Speaker 1: complications and needed several operations over a few years to

370
00:26:09,000 --> 00:26:14,639
Speaker 1: rectify the damage. His wounds had also fallen apart. His

371
00:26:14,920 --> 00:26:19,600
Speaker 1: poor outcomes mortified Sally EELA's. At the age of fourteen,

372
00:26:19,760 --> 00:26:23,800
Speaker 1: she had been diagnosed with Hodgkin's disease. She was a

373
00:26:23,840 --> 00:26:28,080
Speaker 1: cancer survivor, and doctors had told her incorrectly at eighteen

374
00:26:28,240 --> 00:26:32,919
Speaker 1: that she was infertile. Her experiences gave her a unique

375
00:26:33,040 --> 00:26:37,080
Speaker 1: understanding of the mental and physical pain suffered by patience.

376
00:26:37,960 --> 00:26:41,840
Speaker 1: She knew that Patel, her former teacher, was dishonest and

377
00:26:41,960 --> 00:26:45,640
Speaker 1: a predator, but she could not figure out why he

378
00:26:45,760 --> 00:26:50,520
Speaker 1: had rushed Faicin into having the original operation. Duayne Facin

379
00:26:50,640 --> 00:26:55,120
Speaker 1: had not been afflicted with alterative colitis. The young man

380
00:26:55,160 --> 00:26:59,640
Speaker 1: suffered Crohn's disease, a fact established from the pathology report.

381
00:27:00,720 --> 00:27:04,880
Speaker 1: It was as if Patel, whose boastfulness was legendary wanted

382
00:27:04,920 --> 00:27:08,640
Speaker 1: to do the most complex procedures for his own benefit.

383
00:27:09,640 --> 00:27:12,919
Speaker 1: A distressed Dodtor Eelers had been to see Patel to

384
00:27:13,040 --> 00:27:17,280
Speaker 1: discuss his invasive operations and the complications that had ruined

385
00:27:17,359 --> 00:27:19,840
Speaker 1: Dwayne Feakin's quality of life.

386
00:27:20,000 --> 00:27:23,480
Speaker 6: She told him, I have seen the patholodiy report and

387
00:27:23,520 --> 00:27:25,040
Speaker 6: it shows CRuMs to these.

388
00:27:25,600 --> 00:27:27,760
Speaker 1: But the senior surgeon shrugged it off.

389
00:27:28,720 --> 00:27:32,080
Speaker 2: Oh, I'm going to doctor the pathologist. I would to

390
00:27:32,119 --> 00:27:33,920
Speaker 2: get that stretent note.

391
00:27:34,080 --> 00:27:37,720
Speaker 1: When doctor Eelers, safely out of Patel's clutches, went to

392
00:27:37,840 --> 00:27:41,639
Speaker 1: the Morbidity and Mortality meeting at Providence Saint Vincent in

393
00:27:41,720 --> 00:27:46,639
Speaker 1: mid nineteen ninety six and described Vecan's clinical history, including

394
00:27:46,720 --> 00:27:51,399
Speaker 1: his most recent major operation weeks earlier and an intra

395
00:27:51,560 --> 00:27:57,640
Speaker 1: abdominal absess. The other surgeons were unusually somber. They had

396
00:27:57,720 --> 00:28:01,359
Speaker 1: been wary of Patel before doctor e iel spoke, but now,

397
00:28:01,720 --> 00:28:06,080
Speaker 1: after hearing about the pointlessness of Facan's misery, they were worried.

398
00:28:08,000 --> 00:28:11,879
Speaker 1: Doctor Roger Alberti, chief of surgery at the Provident Saint

399
00:28:11,960 --> 00:28:16,040
Speaker 1: Vincent Medical Center, found that other surgeons doing the same

400
00:28:16,119 --> 00:28:20,399
Speaker 1: surgery as Patel were having much better outcomes In the

401
00:28:20,480 --> 00:28:24,359
Speaker 1: same year, Patel was threatened with disciplinary action by the

402
00:28:24,480 --> 00:28:29,600
Speaker 1: regulatory authority in Washington State for seeking registration there and

403
00:28:29,720 --> 00:28:33,560
Speaker 1: lying to conceal an earlier chapter in his disciplinary history.

404
00:28:34,520 --> 00:28:38,800
Speaker 1: By late nineteen ninety seven, several other surgeons employed by

405
00:28:38,840 --> 00:28:43,800
Speaker 1: the Chiser Permanente Group were voicing concern when the group's

406
00:28:43,880 --> 00:28:47,960
Speaker 1: chiefs ordered a clinical audit of seventy nine of his operations.

407
00:28:48,000 --> 00:28:51,800
Speaker 1: The findings were worse than they had feared. Several patients

408
00:28:51,840 --> 00:28:55,320
Speaker 1: had bled to death because banes or arteries or organs

409
00:28:55,400 --> 00:28:58,840
Speaker 1: were nicked in surgery, and a worryingly high number of

410
00:28:58,920 --> 00:29:03,760
Speaker 1: patients had suffered dehesents their wounds literally fell apart due

411
00:29:03,760 --> 00:29:08,280
Speaker 1: to negligent technique. In nineteen ninety eight, when the results

412
00:29:08,280 --> 00:29:12,800
Speaker 1: of the clinical audit were in Kaiser Permanente managers filed

413
00:29:12,840 --> 00:29:17,400
Speaker 1: a confidential adverse action report with the US National Practitioner

414
00:29:17,480 --> 00:29:21,560
Speaker 1: Data Bank. The patients Patel had operated on for the

415
00:29:21,600 --> 00:29:26,480
Speaker 1: preceding decade remained unaware of the serious and adverse findings

416
00:29:26,520 --> 00:29:32,120
Speaker 1: regarding his competence. Patel's surgical work in hospitals operated by

417
00:29:32,120 --> 00:29:35,840
Speaker 1: the Kaiser Permanente Group was severely restricted for the first

418
00:29:35,880 --> 00:29:40,760
Speaker 1: time in late June nineteen ninety eight, a new framework

419
00:29:40,920 --> 00:29:42,800
Speaker 1: established uniquely for him.

420
00:29:42,720 --> 00:29:48,960
Speaker 9: Required mandatory second opinions before undertaking all complicated surgical cases,

421
00:29:49,480 --> 00:29:53,040
Speaker 9: chart reviews, proctoring, attendance of surgical meetings.

422
00:29:54,080 --> 00:29:57,920
Speaker 1: In the two years between Sally Eeler's first voicing her

423
00:29:58,040 --> 00:30:02,040
Speaker 1: long held concerns in nineteen ninety six and the conclusion

424
00:30:02,040 --> 00:30:05,480
Speaker 1: of the clinical audit in nineteen ninety eight, at least

425
00:30:05,640 --> 00:30:09,480
Speaker 1: four patients died in circumstances where death should not have occurred.

426
00:30:11,160 --> 00:30:17,400
Speaker 1: Numerous others were unnecessarily injured. After hearing finally about the

427
00:30:17,440 --> 00:30:21,640
Speaker 1: Patel cases, the Oregon Board of Medical Examiners, which registers

428
00:30:21,680 --> 00:30:25,560
Speaker 1: practitioners to work and decides on disciplinary or regulatory action

429
00:30:25,640 --> 00:30:29,400
Speaker 1: where the public may be at risk, held its own investigation.

430
00:30:30,680 --> 00:30:34,680
Speaker 1: On twenty two September nineteen ninety eight. Patel admitted to

431
00:30:34,720 --> 00:30:39,120
Speaker 1: the Board's investigative committee that he had made serious surgical errors.

432
00:30:40,600 --> 00:30:44,720
Speaker 1: Patel agreed to a range of formal restrictions on his surgery,

433
00:30:45,120 --> 00:30:49,920
Speaker 1: and he undertook to obtain second opinions before considering operations

434
00:30:49,960 --> 00:30:54,320
Speaker 1: that were not straightforward. It took two more years for

435
00:30:54,360 --> 00:30:58,560
Speaker 1: the Board's restrictions and the formal findings of gross or

436
00:30:58,600 --> 00:31:01,800
Speaker 1: repeated acts of neguk diligence to become a matter of

437
00:31:01,880 --> 00:31:06,000
Speaker 1: public record. By two thousand and one, as gossip and

438
00:31:06,080 --> 00:31:11,200
Speaker 1: revelations about Patel's negligence went around Oregon's medical community, the

439
00:31:11,280 --> 00:31:15,640
Speaker 1: surgeon had become a public embarrassment to the Kaiser Permanente group.

440
00:31:16,520 --> 00:31:19,800
Speaker 1: His colleagues had presented him with an award in nineteen

441
00:31:19,880 --> 00:31:25,400
Speaker 1: ninety five, naming him Distinguished Physician of the Year, but

442
00:31:25,520 --> 00:31:28,480
Speaker 1: in June two thousand and one he resigned to avoid

443
00:31:28,600 --> 00:31:32,000
Speaker 1: being fired. In the same year, he was also struck

444
00:31:32,040 --> 00:31:35,360
Speaker 1: off the role of practitioners in New York State, having

445
00:31:35,440 --> 00:31:41,640
Speaker 1: also lied to the medical authorities there about his disciplinary history. Patel,

446
00:31:42,040 --> 00:31:45,680
Speaker 1: desperate to return to the operating theater, was being thwarted

447
00:31:45,840 --> 00:31:50,560
Speaker 1: at every turn. He was incompetent when he came to

448
00:31:50,600 --> 00:31:55,320
Speaker 1: Bundenberg in two thousand and three, but his incompetence was

449
00:31:55,360 --> 00:31:59,640
Speaker 1: compounded by another factor. By April two thousand and three,

450
00:31:59,800 --> 00:32:02,800
Speaker 1: he had not picked up a scalpel for several years.

451
00:32:03,520 --> 00:32:06,200
Speaker 1: He was much more deadly than he had ever been

452
00:32:17,480 --> 00:32:22,840
Speaker 1: Chapter nine, A New Career. March to June two thousand

453
00:32:22,880 --> 00:32:28,240
Speaker 1: and three, Jayan Patel was keen to see his new

454
00:32:28,280 --> 00:32:31,880
Speaker 1: workplace after the Quantus flight from Brisbane touched down late

455
00:32:31,920 --> 00:32:35,920
Speaker 1: in the afternoon of thirty one March. Although tired from

456
00:32:35,960 --> 00:32:40,000
Speaker 1: the travel, he was also excited. His charm and effusive

457
00:32:40,080 --> 00:32:43,880
Speaker 1: friendliness rubbed off on doctor keyes Ndem, the acting Director

458
00:32:43,920 --> 00:32:47,280
Speaker 1: of Medical Services, who showed him around the Bunderberg Hospital

459
00:32:47,320 --> 00:32:52,000
Speaker 1: on Borbonk Street. Patel made light of his long journey

460
00:32:52,040 --> 00:32:55,680
Speaker 1: as he cut a sway through the administration officers, shaking

461
00:32:55,760 --> 00:32:59,960
Speaker 1: hands with senior and junior staff. He read the Queensland

462
00:33:00,080 --> 00:33:03,440
Speaker 1: Health Code of Conduct, and he provided a sample of

463
00:33:03,480 --> 00:33:08,840
Speaker 1: his signature for the official Registry. Hours earlier in Brisbane,

464
00:33:08,880 --> 00:33:11,520
Speaker 1: he had been to the offices of the Medical Board

465
00:33:11,680 --> 00:33:16,200
Speaker 1: and met one of its members, doctor John Waller. It

466
00:33:16,360 --> 00:33:19,360
Speaker 1: involved little more than a friendly greeting and a glance

467
00:33:19,400 --> 00:33:23,600
Speaker 1: at the file. Dr Waller, overlooking the clue to the

468
00:33:23,800 --> 00:33:28,720
Speaker 1: discipline reaction in Oregon, ticked yes next to the criterion

469
00:33:28,760 --> 00:33:33,080
Speaker 1: of Certificate of good standing. The next morning, when doctor

470
00:33:33,080 --> 00:33:36,280
Speaker 1: Patel arrived at Bunderberg Hospital for the start of his

471
00:33:36,440 --> 00:33:40,600
Speaker 1: first working day as a Senior Medical Officer or SMO,

472
00:33:41,240 --> 00:33:45,160
Speaker 1: the town was having a collective laugh. It was April

473
00:33:45,160 --> 00:33:50,160
Speaker 1: Fool's Day. Patients nurses and doctors at the hospital amused

474
00:33:50,200 --> 00:33:55,320
Speaker 1: each other with practical jokes and harmless gags. The Bunderberg

475
00:33:55,440 --> 00:33:58,520
Speaker 1: News mail was in on the fund reporting how rail

476
00:33:58,600 --> 00:34:02,720
Speaker 1: lines at Key Street had had suddenly been removed. One

477
00:34:02,760 --> 00:34:05,480
Speaker 1: reader failed to see the funny side after going to

478
00:34:05,560 --> 00:34:09,160
Speaker 1: inspect the public works only to find nothing had changed.

479
00:34:11,560 --> 00:34:15,600
Speaker 1: On that day, Patel was formally endorsed by the Medical Board.

480
00:34:16,520 --> 00:34:21,200
Speaker 1: It granted him registration certificate number one zero three zero

481
00:34:21,440 --> 00:34:25,640
Speaker 1: four five zero, providing authorization.

482
00:34:25,600 --> 00:34:28,560
Speaker 3: To practice as a senior medical officer in surgery at

483
00:34:28,560 --> 00:34:32,680
Speaker 3: Bunderberg Based Hospital or any other public hospital authorized by

484
00:34:32,680 --> 00:34:35,440
Speaker 3: the Medical Superintendent on a temporary basis.

485
00:34:37,040 --> 00:34:41,200
Speaker 1: The dear Doctor Patel, letter sent by the regulator on

486
00:34:41,200 --> 00:34:44,000
Speaker 1: one April states in bold font.

487
00:34:44,400 --> 00:34:47,279
Speaker 3: It is advised that you are not registered as a specialist.

488
00:34:48,800 --> 00:34:52,839
Speaker 1: This meant he had to be supervised. As Patel had

489
00:34:52,880 --> 00:34:57,560
Speaker 1: come to Bunderberg to perform surgery, the Medical Board carelessly

490
00:34:57,600 --> 00:35:01,880
Speaker 1: assumed the hospital already had a Director of Surgery, in

491
00:35:01,960 --> 00:35:05,680
Speaker 1: other words, a highly qualified specialist who had been vetted

492
00:35:05,719 --> 00:35:09,719
Speaker 1: and credentialed by the Royal Australasian College of Surgeons. To

493
00:35:09,800 --> 00:35:15,000
Speaker 1: scrutinize doctor Pateell's work and identify any problems. But there

494
00:35:15,160 --> 00:35:19,440
Speaker 1: was one major hitch. The last director of Surgery, doctor

495
00:35:19,520 --> 00:35:25,120
Speaker 1: Sam Baker, had quit in disgust months earlier. Doctor keyes Ndem,

496
00:35:25,400 --> 00:35:29,480
Speaker 1: over awed by Patel, was embarrassed that a senior American

497
00:35:29,520 --> 00:35:34,920
Speaker 1: surgeon with apparently immaculate qualifications was a mere senior medical

498
00:35:34,960 --> 00:35:40,680
Speaker 1: officer in a regional Queensland hospital. A week later, Dr Nidam,

499
00:35:41,040 --> 00:35:44,120
Speaker 1: temporarily in charge of the hospital where he had done

500
00:35:44,239 --> 00:35:48,600
Speaker 1: his internship a quarter century earlier, made an executive decision

501
00:35:48,680 --> 00:35:52,600
Speaker 1: to promote doctor Pateell to the position of director of surgery.

502
00:35:54,040 --> 00:35:57,399
Speaker 1: Dr Ndham was breaking the rules with his premature move

503
00:35:57,560 --> 00:36:01,440
Speaker 1: to flatter and elevate an untested surgeon. He barely knew.

504
00:36:02,560 --> 00:36:05,239
Speaker 1: It was the worst decision he had made in his

505
00:36:05,400 --> 00:36:10,239
Speaker 1: professional life. In the year he had reluctantly been in

506
00:36:10,360 --> 00:36:13,920
Speaker 1: charge of the hospital, Doctor Nightham felt like a military

507
00:36:14,000 --> 00:36:18,120
Speaker 1: chief who, when he asked for generals, had been given majors.

508
00:36:18,920 --> 00:36:21,759
Speaker 1: Now that he had a bona fide general when all

509
00:36:21,840 --> 00:36:25,120
Speaker 1: he had asked for was a major, Nidam wanted to

510
00:36:25,120 --> 00:36:28,840
Speaker 1: look after him. Nidam had long taken the view that

511
00:36:28,960 --> 00:36:33,080
Speaker 1: people who worked in public health were either missionaries or idiots.

512
00:36:33,800 --> 00:36:37,640
Speaker 1: He put Patel in the former category. He asked a

513
00:36:37,760 --> 00:36:42,000
Speaker 1: question of Georgie Rose, the hospital's human resources manager.

514
00:36:42,640 --> 00:36:46,160
Speaker 7: Are we paying j Pettell a director's allowance? If not,

515
00:36:46,440 --> 00:36:49,239
Speaker 7: could do we do so please? As he is the

516
00:36:49,280 --> 00:36:50,440
Speaker 7: director of surgery.

517
00:36:51,760 --> 00:36:54,839
Speaker 1: When Jenny White, the singer nurse in charge of the

518
00:36:54,880 --> 00:36:58,600
Speaker 1: operating theaters, met Patel, he laughed as he told her

519
00:36:58,680 --> 00:37:02,759
Speaker 1: he had been given the director position. Jenny White was

520
00:37:02,840 --> 00:37:08,080
Speaker 1: surprised nobody had assessed Patel's surgical technique if it was

521
00:37:08,120 --> 00:37:12,920
Speaker 1: anything like his personality, hot and cold, ranging from brash,

522
00:37:13,040 --> 00:37:17,880
Speaker 1: domineering and rafe to charming and obsequious. The staff and

523
00:37:18,000 --> 00:37:23,520
Speaker 1: patients were in for a wild ride. Another American surgeon,

524
00:37:23,800 --> 00:37:26,880
Speaker 1: doctor Jim Gaffield, was due to start at the hospital

525
00:37:26,960 --> 00:37:30,640
Speaker 1: by the end of the month. Nurse White wondered why

526
00:37:30,680 --> 00:37:33,640
Speaker 1: doctor Gaffield had not been considered for the position of

527
00:37:33,719 --> 00:37:34,680
Speaker 1: director of surgery.

528
00:37:35,800 --> 00:37:37,720
Speaker 2: Well, it must be because they got here first.

529
00:37:40,160 --> 00:37:44,080
Speaker 1: In mid April, Bunderberg Hospital greeted doctor Darren Keating as

530
00:37:44,120 --> 00:37:47,560
Speaker 1: the new Director of Medical Services, to occupy on a

531
00:37:47,640 --> 00:37:50,839
Speaker 1: permanent basis the position that keyes n itdem had been

532
00:37:51,000 --> 00:37:57,080
Speaker 1: unhappily filling Patel, already well ensconced, warmed to the reserved

533
00:37:57,200 --> 00:38:00,680
Speaker 1: former Australian Defense Force doctor who arrived with his young

534
00:38:00,719 --> 00:38:04,400
Speaker 1: family from a small regional public hospital in Western Australia.

535
00:38:05,320 --> 00:38:10,080
Speaker 1: Doctor Keating had never managed a hospital. He displayed unusual

536
00:38:10,160 --> 00:38:13,919
Speaker 1: trays for an executive. When staff came to see him

537
00:38:13,960 --> 00:38:17,920
Speaker 1: in his office, he would invariably continue writing whatever letter

538
00:38:18,040 --> 00:38:21,480
Speaker 1: or report he had in front of him. Sometimes he

539
00:38:21,520 --> 00:38:25,120
Speaker 1: would not bother looking up. Doctors and nurses would leave

540
00:38:25,160 --> 00:38:29,320
Speaker 1: his office shaking their head at his manner. Doctor Keating

541
00:38:29,440 --> 00:38:33,279
Speaker 1: chose to remain isolated from most of the staff. He

542
00:38:33,360 --> 00:38:36,919
Speaker 1: was rarely seen in the intensive care unit, the wards,

543
00:38:37,040 --> 00:38:41,560
Speaker 1: or in medical meetings. Doctor Keating was aloof it came

544
00:38:41,600 --> 00:38:44,560
Speaker 1: across as arrogance, but it could have been shyness and

545
00:38:44,640 --> 00:38:49,360
Speaker 1: a lack of confidence. His limited and general clinical experience

546
00:38:49,440 --> 00:38:52,640
Speaker 1: meant he was hopelessly out of his depth around specialists.

547
00:38:53,719 --> 00:38:58,040
Speaker 1: Doctor Martin Strawn, a visiting medical officer, decided that doctor

548
00:38:58,120 --> 00:39:01,719
Speaker 1: Keating preferred to remain bun in his office lest he

549
00:39:02,040 --> 00:39:07,560
Speaker 1: encounter complaints, and keyes Nidam would later conclude.

550
00:39:07,640 --> 00:39:10,440
Speaker 7: If he was standing against the gray wall, you wouldn't

551
00:39:10,440 --> 00:39:13,160
Speaker 7: even know that he was there, but.

552
00:39:13,239 --> 00:39:17,000
Speaker 1: Right from the start, doctor Keating gave undivided attention to

553
00:39:17,160 --> 00:39:21,760
Speaker 1: Jon Patel. If it were not for Patel's remarkable gusto

554
00:39:22,000 --> 00:39:26,840
Speaker 1: and his enthusiasm for surgery, the hospital's waiting lists would lengthen,

555
00:39:27,440 --> 00:39:31,040
Speaker 1: and that would invite even closer scrutiny of Keating's management

556
00:39:31,120 --> 00:39:38,280
Speaker 1: from more senior bureaucrats in Brisbane. Before anyone unnecessarily began

557
00:39:38,400 --> 00:39:41,879
Speaker 1: to die or suffer injury at Bunderberg Hospital, there were

558
00:39:41,960 --> 00:39:46,960
Speaker 1: red flags, warnings that Patel's competence did not equal his confidence.

559
00:39:48,080 --> 00:39:52,759
Speaker 1: He was too eager to operate, too gung ho, his

560
00:39:53,000 --> 00:39:57,960
Speaker 1: judgment was questionable when surgical errors were made. He fought

561
00:39:58,040 --> 00:40:02,240
Speaker 1: to prevent patience being rushed to better equipped hospitals in Brisbane,

562
00:40:02,440 --> 00:40:06,319
Speaker 1: even when their complications were life threatening and beyond the

563
00:40:06,360 --> 00:40:11,560
Speaker 1: capacity of the regional hospital. Patel told management, it always

564
00:40:11,560 --> 00:40:13,680
Speaker 1: looks right if we do the procedures where we also

565
00:40:13,760 --> 00:40:17,239
Speaker 1: are capable of dealing with the complications. It was a

566
00:40:17,280 --> 00:40:21,640
Speaker 1: theme Petel hammered relentlessly at Bunderberg In the beginning. The

567
00:40:21,719 --> 00:40:25,160
Speaker 1: nurses put it down to his US training, but there

568
00:40:25,160 --> 00:40:29,360
Speaker 1: were too many mishaps. There were too many squandered chances

569
00:40:29,400 --> 00:40:33,600
Speaker 1: to improve a patient's prospects. It took a while for

570
00:40:33,640 --> 00:40:38,440
Speaker 1: Patel's other motive in obstructing transfers to dawn on the nurses.

571
00:40:39,640 --> 00:40:43,000
Speaker 1: He opposed the transfers because the damage he had caused

572
00:40:43,000 --> 00:40:49,839
Speaker 1: to the patients could be identified by other surgeons. With

573
00:40:50,000 --> 00:40:53,920
Speaker 1: cancer on the inside upper section of his ear, Peter

574
00:40:54,080 --> 00:40:57,560
Speaker 1: dale Gleesh spoke to Patel in April about having it removed.

575
00:40:58,600 --> 00:41:02,000
Speaker 1: Patel was shown the Boziz and had the added benefit

576
00:41:02,040 --> 00:41:05,879
Speaker 1: of the notes of the family doctor. On twenty May,

577
00:41:06,000 --> 00:41:09,000
Speaker 1: Pattel confidently went to work on the ear, and he

578
00:41:09,120 --> 00:41:13,400
Speaker 1: declared the procedure a success, but he had operated on

579
00:41:13,480 --> 00:41:15,080
Speaker 1: the wrong part of the year.

580
00:41:16,280 --> 00:41:19,040
Speaker 8: Have you ever had your year operated on, let alone

581
00:41:19,040 --> 00:41:20,200
Speaker 8: the wrong place altogether.

582
00:41:21,360 --> 00:41:25,200
Speaker 1: Dal Gleish put the question to Peter Leck, the hospital's manager.

583
00:41:25,960 --> 00:41:28,080
Speaker 1: To say it is painful would been understatement.

584
00:41:28,160 --> 00:41:30,799
Speaker 7: Indeed, the cancer is still there.

585
00:41:32,000 --> 00:41:35,719
Speaker 1: Doctor Darren Keating spoke to Patel, who refused to accept

586
00:41:35,719 --> 00:41:39,879
Speaker 1: that he had removed healthy tissue and overlooked the cancerous part.

587
00:41:41,600 --> 00:41:45,120
Speaker 1: Paul Jones went in for a procedure on his rights grotum,

588
00:41:45,680 --> 00:41:50,040
Speaker 1: known as an epididymectomy. It was to have been performed

589
00:41:50,160 --> 00:41:54,800
Speaker 1: under a general anesthetic. To his great surprise, Jones received

590
00:41:54,840 --> 00:41:59,920
Speaker 1: an entirely different procedure. Instead of examining his private parts,

591
00:42:00,080 --> 00:42:05,080
Speaker 1: Patel performed a gastroscopy. He pushed a scope down Jones's

592
00:42:05,120 --> 00:42:11,400
Speaker 1: throat and esophagust to investigate his stomach. Nurse Jenny White

593
00:42:11,440 --> 00:42:14,200
Speaker 1: witnessed an episode she likened to something out of the

594
00:42:14,280 --> 00:42:17,600
Speaker 1: Mash comedy series. Set in a field hospital during the

595
00:42:17,680 --> 00:42:21,960
Speaker 1: Korean War. There had been a traffic accident about fifteen

596
00:42:22,040 --> 00:42:25,680
Speaker 1: kilometers from the hospital. White received a frantic phone call

597
00:42:25,760 --> 00:42:27,360
Speaker 1: from Patel, who was in a panic.

598
00:42:29,120 --> 00:42:31,120
Speaker 2: I've got to go out to this accident site and

599
00:42:31,160 --> 00:42:33,760
Speaker 2: I am going to need equipment to amputate limbs.

600
00:42:34,400 --> 00:42:38,719
Speaker 1: White was already wary of Patel. What's he going to do,

601
00:42:38,960 --> 00:42:43,480
Speaker 1: she wondered. She collected equipment. He would need a battery

602
00:42:43,520 --> 00:42:48,120
Speaker 1: operated power source, a large plastic container of blades and saws,

603
00:42:48,440 --> 00:42:53,239
Speaker 1: and packs full of swabs and sutures. Shortly afterwards, the

604
00:42:53,280 --> 00:42:56,120
Speaker 1: lift doors opened and she watched Patel rush out with

605
00:42:56,200 --> 00:43:00,920
Speaker 1: two principal house officers, two interns, and two medical students

606
00:43:00,960 --> 00:43:05,200
Speaker 1: in tow all were in their surgical scrubs. Patel was

607
00:43:05,239 --> 00:43:06,000
Speaker 1: still frantic.

608
00:43:06,360 --> 00:43:08,360
Speaker 2: Where's the equipment? Where's the equipment?

609
00:43:09,040 --> 00:43:13,520
Speaker 1: White replied, look, I have it all here in a trolley.

610
00:43:13,680 --> 00:43:16,040
Speaker 1: The entourage swarm back into the lift.

611
00:43:16,560 --> 00:43:17,560
Speaker 3: You're in the wrong lift.

612
00:43:18,520 --> 00:43:20,879
Speaker 1: One lift was programmed to go up and the other

613
00:43:20,960 --> 00:43:23,600
Speaker 1: to go down. Patel was shouting at the staff and

614
00:43:23,680 --> 00:43:25,400
Speaker 1: urging them to hurry, while White was.

615
00:43:25,440 --> 00:43:28,520
Speaker 2: Yelling doctor Patel, Doctor Petel, you're in the wrong lift.

616
00:43:29,400 --> 00:43:32,360
Speaker 1: He ignored the nurse and she watched the doors close.

617
00:43:33,080 --> 00:43:35,319
Speaker 1: The lift went up and then went down, so they

618
00:43:35,360 --> 00:43:40,000
Speaker 1: could pile out and get into the right lift. As

619
00:43:40,040 --> 00:43:42,680
Speaker 1: it turned out, Patel had no role to play in

620
00:43:42,760 --> 00:43:47,000
Speaker 1: the accident. The passengers were freed by ambulance officers without

621
00:43:47,000 --> 00:43:51,000
Speaker 1: the need to cut off limbs. When Jenny White reflected

622
00:43:51,000 --> 00:43:53,719
Speaker 1: on the incident afterwards, she realized that Patel had not

623
00:43:53,800 --> 00:43:57,560
Speaker 1: even notified an anesthetist to provide pain relief for the

624
00:43:57,640 --> 00:44:03,320
Speaker 1: victims should amputation be needed. From the moment he arrived

625
00:44:03,320 --> 00:44:07,160
Speaker 1: in Bunderberg, ptel strove to make himself invaluable to his

626
00:44:07,320 --> 00:44:10,880
Speaker 1: new employer, Queensland Health and the managers of the hospital

627
00:44:10,920 --> 00:44:15,960
Speaker 1: in Burbong Street. Nobody in Australia knew about the blood

628
00:44:16,040 --> 00:44:22,200
Speaker 1: letting in Oregon nor Patel decided did anyone need to know? Instead,

629
00:44:22,280 --> 00:44:26,240
Speaker 1: Patel had discovered something about the Queensland public health care system.

630
00:44:27,239 --> 00:44:32,080
Speaker 1: He planned to turn it to his advantage. By working

631
00:44:32,160 --> 00:44:37,000
Speaker 1: hard and performing as many operations as humanly possible, Patel

632
00:44:37,040 --> 00:44:41,480
Speaker 1: would cut the waiting lists for surgery. The waiting lists

633
00:44:41,520 --> 00:44:45,000
Speaker 1: were pointed to by the media, the politicians and the

634
00:44:45,040 --> 00:44:51,160
Speaker 1: patients as proof of either maladministration or well oiled efficiency.

635
00:44:51,600 --> 00:44:54,759
Speaker 1: By meeting the targets in surgery, Patel would make the

636
00:44:54,840 --> 00:44:58,680
Speaker 1: hospital look good. He would give Peter Leck an opportunity

637
00:44:58,800 --> 00:45:01,560
Speaker 1: to be lauded ra rather than the lambasted by his

638
00:45:01,680 --> 00:45:05,920
Speaker 1: bosses in Brisbane and by the Labour Party's local parliamentarian

639
00:45:06,239 --> 00:45:11,080
Speaker 1: Nita Cunningham. In turn, Patel would make himself the most

640
00:45:11,239 --> 00:45:15,879
Speaker 1: valued clinician in the district. With hard work, he could

641
00:45:15,960 --> 00:45:19,719
Speaker 1: be so prolific the hospital's new director of medical Services

642
00:45:19,719 --> 00:45:24,800
Speaker 1: would come to view him as indispensable. Their success would

643
00:45:24,800 --> 00:45:28,279
Speaker 1: be tied to him. They would come to need him

644
00:45:28,440 --> 00:45:32,799
Speaker 1: more than he needed them. Patel also knew that his

645
00:45:33,000 --> 00:45:37,560
Speaker 1: zeal would be financially attractive to the hospital, because in

646
00:45:37,600 --> 00:45:41,759
Speaker 1: the end, it always came down to money. The formula

647
00:45:41,920 --> 00:45:45,799
Speaker 1: used by Queensland Health to fund the hospitals was deliberately

648
00:45:45,840 --> 00:45:51,760
Speaker 1: structured to reward volume and complexity of operations. The more,

649
00:45:52,120 --> 00:45:56,960
Speaker 1: the merrier, the riskier, the better. The cash flow depended

650
00:45:57,000 --> 00:46:00,799
Speaker 1: on numbers, not outcomes, and when the hospitals did not

651
00:46:01,000 --> 00:46:06,000
Speaker 1: meet the numbers, their funding shrank. By doing more operations

652
00:46:06,239 --> 00:46:11,040
Speaker 1: and more complex operations, Patel would generate rivers of cash

653
00:46:11,080 --> 00:46:15,400
Speaker 1: for the hospital. He would also generate rivers of blood

654
00:46:15,480 --> 00:46:19,680
Speaker 1: from the patients. In the process. Pettel would set out

655
00:46:19,719 --> 00:46:24,400
Speaker 1: to prove he really could perform brilliant surgery. He wanted

656
00:46:24,440 --> 00:46:29,200
Speaker 1: to recredential himself. He looked forward to complex operations such

657
00:46:29,239 --> 00:46:34,880
Speaker 1: as the sophagectomies operations. His United States peers had forbidden

658
00:46:34,960 --> 00:46:52,120
Speaker 1: him from ever trying again. Chapter ten. Life and Death

659
00:46:52,680 --> 00:47:00,360
Speaker 1: April to June two thousand and three. James Edward fil Sallips,

660
00:47:00,640 --> 00:47:04,080
Speaker 1: forty six, signed his life away on ten May two

661
00:47:04,080 --> 00:47:07,560
Speaker 1: thousand and three next to a handwritten asterisk on a

662
00:47:07,600 --> 00:47:12,080
Speaker 1: consent form. It also bore the name and signature of

663
00:47:12,120 --> 00:47:16,279
Speaker 1: the man who escorted him to a premature death on

664
00:47:16,320 --> 00:47:20,520
Speaker 1: the day he signed. Phillips brimmed with optimism and hope.

665
00:47:20,600 --> 00:47:24,000
Speaker 1: He liked the look and confidence of Bunderberg Hospital's new

666
00:47:24,040 --> 00:47:28,160
Speaker 1: Director of Surgery, doctor j Npateel, even if the operation

667
00:47:28,360 --> 00:47:32,320
Speaker 1: being proposed was difficult to pronounce and harder to spell.

668
00:47:33,120 --> 00:47:38,200
Speaker 1: A soophagectomy an operation so complicated and risky it should

669
00:47:38,200 --> 00:47:42,399
Speaker 1: only be attempted at major hospitals by the most adept specialists,

670
00:47:42,760 --> 00:47:48,880
Speaker 1: preferably gastro entrologists. To maintain proficiency, a surgeon had to

671
00:47:48,920 --> 00:47:52,759
Speaker 1: perform a minimum of thirty such operations a year. It

672
00:47:52,880 --> 00:47:57,279
Speaker 1: is an operation needing specialized and well resourced intensive care

673
00:47:57,400 --> 00:48:02,760
Speaker 1: unit backup. There is only one certainty after an esophagectomy,

674
00:48:03,239 --> 00:48:06,440
Speaker 1: the patient will need close monitoring for a long time.

675
00:48:06,560 --> 00:48:11,320
Speaker 1: In a well equipped hospital, the sophagectamies were well beyond

676
00:48:11,400 --> 00:48:15,120
Speaker 1: the limited scope of the operating theater and the adjacent

677
00:48:15,600 --> 00:48:19,719
Speaker 1: ICU on the first floor of the Bunderberg Hospital. The

678
00:48:19,760 --> 00:48:25,480
Speaker 1: operations were also hopelessly outside the expertise of Patel. His

679
00:48:25,680 --> 00:48:29,000
Speaker 1: lamentable skills were at their negligent best when he was

680
00:48:29,080 --> 00:48:34,360
Speaker 1: regularly performing far less complicated operations in hospitals and Portland, Oregon.

681
00:48:35,440 --> 00:48:40,920
Speaker 1: There his recklessness, rough handling, clumsy techniques, and poor judgment

682
00:48:41,040 --> 00:48:44,800
Speaker 1: had cost his employer millions of dollars in confidential settlements

683
00:48:44,840 --> 00:48:50,439
Speaker 1: for wrongful death and wrongful harm. James Phillips knew none

684
00:48:50,520 --> 00:48:53,480
Speaker 1: of these additional risks when he signed on for an

685
00:48:53,480 --> 00:48:56,799
Speaker 1: operation he hoped would cut out a small lesion in

686
00:48:56,840 --> 00:49:00,760
Speaker 1: his esophagus, the tube linking his throat with his stomach.

687
00:49:02,040 --> 00:49:05,680
Speaker 1: The lesion was blocking part of Phillips's esophagus and making

688
00:49:05,719 --> 00:49:09,560
Speaker 1: it difficult for him to swallow food. Under Patel's plan,

689
00:49:09,800 --> 00:49:13,120
Speaker 1: it would be removed. He hoped it would prolong his

690
00:49:13,239 --> 00:49:18,600
Speaker 1: life by several years. The generic consent form required patients

691
00:49:18,640 --> 00:49:19,920
Speaker 1: to acknowledge the following.

692
00:49:21,000 --> 00:49:24,520
Speaker 3: The doctor has explained my medical condition and the proposed procedure.

693
00:49:25,080 --> 00:49:28,040
Speaker 3: I understand the risks of the procedure, including the risks

694
00:49:28,080 --> 00:49:31,360
Speaker 3: that are specific to me and the likely outcomes. The

695
00:49:31,400 --> 00:49:34,400
Speaker 3: doctor has explained my prognosis and the risks of not

696
00:49:34,520 --> 00:49:38,000
Speaker 3: having the procedure. I understand that no guarantee has been

697
00:49:38,000 --> 00:49:40,799
Speaker 3: made that the procedure will improve the condition, and that

698
00:49:40,800 --> 00:49:44,240
Speaker 3: the procedure may make my condition worse. On the basis

699
00:49:44,280 --> 00:49:47,440
Speaker 3: of the above statements, I request to have the procedure.

700
00:49:48,640 --> 00:49:52,279
Speaker 1: On the same form, Patel set out his plan strategy.

701
00:49:52,920 --> 00:49:56,200
Speaker 1: He would make an incision in the abdomen. He would

702
00:49:56,239 --> 00:49:59,200
Speaker 1: also make an incision on either the left side of

703
00:49:59,239 --> 00:50:01,680
Speaker 1: the neck or or the left side of the chest.

704
00:50:02,800 --> 00:50:05,719
Speaker 1: He would slice through the tissue of the upper part

705
00:50:05,760 --> 00:50:08,839
Speaker 1: of the stomach and the lower part of the esophagus.

706
00:50:10,320 --> 00:50:13,360
Speaker 1: It was a difficult maneuver, but what came next was

707
00:50:13,440 --> 00:50:18,720
Speaker 1: even harder. Patel would need literally to pull Phillips's stomach

708
00:50:18,920 --> 00:50:22,520
Speaker 1: up and attempt at connection to whatever was left of

709
00:50:22,560 --> 00:50:28,120
Speaker 1: his esophagus. A fortnight earlier, Phillips, whose serious kidney problems

710
00:50:28,200 --> 00:50:32,680
Speaker 1: requiring constant dialysis made him a regular visitor to the hospital,

711
00:50:32,960 --> 00:50:37,319
Speaker 1: had seen doctor Mark Appleyard for an examination of his esophagus.

712
00:50:38,640 --> 00:50:42,800
Speaker 1: Doctor Appleyard put a flexible viewing tube into Phillips's mouth

713
00:50:42,920 --> 00:50:46,160
Speaker 1: and carefully inserted it all the way to the duodenum,

714
00:50:46,440 --> 00:50:52,200
Speaker 1: the first stage of the small intestine. Appleyard located a nodule,

715
00:50:52,280 --> 00:50:57,600
Speaker 1: which he noted had a concerning appearance. It crumbled easily.

716
00:50:58,239 --> 00:51:03,560
Speaker 1: It also bled easily on touching. Appleyard wrote the following

717
00:51:03,719 --> 00:51:09,320
Speaker 1: in the patient's notes. I am concerned about the esophagial nodule.

718
00:51:10,920 --> 00:51:14,480
Speaker 1: Fortunately for Phillips, he had been in the safe hands

719
00:51:14,480 --> 00:51:18,960
Speaker 1: of doctor Peter Meak, a highly regarded renal specialist in

720
00:51:19,080 --> 00:51:22,440
Speaker 1: charge of the renal unit who was also the director

721
00:51:22,480 --> 00:51:29,400
Speaker 1: of Medicine. Peter Meak had supervised the ongoing dialysis. Phillips

722
00:51:29,520 --> 00:51:32,440
Speaker 1: was a favorite patient of nurses in the renal unit.

723
00:51:33,000 --> 00:51:38,279
Speaker 1: He rarely complained despite his serious kidney issues, the constant dialysis,

724
00:51:38,320 --> 00:51:44,279
Speaker 1: and his poor overall health. The biopsy results after Appleyard's

725
00:51:44,280 --> 00:51:49,799
Speaker 1: examination were discouraging. When the five pieces of pale, tan

726
00:51:50,040 --> 00:51:54,120
Speaker 1: and brownish tissue measuring up to four millimeters were analyzed,

727
00:51:54,640 --> 00:52:01,440
Speaker 1: they showed evidence of invasive adino carcinoma words, a cancer

728
00:52:01,640 --> 00:52:06,800
Speaker 1: in cells lining the walls of his esophagus. Doctor Miak

729
00:52:06,920 --> 00:52:12,279
Speaker 1: had asked Dr Patel for an opinion. The surgeon recommended

730
00:52:12,320 --> 00:52:17,120
Speaker 1: an esophagectomy, but doctor Miak was against it. He believed

731
00:52:17,120 --> 00:52:21,040
Speaker 1: that Phillips was much too frail. Major surgery would be

732
00:52:21,200 --> 00:52:26,680
Speaker 1: extremely dangerous in someone as ill as Phillips. Doctor Meak

733
00:52:26,840 --> 00:52:31,880
Speaker 1: worried the man would die on the operating table. On

734
00:52:32,120 --> 00:52:37,160
Speaker 1: nineteen May, Dr Patel fast tracked Phillips into theater without

735
00:52:37,239 --> 00:52:42,720
Speaker 1: doctor Miak's knowledge. A little after ten am, Dr Petell

736
00:52:42,880 --> 00:52:46,960
Speaker 1: began to make the incisions. He cut and removed the

737
00:52:47,160 --> 00:52:51,839
Speaker 1: disease tissue and pulled up the stomach. Phillips, still under

738
00:52:51,840 --> 00:52:57,080
Speaker 1: a general anesthetic, went downhill fast. His vital signs were

739
00:52:57,200 --> 00:53:02,000
Speaker 1: rapidly deteriorating. For the last forty five minutes of his operation.

740
00:53:02,200 --> 00:53:06,280
Speaker 1: There was no recordable blood pressure to keep him alive

741
00:53:06,400 --> 00:53:10,200
Speaker 1: and his blood circulating. He received massive doses of inner

742
00:53:10,239 --> 00:53:14,680
Speaker 1: tropic drugs to make his heart beat more strongly. Even

743
00:53:14,719 --> 00:53:19,160
Speaker 1: the adrenaline in the drugs was of little benefit. By

744
00:53:19,239 --> 00:53:23,279
Speaker 1: mid afternoon, doctor Patel had put down his instruments and

745
00:53:23,360 --> 00:53:26,640
Speaker 1: Phillips was wheeled into the intensive care unit in an

746
00:53:26,680 --> 00:53:32,920
Speaker 1: extremely unstable condition. His pupils were fixed and dilated, indicating

747
00:53:33,040 --> 00:53:37,360
Speaker 1: brain death. A renal vein used to take blood away

748
00:53:37,440 --> 00:53:42,480
Speaker 1: from the kidney had become blocked. The blockage was almost inevitable.

749
00:53:42,840 --> 00:53:45,400
Speaker 1: The charts for Phillips, who had not been offered and

750
00:53:45,480 --> 00:53:50,880
Speaker 1: asophagectamy by specialists in Brisbane despite their greater expertise, showed

751
00:53:50,920 --> 00:53:54,880
Speaker 1: the artery was functioning at just seventy percent and a

752
00:53:54,960 --> 00:54:01,439
Speaker 1: soophagectamy would almost guarantee thrombosis, and it did. For much

753
00:54:01,480 --> 00:54:04,839
Speaker 1: of the operation. Phillips was in the operating theatre with

754
00:54:04,960 --> 00:54:09,520
Speaker 1: no dialysis access, and a soaring potassium level, a precursor

755
00:54:09,560 --> 00:54:15,480
Speaker 1: to cardiac arrest. While Patel cut, pulled, and stitched, Phillips's

756
00:54:15,640 --> 00:54:19,280
Speaker 1: heart had given up, his brain was starved of oxygen.

757
00:54:20,120 --> 00:54:23,759
Speaker 1: At bed five, near the window of the Intensive care unit,

758
00:54:23,880 --> 00:54:28,560
Speaker 1: its most senior, nurse, Tony Hoffman, ensured that everything possible

759
00:54:28,680 --> 00:54:32,000
Speaker 1: was being done for Phillips. During the wait for his

760
00:54:32,160 --> 00:54:35,319
Speaker 1: arrival at the ICU, she had been told by one

761
00:54:35,320 --> 00:54:38,839
Speaker 1: of the nurses that the operation had gone badly. When

762
00:54:38,880 --> 00:54:41,799
Speaker 1: she saw mister Phillips lying on his back in a

763
00:54:41,800 --> 00:54:45,560
Speaker 1: white gown with a covering blanket shortly after three pm,

764
00:54:45,880 --> 00:54:50,280
Speaker 1: Hoffman knew instinctively that he was highly unlikely to survive.

765
00:54:51,760 --> 00:54:55,960
Speaker 1: Dr Allison MacCready, the anesthetist who had been in theatre

766
00:54:56,080 --> 00:55:00,040
Speaker 1: with Patel, told Hoffman something as they checked the ventilating

767
00:55:00,080 --> 00:55:04,480
Speaker 1: equipment to ensure it was inflating the man's lungs. It

768
00:55:04,640 --> 00:55:09,480
Speaker 1: is an expensive way to die. Dr McCready said. At

769
00:55:09,520 --> 00:55:13,480
Speaker 1: this early stage, Nurse Tony Hoffman knew little about the

770
00:55:13,520 --> 00:55:17,680
Speaker 1: brash director of surgery. Tony had been on holidays when

771
00:55:17,719 --> 00:55:20,160
Speaker 1: he toured the hospital and met the key staff on

772
00:55:20,239 --> 00:55:25,840
Speaker 1: his first working day, one April, already seven weeks into

773
00:55:25,920 --> 00:55:28,520
Speaker 1: his contract, there was gossip on the wards about his

774
00:55:28,680 --> 00:55:34,520
Speaker 1: flirtatious behavior with younger nurses. Tony Hoffman was broad minded.

775
00:55:35,480 --> 00:55:39,359
Speaker 1: After nursing for more than twenty years in hospitals in Australia,

776
00:55:39,640 --> 00:55:43,520
Speaker 1: Saudi Arabia and London, she was no longer surprised by

777
00:55:43,520 --> 00:55:47,160
Speaker 1: the delusions of some doctors who assumed they were God's

778
00:55:47,200 --> 00:55:51,040
Speaker 1: gift to the nurses, or perhaps that the nurses were

779
00:55:51,080 --> 00:55:55,759
Speaker 1: God's gift to them. She also knew from experience in

780
00:55:55,920 --> 00:56:01,080
Speaker 1: much larger hospitals that a soophagectomies challenged everyone, the patient,

781
00:56:01,480 --> 00:56:06,640
Speaker 1: the surgical team, and ICU staff. She wondered why such

782
00:56:06,680 --> 00:56:11,720
Speaker 1: an ill patient had been subjected to the operation. Hoffman

783
00:56:11,960 --> 00:56:16,160
Speaker 1: was in good company. Doctor Peter Meak, the person most

784
00:56:16,200 --> 00:56:21,880
Speaker 1: familiar with the multiple health problems plaguing Phillips, agreed. Meak's

785
00:56:21,880 --> 00:56:23,600
Speaker 1: position was unequivocal.

786
00:56:24,400 --> 00:56:26,520
Speaker 10: I do not believe that this man should have ever

787
00:56:26,560 --> 00:56:29,759
Speaker 10: gone to theater. There was no urgency about it. There

788
00:56:29,800 --> 00:56:32,799
Speaker 10: was no immediate acute problem in this man. There was

789
00:56:32,840 --> 00:56:35,640
Speaker 10: the major problem with his cancer of the esophagus, but

790
00:56:35,719 --> 00:56:38,560
Speaker 10: there was nothing acute that demanded that he be operated

791
00:56:38,600 --> 00:56:41,080
Speaker 10: on straightway as.

792
00:56:40,920 --> 00:56:44,640
Speaker 1: Tony Hoffman watched the monitors. She questioned why Petel had

793
00:56:44,680 --> 00:56:48,280
Speaker 1: been allowed to attempt it and why he had risked

794
00:56:48,280 --> 00:56:52,440
Speaker 1: it with a patient as weak as Phillips. The nurses

795
00:56:52,480 --> 00:56:56,280
Speaker 1: from the renal unit were distressed. Their bond with Phillips

796
00:56:56,320 --> 00:56:59,839
Speaker 1: included his mum, who waited anxiously in the ICU real

797
00:57:00,440 --> 00:57:05,480
Speaker 1: room and the downstairs cafeteria for any news. When the

798
00:57:05,560 --> 00:57:09,719
Speaker 1: nurses told her that Phillips's condition was very poor, his

799
00:57:09,880 --> 00:57:14,280
Speaker 1: mother went to see Pateel. Up to that point, doctor

800
00:57:14,280 --> 00:57:19,240
Speaker 1: Pateell had been telling her the exact opposite. Furious at

801
00:57:19,280 --> 00:57:23,680
Speaker 1: being questioned, Doctor Petell stormed into the ICU to confront

802
00:57:23,720 --> 00:57:27,440
Speaker 1: Tony Hoffman, and he let rip with a furious tirade.

803
00:57:27,960 --> 00:57:30,840
Speaker 2: It's embarrassing for this to happen. You should have notified

804
00:57:30,880 --> 00:57:32,720
Speaker 2: me first about the beatn's condition getting worse.

805
00:57:34,200 --> 00:57:39,040
Speaker 1: She found the criticisms confusing. Phillips was at death's door.

806
00:57:39,440 --> 00:57:42,640
Speaker 1: That much had been obvious before he went to the ICU.

807
00:57:43,920 --> 00:57:48,760
Speaker 1: His perilous condition had not changed. Drugs were keeping him alive,

808
00:57:49,640 --> 00:57:52,800
Speaker 1: yet Dr Bittell insisted that he was doing fine.

809
00:57:53,840 --> 00:57:56,640
Speaker 11: The patient was not stable and we're not going to

810
00:57:56,680 --> 00:57:59,560
Speaker 11: lie to the relatives. I don't see how you can

811
00:57:59,600 --> 00:58:00,760
Speaker 11: say is stable.

812
00:58:02,360 --> 00:58:06,280
Speaker 1: Patel took his complaint up with doctor Darren Keating, who

813
00:58:06,320 --> 00:58:09,240
Speaker 1: had arrived to be the new director of medical services

814
00:58:09,280 --> 00:58:15,240
Speaker 1: a fortnight after Patel started. After Hoffman and the Director

815
00:58:15,280 --> 00:58:19,480
Speaker 1: of Nursing, Glennys Goodman, met Keating to talk about the problems,

816
00:58:19,960 --> 00:58:24,120
Speaker 1: he tried to mediate the conflict. Doctor Keating suggested to

817
00:58:24,200 --> 00:58:27,320
Speaker 1: nurse Hoffman that she sit down with doctor Patel to

818
00:58:27,400 --> 00:58:31,360
Speaker 1: explain the ICUs constraints and the need to work together

819
00:58:31,520 --> 00:58:35,560
Speaker 1: as a team. Hoffman wondered at the time why it

820
00:58:35,640 --> 00:58:38,960
Speaker 1: was up to her to explain such fundamental issues to

821
00:58:39,040 --> 00:58:43,880
Speaker 1: the hospital's most senior practicing clinician. Surely this was a

822
00:58:43,960 --> 00:58:49,960
Speaker 1: task for doctor Keating. Soon afterwards, Hoffman and Patel spoke

823
00:58:50,040 --> 00:58:53,760
Speaker 1: in her office about the dispute. She tried to explain

824
00:58:53,840 --> 00:58:58,040
Speaker 1: the staffing and equipment limitations of Bunderberg's intensive care unit.

825
00:58:59,120 --> 00:59:02,800
Speaker 11: We can't keepation for more than forty eight hours. The

826
00:59:02,840 --> 00:59:07,880
Speaker 11: patients need to be transferred to the larger hospitals in Brisbane.

827
00:59:08,080 --> 00:59:11,680
Speaker 1: Dr Patell bridled at the idea of losing his patients

828
00:59:11,720 --> 00:59:14,600
Speaker 1: to a larger hospital where they would come under the

829
00:59:14,640 --> 00:59:16,400
Speaker 1: care of specialists.

830
00:59:16,920 --> 00:59:19,840
Speaker 2: I refused to practice medicine like this, I would refuse

831
00:59:19,840 --> 00:59:21,080
Speaker 2: to transform my patern'shud.

832
00:59:22,200 --> 00:59:26,800
Speaker 1: He refused to speak to Hoffmann again. James Edward Phillips

833
00:59:26,840 --> 00:59:30,200
Speaker 1: passed away at ten fifteen pm on twenty one May

834
00:59:30,440 --> 00:59:33,320
Speaker 1: two thousand and three in his bed at the intensive

835
00:59:33,360 --> 00:59:39,600
Speaker 1: care unit. He had never regained consciousness. Patel had tackled

836
00:59:39,680 --> 00:59:44,200
Speaker 1: a challenging trouble prone a sophagectomy which other surgeons would

837
00:59:44,280 --> 00:59:48,880
Speaker 1: not have contemplated. It should have been no surprise to

838
00:59:49,080 --> 01:00:00,280
Speaker 1: Dr Pateell when James Phillips succumbed. Seek to Dare is

839
01:00:00,320 --> 01:00:04,840
Speaker 1: written and presented by me Headley Thomas, the Australian's National

840
01:00:04,960 --> 01:00:11,240
Speaker 1: Chief correspondent. Claire Harvey is The Australian's editorial director. Audio editing,

841
01:00:11,480 --> 01:00:15,520
Speaker 1: production and music have been done by Jasper Leik, with

842
01:00:15,640 --> 01:00:20,760
Speaker 1: assistance from Leah Sammaglu and Neil Sutherland. Our producer is

843
01:00:20,840 --> 01:00:27,440
Speaker 1: Kristin Amias. Production management by Stephanie Coombs. Artwork by Sean Callanan,

844
01:00:28,400 --> 01:00:33,400
Speaker 1: thanks to Ryan Osland, Matthew Condon, Kaarina Berger, Ellie Dudley,

845
01:00:33,800 --> 01:00:39,520
Speaker 1: David Murray, Dominique McDermott, Zach Sculander and all our family,

846
01:00:39,680 --> 01:00:43,880
Speaker 1: friends and colleagues who helped in this series and contributed

847
01:00:44,000 --> 01:00:49,520
Speaker 1: voice acting and special thanks to Tony Hoffman and Rob Messenger.

848
01:00:50,240 --> 01:00:54,520
Speaker 1: Subscribers to The Australian Here new episodes of Sick to

849
01:00:54,640 --> 01:00:59,200
Speaker 1: Death first at Sick to Death podcast dot com and

850
01:00:59,480 --> 01:01:05,480
Speaker 1: on our podcasts. You can get exclusive access to photographs, videos,

851
01:01:05,720 --> 01:01:25,880
Speaker 1: timelines and more at the website