Speaker 1: My name is Headley Thomas. Sick to Death is based
Speaker 1: on my book of the same name, and it's the
Speaker 1: true story of doctor Jayant Patel's lies and manipulation and
Speaker 1: the herculean effort it took to finally stop him. We've
Speaker 1: used voice actors throughout this series, and on occasion the
Speaker 1: real people from this story have read their words for us.
Speaker 1: It is brought to you by me and the Australian
Speaker 1: Chapter eleven Memory Lane. One evening in September nineteen eighty one,
Speaker 1: doctor William L. Craver, chief of surgery at the Genesee
Speaker 1: Hospital in upstate New York, received a worrying telephone call.
Speaker 1: He was accustomed to receiving calls outside normal working hours.
Speaker 1: He dealt with trauma patients ripped apart with gunshot wounds,
Speaker 1: patients mutilated in serious car accidents. The call he received
Speaker 1: on this particular evening was from a senior nurse. She
Speaker 1: had an unusual problem involving one of the young doctors
Speaker 1: from his home near Rochester. Dr Crab, who was retired,
Speaker 1: told me what happened.
Speaker 2: She was concerned because she had been called by the
Speaker 2: floor nurse who had been caring for a patient admitted
Speaker 2: that afternoon for an operation the next morning. Doctor Patel
Speaker 2: was one of the surgical residents who rotated through a
Speaker 2: hospital from the University of Rochester.
Speaker 1: The patient had complained to the nurse that she was
Speaker 1: extremely tired.
Speaker 3: I really would like to get to sleep.
Speaker 2: Another house doctor is supposed to examine me first, and
Speaker 2: I wish she would hurry up.
Speaker 1: The nurse looked at the patient's charts.
Speaker 2: She saw that there was a complete write up and
Speaker 2: work up and record of a physical examination by doctor
Speaker 2: Pateell of the patient. But he had never examined her.
Speaker 2: He had not been to her room. He had made
Speaker 2: it all up based on the notes of the attending surgeon.
Speaker 2: I went there and talked to the woman. The charts
Speaker 2: described a complete examination, including an examination of her breasts.
Speaker 1: Craver has a vivid memory of questioning the woman about
Speaker 1: these examinations and her answers. A nurse herself, the patient
Speaker 1: was adamant. She told him, I know when my breasts
Speaker 1: have been examined.
Speaker 2: I called doctor Pittell to my office to talk to
Speaker 2: him about it. He denied doing anything wrong. He was
Speaker 2: upset that anyone would question his judgments.
Speaker 1: When Dr Craber talked to surgeons and supervisors in other
Speaker 1: hospitals affiliated with the University of Rochester. He discovered that
Speaker 1: doctor Pateell had been the subject of several similar complaints.
Speaker 1: Dr Craver decided that Patel was untrustworth worthy, a bad apple.
Speaker 1: He did not want him having any contact with the patients.
Speaker 1: He recommended that Patel be fired from the program. The
Speaker 1: president of the university agreed.
Speaker 2: I was calling it the way it should be called
Speaker 2: in surgery. He was supposed to be honest and trustworthy
Speaker 2: with total integrity. He showed total lack of integrity. Doctor
Speaker 2: Petell had been working at our hospital for a couple
Speaker 2: of months at that point. Until then, he had a
Speaker 2: good reputation. He was considered a good training but the
Speaker 2: evidence against him held up. We were not making it up.
Speaker 2: I had no personal reason to be against doctor Pittell.
Speaker 1: Official files document Patel's difficulties with regulatory authorities in New
Speaker 1: York State between nineteen eighty one and nineteen eighty three,
Speaker 1: two decades before he ventured to Bunderberg in Queensland, Australia.
Speaker 1: The files and the record of discipline reaction are matters
Speaker 1: of public record and they have always been available from
Speaker 1: both the New York State Department of Health and the
Speaker 1: State Board for Professional Medical Conduct. They corroborate the recollections
Speaker 1: of Dr Craver, who had not seen the material since
Speaker 1: the early nineteen eighties. The documents show that the floor
Speaker 1: nurse was Mary Jackson. They show Patel had diligently written
Speaker 1: a history, physical examination, progress notes, and admission orders into
Speaker 1: the medical record of the woman patient. They show that
Speaker 1: she was deeply distressed. Her surgeon, doctor Renee Mengui, recorded
Speaker 1: her comments. On the same day, Patel had made similar
Speaker 1: entries in the medical records of two other women without
Speaker 1: personally having examined either of them. He concocted similar lies
Speaker 1: in the medical records of a further two patients. He
Speaker 1: had concocted the examination records to cover himself while he
Speaker 1: worked as a second job at the nearby Rochester Psychiatric Center,
Speaker 1: when he was rostered to be available to respond to
Speaker 1: emergencies and calls at the Genesee Hospital, a sprawling one
Speaker 1: hundred twenty year old institution on Alexander Street. After realizing
Speaker 1: that both nurse Jackson and the surgeon, doctor Mengui were
Speaker 1: taking the complaints seriously and talking to the patients. Patel
Speaker 1: turned on one of the patients. She broke down crying
Speaker 1: when Patel accused her of trying to ruin his career.
Speaker 1: Patel told the woman her complaint would put his job
Speaker 1: and schooling in jeopardy. A rigorous year long investigation into
Speaker 1: Pateel's antics by the Office of Professional Discipline, the investigative
Speaker 1: body which compiles evidence for the board, produced more than
Speaker 1: thirty statements and exhibits. After the fifth and final day
Speaker 1: of hearings on ten Mays nineteen eighty three in rooms
Speaker 1: at the Holiday Inn at Rochester Airport, the evidence filled
Speaker 1: more than seven hundred pages of transcript. Three medical practitioners
Speaker 1: doctor Mengui, doctor Raymond Seaymoss and Dr Craver, as well
Speaker 1: as two nurses, Mary Jackson and Gary Nelson, and four
Speaker 1: patients testified on behalf of the prosecuting Department of Health.
Speaker 1: Dr Patel, testifying on his own behalf, was supported by
Speaker 1: the character references of four medical practitioners, doctor James Williams,
Speaker 1: doctor Marguerite Dinsky, doctor William Farlow and doctor Raymond Hinshaw
Speaker 1: as four members, three of whom were doctors of the
Speaker 1: hearing committee of the State Board for Professional Medical Conduct
Speaker 1: weighed the evidence they had to determine if Patel's fabrication
Speaker 1: of the history of patients demonstrated what they called a
Speaker 1: moral unfitness to practice medicine. The charges included practicing the
Speaker 1: profession of medicine fraudulently by entering items in various patients'
Speaker 1: medical records without personally examining the patient, as well as
Speaker 1: gross negligence and incompetence. On more than one occasion, there
Speaker 1: was a charge of abandoning or neglecting a patient in
Speaker 1: need of immediate professional care without making reasonable arrangements. Patel
Speaker 1: had also harassed, abused, and intimidated the first patient in
Speaker 1: an effort to coerce her not to cooperate with an
Speaker 1: official hospital investigation. When most of the charges were approved,
Speaker 1: Patel's career hung by a thread. The matters were serious,
Speaker 1: involving gross and repeated acts of deception and grave breaches
Speaker 1: of trust. His conduct was analogous to a lawyer strapped
Speaker 1: for time fabricating a series of statements on behalf of
Speaker 1: five clients, but of course, a fictitious medical examination could
Speaker 1: have much more serious repercussions. The committee's members were influenced
Speaker 1: by the glowing references and laudatory testimony from medical colleagues
Speaker 1: on doctor Patel's side, Betel's lawyer, John Frizell, from a
Speaker 1: law firm in Buffalo, where Patel was then living, emphasized
Speaker 1: his client's talents and abilities. Doctor Williams called him an
Speaker 1: excellent clinician and very thorough, extremely dedicated. In one prescient moment,
Speaker 1: doctor Williams suggested that Petel's ultimate contribution to the medical
Speaker 1: profession will be exceptional. Doctor Dinsky described Patel as one
Speaker 1: of the best resident doctors she had had contact with
Speaker 1: in her capacity as a chief resident. He was, she suggested,
Speaker 1: a person of high integrity who had made a mistake.
Speaker 1: Doctor Hinshaw, equally effusive, described Patel as technically very gifted.
Speaker 1: He rated his skills among the top three of the
Speaker 1: two hundred residents he had worked with, and although doctor
Speaker 1: Mengui was a witness for the prosecuting authority, he had
Speaker 1: written in a twenty July nineteen eighty one letter that
Speaker 1: Patel was by far the best resident who has rotated
Speaker 1: with me. At the end of the hearings, the committee's chairman,
Speaker 1: doctor Paul de Luca, decided not to crush Patel. He
Speaker 1: was censured and reprimanded instead of panelizing him with an
Speaker 1: immediate fine. In July nineteen eighty three, the committee put
Speaker 1: him on probation for three years. If he misbehaved again,
Speaker 1: he would be fined five th thousand dollars. Two months later,
Speaker 1: doctor David Axelrod, Commissioner of Health in the state of
Speaker 1: New York, reviewed the decision and decided that the hearing
Speaker 1: committee had been too lenient. He rejected the committee's findings
Speaker 1: where doctor Pateel was given the benefit of the doubt.
Speaker 1: Doctor Axelrod stated that this way.
Speaker 4: The failure to examine patients prior to surgery evidence is
Speaker 4: a disregard for and indifference to the results that may
Speaker 4: follow such failure, and thus constitutes gross negligence.
Speaker 1: He decided Patel had clearly demonstrated his moral unfitness to
Speaker 1: practice medicine. Patel's wrongdoing, according to doctor Axelrod, was.
Speaker 4: A serious failure and should be punished by more than
Speaker 4: a censure and reprimand.
Speaker 1: The effect of the tougher line was negligible. All it
Speaker 1: meant was that Patel had to pay the five thousand
Speaker 1: dollars fine. He was free to return to work, and
Speaker 1: he had a set of wonderful references from four respected doctors.
Speaker 1: Those doctors and their references would open new doors. Although
Speaker 1: fired from the Genesee Hospital where he had been doing
Speaker 1: his residency program, Patel had a springboard to a new job.
Speaker 1: Working with Hinshaw as his research associate. He entered the
Speaker 1: residency program of the University of Buffalo, where he completed
Speaker 1: his general surgery training In nineteen eighty eight. Doctor Hinshaw
Speaker 1: helped Patel again. Wanting to put his New York troubles
Speaker 1: a long way behind him, doctor Patel applied to work
Speaker 1: for the Kaiser Permanente Healthcare Group on the other side
Speaker 1: of the country in Portland, Oregon. A laudatory letter dated
Speaker 1: twenty nine Novem nineteen eighty eight from doctor Hinshaw, then
Speaker 1: chief of Surgery at Rochester General Hospital, to the Board
Speaker 1: of Medical Examiners in Oregon avoided any reference to these
Speaker 1: serious convictions against Mattel.
Speaker 5: When doctor Patel was a member of our residency program,
Speaker 5: he showed technical and professional brilliance When I operated on
Speaker 5: the chief of one of our specialty sections. The doctor
Speaker 5: requested specifically that he be my assistant that in my
Speaker 5: experience is unique.
Speaker 1: On twenty three January nineteen eighty nine, doctor Hinshaw, whose
Speaker 1: distinguished forty year surgical career at the University of Rochester
Speaker 1: was drawing to a close, received a letter from the Board.
Speaker 1: The board's license administrator, Jan Bagenstross, had discovered something about
Speaker 1: Patel's dismissal from the University of Rochester's residency program. Jan Bagenstross,
Speaker 1: curious about doctor Hinshaw's failure to this important chapter in
Speaker 1: doctor Pittell's career, sought more information. Doctor Hinshaw's reply, on
Speaker 1: three February nineteen eighty nine, four months before his retirement,
Speaker 1: acknowledged the discipline reaction, but insisted that doctor Petell had
Speaker 1: been harshly treated. He maintained that it was a case
Speaker 1: of the unfair harassment of a brilliant young surgeon. Doctor
Speaker 1: Hinshaw's letter to Jan Bagenstrass says.
Speaker 5: When I appeared before the State Health Department in doctor
Speaker 5: Petell's behalf, I was asked if I believe the charges
Speaker 5: against doctor Petel. I gave my reasons why I did
Speaker 5: not believe them. I was asked what I would think
Speaker 5: if I could indeed be shown that doctor Petell had
Speaker 5: written a physical examination without having examined the patient. I
Speaker 5: stated that such behavior on his part would seem so
Speaker 5: bizarre to me from having worked very closely with him,
Speaker 5: that I do my best to find out what circumstances
Speaker 5: caused such an abberation of behavior.
Speaker 1: Doctor Hinshaw died aged sixty nine in nineteen ninety three.
Speaker 1: Dr Craver did not know until years later about the
Speaker 1: misleading letters of support for Pateel. In his job quest,
Speaker 1: Dr Craver believed that Hinshaw's unwavering support of Patel during
Speaker 1: the earlier disciplinary process was inescapably wrong. Dr Hinshaw's stand
Speaker 1: was a source of tension between the two senior surgeons
Speaker 1: for years afterwards. Dr Craver told me.
Speaker 2: I will never understand why, in the face of all
Speaker 2: this evidence, he would have applauded Doctor Pateell. Has made
Speaker 2: me lose some respect for men. Was a very fine surgeon.
Speaker 1: Chapter twelve. A tussle June and July two thousand and three.
Speaker 1: In the days after James Phillips passed away in the
Speaker 1: intensive care unit, Tony Hoffman became increasingly confused she could
Speaker 1: cope with doctor j. Petel's bombastic and patronizing attitude. She
Speaker 1: could tolerate his kiss up and kick down approach to
Speaker 1: management and nursing staff, but she worried about his clinical
Speaker 1: judgment and expertise. Patel had been telling the nurses ad
Speaker 1: nauseum how experienced he was in the United States. One
Speaker 1: day he said he was a gold standard trauma surgeon,
Speaker 1: the next he was a cardiothoracic surgeon. There was a
Speaker 1: different qualification every other day. The nurses joked he had
Speaker 1: been doing complex surgery for twenty five years. The next
Speaker 1: day it was thirty years. Another day it was twenty years.
Speaker 1: Hoffman feared something else in doctor Patel's character megalomania, a
Speaker 1: boldness bordering on recklessness. He seemed to lack insight into
Speaker 1: the risks he created for the patients. Tony Hoffman was
Speaker 1: also wondering about his knowledge of best practiced drugs for
Speaker 1: the patients. He was demanding drugs like dopamine and buttamine
Speaker 1: that had been superseded years earlier when other doctors used
Speaker 1: modern drugs such as adrenaline and nora adrenaline. Petel told
Speaker 1: the nurses to change the medication back to the obsolete drugs.
Speaker 1: He thought so differently to the other doctors and to
Speaker 1: nurse Tony Hoffman that it was as if she confided
Speaker 1: to doctor Darren keating they.
Speaker 3: Were from two different planets.
Speaker 1: Her attempts to call a truce after the death of
Speaker 1: Phillips failed. Dismally, Hoffman knew that doctor Patel now saw
Speaker 1: her as an enemy. He started undermining her authority and credibility,
Speaker 1: criticizing her and the Intensive care Unit. In talks with
Speaker 1: younger doctors and nurses, she realized that the less experienced
Speaker 1: doctors who relied on Patel to advance their own careers
Speaker 1: lacked the knowledge to see his flaws. They would almost
Speaker 1: always back him, but Patel was now dividing the nursing
Speaker 1: staff to grow his support base and isolate her. Having
Speaker 1: seen through Patel's grandiose claims early on, Tony Hoffman had
Speaker 1: also worked out that Patel was not everything he said
Speaker 1: he was. She became a major threat to him. She
Speaker 1: had to be discredited. Patel began denigrating the ICU as
Speaker 1: third world. He made it clear that he did not
Speaker 1: trust Hoffman nor several of the nurses in the unit.
Speaker 1: On three June, he walked into the ICU to announce
Speaker 1: that he would be performing another esophagectomy. The patient this
Speaker 1: time would be James Grave, aged sixty three.
Speaker 6: I'd be in the unit for the hul dudes while
Speaker 6: my asophagectamy patient is inher until he leaves the unit.
Speaker 1: Nurse k Boison recoiled as Patel continued running the unit down.
Speaker 1: He made it known that he needed to be in
Speaker 1: the ICU for the two days because he thought so
Speaker 1: little of Hoffman's professionalism. Doctor Patel knew that Tony Hoffman
Speaker 1: had voice concerns about the death of James Phillips to
Speaker 1: doctor Keating and to the Director of Nursing, Glennis Goodman.
Speaker 1: The sixth June operation on Grave led to a string
Speaker 1: of complications. Patel had paralyzed Grave's vocal cord, which made
Speaker 1: it difficult for him to clear his airway and breathe.
Speaker 1: In the days afterwards, his wound fell apart twice. The
Speaker 1: nurses rarely saw these instances of wound collapse or dehesiance,
Speaker 1: meaning to gape, but with Patel it was becoming common.
Speaker 1: There was also leakage where Patel had clumsily rejoined Grave's gut.
Speaker 1: Increasingly weak, the patient was wheeled in for three further
Speaker 1: operations by Patel on twelve sixteen and eighteen June. While
Speaker 1: the anesthetist, doctor John Joyner, and the junior doctor James
Speaker 1: Boyd tried to arrange a bed for him in Brisbane,
Speaker 1: Patel stubbornly resisted the transfer. The perilous condition of Grave
Speaker 1: was obvious as he was moved between the ICU, the
Speaker 1: surgical ward and the operating theater. Hoffmann could not understand
Speaker 1: why he had not been transferred out His life hung
Speaker 1: by a thread, even when there was a bed of
Speaker 1: available in Brisbane. On eighteen June, Patel refused to talk
Speaker 1: to the surgeons in Brisbane, making transfer impossible. An incredulous
Speaker 1: doctor from one of the larger hospitals questioned Hoffman, why
Speaker 1: are you doing these big operations there when you can't
Speaker 1: care for these patients. In her long career, Hoffman had
Speaker 1: never taken on a director of surgery, but she could
Speaker 1: see that Grave would die unless someone intervened. She sent
Speaker 1: a note to Glennis Goodman explaining that doctors at the
Speaker 1: Princess Alexandra Hospital and the Royal Brisbane Hospital.
Speaker 7: Have expressed their concern at why such surgery was done
Speaker 7: here when we don't have an intense first Meanwhile, the
Speaker 7: patient continues to deteriorate and we have no bed to
Speaker 7: transfer him too. I think before any more surgery of
Speaker 7: this type is done here, we really have to examine
Speaker 7: whether we can offer the appropriate follow up care.
Speaker 1: Some twenty four hours later, as Grave languished and Patel
Speaker 1: predicted that he would make a miraculous recovery if left
Speaker 1: in Thunderberg, Tony Hoffman went to Darren Keating. She told
Speaker 1: him of Graves complications and how he needed increasing amounts
Speaker 1: of adrenaline because his condition was so unstable.
Speaker 7: Hoffman told Keating there remains unresolved issues with the behavior
Speaker 7: of the surgeon, which is confusing for the nursing staff.
Speaker 7: I believe we're working outside our scope of practice for
Speaker 7: a level one intensive care unit. The ongoing issues regarding
Speaker 7: the transfer of patients and the designated level of this
Speaker 7: ICU may need to be discussed in more detail at
Speaker 7: a later date. The behavior of the surgeon in the
Speaker 7: ICU also needs to be discussed, as certain very disturbing
Speaker 7: scenarios have occurred.
Speaker 1: Hoffman was perturbed that Patel had not recognized a worrying
Speaker 1: feature in graves condition. He had a kyler thorax, a
Speaker 1: build up of a milky fluid in the intercostal catheter
Speaker 1: in his chest. Doctor Joyner was also worried he had
Speaker 1: found a bed for Grave in Brisbane, but when Patel
Speaker 1: discovered the arrangement, he was furious and immediately threatened to quit.
Speaker 1: He confronted Joyner in the corridor between the ICU and
Speaker 1: theater and abused him. Doctor Joyner regarded Patel as forceful, loud,
Speaker 1: and at times intimidating, but doctor Joyner also felt sure
Speaker 1: of his own position. He had read a recent article
Speaker 1: in the British Journal of Anesthesia warning of high death
Speaker 1: rates for esophagectomy patience in smaller hospitals. When doctor Joyner
Speaker 1: took his concerns to doctor Keating, there were more histrionics.
Speaker 1: Patel had a tantrum and a again threatened to quit.
Speaker 1: Finally he agreed to a compromise. On twenty June, the
Speaker 1: patient Grave went to the Martyr, a leading Brisbane private
Speaker 1: hospital which also receives public patients. Its director of Critical
Speaker 1: Care Services, doctor Peter Cook, was surprised at graves condition
Speaker 1: and shocked that a esophagectomy had been attempted at Bunderberg.
Speaker 1: Dr Cook, an intensive care and anesthesia specialist, talked at
Speaker 1: length about the case to a surgeon colleague who shared
Speaker 1: his concerns. They agreed that Patel's contemplation of such procedures
Speaker 1: in Bunderberg called inter question his competence and judgment. The
Speaker 1: botching of the operation gave them even greater cause for concern.
Speaker 1: There was another worry. The charts for Grave showed the
Speaker 1: cancer had spread to lymph nodes outside his a sophot
Speaker 1: and stomach. A large tumor was outside his bowel. Because
Speaker 1: of the cancers spread, the esophagectamy was not only traumatic
Speaker 1: and potentially lethal, it was also fruitless. Cook felt strongly
Speaker 1: that the doomed man should have been at home, comforted
Speaker 1: by loved ones, instead of in acute pain and distress
Speaker 1: from a failed to soophagectamy, which could only shorten his life.
Speaker 1: On one July, unaware of nurse Hoffman's efforts, he telephoned
Speaker 1: Keating and explained the rocky future for the patient Grave
Speaker 1: and the risks for all patients having esophagectamese in Bunderberg.
Speaker 1: The risks and the issues were identical to those already
Speaker 1: outlined by Tony Hoffman. Keating gave an assurance that he
Speaker 1: would take the matter up with doctor Patel. Cook decided
Speaker 1: to document his concerns he knew about the connection between
Speaker 1: public hospital funding and the frequency of operations. He regarded
Speaker 1: it as an unhealthy policy which rewarded surgical volume instead
Speaker 1: of patient outcomes. It produced a dreadful conflict of interest.
Speaker 1: He questioned if Bunderberg was trying to widen its clinical
Speaker 1: practice to boost its coffers. In a memo, he wrote.
Speaker 2: Clearly, this is not appropriate surgery to be done at
Speaker 2: a center with such a small level of support services,
Speaker 2: particularly ICU.
Speaker 1: But Patel remained determined to carry on. He told the
Speaker 1: ICU staff, you will do.
Speaker 6: What I see, or I won't go to Darren Keating.
Speaker 6: I will go to Peter Lac the executive will do
Speaker 6: what I want them to do, because I'm making them
Speaker 6: so much money. I'll resign if they don't let me
Speaker 6: keep my patience here.
Speaker 1: It was all bluff. Patel had nothing to return to
Speaker 1: in the United States except shame. He had been reminded
Speaker 1: of this in a surprise telephone call from an investigator
Speaker 1: with the Oregon Board of Medical Examiners, who was doing
Speaker 1: a routine license check of discipline doctors. Patel lied.
Speaker 6: He told him, I'm retired and practicing medicine on a
Speaker 6: volunteer basis. Only.
Speaker 1: Keating had doctor Joyner, doctor Cook, and nurse Hoffmann in
Speaker 1: one ear telling him the esophagectamies were dangerous, while the
Speaker 1: forceful doctor Patel was angrily making a fierce case to
Speaker 1: keep his patients in Bunderberg and continue doing esophagectamies. The
Speaker 1: operations were so complex they were generously rewarded in extra
Speaker 1: funds for the hospital, and Keating backed his director of surgery,
Speaker 1: doctor Patel. Nurse Gail Dougherty was also becoming worried about
Speaker 1: Patel's insistence on the complex surgery when she questioned doctor
Speaker 1: Marson Carter, the director of anesthetics who headed the intensive
Speaker 1: care unit, he had no qualms. Carter said, the patients
Speaker 1: are fit for anesthetic, and doctor Patel said he could
Speaker 1: do them, so we can't say no. Meanwhile, Dorothy Bryan
Speaker 1: and Muriel Pancheri had fallen into Patel's hands. On nine June,
Speaker 1: Pateel made a technical error, tearing Brian's bow while attempting
Speaker 1: to repair a hernia. Her feces leaked internally, causing a
Speaker 1: serious contamination and contributing to her death. On thirty June.
Speaker 1: Pancheri was so disorientated she could not recall her date
Speaker 1: of birth. The elderly woman's confusion extended to ignorance about
Speaker 1: the procedure Patel had arranged for her a colonoscopy, which
Speaker 1: involved inserting a scope into her anus. He alarmed one
Speaker 1: of the doctors with his overly vigorous use of the device.
Speaker 1: He appeared to be inexperienced with the procedure and had
Speaker 1: a tendency to push too hard, resulting in severe pain
Speaker 1: and an over inflation of the bow. Pancheri succumbed weeks later.
Speaker 1: Chapter thirteen Wounded Pride. For his first five weeks as
Speaker 1: the director of surgery at Bunderberg's Hospital, j Patel was
Speaker 1: shadowed on patient rounds by Gail Aylmer. The senior nurse,
Speaker 1: noticed an alarming pattern as she walked with Patel from
Speaker 1: bed to bed. The doctor, sometimes with an entourage of
Speaker 1: young trainee doctors, was cheerfully removing bandages, handling different instruments,
Speaker 1: and poking around wet and fresh wound sights. Gail Alma
Speaker 1: had no doubts about his work ethic, but his refusal
Speaker 1: to wash his hands between patients or to wear gloves
Speaker 1: made her blood boil. Despite tactfully prompting him over several
Speaker 1: days to adopt basic hygiene, Alma had achieved nothing. She
Speaker 1: spoke to him as firmly as she dared about the
Speaker 1: critical need for infection control techniques, he still refused to
Speaker 1: wear gloves or scrub the pathogens from his hands. Gail
Speaker 1: Alma cringed every time she saw Patel handling the patients.
Speaker 1: She feared contact could be transferring bacteria and unnecessarily causing infection.
Speaker 1: It was madness. Apart from the risk to the patients,
Speaker 1: she worried that the younger doctors whom Patel influenced, would
Speaker 1: pick up the dangerous habit. Her next strategy was to
Speaker 1: walk around behind him with a box of gloves. Each
Speaker 1: time he stopped at a bed, she removed a new,
Speaker 1: sterile pair of gloves.
Speaker 8: I shouldn't have to be giving you these gloves. I'm
Speaker 8: concerned about your practices with hand washing between patients.
Speaker 1: It worked for a while, but Aylman knew that other
Speaker 1: nurses with less experience or confidence to push Patel would
Speaker 1: have no chance. For the benefit of the other doctors,
Speaker 1: but mostly for the benefit of Betel's patients. Gail Aylmer
Speaker 1: asked Judy O'Connor, the medical education officer, to run a
Speaker 1: lunchtime briefing session on the latest hand washing and infection
Speaker 1: control measures. The idea was to do a glitterbug test.
Speaker 1: It meant putting some fluorescent cream on the doctor's hands,
Speaker 1: rubbing it in, and then asking them to wash their
Speaker 1: hands under an ultraviolet line in a darkened room. The
Speaker 1: parts of the hands that had not been washed thoroughly
Speaker 1: would stand out, but Pateel walked out to make a
Speaker 1: phone call. He did not return. Delicate tissue and organs
Speaker 1: can usually withstand gentle exploration, nudging and prodding in a
Speaker 1: surgical procedure. Some surgeons, like doctor Brian Theel, are renowned
Speaker 1: as much for their soft touch as their technical prowess,
Speaker 1: but doctor Patel had a reputation for neither. He ripped tissue,
Speaker 1: he battered organs when suturing the wounds. He treated fragile
Speaker 1: tissue with disdain. His rough handling inevitably bruised the tissue
Speaker 1: and organs, as well as being fertile beds for infection,
Speaker 1: the wounds were less likely to heal after being harshly treated.
Speaker 1: Stitches would make little difference to a wound which was bruised,
Speaker 1: wet and angry. Inevitably, these wounds would fall apart like
Speaker 1: an old and bruised piece of fruit, known as wound dehesiins.
Speaker 1: It had happened twice to James Grave after his esophagectomy.
Speaker 1: Before doctor Patel's arrival, post surgical injuries in Bunderberg had
Speaker 1: been extremely rare. By early July two thousand and three,
Speaker 1: Gail Alma had encountered almost as many instances of woundhesince
Speaker 1: in the preceding months as she had seen in over
Speaker 1: twenty years of nursing. She suspected that most of the
Speaker 1: abdominal wounds were falling apart due to poor surgical technique
Speaker 1: rather than infection. There was gossip on the wards that
Speaker 1: Patel had told some of the junior doctors not to
Speaker 1: make reference todhesiins in the patient's charts. Gail Alma wanted
Speaker 1: to ensure that the nurses were picking it up, even
Speaker 1: if occurrences were being misrepresented. In an email to senior nurses,
Speaker 1: she wrote.
Speaker 8: I am as I know you are as well, becoming
Speaker 8: increasingly concerned. Read the number of woundhesents that have occurred
Speaker 8: over the last six to eight weeks. While it does
Speaker 8: not appear that the dehesions is relating to infection, this
Speaker 8: needs to be investigated further to identify the causes. Things
Speaker 8: to consider, for example, include how frequently is this occurring,
Speaker 8: what type of surgery is involved, how many days post
Speaker 8: op did the dehesions occur, Who the surgeon, assistant, scrub, nurses, etc. Were,
Speaker 8: what theater did the surgery occur in what ward they
Speaker 8: were nursed on.
Speaker 1: Four days later, Gail Almer compiled a report with patient
Speaker 1: charts on thirteen instances of woundehesins. She included patients such
Speaker 1: as James Grave. She noted the dehesients suffered by John Banks,
Speaker 1: whose bow was visible through the staple line. After a
Speaker 1: diseased part of his colon was cut out, one staple
Speaker 1: had become embedded in his bow. There was the case
Speaker 1: of June Ben whose greater omentum, an apron of tissue
Speaker 1: holding the bow together, was protruding from her wound. Ayelma's
Speaker 1: report went to doctor Darren Keating later that day, she
Speaker 1: had an unexpected visit from Patel. He stood over her
Speaker 1: and explained why most of the thirteen cases required no
Speaker 1: further analysis. He gave a variety of excuses and explanations.
Speaker 6: This is right, this is right, this is all accounted for.
Speaker 1: Patel acknowledged in two cases that technique might have meant
Speaker 1: to blame, although he did not accept personal responsibility. Junior
Speaker 1: doctors who worked alongside him in theater copped the blame.
Speaker 6: If you do a lot of operations, you will have
Speaker 6: an increased likelihood of warndahessins.
Speaker 1: Out of her depth and surprise that Patel, rather than
Speaker 1: doctor Keating, had been to see her. Gail Alma felt
Speaker 1: she had nowhere to turn and no way of being
Speaker 1: sure of her ground. She had expected the issues to
Speaker 1: be resolved by Keating after careful analysis. It was why
Speaker 1: she gave him the report. It was not her place
Speaker 1: to argue with the director of surgery about his clinical skills.
Speaker 1: She was hearing disturbing feedback from others in the hospital.
Speaker 1: Jenny White told her that Patel.
Speaker 9: Did not seem to know his instruments well, using the
Speaker 9: wrong clan for frail tissue, and his technique was rough White.
Speaker 1: Who had witnessed Patel's anger when the issue of wound
Speaker 1: ahesince was raised, was reluctant to document her concerns. Alma
Speaker 1: brought it up with the director of Anesthetics, doctor Martin Carter.
Speaker 1: She asked him whether Patel was a good surgeon. Carter replied,
Speaker 1: I wouldn't let him operate on me. On another occasion,
Speaker 1: when she was in the ICU staff room, Alma heard
Speaker 1: Carter refer to Patel as doctor Death. Meanwhile, Tony Hoffman
Speaker 1: felt that she had been let down by Martin Carter.
Speaker 1: She had wanted him to stand up to Patel in
Speaker 1: the beginning. If Carter had bluntly told Patel, this is
Speaker 1: how this intensive care unit runs, Gail Alma would not
Speaker 1: have been in conflict with anyone. Patel might have got
Speaker 1: the message. Disillusioned by the handling of the woundehesion's report,
Speaker 1: Gail Alma wondered why she bothered escalating such issues. Management
Speaker 1: did not want to hear about problems. She believed that
Speaker 1: the hospital's executives took the view, if you're not going
Speaker 1: to deliver me good news, I don't want to know
Speaker 1: any news. Theater nurse Damian Gaddy's was similarly frustrated. A
Speaker 1: thoughtful and gentle care with a reputation for putting the
Speaker 1: patient's interest first, Gaddi's was shocked at Patel's techniques in
Speaker 1: major operations. When it came to routine surgery procedures such
Speaker 1: as hernia repairs, Gaddy's had few qualms about Patel's proficiency,
Speaker 1: but for more complex operations such as bow resections, it
Speaker 1: was a different story. Gaddies had watched dozens of surgeons
Speaker 1: do the same procedure hundreds of times. When a ball
Speaker 1: is resected or the end of the intestine is cut,
Speaker 1: the surgeon should assume they are contaminated. They should be
Speaker 1: held outside the abdominal cavity or swabbed with aquise el
Speaker 1: bettadine to minimize contamination risks. But Gaddi's had often seen
Speaker 1: Patel leave the end of a bowel freely clammed and
Speaker 1: the other end flopping around inside the abdominal cavity, raising
Speaker 1: the infection risk. Patel had extensive dermatitis, with small sare
Speaker 1: covering his arms. Gaddie's watched Patel's haphazard gowning and gloving
Speaker 1: technique closely and concluded that contamination was often inevitable in
Speaker 1: the past. When Gaddi's had raised an issue about a
Speaker 1: pethidine addicted doctor who was stealing drugs from the hospital's stores,
Speaker 1: a supervisor had threatened Gaddy's with dismissal. He had no
Speaker 1: doubt that if a nurse had been discovered with empty
Speaker 1: ampules of pethidine and classic symptoms of addiction, there would
Speaker 1: have been immediate suspension. Gaddi's resented the double standards. It
Speaker 1: seemed to him that doctors in hospitals were a protected species.
Speaker 1: He raised his concerns about Patel with Jenny White, the
Speaker 1: theater nurse in charge.
Speaker 9: What do you expect me to do? You can't expect
Speaker 9: me to tell a surgeon what to do.
Speaker 1: Patient. Ian Fleming, a father of war and a former
Speaker 1: police officer, had hit it off with doctor Patel when
Speaker 1: they first met in May two thousand and three. Fleming
Speaker 1: put it down to Patel's friendly charm. They also shared
Speaker 1: a love of cricket. When Fleming asked him about India's
Speaker 1: youngest Test wicket keeper, eighteen year old Pathiv Patel, who
Speaker 1: was on the tour of Australia, Patel lit, up, is
Speaker 1: my nephew. The doctor told him Fleming liked his easy manner.
Speaker 1: He did not know that Patel was one of the
Speaker 1: most common surnames in India. For months, Ian Fleming had
Speaker 1: been in pain due to the inflammation of tiny, multiple
Speaker 1: sacks or pockets known as diverticular forming part of his
Speaker 1: large intestine. When an attack came on, he would double
Speaker 1: up in agony. It took three attacks for Fleming to
Speaker 1: decide that surgery would be better than the pain. Patel
Speaker 1: showed Fleming his chart and explained how he would cut
Speaker 1: out the growths. On nineteen May, while Fleming was under
Speaker 1: a general anesthetic, his abdomen was cut from the navel
Speaker 1: to the groin at home. Three days later, his stomach
Speaker 1: swelled and turned a bright, angry red. The pain was excruciating.
Speaker 1: Fleming could not eat, sleep, or walk properly. On twenty
Speaker 1: eight May, when he returned to the hospital for treatment,
Speaker 1: Petel told him it was all in his head and
Speaker 1: that he was acting.
Speaker 6: Go home, give the wife and kids a kiss, and
Speaker 6: have a great life.
Speaker 1: Fleming did as he was told. At nine point thirty
Speaker 1: pm the next night, he was sitting on the sofa
Speaker 1: at home when a hole in his wound blew out
Speaker 1: blood and pass poured from the gaping opening. His wife
Speaker 1: had to use a sanitary napkin to cover it as
Speaker 1: they rushed to the emergency department. Fleming needed further surgery
Speaker 1: to correct the and he was in hospital for a
Speaker 1: week with large doses of antibiotics for the infection. The
Speaker 1: nurses wrote on Fleming's chart that the wound was sucking
Speaker 1: and blowing bubbles. When he next saw Patel, the friendly
Speaker 1: rapport was gone. The surgeons seemed angry about Fleming's complications.
Speaker 1: Fleming believed that the nurses were more concerned than Patel
Speaker 1: about his welfare. They suggested a suction pump to drain
Speaker 1: fluid from his wound site, but Patel angrily refused. He
Speaker 1: was hostile to the nurse's suggestions that a different type
Speaker 1: of bandage be used. Fleming's wound adhesiince was noted by
Speaker 1: the nurses in his charts. In October, when Fleming complained
Speaker 1: to the hospital about Patel's handling of his case, Keating
Speaker 1: rang back and told him.
Speaker 10: Who you've lodged a complaint against Dr Patel. I must
Speaker 10: tell you that he is a fine surgeon with impeccable
Speaker 10: credentials and we are lucky to have him here in
Speaker 10: I understand you are bleeding internally since the operation, but
Speaker 10: this could be caused by many factors.
Speaker 1: Back in the ICU, Hoffman was trying to look after
Speaker 1: a disorientated patient, John Breed, who had been living rough
Speaker 1: in parks around Bunderberg when he reached the hospital in
Speaker 1: early July. He had a bleeding stomach ulcer and was
Speaker 1: in very poor condition. After Patel's operation, Hoffman could see
Speaker 1: that Breed's red and swollen stomach wound was clearly infected.
Speaker 1: He had no bowl sounds, and his condition was steadily worsening.
Speaker 1: Hoffman believed he was showing classic science of postoperative sepsis.
Speaker 1: The infection had spread through his bloodstream to the rest
Speaker 1: of his body. Patel refused to acknowledge that there was
Speaker 1: any sign of stomach infection. He put the problems down
Speaker 1: to a chest infection and a carrents, not uncommon for
Speaker 1: patients on ventilating equipment in an ICU. Hoffman couldn't believe it.
Speaker 1: She didn't know what Patel was talking about. Adamant that
Speaker 1: there was no evidence of any chest infection, she knew
Speaker 1: that Breed should have been receiving intensive care in Brisbane
Speaker 1: for a week. Patel refused to let the man go.
Speaker 1: Hoffman had correctly identified Breed's stomach infection arising from Patel's
Speaker 1: surgery as the problem. She heard nothing back from Patel.
Speaker 1: They were no longer on speaking terms. After the eventual
Speaker 1: transfer of John Breed to Brisbane, the nurses were told
Speaker 1: he had died. They collected his personal effects, clothes, densures,
Speaker 1: and spectacles. The spectacles were added to a collection for
Speaker 1: a worthy cause. Days later, the nurses were relieved to
Speaker 1: discover that he had survived, and for a few hours
Speaker 1: there was a frantic search to recover his only pair
Speaker 1: of spectacles. Chapter fourteen, Sex Lies and Doctor Kureshi, August
Speaker 1: to December two thousand and three. In late August, Annette
Speaker 1: Arrowsmith went to Bunderberg Hospital suffering pain in her left breast.
Speaker 1: She hoped a doctor would put her mind at ease,
Speaker 1: perhaps recommend medication for the pain and some tests to
Speaker 1: exclude cancer. Instead, she was fondled for ninety minutes by
Speaker 1: a swarthy man with a mustache. He played with her breasts,
Speaker 1: and he asked if he could examine the lower part
Speaker 1: of her body. Arrowsmith refused. She suspected doctor Tarik Kureshi,
Speaker 1: an overseas trained doctor from Pakistan, was not interested in
Speaker 1: clinical care. She noticed his pants were wet in just
Speaker 1: two months in starting at the hospital with minimal supervision
Speaker 1: and orientation. Kureshi's complete lack of basic clinical knowledge had
Speaker 1: raised eyebrows around the hospital. He was regarded by doctor
Speaker 1: Peter Meak as unbelievably incompetent. Miak, who could not understand
Speaker 1: how someone as ignorant about medicine could have been employed,
Speaker 1: doubted Korreeshi had ever been trained as a doctor. Miak
Speaker 1: went to doctor Darren keating.
Speaker 10: I don't want this chap to work here. He's totally useless. Look,
Speaker 10: if you want to pay him, put him in the
Speaker 10: library and get him to read a book. But he's
Speaker 10: of no use to me.
Speaker 1: Kureshi was also unwelcome in the ICU. Doctor Martin Carter
Speaker 1: did not want him to have anything to do with
Speaker 1: the patients. The nurses were wary of Kureshi for different reasons.
Speaker 1: He kept bumping into them and squashing against their bodies.
Speaker 1: Annette Arrowsmith's formal complaint went to doctor Keatie, who made
Speaker 1: a detailed note of the circumstances and of Kureshi's denial
Speaker 1: of anything untoward. Several weeks later, Karen Mcinness came into
Speaker 1: the hospital for a deep vein thrombosis in her right calf.
Speaker 1: She said of her experience.
Speaker 3: Doctor Kureshi came to examine my leg. After doing this,
Speaker 3: he started rubbing my inner thigh down to my knee
Speaker 3: in a way that made me feel very uneasy. As
Speaker 3: I put my legs back under the blankets, he asked
Speaker 3: to listen to my chest. I lifted my top to
Speaker 3: just under my breast. He listened for a few minutes,
Speaker 3: and then he pulled my top above my breasts and
Speaker 3: started moving the left one in every direction he could.
Speaker 3: I've never had a doctor do this to me before.
Speaker 1: The examination made her skin crawl. Mcinness wished that she
Speaker 1: could curl up and go away. Keating told Korreeshi he
Speaker 1: faced dismissal if he did not have a chaperone in
Speaker 1: further consultations with female patients. On twenty two October, doctor
Speaker 1: Keating told the Medical Board of Queensland about the complaints.
Speaker 1: One of the staff later wrote back to say that
Speaker 1: an investigation might be mounted by September the following year.
Speaker 1: The third complaint was more poignant. Amanda Bully, undergoing neurological
Speaker 1: observations after seizures, became teary when Koreshi came into the cubicle.
Speaker 1: The nurse Daniella Tarlington asked why she was so upset,
Speaker 1: and Bully explained that Koreshi had been in previously. While
Speaker 1: she was having a seizure, Amanda Bully could feel him
Speaker 1: kissing her face and putting his hand down her shirt
Speaker 1: to touch her breasts while she was having convulsions. Although
Speaker 1: able to see and feel the sexual assault, she could
Speaker 1: not respond. But Kueshi continued to work at the hospital.
Speaker 1: Or seven months after the first complaint of a sexual
Speaker 1: nature and some nine months after he had been rated
Speaker 1: as utterly incompetent by doctor Miak. The failure of the
Speaker 1: hospital's management and of the medical board to suspend him
Speaker 1: immediately reinforced a perception among nurses and doctors that serious
Speaker 1: complaints were not dealt with appropriately. Koreshi disappeared overseas in
Speaker 1: March two thousand and four, when police began to look
Speaker 1: for him to ask questions about an unrelated petty crime.
Speaker 1: His destination was unknown. Patel faced a less serious claim
Speaker 1: of sexual harassment. He had asked nurse Patria Azlet for
Speaker 1: her home telephone number over the bed of a patient
Speaker 1: in surgery, and then called her at all hour seeking
Speaker 1: a relationship. Aslet immediately regretted giving him the number, no
Speaker 1: matter how many times she told Patell she was not interested,
Speaker 1: he persisted. The calls ended after Keating, tipped off by
Speaker 1: Tony Hoffman, took Patel aside one day and had a
Speaker 1: chat to him about the nurses forming the wrong impression.
Speaker 1: The next day, Patel made a joke of the episode.
Speaker 6: You can't do anything in Australia without getting into trouble.
Speaker 1: Meanwhile, Hoffman had heard a disturbing rumor which might have
Speaker 1: explained the willingness of doctor Martin Carter, the director of anesthetics,
Speaker 1: to accede to Patel's refusal to transfer the patients. Tony
Speaker 1: Hoffman related it to doctor Keating in a September email.
Speaker 7: I'm told that Dr Patel and Martin Carter have come
Speaker 7: to an agreement by which doctor Patel will operate only
Speaker 7: if Martin Carter agrees to not transfer this page.
Speaker 1: Hoffman believed the situation was dire. Another patient, Mervyn Smith,
Speaker 1: was in a bad way with major chest and spleen
Speaker 1: injuries and five broken ribs after a road accident. He
Speaker 1: had suffered a string of serious complications since surgery by Patel.
Speaker 1: He needed long term intensivist management and the support of
Speaker 1: a cardiothoracic team. Options available in Brisbane, not the regional
Speaker 1: town of Bunderberg. Hoffman's latest email to Keating raised for
Speaker 1: the first time a possible explanation for Ptel's immunity. It
Speaker 1: was the purported arrangement. The email reiterated her concerns about
Speaker 1: what type.
Speaker 7: Of surgery should be done here in relation to our
Speaker 7: follow up care and the services we can provide.
Speaker 1: Although she had no reply from doctor Keating, he spoke
Speaker 1: about the matters to Patel and Martin Carter. They deny
Speaker 1: they had done a deal over the care of patients
Speaker 1: and they strenuously defended the handling of Mervyn Smith. Sick
Speaker 1: to Death is written and presented by me Headley Thomas,
Speaker 1: the Australians National Chief correspondent. Claire Harvey is The Australian's
Speaker 1: editorial director, Audio, editing, production and music have been done
Speaker 1: by Jasper Leik, with assistants from Leah Sammaglu and Neil Sutherland.
Speaker 1: Our producer is Christain Amias. Production management by Stephanie Coombs,
Speaker 1: artwork by Sean Callanan. Thanks to Ryan Osland, Matthew Condon,
Speaker 1: Karina Berger, Ellie Dudley, David Murray, Dominique McDermott, Zach Sculander
Speaker 1: and all our family, friends and colleagues who helped in
Speaker 1: this series and contributed voice acting and special thanks to
Speaker 1: Tony Hoffman and Rob Messenger. Subscribers to The Australian here
Speaker 1: new episodes of Sick to Death first at Sick to
Speaker 1: deathpodcast dot com and on Apple Podcasts. You can get
Speaker 1: exclusive access to photographs, videos, timelines and more at the
Speaker 1: website