WEBVTT - Episode 3: Wounded Pride 0:00:04.840 --> 0:00:08.680 My name is Headley Thomas. Sick to Death is based 0:00:08.680 --> 0:00:10.920 on my book of the same name, and it's the 0:00:11.000 --> 0:00:15.480 true story of doctor Jayant Patel's lies and manipulation and 0:00:15.520 --> 0:00:19.400 the herculean effort it took to finally stop him. We've 0:00:19.520 --> 0:00:23.760 used voice actors throughout this series, and on occasion the 0:00:23.800 --> 0:00:27.080 real people from this story have read their words for us. 0:00:28.200 --> 0:00:31.000 It is brought to you by me and the Australian 0:00:38.640 --> 0:00:50.240 Chapter eleven Memory Lane. One evening in September nineteen eighty one, 0:00:50.720 --> 0:00:55.080 doctor William L. Craver, chief of surgery at the Genesee 0:00:55.200 --> 0:00:59.160 Hospital in upstate New York, received a worrying telephone call. 0:01:00.200 --> 0:01:04.400 He was accustomed to receiving calls outside normal working hours. 0:01:05.040 --> 0:01:08.759 He dealt with trauma patients ripped apart with gunshot wounds, 0:01:09.360 --> 0:01:14.759 patients mutilated in serious car accidents. The call he received 0:01:14.840 --> 0:01:19.000 on this particular evening was from a senior nurse. She 0:01:19.160 --> 0:01:23.279 had an unusual problem involving one of the young doctors 0:01:23.959 --> 0:01:28.039 from his home near Rochester. Dr Crab, who was retired, 0:01:28.480 --> 0:01:29.560 told me what happened. 0:01:30.240 --> 0:01:32.520 She was concerned because she had been called by the 0:01:32.520 --> 0:01:35.120 floor nurse who had been caring for a patient admitted 0:01:35.160 --> 0:01:38.440 that afternoon for an operation the next morning. Doctor Patel 0:01:38.560 --> 0:01:40.600 was one of the surgical residents who rotated through a 0:01:40.680 --> 0:01:42.520 hospital from the University of Rochester. 0:01:43.560 --> 0:01:46.399 The patient had complained to the nurse that she was 0:01:46.640 --> 0:01:47.720 extremely tired. 0:01:48.800 --> 0:01:50.520 I really would like to get to sleep. 0:01:50.920 --> 0:01:53.680 Another house doctor is supposed to examine me first, and 0:01:53.720 --> 0:01:54.840 I wish she would hurry up. 0:01:56.040 --> 0:01:58.320 The nurse looked at the patient's charts. 0:01:59.200 --> 0:02:01.480 She saw that there was a complete write up and 0:02:01.560 --> 0:02:04.280 work up and record of a physical examination by doctor 0:02:04.320 --> 0:02:07.160 Pateell of the patient. But he had never examined her. 0:02:07.560 --> 0:02:09.880 He had not been to her room. He had made 0:02:09.919 --> 0:02:12.520 it all up based on the notes of the attending surgeon. 0:02:13.200 --> 0:02:15.720 I went there and talked to the woman. The charts 0:02:15.760 --> 0:02:19.600 described a complete examination, including an examination of her breasts. 0:02:20.400 --> 0:02:23.880 Craver has a vivid memory of questioning the woman about 0:02:23.919 --> 0:02:29.240 these examinations and her answers. A nurse herself, the patient 0:02:29.480 --> 0:02:33.680 was adamant. She told him, I know when my breasts 0:02:33.680 --> 0:02:34.600 have been examined. 0:02:35.400 --> 0:02:37.280 I called doctor Pittell to my office to talk to 0:02:37.360 --> 0:02:40.360 him about it. He denied doing anything wrong. He was 0:02:40.440 --> 0:02:42.960 upset that anyone would question his judgments. 0:02:43.639 --> 0:02:47.679 When Dr Craber talked to surgeons and supervisors in other 0:02:47.760 --> 0:02:52.440 hospitals affiliated with the University of Rochester. He discovered that 0:02:52.520 --> 0:02:56.120 doctor Pateell had been the subject of several similar complaints. 0:02:56.800 --> 0:03:01.600 Dr Craver decided that Patel was untrustworth worthy, a bad apple. 0:03:02.120 --> 0:03:06.160 He did not want him having any contact with the patients. 0:03:06.560 --> 0:03:10.800 He recommended that Patel be fired from the program. The 0:03:10.840 --> 0:03:13.040 president of the university agreed. 0:03:13.919 --> 0:03:15.560 I was calling it the way it should be called 0:03:16.080 --> 0:03:19.040 in surgery. He was supposed to be honest and trustworthy 0:03:19.120 --> 0:03:23.120 with total integrity. He showed total lack of integrity. Doctor 0:03:23.120 --> 0:03:25.239 Petell had been working at our hospital for a couple 0:03:25.320 --> 0:03:28.000 of months at that point. Until then, he had a 0:03:28.000 --> 0:03:31.600 good reputation. He was considered a good training but the 0:03:31.639 --> 0:03:34.639 evidence against him held up. We were not making it up. 0:03:35.120 --> 0:03:37.440 I had no personal reason to be against doctor Pittell. 0:03:39.280 --> 0:03:44.120 Official files document Patel's difficulties with regulatory authorities in New 0:03:44.200 --> 0:03:48.080 York State between nineteen eighty one and nineteen eighty three, 0:03:48.600 --> 0:03:52.800 two decades before he ventured to Bunderberg in Queensland, Australia. 0:03:54.120 --> 0:03:57.720 The files and the record of discipline reaction are matters 0:03:57.720 --> 0:04:00.960 of public record and they have always been available from 0:04:01.000 --> 0:04:04.120 both the New York State Department of Health and the 0:04:04.160 --> 0:04:10.000 State Board for Professional Medical Conduct. They corroborate the recollections 0:04:10.000 --> 0:04:13.520 of Dr Craver, who had not seen the material since 0:04:13.560 --> 0:04:18.279 the early nineteen eighties. The documents show that the floor 0:04:18.440 --> 0:04:22.960 nurse was Mary Jackson. They show Patel had diligently written 0:04:22.960 --> 0:04:28.200 a history, physical examination, progress notes, and admission orders into 0:04:28.200 --> 0:04:32.160 the medical record of the woman patient. They show that 0:04:32.240 --> 0:04:37.719 she was deeply distressed. Her surgeon, doctor Renee Mengui, recorded 0:04:37.760 --> 0:04:42.360 her comments. On the same day, Patel had made similar 0:04:42.520 --> 0:04:45.719 entries in the medical records of two other women without 0:04:45.800 --> 0:04:51.440 personally having examined either of them. He concocted similar lies 0:04:51.480 --> 0:04:55.200 in the medical records of a further two patients. He 0:04:55.320 --> 0:04:59.480 had concocted the examination records to cover himself while he 0:04:59.520 --> 0:05:03.599 worked as a second job at the nearby Rochester Psychiatric Center, 0:05:03.960 --> 0:05:06.560 when he was rostered to be available to respond to 0:05:06.640 --> 0:05:11.240 emergencies and calls at the Genesee Hospital, a sprawling one 0:05:11.360 --> 0:05:17.400 hundred twenty year old institution on Alexander Street. After realizing 0:05:17.520 --> 0:05:21.560 that both nurse Jackson and the surgeon, doctor Mengui were 0:05:21.640 --> 0:05:26.160 taking the complaints seriously and talking to the patients. Patel 0:05:26.320 --> 0:05:30.400 turned on one of the patients. She broke down crying 0:05:30.440 --> 0:05:33.800 when Patel accused her of trying to ruin his career. 0:05:35.080 --> 0:05:38.200 Patel told the woman her complaint would put his job 0:05:38.520 --> 0:05:43.880 and schooling in jeopardy. A rigorous year long investigation into 0:05:43.920 --> 0:05:48.960 Pateel's antics by the Office of Professional Discipline, the investigative 0:05:49.000 --> 0:05:52.719 body which compiles evidence for the board, produced more than 0:05:52.800 --> 0:05:58.400 thirty statements and exhibits. After the fifth and final day 0:05:58.440 --> 0:06:02.480 of hearings on ten Mays nineteen eighty three in rooms 0:06:02.520 --> 0:06:06.719 at the Holiday Inn at Rochester Airport, the evidence filled 0:06:06.760 --> 0:06:12.159 more than seven hundred pages of transcript. Three medical practitioners 0:06:12.520 --> 0:06:18.040 doctor Mengui, doctor Raymond Seaymoss and Dr Craver, as well 0:06:18.080 --> 0:06:22.880 as two nurses, Mary Jackson and Gary Nelson, and four 0:06:22.920 --> 0:06:26.960 patients testified on behalf of the prosecuting Department of Health. 0:06:27.839 --> 0:06:31.960 Dr Patel, testifying on his own behalf, was supported by 0:06:32.000 --> 0:06:37.160 the character references of four medical practitioners, doctor James Williams, 0:06:37.600 --> 0:06:43.599 doctor Marguerite Dinsky, doctor William Farlow and doctor Raymond Hinshaw 0:06:44.960 --> 0:06:48.520 as four members, three of whom were doctors of the 0:06:48.560 --> 0:06:52.480 hearing committee of the State Board for Professional Medical Conduct 0:06:52.600 --> 0:06:57.440 weighed the evidence they had to determine if Patel's fabrication 0:06:57.880 --> 0:07:01.120 of the history of patients demonstrated what they called a 0:07:01.920 --> 0:07:08.359 moral unfitness to practice medicine. The charges included practicing the 0:07:08.400 --> 0:07:13.840 profession of medicine fraudulently by entering items in various patients' 0:07:13.920 --> 0:07:18.240 medical records without personally examining the patient, as well as 0:07:18.320 --> 0:07:23.600 gross negligence and incompetence. On more than one occasion, there 0:07:23.760 --> 0:07:28.120 was a charge of abandoning or neglecting a patient in 0:07:28.240 --> 0:07:34.560 need of immediate professional care without making reasonable arrangements. Patel 0:07:34.640 --> 0:07:40.200 had also harassed, abused, and intimidated the first patient in 0:07:40.280 --> 0:07:43.760 an effort to coerce her not to cooperate with an 0:07:43.760 --> 0:07:49.640 official hospital investigation. When most of the charges were approved, 0:07:49.800 --> 0:07:53.600 Patel's career hung by a thread. The matters were serious, 0:07:53.640 --> 0:07:58.160 involving gross and repeated acts of deception and grave breaches 0:07:58.200 --> 0:08:02.680 of trust. His conduct was analogous to a lawyer strapped 0:08:02.720 --> 0:08:06.640 for time fabricating a series of statements on behalf of 0:08:06.720 --> 0:08:11.880 five clients, but of course, a fictitious medical examination could 0:08:11.880 --> 0:08:17.560 have much more serious repercussions. The committee's members were influenced 0:08:17.600 --> 0:08:22.240 by the glowing references and laudatory testimony from medical colleagues 0:08:22.280 --> 0:08:27.760 on doctor Patel's side, Betel's lawyer, John Frizell, from a 0:08:27.880 --> 0:08:31.880 law firm in Buffalo, where Patel was then living, emphasized 0:08:31.880 --> 0:08:37.040 his client's talents and abilities. Doctor Williams called him an 0:08:37.040 --> 0:08:43.680 excellent clinician and very thorough, extremely dedicated. In one prescient moment, 0:08:44.080 --> 0:08:49.200 doctor Williams suggested that Petel's ultimate contribution to the medical 0:08:49.240 --> 0:08:54.800 profession will be exceptional. Doctor Dinsky described Patel as one 0:08:54.840 --> 0:08:58.120 of the best resident doctors she had had contact with 0:08:58.240 --> 0:09:03.280 in her capacity as a chief resident. He was, she suggested, 0:09:03.840 --> 0:09:06.960 a person of high integrity who had made a mistake. 0:09:07.960 --> 0:09:13.920 Doctor Hinshaw, equally effusive, described Patel as technically very gifted. 0:09:14.520 --> 0:09:17.280 He rated his skills among the top three of the 0:09:17.360 --> 0:09:21.320 two hundred residents he had worked with, and although doctor 0:09:21.360 --> 0:09:25.680 Mengui was a witness for the prosecuting authority, he had 0:09:25.720 --> 0:09:29.120 written in a twenty July nineteen eighty one letter that 0:09:29.120 --> 0:09:33.160 Patel was by far the best resident who has rotated 0:09:33.200 --> 0:09:38.520 with me. At the end of the hearings, the committee's chairman, 0:09:38.600 --> 0:09:44.080 doctor Paul de Luca, decided not to crush Patel. He 0:09:44.240 --> 0:09:49.200 was censured and reprimanded instead of panelizing him with an 0:09:49.280 --> 0:09:53.719 immediate fine. In July nineteen eighty three, the committee put 0:09:53.760 --> 0:09:58.440 him on probation for three years. If he misbehaved again, 0:09:58.600 --> 0:10:03.120 he would be fined five th thousand dollars. Two months later, 0:10:03.480 --> 0:10:07.600 doctor David Axelrod, Commissioner of Health in the state of 0:10:07.640 --> 0:10:10.800 New York, reviewed the decision and decided that the hearing 0:10:10.840 --> 0:10:15.679 committee had been too lenient. He rejected the committee's findings 0:10:15.720 --> 0:10:18.600 where doctor Pateel was given the benefit of the doubt. 0:10:19.800 --> 0:10:22.360 Doctor Axelrod stated that this way. 0:10:23.520 --> 0:10:27.920 The failure to examine patients prior to surgery evidence is 0:10:28.000 --> 0:10:32.199 a disregard for and indifference to the results that may 0:10:32.280 --> 0:10:36.760 follow such failure, and thus constitutes gross negligence. 0:10:38.720 --> 0:10:43.760 He decided Patel had clearly demonstrated his moral unfitness to 0:10:43.840 --> 0:10:49.960 practice medicine. Patel's wrongdoing, according to doctor Axelrod, was. 0:10:50.760 --> 0:10:54.719 A serious failure and should be punished by more than 0:10:54.760 --> 0:10:57.200 a censure and reprimand. 0:10:58.000 --> 0:11:02.080 The effect of the tougher line was negligible. All it 0:11:02.200 --> 0:11:04.960 meant was that Patel had to pay the five thousand 0:11:05.000 --> 0:11:09.080 dollars fine. He was free to return to work, and 0:11:09.240 --> 0:11:13.440 he had a set of wonderful references from four respected doctors. 0:11:14.520 --> 0:11:19.320 Those doctors and their references would open new doors. Although 0:11:19.440 --> 0:11:22.640 fired from the Genesee Hospital where he had been doing 0:11:22.679 --> 0:11:27.000 his residency program, Patel had a springboard to a new job. 0:11:27.080 --> 0:11:31.600 Working with Hinshaw as his research associate. He entered the 0:11:31.640 --> 0:11:35.719 residency program of the University of Buffalo, where he completed 0:11:35.720 --> 0:11:42.200 his general surgery training In nineteen eighty eight. Doctor Hinshaw 0:11:42.320 --> 0:11:46.440 helped Patel again. Wanting to put his New York troubles 0:11:46.559 --> 0:11:50.040 a long way behind him, doctor Patel applied to work 0:11:50.080 --> 0:11:53.600 for the Kaiser Permanente Healthcare Group on the other side 0:11:53.640 --> 0:11:58.920 of the country in Portland, Oregon. A laudatory letter dated 0:11:59.000 --> 0:12:03.320 twenty nine Novem nineteen eighty eight from doctor Hinshaw, then 0:12:03.400 --> 0:12:07.240 chief of Surgery at Rochester General Hospital, to the Board 0:12:07.240 --> 0:12:11.600 of Medical Examiners in Oregon avoided any reference to these 0:12:11.640 --> 0:12:13.480 serious convictions against Mattel. 0:12:14.640 --> 0:12:17.599 When doctor Patel was a member of our residency program, 0:12:17.880 --> 0:12:21.880 he showed technical and professional brilliance When I operated on 0:12:21.920 --> 0:12:24.720 the chief of one of our specialty sections. The doctor 0:12:24.760 --> 0:12:28.440 requested specifically that he be my assistant that in my 0:12:28.600 --> 0:12:29.960 experience is unique. 0:12:31.000 --> 0:12:35.600 On twenty three January nineteen eighty nine, doctor Hinshaw, whose 0:12:35.679 --> 0:12:39.840 distinguished forty year surgical career at the University of Rochester 0:12:39.960 --> 0:12:43.400 was drawing to a close, received a letter from the Board. 0:12:44.679 --> 0:12:50.120 The board's license administrator, Jan Bagenstross, had discovered something about 0:12:50.160 --> 0:12:57.000 Patel's dismissal from the University of Rochester's residency program. Jan Bagenstross, 0:12:57.360 --> 0:13:02.240 curious about doctor Hinshaw's failure to this important chapter in 0:13:02.360 --> 0:13:08.679 doctor Pittell's career, sought more information. Doctor Hinshaw's reply, on 0:13:08.800 --> 0:13:13.680 three February nineteen eighty nine, four months before his retirement, 0:13:14.120 --> 0:13:18.800 acknowledged the discipline reaction, but insisted that doctor Petell had 0:13:18.840 --> 0:13:22.880 been harshly treated. He maintained that it was a case 0:13:22.920 --> 0:13:28.160 of the unfair harassment of a brilliant young surgeon. Doctor 0:13:28.240 --> 0:13:31.640 Hinshaw's letter to Jan Bagenstrass says. 0:13:32.160 --> 0:13:34.520 When I appeared before the State Health Department in doctor 0:13:34.559 --> 0:13:37.680 Petell's behalf, I was asked if I believe the charges 0:13:37.720 --> 0:13:40.960 against doctor Petel. I gave my reasons why I did 0:13:41.000 --> 0:13:43.800 not believe them. I was asked what I would think 0:13:43.840 --> 0:13:46.160 if I could indeed be shown that doctor Petell had 0:13:46.160 --> 0:13:50.600 written a physical examination without having examined the patient. I 0:13:50.679 --> 0:13:53.200 stated that such behavior on his part would seem so 0:13:53.320 --> 0:13:56.000 bizarre to me from having worked very closely with him, 0:13:56.400 --> 0:13:58.880 that I do my best to find out what circumstances 0:13:59.000 --> 0:14:01.040 caused such an abberation of behavior. 0:14:03.440 --> 0:14:08.559 Doctor Hinshaw died aged sixty nine in nineteen ninety three. 0:14:08.760 --> 0:14:12.560 Dr Craver did not know until years later about the 0:14:12.720 --> 0:14:16.920 misleading letters of support for Pateel. In his job quest, 0:14:18.040 --> 0:14:22.600 Dr Craver believed that Hinshaw's unwavering support of Patel during 0:14:22.640 --> 0:14:28.960 the earlier disciplinary process was inescapably wrong. Dr Hinshaw's stand 0:14:29.160 --> 0:14:32.560 was a source of tension between the two senior surgeons 0:14:32.600 --> 0:14:35.960 for years afterwards. Dr Craver told me. 0:14:36.800 --> 0:14:39.000 I will never understand why, in the face of all 0:14:39.080 --> 0:14:42.280 this evidence, he would have applauded Doctor Pateell. Has made 0:14:42.280 --> 0:14:44.920 me lose some respect for men. Was a very fine surgeon. 0:14:54.480 --> 0:15:00.320 Chapter twelve. A tussle June and July two thousand and three. 0:15:02.760 --> 0:15:05.880 In the days after James Phillips passed away in the 0:15:05.920 --> 0:15:11.520 intensive care unit, Tony Hoffman became increasingly confused she could 0:15:11.560 --> 0:15:16.560 cope with doctor j. Petel's bombastic and patronizing attitude. She 0:15:16.640 --> 0:15:20.840 could tolerate his kiss up and kick down approach to 0:15:20.920 --> 0:15:25.600 management and nursing staff, but she worried about his clinical 0:15:25.680 --> 0:15:31.240 judgment and expertise. Patel had been telling the nurses ad 0:15:31.320 --> 0:15:36.240 nauseum how experienced he was in the United States. One 0:15:36.320 --> 0:15:40.000 day he said he was a gold standard trauma surgeon, 0:15:40.440 --> 0:15:44.640 the next he was a cardiothoracic surgeon. There was a 0:15:44.640 --> 0:15:48.760 different qualification every other day. The nurses joked he had 0:15:48.760 --> 0:15:52.360 been doing complex surgery for twenty five years. The next 0:15:52.440 --> 0:15:55.800 day it was thirty years. Another day it was twenty years. 0:15:57.040 --> 0:16:03.400 Hoffman feared something else in doctor Patel's character megalomania, a 0:16:03.480 --> 0:16:08.720 boldness bordering on recklessness. He seemed to lack insight into 0:16:08.760 --> 0:16:13.320 the risks he created for the patients. Tony Hoffman was 0:16:13.400 --> 0:16:16.880 also wondering about his knowledge of best practiced drugs for 0:16:16.920 --> 0:16:22.440 the patients. He was demanding drugs like dopamine and buttamine 0:16:22.480 --> 0:16:26.840 that had been superseded years earlier when other doctors used 0:16:26.920 --> 0:16:31.080 modern drugs such as adrenaline and nora adrenaline. Petel told 0:16:31.120 --> 0:16:35.040 the nurses to change the medication back to the obsolete drugs. 0:16:36.080 --> 0:16:39.200 He thought so differently to the other doctors and to 0:16:39.360 --> 0:16:42.640 nurse Tony Hoffman that it was as if she confided 0:16:42.680 --> 0:16:44.560 to doctor Darren keating they. 0:16:44.400 --> 0:16:46.560 Were from two different planets. 0:16:47.520 --> 0:16:50.360 Her attempts to call a truce after the death of 0:16:50.440 --> 0:16:55.280 Phillips failed. Dismally, Hoffman knew that doctor Patel now saw 0:16:55.360 --> 0:17:01.480 her as an enemy. He started undermining her authority and credibility, 0:17:01.520 --> 0:17:05.280 criticizing her and the Intensive care Unit. In talks with 0:17:05.440 --> 0:17:11.040 younger doctors and nurses, she realized that the less experienced 0:17:11.160 --> 0:17:14.400 doctors who relied on Patel to advance their own careers 0:17:14.480 --> 0:17:18.720 lacked the knowledge to see his flaws. They would almost 0:17:18.800 --> 0:17:23.479 always back him, but Patel was now dividing the nursing 0:17:23.560 --> 0:17:28.520 staff to grow his support base and isolate her. Having 0:17:28.680 --> 0:17:33.680 seen through Patel's grandiose claims early on, Tony Hoffman had 0:17:33.720 --> 0:17:36.840 also worked out that Patel was not everything he said 0:17:36.880 --> 0:17:41.679 he was. She became a major threat to him. She 0:17:41.920 --> 0:17:47.560 had to be discredited. Patel began denigrating the ICU as 0:17:48.080 --> 0:17:51.200 third world. He made it clear that he did not 0:17:51.320 --> 0:17:54.879 trust Hoffman nor several of the nurses in the unit. 0:17:57.200 --> 0:18:00.640 On three June, he walked into the ICU to announce 0:18:00.640 --> 0:18:05.399 that he would be performing another esophagectomy. The patient this 0:18:05.560 --> 0:18:10.160 time would be James Grave, aged sixty three. 0:18:10.280 --> 0:18:12.360 I'd be in the unit for the hul dudes while 0:18:12.400 --> 0:18:15.440 my asophagectamy patient is inher until he leaves the unit. 0:18:16.800 --> 0:18:21.840 Nurse k Boison recoiled as Patel continued running the unit down. 0:18:22.480 --> 0:18:24.639 He made it known that he needed to be in 0:18:24.720 --> 0:18:27.639 the ICU for the two days because he thought so 0:18:27.800 --> 0:18:32.919 little of Hoffman's professionalism. Doctor Patel knew that Tony Hoffman 0:18:33.040 --> 0:18:36.240 had voice concerns about the death of James Phillips to 0:18:36.320 --> 0:18:40.320 doctor Keating and to the Director of Nursing, Glennis Goodman. 0:18:41.920 --> 0:18:45.840 The sixth June operation on Grave led to a string 0:18:45.920 --> 0:18:51.920 of complications. Patel had paralyzed Grave's vocal cord, which made 0:18:51.920 --> 0:18:55.080 it difficult for him to clear his airway and breathe. 0:18:56.240 --> 0:19:00.720 In the days afterwards, his wound fell apart twice. The 0:19:00.840 --> 0:19:05.840 nurses rarely saw these instances of wound collapse or dehesiance, 0:19:06.280 --> 0:19:10.640 meaning to gape, but with Patel it was becoming common. 0:19:12.040 --> 0:19:17.159 There was also leakage where Patel had clumsily rejoined Grave's gut. 0:19:18.320 --> 0:19:22.439 Increasingly weak, the patient was wheeled in for three further 0:19:22.520 --> 0:19:28.639 operations by Patel on twelve sixteen and eighteen June. While 0:19:28.720 --> 0:19:33.480 the anesthetist, doctor John Joyner, and the junior doctor James 0:19:33.520 --> 0:19:36.680 Boyd tried to arrange a bed for him in Brisbane, 0:19:37.119 --> 0:19:42.959 Patel stubbornly resisted the transfer. The perilous condition of Grave 0:19:43.160 --> 0:19:46.800 was obvious as he was moved between the ICU, the 0:19:46.840 --> 0:19:52.440 surgical ward and the operating theater. Hoffmann could not understand 0:19:52.520 --> 0:19:56.720 why he had not been transferred out His life hung 0:19:56.760 --> 0:19:59.879 by a thread, even when there was a bed of 0:20:00.000 --> 0:20:04.080 available in Brisbane. On eighteen June, Patel refused to talk 0:20:04.119 --> 0:20:10.000 to the surgeons in Brisbane, making transfer impossible. An incredulous 0:20:10.000 --> 0:20:14.320 doctor from one of the larger hospitals questioned Hoffman, why 0:20:14.359 --> 0:20:17.080 are you doing these big operations there when you can't 0:20:17.080 --> 0:20:21.760 care for these patients. In her long career, Hoffman had 0:20:21.840 --> 0:20:24.960 never taken on a director of surgery, but she could 0:20:25.000 --> 0:20:29.680 see that Grave would die unless someone intervened. She sent 0:20:29.720 --> 0:20:33.480 a note to Glennis Goodman explaining that doctors at the 0:20:33.520 --> 0:20:37.400 Princess Alexandra Hospital and the Royal Brisbane Hospital. 0:20:37.440 --> 0:20:41.840 Have expressed their concern at why such surgery was done 0:20:41.880 --> 0:20:45.959 here when we don't have an intense first Meanwhile, the 0:20:46.040 --> 0:20:49.520 patient continues to deteriorate and we have no bed to 0:20:49.600 --> 0:20:53.280 transfer him too. I think before any more surgery of 0:20:53.320 --> 0:20:56.400 this type is done here, we really have to examine 0:20:56.400 --> 0:20:59.040 whether we can offer the appropriate follow up care. 0:21:00.359 --> 0:21:03.840 Some twenty four hours later, as Grave languished and Patel 0:21:03.920 --> 0:21:07.440 predicted that he would make a miraculous recovery if left 0:21:07.480 --> 0:21:12.439 in Thunderberg, Tony Hoffman went to Darren Keating. She told 0:21:12.520 --> 0:21:16.960 him of Graves complications and how he needed increasing amounts 0:21:16.960 --> 0:21:20.080 of adrenaline because his condition was so unstable. 0:21:20.800 --> 0:21:25.639 Hoffman told Keating there remains unresolved issues with the behavior 0:21:25.680 --> 0:21:28.720 of the surgeon, which is confusing for the nursing staff. 0:21:29.280 --> 0:21:32.960 I believe we're working outside our scope of practice for 0:21:33.000 --> 0:21:37.320 a level one intensive care unit. The ongoing issues regarding 0:21:37.359 --> 0:21:40.959 the transfer of patients and the designated level of this 0:21:41.480 --> 0:21:45.040 ICU may need to be discussed in more detail at 0:21:45.080 --> 0:21:49.040 a later date. The behavior of the surgeon in the 0:21:49.320 --> 0:21:53.280 ICU also needs to be discussed, as certain very disturbing 0:21:53.359 --> 0:21:54.800 scenarios have occurred. 0:21:56.280 --> 0:22:00.800 Hoffman was perturbed that Patel had not recognized a worrying 0:22:00.920 --> 0:22:05.560 feature in graves condition. He had a kyler thorax, a 0:22:05.640 --> 0:22:09.440 build up of a milky fluid in the intercostal catheter 0:22:09.760 --> 0:22:14.000 in his chest. Doctor Joyner was also worried he had 0:22:14.040 --> 0:22:18.680 found a bed for Grave in Brisbane, but when Patel 0:22:18.800 --> 0:22:22.880 discovered the arrangement, he was furious and immediately threatened to quit. 0:22:24.160 --> 0:22:28.119 He confronted Joyner in the corridor between the ICU and 0:22:28.240 --> 0:22:34.560 theater and abused him. Doctor Joyner regarded Patel as forceful, loud, 0:22:34.840 --> 0:22:40.080 and at times intimidating, but doctor Joyner also felt sure 0:22:40.200 --> 0:22:43.280 of his own position. He had read a recent article 0:22:43.320 --> 0:22:47.000 in the British Journal of Anesthesia warning of high death 0:22:47.080 --> 0:22:52.800 rates for esophagectomy patience in smaller hospitals. When doctor Joyner 0:22:52.880 --> 0:22:57.119 took his concerns to doctor Keating, there were more histrionics. 0:22:58.080 --> 0:23:01.320 Patel had a tantrum and a again threatened to quit. 0:23:02.640 --> 0:23:08.760 Finally he agreed to a compromise. On twenty June, the 0:23:08.840 --> 0:23:12.880 patient Grave went to the Martyr, a leading Brisbane private 0:23:12.920 --> 0:23:18.240 hospital which also receives public patients. Its director of Critical 0:23:18.280 --> 0:23:22.760 Care Services, doctor Peter Cook, was surprised at graves condition 0:23:22.960 --> 0:23:27.040 and shocked that a esophagectomy had been attempted at Bunderberg. 0:23:28.400 --> 0:23:32.719 Dr Cook, an intensive care and anesthesia specialist, talked at 0:23:32.800 --> 0:23:36.119 length about the case to a surgeon colleague who shared 0:23:36.119 --> 0:23:41.760 his concerns. They agreed that Patel's contemplation of such procedures 0:23:41.800 --> 0:23:47.280 in Bunderberg called inter question his competence and judgment. The 0:23:47.320 --> 0:23:51.320 botching of the operation gave them even greater cause for concern. 0:23:52.760 --> 0:23:56.719 There was another worry. The charts for Grave showed the 0:23:56.760 --> 0:23:59.960 cancer had spread to lymph nodes outside his a sophot 0:24:00.520 --> 0:24:06.800 and stomach. A large tumor was outside his bowel. Because 0:24:06.840 --> 0:24:10.960 of the cancers spread, the esophagectamy was not only traumatic 0:24:11.359 --> 0:24:17.359 and potentially lethal, it was also fruitless. Cook felt strongly 0:24:17.480 --> 0:24:20.960 that the doomed man should have been at home, comforted 0:24:20.960 --> 0:24:24.760 by loved ones, instead of in acute pain and distress 0:24:25.080 --> 0:24:29.320 from a failed to soophagectamy, which could only shorten his life. 0:24:29.960 --> 0:24:35.000 On one July, unaware of nurse Hoffman's efforts, he telephoned 0:24:35.080 --> 0:24:38.760 Keating and explained the rocky future for the patient Grave 0:24:38.880 --> 0:24:42.919 and the risks for all patients having esophagectamese in Bunderberg. 0:24:44.320 --> 0:24:48.200 The risks and the issues were identical to those already 0:24:48.280 --> 0:24:52.960 outlined by Tony Hoffman. Keating gave an assurance that he 0:24:53.000 --> 0:24:57.879 would take the matter up with doctor Patel. Cook decided 0:24:57.920 --> 0:25:02.679 to document his concerns he knew about the connection between 0:25:02.720 --> 0:25:07.520 public hospital funding and the frequency of operations. He regarded 0:25:07.560 --> 0:25:12.119 it as an unhealthy policy which rewarded surgical volume instead 0:25:12.160 --> 0:25:17.000 of patient outcomes. It produced a dreadful conflict of interest. 0:25:17.840 --> 0:25:21.760 He questioned if Bunderberg was trying to widen its clinical 0:25:21.800 --> 0:25:26.720 practice to boost its coffers. In a memo, he wrote. 0:25:27.320 --> 0:25:30.199 Clearly, this is not appropriate surgery to be done at 0:25:30.240 --> 0:25:33.440 a center with such a small level of support services, 0:25:33.480 --> 0:25:34.920 particularly ICU. 0:25:35.760 --> 0:25:40.040 But Patel remained determined to carry on. He told the 0:25:40.320 --> 0:25:42.560 ICU staff, you will do. 0:25:42.520 --> 0:25:44.840 What I see, or I won't go to Darren Keating. 0:25:45.280 --> 0:25:48.199 I will go to Peter Lac the executive will do 0:25:48.240 --> 0:25:50.200 what I want them to do, because I'm making them 0:25:50.240 --> 0:25:52.679 so much money. I'll resign if they don't let me 0:25:52.760 --> 0:25:53.680 keep my patience here. 0:25:55.160 --> 0:25:58.679 It was all bluff. Patel had nothing to return to 0:25:58.920 --> 0:26:03.600 in the United States except shame. He had been reminded 0:26:03.600 --> 0:26:07.159 of this in a surprise telephone call from an investigator 0:26:07.240 --> 0:26:10.760 with the Oregon Board of Medical Examiners, who was doing 0:26:10.760 --> 0:26:15.760 a routine license check of discipline doctors. Patel lied. 0:26:16.440 --> 0:26:19.879 He told him, I'm retired and practicing medicine on a 0:26:19.960 --> 0:26:21.159 volunteer basis. Only. 0:26:22.359 --> 0:26:26.840 Keating had doctor Joyner, doctor Cook, and nurse Hoffmann in 0:26:26.960 --> 0:26:31.359 one ear telling him the esophagectamies were dangerous, while the 0:26:31.400 --> 0:26:35.000 forceful doctor Patel was angrily making a fierce case to 0:26:35.080 --> 0:26:41.159 keep his patients in Bunderberg and continue doing esophagectamies. The 0:26:41.240 --> 0:26:45.359 operations were so complex they were generously rewarded in extra 0:26:45.480 --> 0:26:50.280 funds for the hospital, and Keating backed his director of surgery, 0:26:50.600 --> 0:26:55.879 doctor Patel. Nurse Gail Dougherty was also becoming worried about 0:26:55.920 --> 0:27:01.359 Patel's insistence on the complex surgery when she questioned doctor 0:27:01.440 --> 0:27:05.600 Marson Carter, the director of anesthetics who headed the intensive 0:27:05.640 --> 0:27:12.000 care unit, he had no qualms. Carter said, the patients 0:27:12.000 --> 0:27:15.120 are fit for anesthetic, and doctor Patel said he could 0:27:15.160 --> 0:27:22.200 do them, so we can't say no. Meanwhile, Dorothy Bryan 0:27:22.520 --> 0:27:28.240 and Muriel Pancheri had fallen into Patel's hands. On nine June, 0:27:28.359 --> 0:27:33.200 Pateel made a technical error, tearing Brian's bow while attempting 0:27:33.280 --> 0:27:38.520 to repair a hernia. Her feces leaked internally, causing a 0:27:38.640 --> 0:27:43.560 serious contamination and contributing to her death. On thirty June. 0:27:44.119 --> 0:27:48.040 Pancheri was so disorientated she could not recall her date 0:27:48.080 --> 0:27:52.760 of birth. The elderly woman's confusion extended to ignorance about 0:27:52.760 --> 0:27:56.680 the procedure Patel had arranged for her a colonoscopy, which 0:27:56.720 --> 0:28:01.960 involved inserting a scope into her anus. He alarmed one 0:28:02.000 --> 0:28:05.720 of the doctors with his overly vigorous use of the device. 0:28:06.520 --> 0:28:09.960 He appeared to be inexperienced with the procedure and had 0:28:10.000 --> 0:28:14.000 a tendency to push too hard, resulting in severe pain 0:28:14.400 --> 0:28:20.080 and an over inflation of the bow. Pancheri succumbed weeks later. 0:28:34.359 --> 0:28:42.200 Chapter thirteen Wounded Pride. For his first five weeks as 0:28:42.200 --> 0:28:46.120 the director of surgery at Bunderberg's Hospital, j Patel was 0:28:46.160 --> 0:28:51.480 shadowed on patient rounds by Gail Aylmer. The senior nurse, 0:28:51.600 --> 0:28:54.960 noticed an alarming pattern as she walked with Patel from 0:28:55.000 --> 0:28:59.560 bed to bed. The doctor, sometimes with an entourage of 0:28:59.680 --> 0:29:05.080 young trainee doctors, was cheerfully removing bandages, handling different instruments, 0:29:05.120 --> 0:29:10.320 and poking around wet and fresh wound sights. Gail Alma 0:29:10.480 --> 0:29:14.160 had no doubts about his work ethic, but his refusal 0:29:14.240 --> 0:29:17.760 to wash his hands between patients or to wear gloves 0:29:17.760 --> 0:29:22.720 made her blood boil. Despite tactfully prompting him over several 0:29:22.800 --> 0:29:28.560 days to adopt basic hygiene, Alma had achieved nothing. She 0:29:28.680 --> 0:29:31.400 spoke to him as firmly as she dared about the 0:29:31.400 --> 0:29:35.840 critical need for infection control techniques, he still refused to 0:29:35.880 --> 0:29:41.080 wear gloves or scrub the pathogens from his hands. Gail 0:29:41.120 --> 0:29:45.320