Speaker 1: My name is Hedley Thomas. Sick to Death is based
Speaker 1: on my book of the same name, and it's the
Speaker 1: true story of doctor Jayant Patel's lies and manipulation and
Speaker 1: the herculean effort it took to finally stop him. We've
Speaker 1: used voice actors throughout this series, and on occasion the
Speaker 1: real people from the story have read their words for us.
Speaker 1: It is brought to you by Me and the Australian
Speaker 1: Chapter seven the Web December two thousand and two to
Speaker 1: March two thousand and three. Jayant Patel knew little about
Speaker 1: New Zealand, and even less about Kaitaia, a small township
Speaker 1: in the country's far north. Its hospital, a modern twenty
Speaker 1: eight bed public facility, needed a doctor for a relatively
Speaker 1: undemanding position. There would be no surgery. It was a
Speaker 1: massive step down from the senior surgical positions that doctor
Speaker 1: Patel had held in Portland, Oregon until resigning in disgrace
Speaker 1: in two thousand and one. At Kaitaia, the successful candidate
Speaker 1: would be mostly involved in pre and post operative care
Speaker 1: of the patients. On rare occasions, Pateel may have been
Speaker 1: needed in the operating theater, but only to assist a surgeon.
Speaker 1: On ten December two thousand and two, he wrote this.
Speaker 2: This is exactly the position I'm looking for, a responsible
Speaker 2: practice in a small community.
Speaker 1: His enthusiasm was obvious. Although the position involved a move
Speaker 1: to the other side of the world, Patel said he
Speaker 1: would be available to travel in just three weeks.
Speaker 2: He is corgnificain if there is an interest.
Speaker 1: For months, Patel had been searching the Internet looking for work.
Speaker 1: He was bored. He had been humiliated in the Oregon
Speaker 1: medical community. He needed to go somewhere foreign, a country,
Speaker 1: and a hospital where he would be welcomed and pampered,
Speaker 1: where the doctors and nurses had no knowledge of his past.
Speaker 1: He had registered with an Australian medical recruitment company, Wavelength Consulting,
Speaker 1: which pledged in its mission statement.
Speaker 3: We will always provide our clients with first class candidates,
Speaker 3: our candidates with first class opportunities, and both with unbeatable service.
Speaker 3: We will do so ethically and with the best interests
Speaker 3: of the candidate, client and wider community in mind.
Speaker 1: Its website was busy with job descriptions and easy to navigate.
Speaker 1: Its staff responded promptly to his emails and queries. The company,
Speaker 1: which had a paid up capital of two dollars. Was
Speaker 1: owned by doctor John Bethel and Claire Ponsford in Sydney.
Speaker 1: They headhunted overseas health professionals and matched them with vacancies
Speaker 1: in hospitals and private clinics throughout Australia and New Zealand.
Speaker 1: The company earned a commission from each placement. A chronic
Speaker 1: shortage of doctors and the constant bidding up of salaries
Speaker 1: by increasingly desperate employers had created a lucrative market. Doctor
Speaker 1: Bethel found that he could make more money from his
Speaker 1: internet based business than he could earn by practicing medicine,
Speaker 1: but the hospital at Katya in New Zealand would have
Speaker 1: to make do without doctor Patel. He was flattered when
Speaker 1: a Wavelength staff member told him he would be too
Speaker 1: senior for this post. Instead, doctor Bethel had something else
Speaker 1: up his sleeve. A position as the senior medical officer
Speaker 1: at the Bunderberg Base Hospital had become available. Patel was
Speaker 1: again brimming with enthusiasm. He spoke to Bethel on the
Speaker 1: telephone and followed up in writing.
Speaker 2: I had good training and experience with a majority aspect
Speaker 2: of general and pediatric surgery, including laparoscopic procedures drama surgery,
Speaker 2: including vascular emergencies. I have excellent surgical experience and I'm
Speaker 2: very comfortable with the responsibility. I'm getting a few offers
Speaker 2: within the US, However, my first priority is overseas work.
Speaker 1: Patel explained that he was near retirement and financially secure,
Speaker 1: with a daughter in medical school and his wife KISHOREI,
Speaker 1: still practicing as a doctor. He told Bethel that he
Speaker 1: wanted an altogether different work and life experience. He wanted
Speaker 1: an adventure. Bethel liked what he heard. Doctor Patel had
Speaker 1: held a position as a staff surgeon with the same
Speaker 1: major w organization in Oregon for twelve years, and he
Speaker 1: had headed a surgery residency program which involved teaching and
Speaker 1: mentoring junior surgeons. A number of articles he wrote jointly
Speaker 1: with other surgeons had been published in journals, and unlike
Speaker 1: some of the doctors who promoted their skills through the website,
Speaker 1: Dr Patel was not overly demanding. Doctor Bethel briefed doctor
Speaker 1: keyes ndem Thunderberg Hospitals, acting director of Medical Services about
Speaker 1: doctor Patel.
Speaker 3: He would expect relocation expenses and accommodation, but does not
Speaker 3: need a big house.
Speaker 1: He needs a place to get a good cup of
Speaker 1: coffee in the morning. Patel sent glowing references from three
Speaker 1: of his US referees, doctor Peter Feldman, doctor Bawis Singh,
Speaker 1: and doctor Nora Dantas. Each of the references was written
Speaker 1: on Kaiser Permanente letterhead. Here's doctor Feldman.
Speaker 4: I've known doctor Jayant Patel ever since he came to
Speaker 4: work at Kaiser Permanente in Portland, Oregon. I have many
Speaker 4: good things to say about doctor Patel. He has been
Speaker 4: a wonderful colleague over the years and has been a
Speaker 4: very hard worker. In addition to having a very busy
Speaker 4: surgical practice, he was very active on hospital committees and
Speaker 4: in other administrative forums. He is a well above average
Speaker 4: interest in his work and a well above average knowledge
Speaker 4: of surgery.
Speaker 1: He is doctor Singh.
Speaker 5: As a former chief and staff anesthesiologist, I have had
Speaker 5: the opportunity of working with doctor Patel on numerous occasions,
Speaker 5: both in elective and emergency situations. His balanced judgment, surgical
Speaker 5: skills and decisive steps, especially in the management of high
Speaker 5: risk complex procedures, has always been appreciated by US anesthesiologists
Speaker 5: and other members of the Oregon team. Doctor Patel's professional expertise,
Speaker 5: passion and energy for quality patient care, coupled with ethical
Speaker 5: and best practices advocacy, won him the vote of his
Speaker 5: colleagues for a Distinguished Physician award in nineteen ninety five.
Speaker 5: These qualities undoubtedly will be an integral part of doctor J.
Speaker 5: Pettel's professional career, irrespective of the place of his practice.
Speaker 1: And here is doctor Dantas.
Speaker 6: I worked with him closely at our intensive care unit
Speaker 6: and saw him care for the most difficult surgical cases
Speaker 6: at our hospital. I saw the good results. The nursing
Speaker 6: staff had good things to say about his surgical skills,
Speaker 6: his compassionate care, and his relationship with the nursing and
Speaker 6: medical staff. My countless patients that he took care of
Speaker 6: for the last ten years were very satisfied of his
Speaker 6: results and his skills. And I can say categorically that
Speaker 6: no one ever gave me a negative feedback about him,
Speaker 6: which I always get as a primary care physician when
Speaker 6: patients come back to me.
Speaker 1: Patel's other testimonials were also superb. Doctor Edward Arronilo was
Speaker 1: chief of surgery at the Cause of Permanente Groups bez
Speaker 1: Cais a hospital when he hired Patel in nineteen eighty nine.
Speaker 1: According to Aarronilo.
Speaker 5: From the time he started, he dove into the work
Speaker 5: with full vigor. He generally did about one hundred and
Speaker 5: twenty cases of pediatric surgery per year, in addition to
Speaker 5: a full load of general surgery. Doctor Patel had excellent
Speaker 5: results with no serious problems or complications. As far as
Speaker 5: general surgery is concerned. He took on the easy cases
Speaker 5: and more often the more difficult, challenging and risky cases.
Speaker 5: He achieved remarkable results and successes. In so far as
Speaker 5: patients are concerned. They keep coming back to him. They
Speaker 5: trust him, and he delivers the best care he can.
Speaker 1: When doctor Bethel called doctor Feldman and Singh, they both
Speaker 1: continued the praise. Neither mentioned the most relevant chapter in
Speaker 1: their former colleague's career, his record of botchups and discipline reaction.
Speaker 1: Although doctor Feldman gave a cryptic clue when he said
Speaker 1: that Patel sometimes took on complex cases handed to him
Speaker 1: by colleagues and found it hard to say no. Doctor
Speaker 1: Bethel voiced one minor concern. It was that doctor Patel
Speaker 1: had not worked for almost eighteen months. According to his
Speaker 1: curriculum Vitae In a subsequent CV sent by Patel, the
Speaker 1: date on which he claimed to have left Kaiser Permanente
Speaker 1: in Portland had been changed from two thousand and one
Speaker 1: to two thousand and two, but the change went unnoticed.
Speaker 1: On Christmas Eve, doctor Patel received an early present a
Speaker 1: letter of appointment as seen medical officer at Bunderberg Base Hospital.
Speaker 1: He promptly signed and returned the document. His starting date
Speaker 1: was confirmed as one April two thousand and three. Before
Speaker 1: he farewell his wife, Kashoori, his daughter and friends in Oregon,
Speaker 1: there was a pile of paperwork and red tape to
Speaker 1: be dealt with. Patel needed a rubber stamp from the
Speaker 1: Medical Board of Queensland to say he was a properly
Speaker 1: credential doctor. Although the Board had a statutory duty to
Speaker 1: register doctors and protect the public from Charlatan's, its procedures
Speaker 1: were negligently lax. The Board performed no independent checks of
Speaker 1: the references or credentials of incoming doctors. Their fellow physicians
Speaker 1: were above suspicion. In Petel's case, the Board simply required
Speaker 1: a document from the Oregon Board of Medical Examiners certifying
Speaker 1: that he was properly registered and had not been disciplined.
Speaker 1: Patel gave an assurance to Susie Taurs, one of the
Speaker 1: Wavelength staff handling his file, in January, I.
Speaker 2: Will fax you the letter and put the original in
Speaker 2: the men.
Speaker 1: Tours forwarded the documents from doctor Patel to Ainsley McMullan,
Speaker 1: an officer with the Medical Board of Queensland. Neither Tours.
Speaker 1: Normcmullen noticed that the certificate from Oregon hinted at a
Speaker 1: potentially serious problem. In black and white it said standing
Speaker 1: public order on file Sea attached, but there was nothing attached.
Speaker 1: The documents setting out the details of Patel's negligence and
Speaker 1: his disciplinary history had been removed. One of the Medical
Speaker 1: Board forms requires doctors to declare whether their registration overseas
Speaker 1: has been the subject of any condition, suspension, undertaking or cancelation. Patel,
Speaker 1: in his response wrote no. McMullen processed the file, one
Speaker 1: of one hundreds she had handled for the board. Wavelength
Speaker 1: would receive thirteen thousand, nine hundred and twenty four dollars
Speaker 1: for its efforts in recruiting Dr Patel. His travel plans
Speaker 1: were locked in by the administrative staff at Bunderberg Hospital.
Speaker 1: He was scheduled to arrive in Brisbane on a Quantus
Speaker 1: flight on thirty one March, go to a twelve thirty
Speaker 1: pm meeting with a medical Board representative at Forestry House
Speaker 1: in the city, and then head back to the airport
Speaker 1: for a three thirty pm flight to Bunderberg. He wrote
Speaker 1: to the hospital's Lynn McKean, who was taking care of
Speaker 1: his travel and accommodation.
Speaker 2: I'm looking forward to meeting all of you and having
Speaker 2: a very productive year.
Speaker 1: She had booked him into one of the nicer beachside
Speaker 1: apartments in Miller Street, Aagara, a fifteen minute drive from
Speaker 1: the hospital. It offered a superb view of sand, volcanic
Speaker 1: rock and sea.
Speaker 6: We are also looking forward to your arrival and I
Speaker 6: know you will have an enjoyable year.
Speaker 1: Chapter eight, Flashback a Vicious Cycle. It was May nineteen
Speaker 1: ninety three and Jayne Patel, smiling warmly uttered his umpty
Speaker 1: self serving sentence in the twenty minutes that he and
Speaker 1: doctor Sally Eelers had been seated together.
Speaker 2: Congratulations, you've got the job. I make my decisions quickly.
Speaker 1: At twenty nine, and newly separated from her husband, the
Speaker 1: father of her four year old son, Sally Eelers found
Speaker 1: the interview disturbing. She had the job, but already she
Speaker 1: was concerned about the underlying ambitions of her new boss.
Speaker 1: She wanted the position as a second year resident in
Speaker 1: an integrated surgical Residency PROB run by Emmanuel Hospital and
Speaker 1: Health Center and Kaiser Foundation Hospitals in Portland, Oregon. She
Speaker 1: guessed that doctor Patel, the program director, had hired her
Speaker 1: because of her attractive appearance, age, and gender, not because
Speaker 1: of the strength of her impressive curriculum vitae. Driving home,
Speaker 1: doctor Eelers replayed in her mind the clues to Petel's
Speaker 1: less than subtle antics, and she recalled his repeated references
Speaker 1: to his age. He had boasted several times that he
Speaker 1: was only thirty nine. He and his wife, Kshoori, a
Speaker 1: competent physician, had bought a mansion in Beaverton, an expensive
Speaker 1: suburb in northeast Portland, two years earlier for four hundred
Speaker 1: and twenty thousand dollars US. But Patel's partner since medical
Speaker 1: college in India, rarely came up in conversation. His ego
Speaker 1: was colossal. From himself, Patel had little to talk about.
Speaker 1: He stressed how much he had achieved and how clever
Speaker 1: he was. The young surgical residents who looked up to
Speaker 1: Patel had voted him Teacher of the Year in nineteen
Speaker 1: ninety one and nineteen ninety two. He was determined to
Speaker 1: educate Sally Eelers and school her in the intricacies of
Speaker 1: a wonderful subject himself. He boasted how he had embarked
Speaker 1: on an extraordinarily successful journey in surgery and he was, still,
Speaker 1: as he put it, so young. He wanted Elers to
Speaker 1: nod and fawn in obsequious approval and flatter him with
Speaker 1: tributes to his stellar career. Patel, who shamelessly complimented himself,
Speaker 1: had turned a job interview into a flawless self appraisal,
Speaker 1: and doctor Sally Eelers concluded that he wanted her to
Speaker 1: understand something else. Their age difference was trivial. Years. Separating
Speaker 1: the chain smoking and overweight surgeon from his fit understudy
Speaker 1: was no barrier to a relationship outside the operating theater,
Speaker 1: he insisted. But it was another clumsy lie, another hopeless misrepresentation.
Speaker 1: At that time, Patel was not thirty nine. He had
Speaker 1: just turned forty three. It would take another seven years
Speaker 1: for regulators in Portland to ban Patel from a wide
Speaker 1: range of surgery, but the number of patients who were
Speaker 1: dying or suffering in pain due to his negligence was
Speaker 1: growing even before doctor Eelers received her letter of appointment.
Speaker 1: Every time his scalpels slipped and nicked an artery or
Speaker 1: vain or vital organ, Peateel lacerated the quality of life
Speaker 1: of a patient in Oregon. In at least a handful
Speaker 1: of cases, the ones that stood out for the glaring
Speaker 1: ineptitude or because the family's demanded answers. His blade was
Speaker 1: an instrument of death, and some of his colleagues had
Speaker 1: begun to express disquiet. But before Sally Eelers had seen
Speaker 1: him operate or surveyed the dreadful complications in the patients,
Speaker 1: she was busy discouraging his advances. He spoke to her
Speaker 1: in the car park a month after their first meeting.
Speaker 2: You may never get to have drinks with your program
Speaker 2: director again. What do you really need as a boyfriend?
Speaker 1: Sally Eelers replied, well.
Speaker 7: Doctor Patel, I have a boyfriend, and you know that
Speaker 7: you've met him.
Speaker 1: She had been seeing another doctor, a tool Thacka. Patel
Speaker 1: knew about their blossoming relationship because Sally had introduced them
Speaker 1: at an annual resident graduation dinner. Doctor Thacker was ethnic Indian,
Speaker 1: although the similarities with Patel ended there. He had grown
Speaker 1: up in the United States. He had graduated from the
Speaker 1: medical school at University of California, Los Angeles or UCLA,
Speaker 1: and he was a resident at Oregon Health and Science University.
Speaker 1: He was popular, and he was younger. When Patel again
Speaker 1: tried to start a relationship with doctor Elers, she told
Speaker 1: him Thaka was a serious boyfriend. Patel's demeanor changed immediately
Speaker 1: for the worse. Other young female doctors felt uncomfortable around
Speaker 1: doctor Patel. As participants in the immanual residency program, they
Speaker 1: lived in adjoining accommodation. Patel would barge into the women's
Speaker 1: area without knocking, surprising the residents in various states of
Speaker 1: undress after a shower or while changing clothes. He had
Speaker 1: no place being there. For the next three years, Patel
Speaker 1: prevented Elers from performing complex and challenging surgery in educational conferences.
Speaker 1: He was hostile and shouted her down when she offered answers.
Speaker 1: He singled her out for nasty asa words and made
Speaker 1: her feel inferior around the other resident surgeons, those surgeons
Speaker 1: in Patel's good books, those he dominated and groomed for
Speaker 1: his clique. They clamored and competed for his attention, but
Speaker 1: ELA's wanted none of it. She suspected that Patel would
Speaker 1: have been reasonable towards her if it were not for
Speaker 1: Thacker's ethnicity. The handsome, younger ethnic Indian unwittingly highlighted Patel's shortcomings.
Speaker 1: On twelve January nineteen ninety five, Patel sent her a
Speaker 1: formal letter, accusing her of being argumentative, alienating nursing staff,
Speaker 1: manipulating the people around her, resisting constructive criticism, and having
Speaker 1: little insight into her conduct. It was classic self projection.
Speaker 1: ELA's had been highly regarded and received outstanding marks before
Speaker 1: and after her contact with Patel, but he had decided
Speaker 1: to teach her a lesson. His letter to her went
Speaker 1: on to state.
Speaker 2: Your performance in your surgical residency at Emmanuel has remained unsatisfactory.
Speaker 2: This is primarily because of your attitude and behavior. You
Speaker 2: are being perceived as argumentative, disrespectful, dogmatic, and arrogant. Being disrespectful,
Speaker 2: especially to the attending staff, is an unacceptable behavior in
Speaker 2: the surgical residency.
Speaker 1: Program.
Speaker 2: I am blessing you on probation immediately. If you desire,
Speaker 2: we will be very happy to arrange for counseling. Depending
Speaker 2: on the evaluations at the end of your probationary term,
Speaker 2: you will either be removed from probation and allowed to continue,
Speaker 2: or be subject to disciplinary actions, including removal or repeat.
Speaker 1: Patel should have been more worried about his own failures
Speaker 1: in theater. The corridor. Gossip at the best Chise of
Speaker 1: medical center was spreading like a virus, with several doctors
Speaker 1: outside Betel's influence questioning the competence of the staff. Surgeon.
Speaker 1: Patel's knowledge of surgery was good. He was clearly an
Speaker 1: intelligent man, but in many procedures, particularly those involving painstaking
Speaker 1: and tedious work over several hours, his sloppiness was remarkable.
Speaker 1: Some of the doctors had a theory. They believed his
Speaker 1: addiction to smoking was a large part of the problem.
Speaker 1: Craving the nicotine of a cigarette when he should have
Speaker 1: been meticulously maneuvering his scalpel around delicate organs, he would,
Speaker 1: they suggested, lose focus and nerve. He would rush the procedures,
Speaker 1: take shortcuts, leave theater before the job was done and
Speaker 1: stride outside to light up. Sometimes his patients paid with
Speaker 1: their lives or their organs, but still none of his colleagues,
Speaker 1: who harbored these concerns went to the authorities. By late
Speaker 1: nineteen ninety five, a restructuring of the hospital set up
Speaker 1: led to Patel being assigned to work with more experienced
Speaker 1: surgeons for the first time. Until then, he had been
Speaker 1: top of the heap. He thrived on conflict and had
Speaker 1: reinforced perceptions of his aggressive nature by chastising another surgeon
Speaker 1: and questioning his expertise. But now better surgeons were seeing
Speaker 1: his handiwork. Although Jayon Patel had made a lot of
Speaker 1: money for the Kaiser Permanent Group, the legal actions brought
Speaker 1: by the victims of his incompetence were increasingly expensive. Roanila
Speaker 1: T Pei eighteen was suffering abdominal pain and a family
Speaker 1: history of polyposis, a predisposition to colon cancer when she
Speaker 1: went to Sea Patel. As her father and her uncle
Speaker 1: had died at an early age of colon cancer, Ronila
Speaker 1: was at similar risk. Despite knowing the family history, Patel
Speaker 1: ordered the wrong diagnostic test for the young woman. The
Speaker 1: limited scope of the test meant its results were inconclusive,
Speaker 1: and Patel assured Ranila that she was fined. The failure
Speaker 1: to examine her entire colon meant that polyps already present
Speaker 1: went undetected. Her death at twenty of colon cancer devastated
Speaker 1: her young husband, who was left to raise an infant son.
Speaker 1: The only consolation was financial Caizer Permanente settled the case
Speaker 1: for US one point four million dollars. The hospital group
Speaker 1: also paid out to the family of Leitras Fairchild, who
Speaker 1: died two months after Patel removed part of her stomach.
Speaker 1: The surgical wound collapsed in a hideous mess, leading to
Speaker 1: serious complications and death. Kaiser settled this one for US
Speaker 1: three hundred and seventy five thousand dollars. Throughout nineteen nine five,
Speaker 1: there were more deaths, injuries, and payouts, and a trio
Speaker 1: of shocking cases. Gerald Tucker, who bled to death that
Speaker 1: cost US nine hundred thousand dollars. Helen Brooks, whose eureta
Speaker 1: was accidentally cut. That was a confidential settlement, and another
Speaker 1: confidential settlement in relation to Susan Tomblin, whose femeral vein
Speaker 1: was cut. One of the younger surgeons tasked with assisting Patel.
Speaker 1: Doctor Sanjeev Sharma would later tell Susan Goldsmith, a senior
Speaker 1: investigative journalist at the Oregonian newspaper, of his efforts in
Speaker 1: the operating room to help Helen Brooks. He tried alerting
Speaker 1: Patel to his mistake.
Speaker 2: I tried very hard to get him to realize there
Speaker 2: was a problem.
Speaker 1: After the surgery, I spoke up about missus Brooks to
Speaker 1: Patel and he said, it's okay. It's okay. Susan Tombland
Speaker 1: discovered and how she had been unnecessarily injured when a
Speaker 1: nurse told her that the operation went terribly wrong.
Speaker 8: When I saw another doctor, he said, I was a
Speaker 8: walking time bomb from this. They said, this could kill
Speaker 8: you if a piece of this blood clock gets loose.
Speaker 8: When I mentioned that to doctor Patel, he screamed at
Speaker 8: me like I was a two year old Tommy. I
Speaker 8: wasn't to talk to anybody about what happened.
Speaker 1: The hospital's managers and lawyers elected to keep the litigation
Speaker 1: and the payouts a secret from Oregon's regulatory body, the
Speaker 1: Board of Medical Examiners. In mid nineteen ninety six, in
Speaker 1: the months after the closure of the Best Caiser Medical Center,
Speaker 1: doctor Sally Eelers went to a weekly meeting of doctors
Speaker 1: at another hospital, Providence, Saint Vincent, to compare notes on
Speaker 1: problem surgeries. That's where Sally Elers disclosed the case of
Speaker 1: Dwayne Feken, whose large intestine was removed by Patel. It
Speaker 1: was the wrong decision. Facin suffered a string of serious
Speaker 1: complications and needed several operations over a few years to
Speaker 1: rectify the damage. His wounds had also fallen apart. His
Speaker 1: poor outcomes mortified Sally EELA's. At the age of fourteen,
Speaker 1: she had been diagnosed with Hodgkin's disease. She was a
Speaker 1: cancer survivor, and doctors had told her incorrectly at eighteen
Speaker 1: that she was infertile. Her experiences gave her a unique
Speaker 1: understanding of the mental and physical pain suffered by patience.
Speaker 1: She knew that Patel, her former teacher, was dishonest and
Speaker 1: a predator, but she could not figure out why he
Speaker 1: had rushed Faicin into having the original operation. Duayne Facin
Speaker 1: had not been afflicted with alterative colitis. The young man
Speaker 1: suffered Crohn's disease, a fact established from the pathology report.
Speaker 1: It was as if Patel, whose boastfulness was legendary wanted
Speaker 1: to do the most complex procedures for his own benefit.
Speaker 1: A distressed Dodtor Eelers had been to see Patel to
Speaker 1: discuss his invasive operations and the complications that had ruined
Speaker 1: Dwayne Feakin's quality of life.
Speaker 6: She told him, I have seen the patholodiy report and
Speaker 6: it shows CRuMs to these.
Speaker 1: But the senior surgeon shrugged it off.
Speaker 2: Oh, I'm going to doctor the pathologist. I would to
Speaker 2: get that stretent note.
Speaker 1: When doctor Eelers, safely out of Patel's clutches, went to
Speaker 1: the Morbidity and Mortality meeting at Providence Saint Vincent in
Speaker 1: mid nineteen ninety six and described Vecan's clinical history, including
Speaker 1: his most recent major operation weeks earlier and an intra
Speaker 1: abdominal absess. The other surgeons were unusually somber. They had
Speaker 1: been wary of Patel before doctor e iel spoke, but now,
Speaker 1: after hearing about the pointlessness of Facan's misery, they were worried.
Speaker 1: Doctor Roger Alberti, chief of surgery at the Provident Saint
Speaker 1: Vincent Medical Center, found that other surgeons doing the same
Speaker 1: surgery as Patel were having much better outcomes In the
Speaker 1: same year, Patel was threatened with disciplinary action by the
Speaker 1: regulatory authority in Washington State for seeking registration there and
Speaker 1: lying to conceal an earlier chapter in his disciplinary history.
Speaker 1: By late nineteen ninety seven, several other surgeons employed by
Speaker 1: the Chiser Permanente Group were voicing concern when the group's
Speaker 1: chiefs ordered a clinical audit of seventy nine of his operations.
Speaker 1: The findings were worse than they had feared. Several patients
Speaker 1: had bled to death because banes or arteries or organs
Speaker 1: were nicked in surgery, and a worryingly high number of
Speaker 1: patients had suffered dehesents their wounds literally fell apart due
Speaker 1: to negligent technique. In nineteen ninety eight, when the results
Speaker 1: of the clinical audit were in Kaiser Permanente managers filed
Speaker 1: a confidential adverse action report with the US National Practitioner
Speaker 1: Data Bank. The patients Patel had operated on for the
Speaker 1: preceding decade remained unaware of the serious and adverse findings
Speaker 1: regarding his competence. Patel's surgical work in hospitals operated by
Speaker 1: the Kaiser Permanente Group was severely restricted for the first
Speaker 1: time in late June nineteen ninety eight, a new framework
Speaker 1: established uniquely for him.
Speaker 9: Required mandatory second opinions before undertaking all complicated surgical cases,
Speaker 9: chart reviews, proctoring, attendance of surgical meetings.
Speaker 1: In the two years between Sally Eeler's first voicing her
Speaker 1: long held concerns in nineteen ninety six and the conclusion
Speaker 1: of the clinical audit in nineteen ninety eight, at least
Speaker 1: four patients died in circumstances where death should not have occurred.
Speaker 1: Numerous others were unnecessarily injured. After hearing finally about the
Speaker 1: Patel cases, the Oregon Board of Medical Examiners, which registers
Speaker 1: practitioners to work and decides on disciplinary or regulatory action
Speaker 1: where the public may be at risk, held its own investigation.
Speaker 1: On twenty two September nineteen ninety eight. Patel admitted to
Speaker 1: the Board's investigative committee that he had made serious surgical errors.
Speaker 1: Patel agreed to a range of formal restrictions on his surgery,
Speaker 1: and he undertook to obtain second opinions before considering operations
Speaker 1: that were not straightforward. It took two more years for
Speaker 1: the Board's restrictions and the formal findings of gross or
Speaker 1: repeated acts of neguk diligence to become a matter of
Speaker 1: public record. By two thousand and one, as gossip and
Speaker 1: revelations about Patel's negligence went around Oregon's medical community, the
Speaker 1: surgeon had become a public embarrassment to the Kaiser Permanente group.
Speaker 1: His colleagues had presented him with an award in nineteen
Speaker 1: ninety five, naming him Distinguished Physician of the Year, but
Speaker 1: in June two thousand and one he resigned to avoid
Speaker 1: being fired. In the same year, he was also struck
Speaker 1: off the role of practitioners in New York State, having
Speaker 1: also lied to the medical authorities there about his disciplinary history. Patel,
Speaker 1: desperate to return to the operating theater, was being thwarted
Speaker 1: at every turn. He was incompetent when he came to
Speaker 1: Bundenberg in two thousand and three, but his incompetence was
Speaker 1: compounded by another factor. By April two thousand and three,
Speaker 1: he had not picked up a scalpel for several years.
Speaker 1: He was much more deadly than he had ever been
Speaker 1: Chapter nine, A New Career. March to June two thousand
Speaker 1: and three, Jayan Patel was keen to see his new
Speaker 1: workplace after the Quantus flight from Brisbane touched down late
Speaker 1: in the afternoon of thirty one March. Although tired from
Speaker 1: the travel, he was also excited. His charm and effusive
Speaker 1: friendliness rubbed off on doctor keyes Ndem, the acting Director
Speaker 1: of Medical Services, who showed him around the Bunderberg Hospital
Speaker 1: on Borbonk Street. Patel made light of his long journey
Speaker 1: as he cut a sway through the administration officers, shaking
Speaker 1: hands with senior and junior staff. He read the Queensland
Speaker 1: Health Code of Conduct, and he provided a sample of
Speaker 1: his signature for the official Registry. Hours earlier in Brisbane,
Speaker 1: he had been to the offices of the Medical Board
Speaker 1: and met one of its members, doctor John Waller. It
Speaker 1: involved little more than a friendly greeting and a glance
Speaker 1: at the file. Dr Waller, overlooking the clue to the
Speaker 1: discipline reaction in Oregon, ticked yes next to the criterion
Speaker 1: of Certificate of good standing. The next morning, when doctor
Speaker 1: Patel arrived at Bunderberg Hospital for the start of his
Speaker 1: first working day as a Senior Medical Officer or SMO,
Speaker 1: the town was having a collective laugh. It was April
Speaker 1: Fool's Day. Patients nurses and doctors at the hospital amused
Speaker 1: each other with practical jokes and harmless gags. The Bunderberg
Speaker 1: News mail was in on the fund reporting how rail
Speaker 1: lines at Key Street had had suddenly been removed. One
Speaker 1: reader failed to see the funny side after going to
Speaker 1: inspect the public works only to find nothing had changed.
Speaker 1: On that day, Patel was formally endorsed by the Medical Board.
Speaker 1: It granted him registration certificate number one zero three zero
Speaker 1: four five zero, providing authorization.
Speaker 3: To practice as a senior medical officer in surgery at
Speaker 3: Bunderberg Based Hospital or any other public hospital authorized by
Speaker 3: the Medical Superintendent on a temporary basis.
Speaker 1: The dear Doctor Patel, letter sent by the regulator on
Speaker 1: one April states in bold font.
Speaker 3: It is advised that you are not registered as a specialist.
Speaker 1: This meant he had to be supervised. As Patel had
Speaker 1: come to Bunderberg to perform surgery, the Medical Board carelessly
Speaker 1: assumed the hospital already had a Director of Surgery, in
Speaker 1: other words, a highly qualified specialist who had been vetted
Speaker 1: and credentialed by the Royal Australasian College of Surgeons. To
Speaker 1: scrutinize doctor Pateell's work and identify any problems. But there
Speaker 1: was one major hitch. The last director of Surgery, doctor
Speaker 1: Sam Baker, had quit in disgust months earlier. Doctor keyes Ndem,
Speaker 1: over awed by Patel, was embarrassed that a senior American
Speaker 1: surgeon with apparently immaculate qualifications was a mere senior medical
Speaker 1: officer in a regional Queensland hospital. A week later, Dr Nidam,
Speaker 1: temporarily in charge of the hospital where he had done
Speaker 1: his internship a quarter century earlier, made an executive decision
Speaker 1: to promote doctor Pateell to the position of director of surgery.
Speaker 1: Dr Ndham was breaking the rules with his premature move
Speaker 1: to flatter and elevate an untested surgeon. He barely knew.
Speaker 1: It was the worst decision he had made in his
Speaker 1: professional life. In the year he had reluctantly been in
Speaker 1: charge of the hospital, Doctor Nightham felt like a military
Speaker 1: chief who, when he asked for generals, had been given majors.
Speaker 1: Now that he had a bona fide general when all
Speaker 1: he had asked for was a major, Nidam wanted to
Speaker 1: look after him. Nidam had long taken the view that
Speaker 1: people who worked in public health were either missionaries or idiots.
Speaker 1: He put Patel in the former category. He asked a
Speaker 1: question of Georgie Rose, the hospital's human resources manager.
Speaker 7: Are we paying j Pettell a director's allowance? If not,
Speaker 7: could do we do so please? As he is the
Speaker 7: director of surgery.
Speaker 1: When Jenny White, the singer nurse in charge of the
Speaker 1: operating theaters, met Patel, he laughed as he told her
Speaker 1: he had been given the director position. Jenny White was
Speaker 1: surprised nobody had assessed Patel's surgical technique if it was
Speaker 1: anything like his personality, hot and cold, ranging from brash,
Speaker 1: domineering and rafe to charming and obsequious. The staff and
Speaker 1: patients were in for a wild ride. Another American surgeon,
Speaker 1: doctor Jim Gaffield, was due to start at the hospital
Speaker 1: by the end of the month. Nurse White wondered why
Speaker 1: doctor Gaffield had not been considered for the position of
Speaker 1: director of surgery.
Speaker 2: Well, it must be because they got here first.
Speaker 1: In mid April, Bunderberg Hospital greeted doctor Darren Keating as
Speaker 1: the new Director of Medical Services, to occupy on a
Speaker 1: permanent basis the position that keyes n itdem had been
Speaker 1: unhappily filling Patel, already well ensconced, warmed to the reserved
Speaker 1: former Australian Defense Force doctor who arrived with his young
Speaker 1: family from a small regional public hospital in Western Australia.
Speaker 1: Doctor Keating had never managed a hospital. He displayed unusual
Speaker 1: trays for an executive. When staff came to see him
Speaker 1: in his office, he would invariably continue writing whatever letter
Speaker 1: or report he had in front of him. Sometimes he
Speaker 1: would not bother looking up. Doctors and nurses would leave
Speaker 1: his office shaking their head at his manner. Doctor Keating
Speaker 1: chose to remain isolated from most of the staff. He
Speaker 1: was rarely seen in the intensive care unit, the wards,
Speaker 1: or in medical meetings. Doctor Keating was aloof it came
Speaker 1: across as arrogance, but it could have been shyness and
Speaker 1: a lack of confidence. His limited and general clinical experience
Speaker 1: meant he was hopelessly out of his depth around specialists.
Speaker 1: Doctor Martin Strawn, a visiting medical officer, decided that doctor
Speaker 1: Keating preferred to remain bun in his office lest he
Speaker 1: encounter complaints, and keyes Nidam would later conclude.
Speaker 7: If he was standing against the gray wall, you wouldn't
Speaker 7: even know that he was there, but.
Speaker 1: Right from the start, doctor Keating gave undivided attention to
Speaker 1: Jon Patel. If it were not for Patel's remarkable gusto
Speaker 1: and his enthusiasm for surgery, the hospital's waiting lists would lengthen,
Speaker 1: and that would invite even closer scrutiny of Keating's management
Speaker 1: from more senior bureaucrats in Brisbane. Before anyone unnecessarily began
Speaker 1: to die or suffer injury at Bunderberg Hospital, there were
Speaker 1: red flags, warnings that Patel's competence did not equal his confidence.
Speaker 1: He was too eager to operate, too gung ho, his
Speaker 1: judgment was questionable when surgical errors were made. He fought
Speaker 1: to prevent patience being rushed to better equipped hospitals in Brisbane,
Speaker 1: even when their complications were life threatening and beyond the
Speaker 1: capacity of the regional hospital. Patel told management, it always
Speaker 1: looks right if we do the procedures where we also
Speaker 1: are capable of dealing with the complications. It was a
Speaker 1: theme Petel hammered relentlessly at Bunderberg In the beginning. The
Speaker 1: nurses put it down to his US training, but there
Speaker 1: were too many mishaps. There were too many squandered chances
Speaker 1: to improve a patient's prospects. It took a while for
Speaker 1: Patel's other motive in obstructing transfers to dawn on the nurses.
Speaker 1: He opposed the transfers because the damage he had caused
Speaker 1: to the patients could be identified by other surgeons. With
Speaker 1: cancer on the inside upper section of his ear, Peter
Speaker 1: dale Gleesh spoke to Patel in April about having it removed.
Speaker 1: Patel was shown the Boziz and had the added benefit
Speaker 1: of the notes of the family doctor. On twenty May,
Speaker 1: Pattel confidently went to work on the ear, and he
Speaker 1: declared the procedure a success, but he had operated on
Speaker 1: the wrong part of the year.
Speaker 8: Have you ever had your year operated on, let alone
Speaker 8: the wrong place altogether.
Speaker 1: Dal Gleish put the question to Peter Leck, the hospital's manager.
Speaker 1: To say it is painful would been understatement.
Speaker 7: Indeed, the cancer is still there.
Speaker 1: Doctor Darren Keating spoke to Patel, who refused to accept
Speaker 1: that he had removed healthy tissue and overlooked the cancerous part.
Speaker 1: Paul Jones went in for a procedure on his rights grotum,
Speaker 1: known as an epididymectomy. It was to have been performed
Speaker 1: under a general anesthetic. To his great surprise, Jones received
Speaker 1: an entirely different procedure. Instead of examining his private parts,
Speaker 1: Patel performed a gastroscopy. He pushed a scope down Jones's
Speaker 1: throat and esophagust to investigate his stomach. Nurse Jenny White
Speaker 1: witnessed an episode she likened to something out of the
Speaker 1: Mash comedy series. Set in a field hospital during the
Speaker 1: Korean War. There had been a traffic accident about fifteen
Speaker 1: kilometers from the hospital. White received a frantic phone call
Speaker 1: from Patel, who was in a panic.
Speaker 2: I've got to go out to this accident site and
Speaker 2: I am going to need equipment to amputate limbs.
Speaker 1: White was already wary of Patel. What's he going to do,
Speaker 1: she wondered. She collected equipment. He would need a battery
Speaker 1: operated power source, a large plastic container of blades and saws,
Speaker 1: and packs full of swabs and sutures. Shortly afterwards, the
Speaker 1: lift doors opened and she watched Patel rush out with
Speaker 1: two principal house officers, two interns, and two medical students
Speaker 1: in tow all were in their surgical scrubs. Patel was
Speaker 1: still frantic.
Speaker 2: Where's the equipment? Where's the equipment?
Speaker 1: White replied, look, I have it all here in a trolley.
Speaker 1: The entourage swarm back into the lift.
Speaker 3: You're in the wrong lift.
Speaker 1: One lift was programmed to go up and the other
Speaker 1: to go down. Patel was shouting at the staff and
Speaker 1: urging them to hurry, while White was.
Speaker 2: Yelling doctor Patel, Doctor Petel, you're in the wrong lift.
Speaker 1: He ignored the nurse and she watched the doors close.
Speaker 1: The lift went up and then went down, so they
Speaker 1: could pile out and get into the right lift. As
Speaker 1: it turned out, Patel had no role to play in
Speaker 1: the accident. The passengers were freed by ambulance officers without
Speaker 1: the need to cut off limbs. When Jenny White reflected
Speaker 1: on the incident afterwards, she realized that Patel had not
Speaker 1: even notified an anesthetist to provide pain relief for the
Speaker 1: victims should amputation be needed. From the moment he arrived
Speaker 1: in Bunderberg, ptel strove to make himself invaluable to his
Speaker 1: new employer, Queensland Health and the managers of the hospital
Speaker 1: in Burbong Street. Nobody in Australia knew about the blood
Speaker 1: letting in Oregon nor Patel decided did anyone need to know? Instead,
Speaker 1: Patel had discovered something about the Queensland public health care system.
Speaker 1: He planned to turn it to his advantage. By working
Speaker 1: hard and performing as many operations as humanly possible, Patel
Speaker 1: would cut the waiting lists for surgery. The waiting lists
Speaker 1: were pointed to by the media, the politicians and the
Speaker 1: patients as proof of either maladministration or well oiled efficiency.
Speaker 1: By meeting the targets in surgery, Patel would make the
Speaker 1: hospital look good. He would give Peter Leck an opportunity
Speaker 1: to be lauded ra rather than the lambasted by his
Speaker 1: bosses in Brisbane and by the Labour Party's local parliamentarian
Speaker 1: Nita Cunningham. In turn, Patel would make himself the most
Speaker 1: valued clinician in the district. With hard work, he could
Speaker 1: be so prolific the hospital's new director of medical Services
Speaker 1: would come to view him as indispensable. Their success would
Speaker 1: be tied to him. They would come to need him
Speaker 1: more than he needed them. Patel also knew that his
Speaker 1: zeal would be financially attractive to the hospital, because in
Speaker 1: the end, it always came down to money. The formula
Speaker 1: used by Queensland Health to fund the hospitals was deliberately
Speaker 1: structured to reward volume and complexity of operations. The more,
Speaker 1: the merrier, the riskier, the better. The cash flow depended
Speaker 1: on numbers, not outcomes, and when the hospitals did not
Speaker 1: meet the numbers, their funding shrank. By doing more operations
Speaker 1: and more complex operations, Patel would generate rivers of cash
Speaker 1: for the hospital. He would also generate rivers of blood
Speaker 1: from the patients. In the process. Pettel would set out
Speaker 1: to prove he really could perform brilliant surgery. He wanted
Speaker 1: to recredential himself. He looked forward to complex operations such
Speaker 1: as the sophagectomies operations. His United States peers had forbidden
Speaker 1: him from ever trying again. Chapter ten. Life and Death
Speaker 1: April to June two thousand and three. James Edward fil Sallips,
Speaker 1: forty six, signed his life away on ten May two
Speaker 1: thousand and three next to a handwritten asterisk on a
Speaker 1: consent form. It also bore the name and signature of
Speaker 1: the man who escorted him to a premature death on
Speaker 1: the day he signed. Phillips brimmed with optimism and hope.
Speaker 1: He liked the look and confidence of Bunderberg Hospital's new
Speaker 1: Director of Surgery, doctor j Npateel, even if the operation
Speaker 1: being proposed was difficult to pronounce and harder to spell.
Speaker 1: A soophagectomy an operation so complicated and risky it should
Speaker 1: only be attempted at major hospitals by the most adept specialists,
Speaker 1: preferably gastro entrologists. To maintain proficiency, a surgeon had to
Speaker 1: perform a minimum of thirty such operations a year. It
Speaker 1: is an operation needing specialized and well resourced intensive care
Speaker 1: unit backup. There is only one certainty after an esophagectomy,
Speaker 1: the patient will need close monitoring for a long time.
Speaker 1: In a well equipped hospital, the sophagectamies were well beyond
Speaker 1: the limited scope of the operating theater and the adjacent
Speaker 1: ICU on the first floor of the Bunderberg Hospital. The
Speaker 1: operations were also hopelessly outside the expertise of Patel. His
Speaker 1: lamentable skills were at their negligent best when he was
Speaker 1: regularly performing far less complicated operations in hospitals and Portland, Oregon.
Speaker 1: There his recklessness, rough handling, clumsy techniques, and poor judgment
Speaker 1: had cost his employer millions of dollars in confidential settlements
Speaker 1: for wrongful death and wrongful harm. James Phillips knew none
Speaker 1: of these additional risks when he signed on for an
Speaker 1: operation he hoped would cut out a small lesion in
Speaker 1: his esophagus, the tube linking his throat with his stomach.
Speaker 1: The lesion was blocking part of Phillips's esophagus and making
Speaker 1: it difficult for him to swallow food. Under Patel's plan,
Speaker 1: it would be removed. He hoped it would prolong his
Speaker 1: life by several years. The generic consent form required patients
Speaker 1: to acknowledge the following.
Speaker 3: The doctor has explained my medical condition and the proposed procedure.
Speaker 3: I understand the risks of the procedure, including the risks
Speaker 3: that are specific to me and the likely outcomes. The
Speaker 3: doctor has explained my prognosis and the risks of not
Speaker 3: having the procedure. I understand that no guarantee has been
Speaker 3: made that the procedure will improve the condition, and that
Speaker 3: the procedure may make my condition worse. On the basis
Speaker 3: of the above statements, I request to have the procedure.
Speaker 1: On the same form, Patel set out his plan strategy.
Speaker 1: He would make an incision in the abdomen. He would
Speaker 1: also make an incision on either the left side of
Speaker 1: the neck or or the left side of the chest.
Speaker 1: He would slice through the tissue of the upper part
Speaker 1: of the stomach and the lower part of the esophagus.
Speaker 1: It was a difficult maneuver, but what came next was
Speaker 1: even harder. Patel would need literally to pull Phillips's stomach
Speaker 1: up and attempt at connection to whatever was left of
Speaker 1: his esophagus. A fortnight earlier, Phillips, whose serious kidney problems
Speaker 1: requiring constant dialysis made him a regular visitor to the hospital,
Speaker 1: had seen doctor Mark Appleyard for an examination of his esophagus.
Speaker 1: Doctor Appleyard put a flexible viewing tube into Phillips's mouth
Speaker 1: and carefully inserted it all the way to the duodenum,
Speaker 1: the first stage of the small intestine. Appleyard located a nodule,
Speaker 1: which he noted had a concerning appearance. It crumbled easily.
Speaker 1: It also bled easily on touching. Appleyard wrote the following
Speaker 1: in the patient's notes. I am concerned about the esophagial nodule.
Speaker 1: Fortunately for Phillips, he had been in the safe hands
Speaker 1: of doctor Peter Meak, a highly regarded renal specialist in
Speaker 1: charge of the renal unit who was also the director
Speaker 1: of Medicine. Peter Meak had supervised the ongoing dialysis. Phillips
Speaker 1: was a favorite patient of nurses in the renal unit.
Speaker 1: He rarely complained despite his serious kidney issues, the constant dialysis,
Speaker 1: and his poor overall health. The biopsy results after Appleyard's
Speaker 1: examination were discouraging. When the five pieces of pale, tan
Speaker 1: and brownish tissue measuring up to four millimeters were analyzed,
Speaker 1: they showed evidence of invasive adino carcinoma words, a cancer
Speaker 1: in cells lining the walls of his esophagus. Doctor Miak
Speaker 1: had asked Dr Patel for an opinion. The surgeon recommended
Speaker 1: an esophagectomy, but doctor Miak was against it. He believed
Speaker 1: that Phillips was much too frail. Major surgery would be
Speaker 1: extremely dangerous in someone as ill as Phillips. Doctor Meak
Speaker 1: worried the man would die on the operating table. On
Speaker 1: nineteen May, Dr Patel fast tracked Phillips into theater without
Speaker 1: doctor Miak's knowledge. A little after ten am, Dr Petell
Speaker 1: began to make the incisions. He cut and removed the
Speaker 1: disease tissue and pulled up the stomach. Phillips, still under
Speaker 1: a general anesthetic, went downhill fast. His vital signs were
Speaker 1: rapidly deteriorating. For the last forty five minutes of his operation.
Speaker 1: There was no recordable blood pressure to keep him alive
Speaker 1: and his blood circulating. He received massive doses of inner
Speaker 1: tropic drugs to make his heart beat more strongly. Even
Speaker 1: the adrenaline in the drugs was of little benefit. By
Speaker 1: mid afternoon, doctor Patel had put down his instruments and
Speaker 1: Phillips was wheeled into the intensive care unit in an
Speaker 1: extremely unstable condition. His pupils were fixed and dilated, indicating
Speaker 1: brain death. A renal vein used to take blood away
Speaker 1: from the kidney had become blocked. The blockage was almost inevitable.
Speaker 1: The charts for Phillips, who had not been offered and
Speaker 1: asophagectamy by specialists in Brisbane despite their greater expertise, showed
Speaker 1: the artery was functioning at just seventy percent and a
Speaker 1: soophagectamy would almost guarantee thrombosis, and it did. For much
Speaker 1: of the operation. Phillips was in the operating theatre with
Speaker 1: no dialysis access, and a soaring potassium level, a precursor
Speaker 1: to cardiac arrest. While Patel cut, pulled, and stitched, Phillips's
Speaker 1: heart had given up, his brain was starved of oxygen.
Speaker 1: At bed five, near the window of the Intensive care unit,
Speaker 1: its most senior, nurse, Tony Hoffman, ensured that everything possible
Speaker 1: was being done for Phillips. During the wait for his
Speaker 1: arrival at the ICU, she had been told by one
Speaker 1: of the nurses that the operation had gone badly. When
Speaker 1: she saw mister Phillips lying on his back in a
Speaker 1: white gown with a covering blanket shortly after three pm,
Speaker 1: Hoffman knew instinctively that he was highly unlikely to survive.
Speaker 1: Dr Allison MacCready, the anesthetist who had been in theatre
Speaker 1: with Patel, told Hoffman something as they checked the ventilating
Speaker 1: equipment to ensure it was inflating the man's lungs. It
Speaker 1: is an expensive way to die. Dr McCready said. At
Speaker 1: this early stage, Nurse Tony Hoffman knew little about the
Speaker 1: brash director of surgery. Tony had been on holidays when
Speaker 1: he toured the hospital and met the key staff on
Speaker 1: his first working day, one April, already seven weeks into
Speaker 1: his contract, there was gossip on the wards about his
Speaker 1: flirtatious behavior with younger nurses. Tony Hoffman was broad minded.
Speaker 1: After nursing for more than twenty years in hospitals in Australia,
Speaker 1: Saudi Arabia and London, she was no longer surprised by
Speaker 1: the delusions of some doctors who assumed they were God's
Speaker 1: gift to the nurses, or perhaps that the nurses were
Speaker 1: God's gift to them. She also knew from experience in
Speaker 1: much larger hospitals that a soophagectomies challenged everyone, the patient,
Speaker 1: the surgical team, and ICU staff. She wondered why such
Speaker 1: an ill patient had been subjected to the operation. Hoffman
Speaker 1: was in good company. Doctor Peter Meak, the person most
Speaker 1: familiar with the multiple health problems plaguing Phillips, agreed. Meak's
Speaker 1: position was unequivocal.
Speaker 10: I do not believe that this man should have ever
Speaker 10: gone to theater. There was no urgency about it. There
Speaker 10: was no immediate acute problem in this man. There was
Speaker 10: the major problem with his cancer of the esophagus, but
Speaker 10: there was nothing acute that demanded that he be operated
Speaker 10: on straightway as.
Speaker 1: Tony Hoffman watched the monitors. She questioned why Petel had
Speaker 1: been allowed to attempt it and why he had risked
Speaker 1: it with a patient as weak as Phillips. The nurses
Speaker 1: from the renal unit were distressed. Their bond with Phillips
Speaker 1: included his mum, who waited anxiously in the ICU real
Speaker 1: room and the downstairs cafeteria for any news. When the
Speaker 1: nurses told her that Phillips's condition was very poor, his
Speaker 1: mother went to see Pateel. Up to that point, doctor
Speaker 1: Pateell had been telling her the exact opposite. Furious at
Speaker 1: being questioned, Doctor Petell stormed into the ICU to confront
Speaker 1: Tony Hoffman, and he let rip with a furious tirade.
Speaker 2: It's embarrassing for this to happen. You should have notified
Speaker 2: me first about the beatn's condition getting worse.
Speaker 1: She found the criticisms confusing. Phillips was at death's door.
Speaker 1: That much had been obvious before he went to the ICU.
Speaker 1: His perilous condition had not changed. Drugs were keeping him alive,
Speaker 1: yet Dr Bittell insisted that he was doing fine.
Speaker 11: The patient was not stable and we're not going to
Speaker 11: lie to the relatives. I don't see how you can
Speaker 11: say is stable.
Speaker 1: Patel took his complaint up with doctor Darren Keating, who
Speaker 1: had arrived to be the new director of medical services
Speaker 1: a fortnight after Patel started. After Hoffman and the Director
Speaker 1: of Nursing, Glennys Goodman, met Keating to talk about the problems,
Speaker 1: he tried to mediate the conflict. Doctor Keating suggested to
Speaker 1: nurse Hoffman that she sit down with doctor Patel to
Speaker 1: explain the ICUs constraints and the need to work together
Speaker 1: as a team. Hoffman wondered at the time why it
Speaker 1: was up to her to explain such fundamental issues to
Speaker 1: the hospital's most senior practicing clinician. Surely this was a
Speaker 1: task for doctor Keating. Soon afterwards, Hoffman and Patel spoke
Speaker 1: in her office about the dispute. She tried to explain
Speaker 1: the staffing and equipment limitations of Bunderberg's intensive care unit.
Speaker 11: We can't keepation for more than forty eight hours. The
Speaker 11: patients need to be transferred to the larger hospitals in Brisbane.
Speaker 1: Dr Patell bridled at the idea of losing his patients
Speaker 1: to a larger hospital where they would come under the
Speaker 1: care of specialists.
Speaker 2: I refused to practice medicine like this, I would refuse
Speaker 2: to transform my patern'shud.
Speaker 1: He refused to speak to Hoffmann again. James Edward Phillips
Speaker 1: passed away at ten fifteen pm on twenty one May
Speaker 1: two thousand and three in his bed at the intensive
Speaker 1: care unit. He had never regained consciousness. Patel had tackled
Speaker 1: a challenging trouble prone a sophagectomy which other surgeons would
Speaker 1: not have contemplated. It should have been no surprise to
Speaker 1: Dr Pateell when James Phillips succumbed. Seek to Dare is
Speaker 1: written and presented by me Headley Thomas, the Australian's National
Speaker 1: Chief correspondent. Claire Harvey is The Australian's editorial director. Audio editing,
Speaker 1: production and music have been done by Jasper Leik, with
Speaker 1: assistance from Leah Sammaglu and Neil Sutherland. Our producer is
Speaker 1: Kristin Amias. Production management by Stephanie Coombs. Artwork by Sean Callanan,
Speaker 1: thanks to Ryan Osland, Matthew Condon, Kaarina Berger, Ellie Dudley,
Speaker 1: David Murray, Dominique McDermott, Zach Sculander and all our family,
Speaker 1: friends and colleagues who helped in this series and contributed
Speaker 1: voice acting and special thanks to Tony Hoffman and Rob Messenger.
Speaker 1: Subscribers to The Australian Here new episodes of Sick to
Speaker 1: Death first at Sick to Death podcast dot com and
Speaker 1: on our podcasts. You can get exclusive access to photographs, videos,
Speaker 1: timelines and more at the website