1 00:00:04,840 --> 00:00:08,680 Speaker 1: My name is Headley Thomas. Sick to Death is based 2 00:00:08,680 --> 00:00:10,920 Speaker 1: on my book of the same name, and it's the 3 00:00:11,000 --> 00:00:15,480 Speaker 1: true story of doctor Jayant Patel's lies and manipulation and 4 00:00:15,520 --> 00:00:19,400 Speaker 1: the herculean effort it took to finally stop him. We've 5 00:00:19,520 --> 00:00:23,760 Speaker 1: used voice actors throughout this series, and on occasion the 6 00:00:23,800 --> 00:00:27,080 Speaker 1: real people from this story have read their words for us. 7 00:00:28,200 --> 00:00:31,000 Speaker 1: It is brought to you by me and the Australian 8 00:00:38,640 --> 00:00:50,240 Speaker 1: Chapter eleven Memory Lane. One evening in September nineteen eighty one, 9 00:00:50,720 --> 00:00:55,080 Speaker 1: doctor William L. Craver, chief of surgery at the Genesee 10 00:00:55,200 --> 00:00:59,160 Speaker 1: Hospital in upstate New York, received a worrying telephone call. 11 00:01:00,200 --> 00:01:04,400 Speaker 1: He was accustomed to receiving calls outside normal working hours. 12 00:01:05,040 --> 00:01:08,759 Speaker 1: He dealt with trauma patients ripped apart with gunshot wounds, 13 00:01:09,360 --> 00:01:14,759 Speaker 1: patients mutilated in serious car accidents. The call he received 14 00:01:14,840 --> 00:01:19,000 Speaker 1: on this particular evening was from a senior nurse. She 15 00:01:19,160 --> 00:01:23,279 Speaker 1: had an unusual problem involving one of the young doctors 16 00:01:23,959 --> 00:01:28,039 Speaker 1: from his home near Rochester. Dr Crab, who was retired, 17 00:01:28,480 --> 00:01:29,560 Speaker 1: told me what happened. 18 00:01:30,240 --> 00:01:32,520 Speaker 2: She was concerned because she had been called by the 19 00:01:32,520 --> 00:01:35,120 Speaker 2: floor nurse who had been caring for a patient admitted 20 00:01:35,160 --> 00:01:38,440 Speaker 2: that afternoon for an operation the next morning. Doctor Patel 21 00:01:38,560 --> 00:01:40,600 Speaker 2: was one of the surgical residents who rotated through a 22 00:01:40,680 --> 00:01:42,520 Speaker 2: hospital from the University of Rochester. 23 00:01:43,560 --> 00:01:46,399 Speaker 1: The patient had complained to the nurse that she was 24 00:01:46,640 --> 00:01:47,720 Speaker 1: extremely tired. 25 00:01:48,800 --> 00:01:50,520 Speaker 3: I really would like to get to sleep. 26 00:01:50,920 --> 00:01:53,680 Speaker 2: Another house doctor is supposed to examine me first, and 27 00:01:53,720 --> 00:01:54,840 Speaker 2: I wish she would hurry up. 28 00:01:56,040 --> 00:01:58,320 Speaker 1: The nurse looked at the patient's charts. 29 00:01:59,200 --> 00:02:01,480 Speaker 2: She saw that there was a complete write up and 30 00:02:01,560 --> 00:02:04,280 Speaker 2: work up and record of a physical examination by doctor 31 00:02:04,320 --> 00:02:07,160 Speaker 2: Pateell of the patient. But he had never examined her. 32 00:02:07,560 --> 00:02:09,880 Speaker 2: He had not been to her room. He had made 33 00:02:09,919 --> 00:02:12,520 Speaker 2: it all up based on the notes of the attending surgeon. 34 00:02:13,200 --> 00:02:15,720 Speaker 2: I went there and talked to the woman. The charts 35 00:02:15,760 --> 00:02:19,600 Speaker 2: described a complete examination, including an examination of her breasts. 36 00:02:20,400 --> 00:02:23,880 Speaker 1: Craver has a vivid memory of questioning the woman about 37 00:02:23,919 --> 00:02:29,240 Speaker 1: these examinations and her answers. A nurse herself, the patient 38 00:02:29,480 --> 00:02:33,680 Speaker 1: was adamant. She told him, I know when my breasts 39 00:02:33,680 --> 00:02:34,600 Speaker 1: have been examined. 40 00:02:35,400 --> 00:02:37,280 Speaker 2: I called doctor Pittell to my office to talk to 41 00:02:37,360 --> 00:02:40,360 Speaker 2: him about it. He denied doing anything wrong. He was 42 00:02:40,440 --> 00:02:42,960 Speaker 2: upset that anyone would question his judgments. 43 00:02:43,639 --> 00:02:47,679 Speaker 1: When Dr Craber talked to surgeons and supervisors in other 44 00:02:47,760 --> 00:02:52,440 Speaker 1: hospitals affiliated with the University of Rochester. He discovered that 45 00:02:52,520 --> 00:02:56,120 Speaker 1: doctor Pateell had been the subject of several similar complaints. 46 00:02:56,800 --> 00:03:01,600 Speaker 1: Dr Craver decided that Patel was untrustworth worthy, a bad apple. 47 00:03:02,120 --> 00:03:06,160 Speaker 1: He did not want him having any contact with the patients. 48 00:03:06,560 --> 00:03:10,800 Speaker 1: He recommended that Patel be fired from the program. The 49 00:03:10,840 --> 00:03:13,040 Speaker 1: president of the university agreed. 50 00:03:13,919 --> 00:03:15,560 Speaker 2: I was calling it the way it should be called 51 00:03:16,080 --> 00:03:19,040 Speaker 2: in surgery. He was supposed to be honest and trustworthy 52 00:03:19,120 --> 00:03:23,120 Speaker 2: with total integrity. He showed total lack of integrity. Doctor 53 00:03:23,120 --> 00:03:25,239 Speaker 2: Petell had been working at our hospital for a couple 54 00:03:25,320 --> 00:03:28,000 Speaker 2: of months at that point. Until then, he had a 55 00:03:28,000 --> 00:03:31,600 Speaker 2: good reputation. He was considered a good training but the 56 00:03:31,639 --> 00:03:34,639 Speaker 2: evidence against him held up. We were not making it up. 57 00:03:35,120 --> 00:03:37,440 Speaker 2: I had no personal reason to be against doctor Pittell. 58 00:03:39,280 --> 00:03:44,120 Speaker 1: Official files document Patel's difficulties with regulatory authorities in New 59 00:03:44,200 --> 00:03:48,080 Speaker 1: York State between nineteen eighty one and nineteen eighty three, 60 00:03:48,600 --> 00:03:52,800 Speaker 1: two decades before he ventured to Bunderberg in Queensland, Australia. 61 00:03:54,120 --> 00:03:57,720 Speaker 1: The files and the record of discipline reaction are matters 62 00:03:57,720 --> 00:04:00,960 Speaker 1: of public record and they have always been available from 63 00:04:01,000 --> 00:04:04,120 Speaker 1: both the New York State Department of Health and the 64 00:04:04,160 --> 00:04:10,000 Speaker 1: State Board for Professional Medical Conduct. They corroborate the recollections 65 00:04:10,000 --> 00:04:13,520 Speaker 1: of Dr Craver, who had not seen the material since 66 00:04:13,560 --> 00:04:18,279 Speaker 1: the early nineteen eighties. The documents show that the floor 67 00:04:18,440 --> 00:04:22,960 Speaker 1: nurse was Mary Jackson. They show Patel had diligently written 68 00:04:22,960 --> 00:04:28,200 Speaker 1: a history, physical examination, progress notes, and admission orders into 69 00:04:28,200 --> 00:04:32,160 Speaker 1: the medical record of the woman patient. They show that 70 00:04:32,240 --> 00:04:37,719 Speaker 1: she was deeply distressed. Her surgeon, doctor Renee Mengui, recorded 71 00:04:37,760 --> 00:04:42,360 Speaker 1: her comments. On the same day, Patel had made similar 72 00:04:42,520 --> 00:04:45,719 Speaker 1: entries in the medical records of two other women without 73 00:04:45,800 --> 00:04:51,440 Speaker 1: personally having examined either of them. He concocted similar lies 74 00:04:51,480 --> 00:04:55,200 Speaker 1: in the medical records of a further two patients. He 75 00:04:55,320 --> 00:04:59,480 Speaker 1: had concocted the examination records to cover himself while he 76 00:04:59,520 --> 00:05:03,599 Speaker 1: worked as a second job at the nearby Rochester Psychiatric Center, 77 00:05:03,960 --> 00:05:06,560 Speaker 1: when he was rostered to be available to respond to 78 00:05:06,640 --> 00:05:11,240 Speaker 1: emergencies and calls at the Genesee Hospital, a sprawling one 79 00:05:11,360 --> 00:05:17,400 Speaker 1: hundred twenty year old institution on Alexander Street. After realizing 80 00:05:17,520 --> 00:05:21,560 Speaker 1: that both nurse Jackson and the surgeon, doctor Mengui were 81 00:05:21,640 --> 00:05:26,160 Speaker 1: taking the complaints seriously and talking to the patients. Patel 82 00:05:26,320 --> 00:05:30,400 Speaker 1: turned on one of the patients. She broke down crying 83 00:05:30,440 --> 00:05:33,800 Speaker 1: when Patel accused her of trying to ruin his career. 84 00:05:35,080 --> 00:05:38,200 Speaker 1: Patel told the woman her complaint would put his job 85 00:05:38,520 --> 00:05:43,880 Speaker 1: and schooling in jeopardy. A rigorous year long investigation into 86 00:05:43,920 --> 00:05:48,960 Speaker 1: Pateel's antics by the Office of Professional Discipline, the investigative 87 00:05:49,000 --> 00:05:52,719 Speaker 1: body which compiles evidence for the board, produced more than 88 00:05:52,800 --> 00:05:58,400 Speaker 1: thirty statements and exhibits. After the fifth and final day 89 00:05:58,440 --> 00:06:02,480 Speaker 1: of hearings on ten Mays nineteen eighty three in rooms 90 00:06:02,520 --> 00:06:06,719 Speaker 1: at the Holiday Inn at Rochester Airport, the evidence filled 91 00:06:06,760 --> 00:06:12,159 Speaker 1: more than seven hundred pages of transcript. Three medical practitioners 92 00:06:12,520 --> 00:06:18,040 Speaker 1: doctor Mengui, doctor Raymond Seaymoss and Dr Craver, as well 93 00:06:18,080 --> 00:06:22,880 Speaker 1: as two nurses, Mary Jackson and Gary Nelson, and four 94 00:06:22,920 --> 00:06:26,960 Speaker 1: patients testified on behalf of the prosecuting Department of Health. 95 00:06:27,839 --> 00:06:31,960 Speaker 1: Dr Patel, testifying on his own behalf, was supported by 96 00:06:32,000 --> 00:06:37,160 Speaker 1: the character references of four medical practitioners, doctor James Williams, 97 00:06:37,600 --> 00:06:43,599 Speaker 1: doctor Marguerite Dinsky, doctor William Farlow and doctor Raymond Hinshaw 98 00:06:44,960 --> 00:06:48,520 Speaker 1: as four members, three of whom were doctors of the 99 00:06:48,560 --> 00:06:52,480 Speaker 1: hearing committee of the State Board for Professional Medical Conduct 100 00:06:52,600 --> 00:06:57,440 Speaker 1: weighed the evidence they had to determine if Patel's fabrication 101 00:06:57,880 --> 00:07:01,120 Speaker 1: of the history of patients demonstrated what they called a 102 00:07:01,920 --> 00:07:08,359 Speaker 1: moral unfitness to practice medicine. The charges included practicing the 103 00:07:08,400 --> 00:07:13,840 Speaker 1: profession of medicine fraudulently by entering items in various patients' 104 00:07:13,920 --> 00:07:18,240 Speaker 1: medical records without personally examining the patient, as well as 105 00:07:18,320 --> 00:07:23,600 Speaker 1: gross negligence and incompetence. On more than one occasion, there 106 00:07:23,760 --> 00:07:28,120 Speaker 1: was a charge of abandoning or neglecting a patient in 107 00:07:28,240 --> 00:07:34,560 Speaker 1: need of immediate professional care without making reasonable arrangements. Patel 108 00:07:34,640 --> 00:07:40,200 Speaker 1: had also harassed, abused, and intimidated the first patient in 109 00:07:40,280 --> 00:07:43,760 Speaker 1: an effort to coerce her not to cooperate with an 110 00:07:43,760 --> 00:07:49,640 Speaker 1: official hospital investigation. When most of the charges were approved, 111 00:07:49,800 --> 00:07:53,600 Speaker 1: Patel's career hung by a thread. The matters were serious, 112 00:07:53,640 --> 00:07:58,160 Speaker 1: involving gross and repeated acts of deception and grave breaches 113 00:07:58,200 --> 00:08:02,680 Speaker 1: of trust. His conduct was analogous to a lawyer strapped 114 00:08:02,720 --> 00:08:06,640 Speaker 1: for time fabricating a series of statements on behalf of 115 00:08:06,720 --> 00:08:11,880 Speaker 1: five clients, but of course, a fictitious medical examination could 116 00:08:11,880 --> 00:08:17,560 Speaker 1: have much more serious repercussions. The committee's members were influenced 117 00:08:17,600 --> 00:08:22,240 Speaker 1: by the glowing references and laudatory testimony from medical colleagues 118 00:08:22,280 --> 00:08:27,760 Speaker 1: on doctor Patel's side, Betel's lawyer, John Frizell, from a 119 00:08:27,880 --> 00:08:31,880 Speaker 1: law firm in Buffalo, where Patel was then living, emphasized 120 00:08:31,880 --> 00:08:37,040 Speaker 1: his client's talents and abilities. Doctor Williams called him an 121 00:08:37,040 --> 00:08:43,680 Speaker 1: excellent clinician and very thorough, extremely dedicated. In one prescient moment, 122 00:08:44,080 --> 00:08:49,200 Speaker 1: doctor Williams suggested that Petel's ultimate contribution to the medical 123 00:08:49,240 --> 00:08:54,800 Speaker 1: profession will be exceptional. Doctor Dinsky described Patel as one 124 00:08:54,840 --> 00:08:58,120 Speaker 1: of the best resident doctors she had had contact with 125 00:08:58,240 --> 00:09:03,280 Speaker 1: in her capacity as a chief resident. He was, she suggested, 126 00:09:03,840 --> 00:09:06,960 Speaker 1: a person of high integrity who had made a mistake. 127 00:09:07,960 --> 00:09:13,920 Speaker 1: Doctor Hinshaw, equally effusive, described Patel as technically very gifted. 128 00:09:14,520 --> 00:09:17,280 Speaker 1: He rated his skills among the top three of the 129 00:09:17,360 --> 00:09:21,320 Speaker 1: two hundred residents he had worked with, and although doctor 130 00:09:21,360 --> 00:09:25,680 Speaker 1: Mengui was a witness for the prosecuting authority, he had 131 00:09:25,720 --> 00:09:29,120 Speaker 1: written in a twenty July nineteen eighty one letter that 132 00:09:29,120 --> 00:09:33,160 Speaker 1: Patel was by far the best resident who has rotated 133 00:09:33,200 --> 00:09:38,520 Speaker 1: with me. At the end of the hearings, the committee's chairman, 134 00:09:38,600 --> 00:09:44,080 Speaker 1: doctor Paul de Luca, decided not to crush Patel. He 135 00:09:44,240 --> 00:09:49,200 Speaker 1: was censured and reprimanded instead of panelizing him with an 136 00:09:49,280 --> 00:09:53,719 Speaker 1: immediate fine. In July nineteen eighty three, the committee put 137 00:09:53,760 --> 00:09:58,440 Speaker 1: him on probation for three years. If he misbehaved again, 138 00:09:58,600 --> 00:10:03,120 Speaker 1: he would be fined five th thousand dollars. Two months later, 139 00:10:03,480 --> 00:10:07,600 Speaker 1: doctor David Axelrod, Commissioner of Health in the state of 140 00:10:07,640 --> 00:10:10,800 Speaker 1: New York, reviewed the decision and decided that the hearing 141 00:10:10,840 --> 00:10:15,679 Speaker 1: committee had been too lenient. He rejected the committee's findings 142 00:10:15,720 --> 00:10:18,600 Speaker 1: where doctor Pateel was given the benefit of the doubt. 143 00:10:19,800 --> 00:10:22,360 Speaker 1: Doctor Axelrod stated that this way. 144 00:10:23,520 --> 00:10:27,920 Speaker 4: The failure to examine patients prior to surgery evidence is 145 00:10:28,000 --> 00:10:32,199 Speaker 4: a disregard for and indifference to the results that may 146 00:10:32,280 --> 00:10:36,760 Speaker 4: follow such failure, and thus constitutes gross negligence. 147 00:10:38,720 --> 00:10:43,760 Speaker 1: He decided Patel had clearly demonstrated his moral unfitness to 148 00:10:43,840 --> 00:10:49,960 Speaker 1: practice medicine. Patel's wrongdoing, according to doctor Axelrod, was. 149 00:10:50,760 --> 00:10:54,719 Speaker 4: A serious failure and should be punished by more than 150 00:10:54,760 --> 00:10:57,200 Speaker 4: a censure and reprimand. 151 00:10:58,000 --> 00:11:02,080 Speaker 1: The effect of the tougher line was negligible. All it 152 00:11:02,200 --> 00:11:04,960 Speaker 1: meant was that Patel had to pay the five thousand 153 00:11:05,000 --> 00:11:09,080 Speaker 1: dollars fine. He was free to return to work, and 154 00:11:09,240 --> 00:11:13,440 Speaker 1: he had a set of wonderful references from four respected doctors. 155 00:11:14,520 --> 00:11:19,320 Speaker 1: Those doctors and their references would open new doors. Although 156 00:11:19,440 --> 00:11:22,640 Speaker 1: fired from the Genesee Hospital where he had been doing 157 00:11:22,679 --> 00:11:27,000 Speaker 1: his residency program, Patel had a springboard to a new job. 158 00:11:27,080 --> 00:11:31,600 Speaker 1: Working with Hinshaw as his research associate. He entered the 159 00:11:31,640 --> 00:11:35,719 Speaker 1: residency program of the University of Buffalo, where he completed 160 00:11:35,720 --> 00:11:42,200 Speaker 1: his general surgery training In nineteen eighty eight. Doctor Hinshaw 161 00:11:42,320 --> 00:11:46,440 Speaker 1: helped Patel again. Wanting to put his New York troubles 162 00:11:46,559 --> 00:11:50,040 Speaker 1: a long way behind him, doctor Patel applied to work 163 00:11:50,080 --> 00:11:53,600 Speaker 1: for the Kaiser Permanente Healthcare Group on the other side 164 00:11:53,640 --> 00:11:58,920 Speaker 1: of the country in Portland, Oregon. A laudatory letter dated 165 00:11:59,000 --> 00:12:03,320 Speaker 1: twenty nine Novem nineteen eighty eight from doctor Hinshaw, then 166 00:12:03,400 --> 00:12:07,240 Speaker 1: chief of Surgery at Rochester General Hospital, to the Board 167 00:12:07,240 --> 00:12:11,600 Speaker 1: of Medical Examiners in Oregon avoided any reference to these 168 00:12:11,640 --> 00:12:13,480 Speaker 1: serious convictions against Mattel. 169 00:12:14,640 --> 00:12:17,599 Speaker 5: When doctor Patel was a member of our residency program, 170 00:12:17,880 --> 00:12:21,880 Speaker 5: he showed technical and professional brilliance When I operated on 171 00:12:21,920 --> 00:12:24,720 Speaker 5: the chief of one of our specialty sections. The doctor 172 00:12:24,760 --> 00:12:28,440 Speaker 5: requested specifically that he be my assistant that in my 173 00:12:28,600 --> 00:12:29,960 Speaker 5: experience is unique. 174 00:12:31,000 --> 00:12:35,600 Speaker 1: On twenty three January nineteen eighty nine, doctor Hinshaw, whose 175 00:12:35,679 --> 00:12:39,840 Speaker 1: distinguished forty year surgical career at the University of Rochester 176 00:12:39,960 --> 00:12:43,400 Speaker 1: was drawing to a close, received a letter from the Board. 177 00:12:44,679 --> 00:12:50,120 Speaker 1: The board's license administrator, Jan Bagenstross, had discovered something about 178 00:12:50,160 --> 00:12:57,000 Speaker 1: Patel's dismissal from the University of Rochester's residency program. Jan Bagenstross, 179 00:12:57,360 --> 00:13:02,240 Speaker 1: curious about doctor Hinshaw's failure to this important chapter in 180 00:13:02,360 --> 00:13:08,679 Speaker 1: doctor Pittell's career, sought more information. Doctor Hinshaw's reply, on 181 00:13:08,800 --> 00:13:13,680 Speaker 1: three February nineteen eighty nine, four months before his retirement, 182 00:13:14,120 --> 00:13:18,800 Speaker 1: acknowledged the discipline reaction, but insisted that doctor Petell had 183 00:13:18,840 --> 00:13:22,880 Speaker 1: been harshly treated. He maintained that it was a case 184 00:13:22,920 --> 00:13:28,160 Speaker 1: of the unfair harassment of a brilliant young surgeon. Doctor 185 00:13:28,240 --> 00:13:31,640 Speaker 1: Hinshaw's letter to Jan Bagenstrass says. 186 00:13:32,160 --> 00:13:34,520 Speaker 5: When I appeared before the State Health Department in doctor 187 00:13:34,559 --> 00:13:37,680 Speaker 5: Petell's behalf, I was asked if I believe the charges 188 00:13:37,720 --> 00:13:40,960 Speaker 5: against doctor Petel. I gave my reasons why I did 189 00:13:41,000 --> 00:13:43,800 Speaker 5: not believe them. I was asked what I would think 190 00:13:43,840 --> 00:13:46,160 Speaker 5: if I could indeed be shown that doctor Petell had 191 00:13:46,160 --> 00:13:50,600 Speaker 5: written a physical examination without having examined the patient. I 192 00:13:50,679 --> 00:13:53,200 Speaker 5: stated that such behavior on his part would seem so 193 00:13:53,320 --> 00:13:56,000 Speaker 5: bizarre to me from having worked very closely with him, 194 00:13:56,400 --> 00:13:58,880 Speaker 5: that I do my best to find out what circumstances 195 00:13:59,000 --> 00:14:01,040 Speaker 5: caused such an abberation of behavior. 196 00:14:03,440 --> 00:14:08,559 Speaker 1: Doctor Hinshaw died aged sixty nine in nineteen ninety three. 197 00:14:08,760 --> 00:14:12,560 Speaker 1: Dr Craver did not know until years later about the 198 00:14:12,720 --> 00:14:16,920 Speaker 1: misleading letters of support for Pateel. In his job quest, 199 00:14:18,040 --> 00:14:22,600 Speaker 1: Dr Craver believed that Hinshaw's unwavering support of Patel during 200 00:14:22,640 --> 00:14:28,960 Speaker 1: the earlier disciplinary process was inescapably wrong. Dr Hinshaw's stand 201 00:14:29,160 --> 00:14:32,560 Speaker 1: was a source of tension between the two senior surgeons 202 00:14:32,600 --> 00:14:35,960 Speaker 1: for years afterwards. Dr Craver told me. 203 00:14:36,800 --> 00:14:39,000 Speaker 2: I will never understand why, in the face of all 204 00:14:39,080 --> 00:14:42,280 Speaker 2: this evidence, he would have applauded Doctor Pateell. Has made 205 00:14:42,280 --> 00:14:44,920 Speaker 2: me lose some respect for men. Was a very fine surgeon. 206 00:14:54,480 --> 00:15:00,320 Speaker 1: Chapter twelve. A tussle June and July two thousand and three. 207 00:15:02,760 --> 00:15:05,880 Speaker 1: In the days after James Phillips passed away in the 208 00:15:05,920 --> 00:15:11,520 Speaker 1: intensive care unit, Tony Hoffman became increasingly confused she could 209 00:15:11,560 --> 00:15:16,560 Speaker 1: cope with doctor j. Petel's bombastic and patronizing attitude. She 210 00:15:16,640 --> 00:15:20,840 Speaker 1: could tolerate his kiss up and kick down approach to 211 00:15:20,920 --> 00:15:25,600 Speaker 1: management and nursing staff, but she worried about his clinical 212 00:15:25,680 --> 00:15:31,240 Speaker 1: judgment and expertise. Patel had been telling the nurses ad 213 00:15:31,320 --> 00:15:36,240 Speaker 1: nauseum how experienced he was in the United States. One 214 00:15:36,320 --> 00:15:40,000 Speaker 1: day he said he was a gold standard trauma surgeon, 215 00:15:40,440 --> 00:15:44,640 Speaker 1: the next he was a cardiothoracic surgeon. There was a 216 00:15:44,640 --> 00:15:48,760 Speaker 1: different qualification every other day. The nurses joked he had 217 00:15:48,760 --> 00:15:52,360 Speaker 1: been doing complex surgery for twenty five years. The next 218 00:15:52,440 --> 00:15:55,800 Speaker 1: day it was thirty years. Another day it was twenty years. 219 00:15:57,040 --> 00:16:03,400 Speaker 1: Hoffman feared something else in doctor Patel's character megalomania, a 220 00:16:03,480 --> 00:16:08,720 Speaker 1: boldness bordering on recklessness. He seemed to lack insight into 221 00:16:08,760 --> 00:16:13,320 Speaker 1: the risks he created for the patients. Tony Hoffman was 222 00:16:13,400 --> 00:16:16,880 Speaker 1: also wondering about his knowledge of best practiced drugs for 223 00:16:16,920 --> 00:16:22,440 Speaker 1: the patients. He was demanding drugs like dopamine and buttamine 224 00:16:22,480 --> 00:16:26,840 Speaker 1: that had been superseded years earlier when other doctors used 225 00:16:26,920 --> 00:16:31,080 Speaker 1: modern drugs such as adrenaline and nora adrenaline. Petel told 226 00:16:31,120 --> 00:16:35,040 Speaker 1: the nurses to change the medication back to the obsolete drugs. 227 00:16:36,080 --> 00:16:39,200 Speaker 1: He thought so differently to the other doctors and to 228 00:16:39,360 --> 00:16:42,640 Speaker 1: nurse Tony Hoffman that it was as if she confided 229 00:16:42,680 --> 00:16:44,560 Speaker 1: to doctor Darren keating they. 230 00:16:44,400 --> 00:16:46,560 Speaker 3: Were from two different planets. 231 00:16:47,520 --> 00:16:50,360 Speaker 1: Her attempts to call a truce after the death of 232 00:16:50,440 --> 00:16:55,280 Speaker 1: Phillips failed. Dismally, Hoffman knew that doctor Patel now saw 233 00:16:55,360 --> 00:17:01,480 Speaker 1: her as an enemy. He started undermining her authority and credibility, 234 00:17:01,520 --> 00:17:05,280 Speaker 1: criticizing her and the Intensive care Unit. In talks with 235 00:17:05,440 --> 00:17:11,040 Speaker 1: younger doctors and nurses, she realized that the less experienced 236 00:17:11,160 --> 00:17:14,400 Speaker 1: doctors who relied on Patel to advance their own careers 237 00:17:14,480 --> 00:17:18,720 Speaker 1: lacked the knowledge to see his flaws. They would almost 238 00:17:18,800 --> 00:17:23,479 Speaker 1: always back him, but Patel was now dividing the nursing 239 00:17:23,560 --> 00:17:28,520 Speaker 1: staff to grow his support base and isolate her. Having 240 00:17:28,680 --> 00:17:33,680 Speaker 1: seen through Patel's grandiose claims early on, Tony Hoffman had 241 00:17:33,720 --> 00:17:36,840 Speaker 1: also worked out that Patel was not everything he said 242 00:17:36,880 --> 00:17:41,679 Speaker 1: he was. She became a major threat to him. She 243 00:17:41,920 --> 00:17:47,560 Speaker 1: had to be discredited. Patel began denigrating the ICU as 244 00:17:48,080 --> 00:17:51,200 Speaker 1: third world. He made it clear that he did not 245 00:17:51,320 --> 00:17:54,879 Speaker 1: trust Hoffman nor several of the nurses in the unit. 246 00:17:57,200 --> 00:18:00,640 Speaker 1: On three June, he walked into the ICU to announce 247 00:18:00,640 --> 00:18:05,399 Speaker 1: that he would be performing another esophagectomy. The patient this 248 00:18:05,560 --> 00:18:10,160 Speaker 1: time would be James Grave, aged sixty three. 249 00:18:10,280 --> 00:18:12,360 Speaker 6: I'd be in the unit for the hul dudes while 250 00:18:12,400 --> 00:18:15,440 Speaker 6: my asophagectamy patient is inher until he leaves the unit. 251 00:18:16,800 --> 00:18:21,840 Speaker 1: Nurse k Boison recoiled as Patel continued running the unit down. 252 00:18:22,480 --> 00:18:24,639 Speaker 1: He made it known that he needed to be in 253 00:18:24,720 --> 00:18:27,639 Speaker 1: the ICU for the two days because he thought so 254 00:18:27,800 --> 00:18:32,919 Speaker 1: little of Hoffman's professionalism. Doctor Patel knew that Tony Hoffman 255 00:18:33,040 --> 00:18:36,240 Speaker 1: had voice concerns about the death of James Phillips to 256 00:18:36,320 --> 00:18:40,320 Speaker 1: doctor Keating and to the Director of Nursing, Glennis Goodman. 257 00:18:41,920 --> 00:18:45,840 Speaker 1: The sixth June operation on Grave led to a string 258 00:18:45,920 --> 00:18:51,920 Speaker 1: of complications. Patel had paralyzed Grave's vocal cord, which made 259 00:18:51,920 --> 00:18:55,080 Speaker 1: it difficult for him to clear his airway and breathe. 260 00:18:56,240 --> 00:19:00,720 Speaker 1: In the days afterwards, his wound fell apart twice. The 261 00:19:00,840 --> 00:19:05,840 Speaker 1: nurses rarely saw these instances of wound collapse or dehesiance, 262 00:19:06,280 --> 00:19:10,640 Speaker 1: meaning to gape, but with Patel it was becoming common. 263 00:19:12,040 --> 00:19:17,159 Speaker 1: There was also leakage where Patel had clumsily rejoined Grave's gut. 264 00:19:18,320 --> 00:19:22,439 Speaker 1: Increasingly weak, the patient was wheeled in for three further 265 00:19:22,520 --> 00:19:28,639 Speaker 1: operations by Patel on twelve sixteen and eighteen June. While 266 00:19:28,720 --> 00:19:33,480 Speaker 1: the anesthetist, doctor John Joyner, and the junior doctor James 267 00:19:33,520 --> 00:19:36,680 Speaker 1: Boyd tried to arrange a bed for him in Brisbane, 268 00:19:37,119 --> 00:19:42,959 Speaker 1: Patel stubbornly resisted the transfer. The perilous condition of Grave 269 00:19:43,160 --> 00:19:46,800 Speaker 1: was obvious as he was moved between the ICU, the 270 00:19:46,840 --> 00:19:52,440 Speaker 1: surgical ward and the operating theater. Hoffmann could not understand 271 00:19:52,520 --> 00:19:56,720 Speaker 1: why he had not been transferred out His life hung 272 00:19:56,760 --> 00:19:59,879 Speaker 1: by a thread, even when there was a bed of 273 00:20:00,000 --> 00:20:04,080 Speaker 1: available in Brisbane. On eighteen June, Patel refused to talk 274 00:20:04,119 --> 00:20:10,000 Speaker 1: to the surgeons in Brisbane, making transfer impossible. An incredulous 275 00:20:10,000 --> 00:20:14,320 Speaker 1: doctor from one of the larger hospitals questioned Hoffman, why 276 00:20:14,359 --> 00:20:17,080 Speaker 1: are you doing these big operations there when you can't 277 00:20:17,080 --> 00:20:21,760 Speaker 1: care for these patients. In her long career, Hoffman had 278 00:20:21,840 --> 00:20:24,960 Speaker 1: never taken on a director of surgery, but she could 279 00:20:25,000 --> 00:20:29,680 Speaker 1: see that Grave would die unless someone intervened. She sent 280 00:20:29,720 --> 00:20:33,480 Speaker 1: a note to Glennis Goodman explaining that doctors at the 281 00:20:33,520 --> 00:20:37,400 Speaker 1: Princess Alexandra Hospital and the Royal Brisbane Hospital. 282 00:20:37,440 --> 00:20:41,840 Speaker 7: Have expressed their concern at why such surgery was done 283 00:20:41,880 --> 00:20:45,959 Speaker 7: here when we don't have an intense first Meanwhile, the 284 00:20:46,040 --> 00:20:49,520 Speaker 7: patient continues to deteriorate and we have no bed to 285 00:20:49,600 --> 00:20:53,280 Speaker 7: transfer him too. I think before any more surgery of 286 00:20:53,320 --> 00:20:56,400 Speaker 7: this type is done here, we really have to examine 287 00:20:56,400 --> 00:20:59,040 Speaker 7: whether we can offer the appropriate follow up care. 288 00:21:00,359 --> 00:21:03,840 Speaker 1: Some twenty four hours later, as Grave languished and Patel 289 00:21:03,920 --> 00:21:07,440 Speaker 1: predicted that he would make a miraculous recovery if left 290 00:21:07,480 --> 00:21:12,439 Speaker 1: in Thunderberg, Tony Hoffman went to Darren Keating. She told 291 00:21:12,520 --> 00:21:16,960 Speaker 1: him of Graves complications and how he needed increasing amounts 292 00:21:16,960 --> 00:21:20,080 Speaker 1: of adrenaline because his condition was so unstable. 293 00:21:20,800 --> 00:21:25,639 Speaker 7: Hoffman told Keating there remains unresolved issues with the behavior 294 00:21:25,680 --> 00:21:28,720 Speaker 7: of the surgeon, which is confusing for the nursing staff. 295 00:21:29,280 --> 00:21:32,960 Speaker 7: I believe we're working outside our scope of practice for 296 00:21:33,000 --> 00:21:37,320 Speaker 7: a level one intensive care unit. The ongoing issues regarding 297 00:21:37,359 --> 00:21:40,959 Speaker 7: the transfer of patients and the designated level of this 298 00:21:41,480 --> 00:21:45,040 Speaker 7: ICU may need to be discussed in more detail at 299 00:21:45,080 --> 00:21:49,040 Speaker 7: a later date. The behavior of the surgeon in the 300 00:21:49,320 --> 00:21:53,280 Speaker 7: ICU also needs to be discussed, as certain very disturbing 301 00:21:53,359 --> 00:21:54,800 Speaker 7: scenarios have occurred. 302 00:21:56,280 --> 00:22:00,800 Speaker 1: Hoffman was perturbed that Patel had not recognized a worrying 303 00:22:00,920 --> 00:22:05,560 Speaker 1: feature in graves condition. He had a kyler thorax, a 304 00:22:05,640 --> 00:22:09,440 Speaker 1: build up of a milky fluid in the intercostal catheter 305 00:22:09,760 --> 00:22:14,000 Speaker 1: in his chest. Doctor Joyner was also worried he had 306 00:22:14,040 --> 00:22:18,680 Speaker 1: found a bed for Grave in Brisbane, but when Patel 307 00:22:18,800 --> 00:22:22,880 Speaker 1: discovered the arrangement, he was furious and immediately threatened to quit. 308 00:22:24,160 --> 00:22:28,119 Speaker 1: He confronted Joyner in the corridor between the ICU and 309 00:22:28,240 --> 00:22:34,560 Speaker 1: theater and abused him. Doctor Joyner regarded Patel as forceful, loud, 310 00:22:34,840 --> 00:22:40,080 Speaker 1: and at times intimidating, but doctor Joyner also felt sure 311 00:22:40,200 --> 00:22:43,280 Speaker 1: of his own position. He had read a recent article 312 00:22:43,320 --> 00:22:47,000 Speaker 1: in the British Journal of Anesthesia warning of high death 313 00:22:47,080 --> 00:22:52,800 Speaker 1: rates for esophagectomy patience in smaller hospitals. When doctor Joyner 314 00:22:52,880 --> 00:22:57,119 Speaker 1: took his concerns to doctor Keating, there were more histrionics. 315 00:22:58,080 --> 00:23:01,320 Speaker 1: Patel had a tantrum and a again threatened to quit. 316 00:23:02,640 --> 00:23:08,760 Speaker 1: Finally he agreed to a compromise. On twenty June, the 317 00:23:08,840 --> 00:23:12,880 Speaker 1: patient Grave went to the Martyr, a leading Brisbane private 318 00:23:12,920 --> 00:23:18,240 Speaker 1: hospital which also receives public patients. Its director of Critical 319 00:23:18,280 --> 00:23:22,760 Speaker 1: Care Services, doctor Peter Cook, was surprised at graves condition 320 00:23:22,960 --> 00:23:27,040 Speaker 1: and shocked that a esophagectomy had been attempted at Bunderberg. 321 00:23:28,400 --> 00:23:32,719 Speaker 1: Dr Cook, an intensive care and anesthesia specialist, talked at 322 00:23:32,800 --> 00:23:36,119 Speaker 1: length about the case to a surgeon colleague who shared 323 00:23:36,119 --> 00:23:41,760 Speaker 1: his concerns. They agreed that Patel's contemplation of such procedures 324 00:23:41,800 --> 00:23:47,280 Speaker 1: in Bunderberg called inter question his competence and judgment. The 325 00:23:47,320 --> 00:23:51,320 Speaker 1: botching of the operation gave them even greater cause for concern. 326 00:23:52,760 --> 00:23:56,719 Speaker 1: There was another worry. The charts for Grave showed the 327 00:23:56,760 --> 00:23:59,960 Speaker 1: cancer had spread to lymph nodes outside his a sophot 328 00:24:00,520 --> 00:24:06,800 Speaker 1: and stomach. A large tumor was outside his bowel. Because 329 00:24:06,840 --> 00:24:10,960 Speaker 1: of the cancers spread, the esophagectamy was not only traumatic 330 00:24:11,359 --> 00:24:17,359 Speaker 1: and potentially lethal, it was also fruitless. Cook felt strongly 331 00:24:17,480 --> 00:24:20,960 Speaker 1: that the doomed man should have been at home, comforted 332 00:24:20,960 --> 00:24:24,760 Speaker 1: by loved ones, instead of in acute pain and distress 333 00:24:25,080 --> 00:24:29,320 Speaker 1: from a failed to soophagectamy, which could only shorten his life. 334 00:24:29,960 --> 00:24:35,000 Speaker 1: On one July, unaware of nurse Hoffman's efforts, he telephoned 335 00:24:35,080 --> 00:24:38,760 Speaker 1: Keating and explained the rocky future for the patient Grave 336 00:24:38,880 --> 00:24:42,919 Speaker 1: and the risks for all patients having esophagectamese in Bunderberg. 337 00:24:44,320 --> 00:24:48,200 Speaker 1: The risks and the issues were identical to those already 338 00:24:48,280 --> 00:24:52,960 Speaker 1: outlined by Tony Hoffman. Keating gave an assurance that he 339 00:24:53,000 --> 00:24:57,879 Speaker 1: would take the matter up with doctor Patel. Cook decided 340 00:24:57,920 --> 00:25:02,679 Speaker 1: to document his concerns he knew about the connection between 341 00:25:02,720 --> 00:25:07,520 Speaker 1: public hospital funding and the frequency of operations. He regarded 342 00:25:07,560 --> 00:25:12,119 Speaker 1: it as an unhealthy policy which rewarded surgical volume instead 343 00:25:12,160 --> 00:25:17,000 Speaker 1: of patient outcomes. It produced a dreadful conflict of interest. 344 00:25:17,840 --> 00:25:21,760 Speaker 1: He questioned if Bunderberg was trying to widen its clinical 345 00:25:21,800 --> 00:25:26,720 Speaker 1: practice to boost its coffers. In a memo, he wrote. 346 00:25:27,320 --> 00:25:30,199 Speaker 2: Clearly, this is not appropriate surgery to be done at 347 00:25:30,240 --> 00:25:33,440 Speaker 2: a center with such a small level of support services, 348 00:25:33,480 --> 00:25:34,920 Speaker 2: particularly ICU. 349 00:25:35,760 --> 00:25:40,040 Speaker 1: But Patel remained determined to carry on. He told the 350 00:25:40,320 --> 00:25:42,560 Speaker 1: ICU staff, you will do. 351 00:25:42,520 --> 00:25:44,840 Speaker 6: What I see, or I won't go to Darren Keating. 352 00:25:45,280 --> 00:25:48,199 Speaker 6: I will go to Peter Lac the executive will do 353 00:25:48,240 --> 00:25:50,200 Speaker 6: what I want them to do, because I'm making them 354 00:25:50,240 --> 00:25:52,679 Speaker 6: so much money. I'll resign if they don't let me 355 00:25:52,760 --> 00:25:53,680 Speaker 6: keep my patience here. 356 00:25:55,160 --> 00:25:58,679 Speaker 1: It was all bluff. Patel had nothing to return to 357 00:25:58,920 --> 00:26:03,600 Speaker 1: in the United States except shame. He had been reminded 358 00:26:03,600 --> 00:26:07,159 Speaker 1: of this in a surprise telephone call from an investigator 359 00:26:07,240 --> 00:26:10,760 Speaker 1: with the Oregon Board of Medical Examiners, who was doing 360 00:26:10,760 --> 00:26:15,760 Speaker 1: a routine license check of discipline doctors. Patel lied. 361 00:26:16,440 --> 00:26:19,879 Speaker 6: He told him, I'm retired and practicing medicine on a 362 00:26:19,960 --> 00:26:21,159 Speaker 6: volunteer basis. Only. 363 00:26:22,359 --> 00:26:26,840 Speaker 1: Keating had doctor Joyner, doctor Cook, and nurse Hoffmann in 364 00:26:26,960 --> 00:26:31,359 Speaker 1: one ear telling him the esophagectamies were dangerous, while the 365 00:26:31,400 --> 00:26:35,000 Speaker 1: forceful doctor Patel was angrily making a fierce case to 366 00:26:35,080 --> 00:26:41,159 Speaker 1: keep his patients in Bunderberg and continue doing esophagectamies. The 367 00:26:41,240 --> 00:26:45,359 Speaker 1: operations were so complex they were generously rewarded in extra 368 00:26:45,480 --> 00:26:50,280 Speaker 1: funds for the hospital, and Keating backed his director of surgery, 369 00:26:50,600 --> 00:26:55,879 Speaker 1: doctor Patel. Nurse Gail Dougherty was also becoming worried about 370 00:26:55,920 --> 00:27:01,359 Speaker 1: Patel's insistence on the complex surgery when she questioned doctor 371 00:27:01,440 --> 00:27:05,600 Speaker 1: Marson Carter, the director of anesthetics who headed the intensive 372 00:27:05,640 --> 00:27:12,000 Speaker 1: care unit, he had no qualms. Carter said, the patients 373 00:27:12,000 --> 00:27:15,120 Speaker 1: are fit for anesthetic, and doctor Patel said he could 374 00:27:15,160 --> 00:27:22,200 Speaker 1: do them, so we can't say no. Meanwhile, Dorothy Bryan 375 00:27:22,520 --> 00:27:28,240 Speaker 1: and Muriel Pancheri had fallen into Patel's hands. On nine June, 376 00:27:28,359 --> 00:27:33,200 Speaker 1: Pateel made a technical error, tearing Brian's bow while attempting 377 00:27:33,280 --> 00:27:38,520 Speaker 1: to repair a hernia. Her feces leaked internally, causing a 378 00:27:38,640 --> 00:27:43,560 Speaker 1: serious contamination and contributing to her death. On thirty June. 379 00:27:44,119 --> 00:27:48,040 Speaker 1: Pancheri was so disorientated she could not recall her date 380 00:27:48,080 --> 00:27:52,760 Speaker 1: of birth. The elderly woman's confusion extended to ignorance about 381 00:27:52,760 --> 00:27:56,680 Speaker 1: the procedure Patel had arranged for her a colonoscopy, which 382 00:27:56,720 --> 00:28:01,960 Speaker 1: involved inserting a scope into her anus. He alarmed one 383 00:28:02,000 --> 00:28:05,720 Speaker 1: of the doctors with his overly vigorous use of the device. 384 00:28:06,520 --> 00:28:09,960 Speaker 1: He appeared to be inexperienced with the procedure and had 385 00:28:10,000 --> 00:28:14,000 Speaker 1: a tendency to push too hard, resulting in severe pain 386 00:28:14,400 --> 00:28:20,080 Speaker 1: and an over inflation of the bow. Pancheri succumbed weeks later. 387 00:28:34,359 --> 00:28:42,200 Speaker 1: Chapter thirteen Wounded Pride. For his first five weeks as 388 00:28:42,200 --> 00:28:46,120 Speaker 1: the director of surgery at Bunderberg's Hospital, j Patel was 389 00:28:46,160 --> 00:28:51,480 Speaker 1: shadowed on patient rounds by Gail Aylmer. The senior nurse, 390 00:28:51,600 --> 00:28:54,960 Speaker 1: noticed an alarming pattern as she walked with Patel from 391 00:28:55,000 --> 00:28:59,560 Speaker 1: bed to bed. The doctor, sometimes with an entourage of 392 00:28:59,680 --> 00:29:05,080 Speaker 1: young trainee doctors, was cheerfully removing bandages, handling different instruments, 393 00:29:05,120 --> 00:29:10,320 Speaker 1: and poking around wet and fresh wound sights. Gail Alma 394 00:29:10,480 --> 00:29:14,160 Speaker 1: had no doubts about his work ethic, but his refusal 395 00:29:14,240 --> 00:29:17,760 Speaker 1: to wash his hands between patients or to wear gloves 396 00:29:17,760 --> 00:29:22,720 Speaker 1: made her blood boil. Despite tactfully prompting him over several 397 00:29:22,800 --> 00:29:28,560 Speaker 1: days to adopt basic hygiene, Alma had achieved nothing. She 398 00:29:28,680 --> 00:29:31,400 Speaker 1: spoke to him as firmly as she dared about the 399 00:29:31,400 --> 00:29:35,840 Speaker 1: critical need for infection control techniques, he still refused to 400 00:29:35,880 --> 00:29:41,080 Speaker 1: wear gloves or scrub the pathogens from his hands. Gail 401 00:29:41,120 --> 00:29:45,320 Speaker 1: Alma cringed every time she saw Patel handling the patients. 402 00:29:45,880 --> 00:29:51,520 Speaker 1: She feared contact could be transferring bacteria and unnecessarily causing infection. 403 00:29:52,360 --> 00:29:56,320 Speaker 1: It was madness. Apart from the risk to the patients, 404 00:29:56,520 --> 00:29:59,880 Speaker 1: she worried that the younger doctors whom Patel influenced, would 405 00:30:00,040 --> 00:30:03,760 Speaker 1: pick up the dangerous habit. Her next strategy was to 406 00:30:03,840 --> 00:30:07,600 Speaker 1: walk around behind him with a box of gloves. Each 407 00:30:07,680 --> 00:30:10,160 Speaker 1: time he stopped at a bed, she removed a new, 408 00:30:10,280 --> 00:30:12,000 Speaker 1: sterile pair of gloves. 409 00:30:13,000 --> 00:30:15,440 Speaker 8: I shouldn't have to be giving you these gloves. I'm 410 00:30:15,480 --> 00:30:19,280 Speaker 8: concerned about your practices with hand washing between patients. 411 00:30:20,480 --> 00:30:23,520 Speaker 1: It worked for a while, but Aylman knew that other 412 00:30:23,600 --> 00:30:27,760 Speaker 1: nurses with less experience or confidence to push Patel would 413 00:30:27,760 --> 00:30:31,600 Speaker 1: have no chance. For the benefit of the other doctors, 414 00:30:31,720 --> 00:30:36,040 Speaker 1: but mostly for the benefit of Betel's patients. Gail Aylmer 415 00:30:36,200 --> 00:30:40,440 Speaker 1: asked Judy O'Connor, the medical education officer, to run a 416 00:30:40,520 --> 00:30:44,600 Speaker 1: lunchtime briefing session on the latest hand washing and infection 417 00:30:44,760 --> 00:30:49,760 Speaker 1: control measures. The idea was to do a glitterbug test. 418 00:30:50,640 --> 00:30:54,160 Speaker 1: It meant putting some fluorescent cream on the doctor's hands, 419 00:30:54,440 --> 00:30:57,120 Speaker 1: rubbing it in, and then asking them to wash their 420 00:30:57,120 --> 00:31:01,840 Speaker 1: hands under an ultraviolet line in a darkened room. The 421 00:31:01,880 --> 00:31:04,800 Speaker 1: parts of the hands that had not been washed thoroughly 422 00:31:04,880 --> 00:31:08,720 Speaker 1: would stand out, but Pateel walked out to make a 423 00:31:08,720 --> 00:31:16,400 Speaker 1: phone call. He did not return. Delicate tissue and organs 424 00:31:16,440 --> 00:31:21,080 Speaker 1: can usually withstand gentle exploration, nudging and prodding in a 425 00:31:21,160 --> 00:31:27,240 Speaker 1: surgical procedure. Some surgeons, like doctor Brian Theel, are renowned 426 00:31:27,280 --> 00:31:30,680 Speaker 1: as much for their soft touch as their technical prowess, 427 00:31:31,560 --> 00:31:36,040 Speaker 1: but doctor Patel had a reputation for neither. He ripped tissue, 428 00:31:36,280 --> 00:31:40,680 Speaker 1: he battered organs when suturing the wounds. He treated fragile 429 00:31:40,720 --> 00:31:46,760 Speaker 1: tissue with disdain. His rough handling inevitably bruised the tissue 430 00:31:46,800 --> 00:31:51,160 Speaker 1: and organs, as well as being fertile beds for infection, 431 00:31:51,640 --> 00:31:55,120 Speaker 1: the wounds were less likely to heal after being harshly treated. 432 00:31:56,320 --> 00:31:59,840 Speaker 1: Stitches would make little difference to a wound which was bruised, 433 00:32:00,080 --> 00:32:05,200 Speaker 1: wet and angry. Inevitably, these wounds would fall apart like 434 00:32:05,240 --> 00:32:10,240 Speaker 1: an old and bruised piece of fruit, known as wound dehesiins. 435 00:32:10,360 --> 00:32:14,120 Speaker 1: It had happened twice to James Grave after his esophagectomy. 436 00:32:15,200 --> 00:32:20,120 Speaker 1: Before doctor Patel's arrival, post surgical injuries in Bunderberg had 437 00:32:20,200 --> 00:32:25,120 Speaker 1: been extremely rare. By early July two thousand and three, 438 00:32:25,840 --> 00:32:30,600 Speaker 1: Gail Alma had encountered almost as many instances of woundhesince 439 00:32:30,640 --> 00:32:33,560 Speaker 1: in the preceding months as she had seen in over 440 00:32:33,640 --> 00:32:38,000 Speaker 1: twenty years of nursing. She suspected that most of the 441 00:32:38,200 --> 00:32:42,440 Speaker 1: abdominal wounds were falling apart due to poor surgical technique 442 00:32:42,560 --> 00:32:46,440 Speaker 1: rather than infection. There was gossip on the wards that 443 00:32:46,480 --> 00:32:49,239 Speaker 1: Patel had told some of the junior doctors not to 444 00:32:49,280 --> 00:32:54,760 Speaker 1: make reference todhesiins in the patient's charts. Gail Alma wanted 445 00:32:54,760 --> 00:32:57,400 Speaker 1: to ensure that the nurses were picking it up, even 446 00:32:57,440 --> 00:33:02,760 Speaker 1: if occurrences were being misrepresented. In an email to senior nurses, 447 00:33:03,280 --> 00:33:04,640 Speaker 1: she wrote. 448 00:33:04,880 --> 00:33:07,800 Speaker 8: I am as I know you are as well, becoming 449 00:33:07,880 --> 00:33:11,280 Speaker 8: increasingly concerned. Read the number of woundhesents that have occurred 450 00:33:11,320 --> 00:33:14,560 Speaker 8: over the last six to eight weeks. While it does 451 00:33:14,600 --> 00:33:17,520 Speaker 8: not appear that the dehesions is relating to infection, this 452 00:33:17,680 --> 00:33:21,440 Speaker 8: needs to be investigated further to identify the causes. Things 453 00:33:21,480 --> 00:33:25,880 Speaker 8: to consider, for example, include how frequently is this occurring, 454 00:33:26,320 --> 00:33:29,600 Speaker 8: what type of surgery is involved, how many days post 455 00:33:29,640 --> 00:33:35,440 Speaker 8: op did the dehesions occur, Who the surgeon, assistant, scrub, nurses, etc. Were, 456 00:33:35,880 --> 00:33:39,520 Speaker 8: what theater did the surgery occur in what ward they 457 00:33:39,560 --> 00:33:40,240 Speaker 8: were nursed on. 458 00:33:42,120 --> 00:33:46,320 Speaker 1: Four days later, Gail Almer compiled a report with patient 459 00:33:46,440 --> 00:33:52,040 Speaker 1: charts on thirteen instances of woundehesins. She included patients such 460 00:33:52,080 --> 00:33:56,520 Speaker 1: as James Grave. She noted the dehesients suffered by John Banks, 461 00:33:56,800 --> 00:34:00,040 Speaker 1: whose bow was visible through the staple line. After a 462 00:34:00,120 --> 00:34:04,160 Speaker 1: diseased part of his colon was cut out, one staple 463 00:34:04,280 --> 00:34:08,040 Speaker 1: had become embedded in his bow. There was the case 464 00:34:08,080 --> 00:34:12,360 Speaker 1: of June Ben whose greater omentum, an apron of tissue 465 00:34:12,400 --> 00:34:17,719 Speaker 1: holding the bow together, was protruding from her wound. Ayelma's 466 00:34:17,760 --> 00:34:21,560 Speaker 1: report went to doctor Darren Keating later that day, she 467 00:34:21,719 --> 00:34:25,279 Speaker 1: had an unexpected visit from Patel. He stood over her 468 00:34:25,320 --> 00:34:29,080 Speaker 1: and explained why most of the thirteen cases required no 469 00:34:29,280 --> 00:34:35,319 Speaker 1: further analysis. He gave a variety of excuses and explanations. 470 00:34:35,960 --> 00:34:38,759 Speaker 6: This is right, this is right, this is all accounted for. 471 00:34:40,160 --> 00:34:44,520 Speaker 1: Patel acknowledged in two cases that technique might have meant 472 00:34:44,560 --> 00:34:48,960 Speaker 1: to blame, although he did not accept personal responsibility. Junior 473 00:34:49,000 --> 00:34:52,440 Speaker 1: doctors who worked alongside him in theater copped the blame. 474 00:34:53,120 --> 00:34:55,000 Speaker 6: If you do a lot of operations, you will have 475 00:34:55,040 --> 00:34:58,800 Speaker 6: an increased likelihood of warndahessins. 476 00:34:58,200 --> 00:35:01,399 Speaker 1: Out of her depth and surprise that Patel, rather than 477 00:35:01,440 --> 00:35:05,000 Speaker 1: doctor Keating, had been to see her. Gail Alma felt 478 00:35:05,080 --> 00:35:07,719 Speaker 1: she had nowhere to turn and no way of being 479 00:35:07,760 --> 00:35:11,960 Speaker 1: sure of her ground. She had expected the issues to 480 00:35:12,000 --> 00:35:16,040 Speaker 1: be resolved by Keating after careful analysis. It was why 481 00:35:16,120 --> 00:35:18,960 Speaker 1: she gave him the report. It was not her place 482 00:35:19,000 --> 00:35:22,719 Speaker 1: to argue with the director of surgery about his clinical skills. 483 00:35:24,040 --> 00:35:27,560 Speaker 1: She was hearing disturbing feedback from others in the hospital. 484 00:35:28,360 --> 00:35:30,680 Speaker 1: Jenny White told her that Patel. 485 00:35:30,920 --> 00:35:34,080 Speaker 9: Did not seem to know his instruments well, using the 486 00:35:34,120 --> 00:35:39,719 Speaker 9: wrong clan for frail tissue, and his technique was rough White. 487 00:35:39,320 --> 00:35:42,160 Speaker 1: Who had witnessed Patel's anger when the issue of wound 488 00:35:42,200 --> 00:35:47,400 Speaker 1: ahesince was raised, was reluctant to document her concerns. Alma 489 00:35:47,480 --> 00:35:51,160 Speaker 1: brought it up with the director of Anesthetics, doctor Martin Carter. 490 00:35:52,160 --> 00:35:56,640 Speaker 1: She asked him whether Patel was a good surgeon. Carter replied, 491 00:35:57,440 --> 00:36:01,279 Speaker 1: I wouldn't let him operate on me. On another occasion, 492 00:36:01,360 --> 00:36:05,040 Speaker 1: when she was in the ICU staff room, Alma heard 493 00:36:05,200 --> 00:36:11,520 Speaker 1: Carter refer to Patel as doctor Death. Meanwhile, Tony Hoffman 494 00:36:11,600 --> 00:36:14,280 Speaker 1: felt that she had been let down by Martin Carter. 495 00:36:14,960 --> 00:36:17,480 Speaker 1: She had wanted him to stand up to Patel in 496 00:36:17,520 --> 00:36:22,480 Speaker 1: the beginning. If Carter had bluntly told Patel, this is 497 00:36:22,520 --> 00:36:26,640 Speaker 1: how this intensive care unit runs, Gail Alma would not 498 00:36:26,680 --> 00:36:29,839 Speaker 1: have been in conflict with anyone. Patel might have got 499 00:36:29,840 --> 00:36:35,680 Speaker 1: the message. Disillusioned by the handling of the woundehesion's report, 500 00:36:36,000 --> 00:36:40,680 Speaker 1: Gail Alma wondered why she bothered escalating such issues. Management 501 00:36:40,719 --> 00:36:44,120 Speaker 1: did not want to hear about problems. She believed that 502 00:36:44,160 --> 00:36:47,879 Speaker 1: the hospital's executives took the view, if you're not going 503 00:36:47,920 --> 00:36:50,400 Speaker 1: to deliver me good news, I don't want to know 504 00:36:50,560 --> 00:36:57,399 Speaker 1: any news. Theater nurse Damian Gaddy's was similarly frustrated. A 505 00:36:57,440 --> 00:37:00,880 Speaker 1: thoughtful and gentle care with a reputation for putting the 506 00:37:00,960 --> 00:37:05,560 Speaker 1: patient's interest first, Gaddi's was shocked at Patel's techniques in 507 00:37:05,680 --> 00:37:11,200 Speaker 1: major operations. When it came to routine surgery procedures such 508 00:37:11,280 --> 00:37:15,799 Speaker 1: as hernia repairs, Gaddy's had few qualms about Patel's proficiency, 509 00:37:16,600 --> 00:37:20,239 Speaker 1: but for more complex operations such as bow resections, it 510 00:37:20,440 --> 00:37:24,320 Speaker 1: was a different story. Gaddies had watched dozens of surgeons 511 00:37:24,360 --> 00:37:28,919 Speaker 1: do the same procedure hundreds of times. When a ball 512 00:37:29,080 --> 00:37:32,360 Speaker 1: is resected or the end of the intestine is cut, 513 00:37:32,680 --> 00:37:36,759 Speaker 1: the surgeon should assume they are contaminated. They should be 514 00:37:36,800 --> 00:37:40,680 Speaker 1: held outside the abdominal cavity or swabbed with aquise el 515 00:37:40,760 --> 00:37:46,239 Speaker 1: bettadine to minimize contamination risks. But Gaddi's had often seen 516 00:37:46,320 --> 00:37:49,400 Speaker 1: Patel leave the end of a bowel freely clammed and 517 00:37:49,480 --> 00:37:53,800 Speaker 1: the other end flopping around inside the abdominal cavity, raising 518 00:37:53,840 --> 00:37:59,879 Speaker 1: the infection risk. Patel had extensive dermatitis, with small sare 519 00:38:00,280 --> 00:38:05,320 Speaker 1: covering his arms. Gaddie's watched Patel's haphazard gowning and gloving 520 00:38:05,400 --> 00:38:12,160 Speaker 1: technique closely and concluded that contamination was often inevitable in 521 00:38:12,239 --> 00:38:15,040 Speaker 1: the past. When Gaddi's had raised an issue about a 522 00:38:15,040 --> 00:38:19,200 Speaker 1: pethidine addicted doctor who was stealing drugs from the hospital's stores, 523 00:38:19,719 --> 00:38:24,279 Speaker 1: a supervisor had threatened Gaddy's with dismissal. He had no 524 00:38:24,400 --> 00:38:27,160 Speaker 1: doubt that if a nurse had been discovered with empty 525 00:38:27,200 --> 00:38:31,239 Speaker 1: ampules of pethidine and classic symptoms of addiction, there would 526 00:38:31,280 --> 00:38:36,520 Speaker 1: have been immediate suspension. Gaddi's resented the double standards. It 527 00:38:36,640 --> 00:38:40,759 Speaker 1: seemed to him that doctors in hospitals were a protected species. 528 00:38:41,360 --> 00:38:44,960 Speaker 1: He raised his concerns about Patel with Jenny White, the 529 00:38:44,960 --> 00:38:46,560 Speaker 1: theater nurse in charge. 530 00:38:47,120 --> 00:38:49,560 Speaker 9: What do you expect me to do? You can't expect 531 00:38:49,600 --> 00:38:51,000 Speaker 9: me to tell a surgeon what to do. 532 00:38:56,080 --> 00:38:59,520 Speaker 1: Patient. Ian Fleming, a father of war and a former 533 00:38:59,520 --> 00:39:02,680 Speaker 1: police officer, had hit it off with doctor Patel when 534 00:39:02,680 --> 00:39:06,600 Speaker 1: they first met in May two thousand and three. Fleming 535 00:39:06,640 --> 00:39:10,760 Speaker 1: put it down to Patel's friendly charm. They also shared 536 00:39:10,840 --> 00:39:14,960 Speaker 1: a love of cricket. When Fleming asked him about India's 537 00:39:15,000 --> 00:39:19,520 Speaker 1: youngest Test wicket keeper, eighteen year old Pathiv Patel, who 538 00:39:19,600 --> 00:39:23,520 Speaker 1: was on the tour of Australia, Patel lit, up, is 539 00:39:23,600 --> 00:39:28,840 Speaker 1: my nephew. The doctor told him Fleming liked his easy manner. 540 00:39:29,080 --> 00:39:31,080 Speaker 1: He did not know that Patel was one of the 541 00:39:31,120 --> 00:39:35,839 Speaker 1: most common surnames in India. For months, Ian Fleming had 542 00:39:35,840 --> 00:39:39,240 Speaker 1: been in pain due to the inflammation of tiny, multiple 543 00:39:39,320 --> 00:39:43,759 Speaker 1: sacks or pockets known as diverticular forming part of his 544 00:39:43,880 --> 00:39:48,440 Speaker 1: large intestine. When an attack came on, he would double 545 00:39:48,560 --> 00:39:52,040 Speaker 1: up in agony. It took three attacks for Fleming to 546 00:39:52,120 --> 00:39:57,320 Speaker 1: decide that surgery would be better than the pain. Patel 547 00:39:57,480 --> 00:40:01,000 Speaker 1: showed Fleming his chart and explained how he would cut 548 00:40:01,040 --> 00:40:06,080 Speaker 1: out the growths. On nineteen May, while Fleming was under 549 00:40:06,160 --> 00:40:09,760 Speaker 1: a general anesthetic, his abdomen was cut from the navel 550 00:40:09,840 --> 00:40:13,880 Speaker 1: to the groin at home. Three days later, his stomach 551 00:40:14,000 --> 00:40:19,920 Speaker 1: swelled and turned a bright, angry red. The pain was excruciating. 552 00:40:20,280 --> 00:40:25,280 Speaker 1: Fleming could not eat, sleep, or walk properly. On twenty 553 00:40:25,280 --> 00:40:28,280 Speaker 1: eight May, when he returned to the hospital for treatment, 554 00:40:28,560 --> 00:40:31,560 Speaker 1: Petel told him it was all in his head and 555 00:40:31,600 --> 00:40:32,799 Speaker 1: that he was acting. 556 00:40:33,800 --> 00:40:36,000 Speaker 6: Go home, give the wife and kids a kiss, and 557 00:40:36,040 --> 00:40:38,200 Speaker 6: have a great life. 558 00:40:38,600 --> 00:40:42,200 Speaker 1: Fleming did as he was told. At nine point thirty 559 00:40:42,200 --> 00:40:44,600 Speaker 1: pm the next night, he was sitting on the sofa 560 00:40:44,680 --> 00:40:47,440 Speaker 1: at home when a hole in his wound blew out 561 00:40:47,800 --> 00:40:51,560 Speaker 1: blood and pass poured from the gaping opening. His wife 562 00:40:51,560 --> 00:40:54,279 Speaker 1: had to use a sanitary napkin to cover it as 563 00:40:54,320 --> 00:40:59,200 Speaker 1: they rushed to the emergency department. Fleming needed further surgery 564 00:40:59,239 --> 00:41:01,640 Speaker 1: to correct the and he was in hospital for a 565 00:41:01,719 --> 00:41:06,239 Speaker 1: week with large doses of antibiotics for the infection. The 566 00:41:06,320 --> 00:41:10,240 Speaker 1: nurses wrote on Fleming's chart that the wound was sucking 567 00:41:10,320 --> 00:41:14,960 Speaker 1: and blowing bubbles. When he next saw Patel, the friendly 568 00:41:15,040 --> 00:41:20,120 Speaker 1: rapport was gone. The surgeons seemed angry about Fleming's complications. 569 00:41:21,080 --> 00:41:24,360 Speaker 1: Fleming believed that the nurses were more concerned than Patel 570 00:41:24,440 --> 00:41:28,960 Speaker 1: about his welfare. They suggested a suction pump to drain 571 00:41:29,160 --> 00:41:33,560 Speaker 1: fluid from his wound site, but Patel angrily refused. He 572 00:41:33,719 --> 00:41:36,560 Speaker 1: was hostile to the nurse's suggestions that a different type 573 00:41:36,600 --> 00:41:40,839 Speaker 1: of bandage be used. Fleming's wound adhesiince was noted by 574 00:41:40,880 --> 00:41:45,280 Speaker 1: the nurses in his charts. In October, when Fleming complained 575 00:41:45,320 --> 00:41:48,800 Speaker 1: to the hospital about Patel's handling of his case, Keating 576 00:41:48,880 --> 00:41:51,480 Speaker 1: rang back and told him. 577 00:41:51,200 --> 00:41:54,399 Speaker 10: Who you've lodged a complaint against Dr Patel. I must 578 00:41:54,480 --> 00:41:57,200 Speaker 10: tell you that he is a fine surgeon with impeccable 579 00:41:57,239 --> 00:41:59,680 Speaker 10: credentials and we are lucky to have him here in 580 00:42:00,960 --> 00:42:04,440 Speaker 10: I understand you are bleeding internally since the operation, but 581 00:42:04,480 --> 00:42:06,760 Speaker 10: this could be caused by many factors. 582 00:42:10,360 --> 00:42:13,920 Speaker 1: Back in the ICU, Hoffman was trying to look after 583 00:42:14,040 --> 00:42:18,360 Speaker 1: a disorientated patient, John Breed, who had been living rough 584 00:42:18,400 --> 00:42:22,440 Speaker 1: in parks around Bunderberg when he reached the hospital in 585 00:42:22,520 --> 00:42:25,799 Speaker 1: early July. He had a bleeding stomach ulcer and was 586 00:42:25,840 --> 00:42:31,520 Speaker 1: in very poor condition. After Patel's operation, Hoffman could see 587 00:42:31,560 --> 00:42:35,520 Speaker 1: that Breed's red and swollen stomach wound was clearly infected. 588 00:42:36,360 --> 00:42:40,360 Speaker 1: He had no bowl sounds, and his condition was steadily worsening. 589 00:42:41,239 --> 00:42:45,840 Speaker 1: Hoffman believed he was showing classic science of postoperative sepsis. 590 00:42:46,239 --> 00:42:49,680 Speaker 1: The infection had spread through his bloodstream to the rest 591 00:42:49,680 --> 00:42:53,759 Speaker 1: of his body. Patel refused to acknowledge that there was 592 00:42:53,920 --> 00:42:57,759 Speaker 1: any sign of stomach infection. He put the problems down 593 00:42:57,840 --> 00:43:01,520 Speaker 1: to a chest infection and a carrents, not uncommon for 594 00:43:01,640 --> 00:43:07,440 Speaker 1: patients on ventilating equipment in an ICU. Hoffman couldn't believe it. 595 00:43:07,880 --> 00:43:11,839 Speaker 1: She didn't know what Patel was talking about. Adamant that 596 00:43:11,880 --> 00:43:15,240 Speaker 1: there was no evidence of any chest infection, she knew 597 00:43:15,239 --> 00:43:18,960 Speaker 1: that Breed should have been receiving intensive care in Brisbane 598 00:43:19,840 --> 00:43:22,600 Speaker 1: for a week. Patel refused to let the man go. 599 00:43:23,800 --> 00:43:29,239 Speaker 1: Hoffman had correctly identified Breed's stomach infection arising from Patel's 600 00:43:29,280 --> 00:43:33,400 Speaker 1: surgery as the problem. She heard nothing back from Patel. 601 00:43:33,840 --> 00:43:38,320 Speaker 1: They were no longer on speaking terms. After the eventual 602 00:43:38,440 --> 00:43:42,160 Speaker 1: transfer of John Breed to Brisbane, the nurses were told 603 00:43:42,280 --> 00:43:47,000 Speaker 1: he had died. They collected his personal effects, clothes, densures, 604 00:43:47,239 --> 00:43:52,360 Speaker 1: and spectacles. The spectacles were added to a collection for 605 00:43:52,440 --> 00:43:57,200 Speaker 1: a worthy cause. Days later, the nurses were relieved to 606 00:43:57,239 --> 00:44:00,680 Speaker 1: discover that he had survived, and for a few hours 607 00:44:00,719 --> 00:44:03,439 Speaker 1: there was a frantic search to recover his only pair 608 00:44:03,480 --> 00:44:13,400 Speaker 1: of spectacles. Chapter fourteen, Sex Lies and Doctor Kureshi, August 609 00:44:13,480 --> 00:44:18,719 Speaker 1: to December two thousand and three. In late August, Annette 610 00:44:18,800 --> 00:44:23,160 Speaker 1: Arrowsmith went to Bunderberg Hospital suffering pain in her left breast. 611 00:44:24,200 --> 00:44:26,520 Speaker 1: She hoped a doctor would put her mind at ease, 612 00:44:27,000 --> 00:44:30,520 Speaker 1: perhaps recommend medication for the pain and some tests to 613 00:44:30,600 --> 00:44:35,319 Speaker 1: exclude cancer. Instead, she was fondled for ninety minutes by 614 00:44:35,360 --> 00:44:39,360 Speaker 1: a swarthy man with a mustache. He played with her breasts, 615 00:44:39,560 --> 00:44:41,879 Speaker 1: and he asked if he could examine the lower part 616 00:44:41,920 --> 00:44:48,080 Speaker 1: of her body. Arrowsmith refused. She suspected doctor Tarik Kureshi, 617 00:44:48,480 --> 00:44:52,480 Speaker 1: an overseas trained doctor from Pakistan, was not interested in 618 00:44:52,600 --> 00:44:58,480 Speaker 1: clinical care. She noticed his pants were wet in just 619 00:44:58,600 --> 00:45:02,080 Speaker 1: two months in starting at the hospital with minimal supervision 620 00:45:02,160 --> 00:45:07,000 Speaker 1: and orientation. Kureshi's complete lack of basic clinical knowledge had 621 00:45:07,080 --> 00:45:11,720 Speaker 1: raised eyebrows around the hospital. He was regarded by doctor 622 00:45:11,800 --> 00:45:18,040 Speaker 1: Peter Meak as unbelievably incompetent. Miak, who could not understand 623 00:45:18,080 --> 00:45:21,760 Speaker 1: how someone as ignorant about medicine could have been employed, 624 00:45:22,040 --> 00:45:26,800 Speaker 1: doubted Korreeshi had ever been trained as a doctor. Miak 625 00:45:26,880 --> 00:45:28,759 Speaker 1: went to doctor Darren keating. 626 00:45:29,440 --> 00:45:33,279 Speaker 10: I don't want this chap to work here. He's totally useless. Look, 627 00:45:33,320 --> 00:45:35,040 Speaker 10: if you want to pay him, put him in the 628 00:45:35,040 --> 00:45:37,160 Speaker 10: library and get him to read a book. But he's 629 00:45:37,200 --> 00:45:38,040 Speaker 10: of no use to me. 630 00:45:40,000 --> 00:45:44,720 Speaker 1: Kureshi was also unwelcome in the ICU. Doctor Martin Carter 631 00:45:44,880 --> 00:45:47,000 Speaker 1: did not want him to have anything to do with 632 00:45:47,080 --> 00:45:51,440 Speaker 1: the patients. The nurses were wary of Kureshi for different reasons. 633 00:45:51,760 --> 00:45:55,600 Speaker 1: He kept bumping into them and squashing against their bodies. 634 00:45:56,600 --> 00:46:00,799 Speaker 1: Annette Arrowsmith's formal complaint went to doctor Keatie, who made 635 00:46:00,800 --> 00:46:04,840 Speaker 1: a detailed note of the circumstances and of Kureshi's denial 636 00:46:04,960 --> 00:46:10,040 Speaker 1: of anything untoward. Several weeks later, Karen Mcinness came into 637 00:46:10,080 --> 00:46:13,640 Speaker 1: the hospital for a deep vein thrombosis in her right calf. 638 00:46:14,600 --> 00:46:16,920 Speaker 1: She said of her experience. 639 00:46:17,320 --> 00:46:21,440 Speaker 3: Doctor Kureshi came to examine my leg. After doing this, 640 00:46:21,680 --> 00:46:24,840 Speaker 3: he started rubbing my inner thigh down to my knee 641 00:46:24,880 --> 00:46:28,799 Speaker 3: in a way that made me feel very uneasy. As 642 00:46:28,800 --> 00:46:31,880 Speaker 3: I put my legs back under the blankets, he asked 643 00:46:31,880 --> 00:46:35,360 Speaker 3: to listen to my chest. I lifted my top to 644 00:46:35,560 --> 00:46:39,160 Speaker 3: just under my breast. He listened for a few minutes, 645 00:46:39,600 --> 00:46:42,480 Speaker 3: and then he pulled my top above my breasts and 646 00:46:42,600 --> 00:46:46,040 Speaker 3: started moving the left one in every direction he could. 647 00:46:47,160 --> 00:46:49,320 Speaker 3: I've never had a doctor do this to me before. 648 00:46:51,560 --> 00:46:56,040 Speaker 1: The examination made her skin crawl. Mcinness wished that she 649 00:46:56,160 --> 00:47:04,759 Speaker 1: could curl up and go away. Keating told Korreeshi he 650 00:47:04,920 --> 00:47:08,040 Speaker 1: faced dismissal if he did not have a chaperone in 651 00:47:08,160 --> 00:47:13,800 Speaker 1: further consultations with female patients. On twenty two October, doctor 652 00:47:13,880 --> 00:47:17,120 Speaker 1: Keating told the Medical Board of Queensland about the complaints. 653 00:47:17,719 --> 00:47:20,319 Speaker 1: One of the staff later wrote back to say that 654 00:47:20,360 --> 00:47:24,759 Speaker 1: an investigation might be mounted by September the following year. 655 00:47:26,320 --> 00:47:31,760 Speaker 1: The third complaint was more poignant. Amanda Bully, undergoing neurological 656 00:47:31,800 --> 00:47:36,800 Speaker 1: observations after seizures, became teary when Koreshi came into the cubicle. 657 00:47:37,880 --> 00:47:42,280 Speaker 1: The nurse Daniella Tarlington asked why she was so upset, 658 00:47:42,600 --> 00:47:46,120 Speaker 1: and Bully explained that Koreshi had been in previously. While 659 00:47:46,200 --> 00:47:50,359 Speaker 1: she was having a seizure, Amanda Bully could feel him 660 00:47:50,440 --> 00:47:53,760 Speaker 1: kissing her face and putting his hand down her shirt 661 00:47:53,880 --> 00:47:58,080 Speaker 1: to touch her breasts while she was having convulsions. Although 662 00:47:58,120 --> 00:48:01,640 Speaker 1: able to see and feel the sexual assault, she could 663 00:48:01,680 --> 00:48:08,680 Speaker 1: not respond. But Kueshi continued to work at the hospital. 664 00:48:08,920 --> 00:48:11,840 Speaker 1: Or seven months after the first complaint of a sexual 665 00:48:11,960 --> 00:48:15,920 Speaker 1: nature and some nine months after he had been rated 666 00:48:15,960 --> 00:48:21,080 Speaker 1: as utterly incompetent by doctor Miak. The failure of the 667 00:48:21,120 --> 00:48:24,600 Speaker 1: hospital's management and of the medical board to suspend him 668 00:48:24,680 --> 00:48:29,680 Speaker 1: immediately reinforced a perception among nurses and doctors that serious 669 00:48:29,719 --> 00:48:36,000 Speaker 1: complaints were not dealt with appropriately. Koreshi disappeared overseas in 670 00:48:36,080 --> 00:48:38,799 Speaker 1: March two thousand and four, when police began to look 671 00:48:38,840 --> 00:48:42,600 Speaker 1: for him to ask questions about an unrelated petty crime. 672 00:48:43,719 --> 00:48:50,320 Speaker 1: His destination was unknown. Patel faced a less serious claim 673 00:48:50,440 --> 00:48:55,200 Speaker 1: of sexual harassment. He had asked nurse Patria Azlet for 674 00:48:55,280 --> 00:48:58,120 Speaker 1: her home telephone number over the bed of a patient 675 00:48:58,160 --> 00:49:01,840 Speaker 1: in surgery, and then called her at all hour seeking 676 00:49:01,880 --> 00:49:07,640 Speaker 1: a relationship. Aslet immediately regretted giving him the number, no 677 00:49:07,719 --> 00:49:11,359 Speaker 1: matter how many times she told Patell she was not interested, 678 00:49:11,719 --> 00:49:16,560 Speaker 1: he persisted. The calls ended after Keating, tipped off by 679 00:49:16,560 --> 00:49:20,040 Speaker 1: Tony Hoffman, took Patel aside one day and had a 680 00:49:20,120 --> 00:49:22,960 Speaker 1: chat to him about the nurses forming the wrong impression. 681 00:49:24,280 --> 00:49:30,239 Speaker 1: The next day, Patel made a joke of the episode. 682 00:49:28,920 --> 00:49:31,440 Speaker 6: You can't do anything in Australia without getting into trouble. 683 00:49:32,600 --> 00:49:36,279 Speaker 1: Meanwhile, Hoffman had heard a disturbing rumor which might have 684 00:49:36,360 --> 00:49:41,040 Speaker 1: explained the willingness of doctor Martin Carter, the director of anesthetics, 685 00:49:41,040 --> 00:49:45,720 Speaker 1: to accede to Patel's refusal to transfer the patients. Tony 686 00:49:45,760 --> 00:49:49,320 Speaker 1: Hoffman related it to doctor Keating in a September email. 687 00:49:50,280 --> 00:49:53,239 Speaker 7: I'm told that Dr Patel and Martin Carter have come 688 00:49:53,280 --> 00:49:56,600 Speaker 7: to an agreement by which doctor Patel will operate only 689 00:49:56,640 --> 00:50:00,640 Speaker 7: if Martin Carter agrees to not transfer this page. 690 00:50:01,920 --> 00:50:07,120 Speaker 1: Hoffman believed the situation was dire. Another patient, Mervyn Smith, 691 00:50:07,280 --> 00:50:10,160 Speaker 1: was in a bad way with major chest and spleen 692 00:50:10,239 --> 00:50:14,360 Speaker 1: injuries and five broken ribs after a road accident. He 693 00:50:14,440 --> 00:50:18,760 Speaker 1: had suffered a string of serious complications since surgery by Patel. 694 00:50:19,280 --> 00:50:22,960 Speaker 1: He needed long term intensivist management and the support of 695 00:50:23,000 --> 00:50:28,040 Speaker 1: a cardiothoracic team. Options available in Brisbane, not the regional 696 00:50:28,080 --> 00:50:33,239 Speaker 1: town of Bunderberg. Hoffman's latest email to Keating raised for 697 00:50:33,280 --> 00:50:38,120 Speaker 1: the first time a possible explanation for Ptel's immunity. It 698 00:50:38,200 --> 00:50:43,800 Speaker 1: was the purported arrangement. The email reiterated her concerns about 699 00:50:44,400 --> 00:50:45,279 Speaker 1: what type. 700 00:50:45,000 --> 00:50:47,799 Speaker 7: Of surgery should be done here in relation to our 701 00:50:47,840 --> 00:50:52,360 Speaker 7: follow up care and the services we can provide. 702 00:50:52,400 --> 00:50:55,800 Speaker 1: Although she had no reply from doctor Keating, he spoke 703 00:50:55,840 --> 00:50:59,840 Speaker 1: about the matters to Patel and Martin Carter. They deny 704 00:51:00,160 --> 00:51:02,800 Speaker 1: they had done a deal over the care of patients 705 00:51:03,719 --> 00:51:12,959 Speaker 1: and they strenuously defended the handling of Mervyn Smith. Sick 706 00:51:13,040 --> 00:51:16,560 Speaker 1: to Death is written and presented by me Headley Thomas, 707 00:51:16,719 --> 00:51:21,879 Speaker 1: the Australians National Chief correspondent. Claire Harvey is The Australian's 708 00:51:22,040 --> 00:51:27,439 Speaker 1: editorial director, Audio, editing, production and music have been done 709 00:51:27,480 --> 00:51:32,799 Speaker 1: by Jasper Leik, with assistants from Leah Sammaglu and Neil Sutherland. 710 00:51:33,280 --> 00:51:38,240 Speaker 1: Our producer is Christain Amias. Production management by Stephanie Coombs, 711 00:51:38,920 --> 00:51:44,400 Speaker 1: artwork by Sean Callanan. Thanks to Ryan Osland, Matthew Condon, 712 00:51:44,680 --> 00:51:51,360 Speaker 1: Karina Berger, Ellie Dudley, David Murray, Dominique McDermott, Zach Sculander 713 00:51:51,680 --> 00:51:55,480 Speaker 1: and all our family, friends and colleagues who helped in 714 00:51:55,520 --> 00:52:00,320 Speaker 1: this series and contributed voice acting and special thanks to 715 00:52:00,000 --> 00:52:05,879 Speaker 1: Tony Hoffman and Rob Messenger. Subscribers to The Australian here 716 00:52:06,160 --> 00:52:10,160 Speaker 1: new episodes of Sick to Death first at Sick to 717 00:52:10,280 --> 00:52:15,640 Speaker 1: deathpodcast dot com and on Apple Podcasts. You can get 718 00:52:15,680 --> 00:52:21,279 Speaker 1: exclusive access to photographs, videos, timelines and more at the 719 00:52:21,360 --> 00:52:39,240 Speaker 1: website