WEBVTT - Episode 6: The Bloodletting 0:00:04.840 --> 0:00:08.680 My name is Hedley Thomas. Sick to Death is based 0:00:08.720 --> 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 Jan 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 0:00:19.560 --> 0:00:23.680 used voice actors throughout this series, and on occasion the 0:00:23.800 --> 0:00:27.080 real people from the story have read their words for us. 0:00:28.240 --> 0:00:31.000 It is brought to you by Me and the Australian. 0:00:39.400 --> 0:00:45.040 Chapter twenty four, The Outpouring October to November two thousand 0:00:45.080 --> 0:00:56.160 and four, Tony Hoffman finally lost patience with her smug 0:00:56.320 --> 0:01:02.080 and unresponsive managers. Her more than enough about the merits 0:01:02.120 --> 0:01:08.039 of mediation. She did not want psychological counseling. She felt 0:01:08.040 --> 0:01:13.399 patronized by all the talk about personality conflict with Jon Patel, 0:01:14.200 --> 0:01:17.480 and she was angry that the nurse unit manager, Linda 0:01:17.560 --> 0:01:21.080 Mulligan believed the problems on the wards and in the 0:01:21.120 --> 0:01:24.919 intensive care unit might be fixed by a book called 0:01:25.319 --> 0:01:31.360 Coping with Difficult People. Doctor Darren Keating had convinced himself 0:01:31.480 --> 0:01:34.600 and others that much of the criticism of Patel was 0:01:34.640 --> 0:01:38.600 the product of the surgeon's personality. Clash with Tony Hoffman. 0:01:39.880 --> 0:01:44.759 On eighteen October, doctor Keating, Peter Leck, and Linda Mulligan 0:01:44.880 --> 0:01:48.800 met to talk about the problems. They agreed that there 0:01:48.840 --> 0:01:52.800 needed to be mediation. The constant bickering was having an 0:01:52.840 --> 0:01:57.440 impact on the operations of the intensive care unit. Keating 0:01:57.600 --> 0:02:00.720 was fed up with the stream of complaints against the 0:02:00.760 --> 0:02:04.559 star surgeon. He made time in his diary to meet 0:02:04.560 --> 0:02:09.359 Patel and Hoffman together. He doubted he could resolve their feud, 0:02:10.080 --> 0:02:12.760 but he might be able to placate them for a while. 0:02:13.680 --> 0:02:17.640 Keating had made no secret of his admiration for Patel. 0:02:19.040 --> 0:02:24.200 Hoffman believed that it verged on sicker fancy. As Keating 0:02:24.360 --> 0:02:28.440 told one of the ICU nurses in doctor Pateel's presence 0:02:28.560 --> 0:02:31.119 outside the hospital canteen. 0:02:31.480 --> 0:02:33.360 When you get to be as great as this man, 0:02:33.440 --> 0:02:34.600 you can do what you want. 0:02:37.800 --> 0:02:43.320 When Linda Mulligan again raised unresolved behavior and communication issues, 0:02:43.360 --> 0:02:47.800 shortly before lunch on twenty October, Tony Hoffman made her 0:02:47.919 --> 0:02:51.800 most forceful effort yet to bring about decisive action. 0:02:52.880 --> 0:02:56.040 Doctor Petel's the patient for dying because of his care. 0:02:57.200 --> 0:03:01.079 Hoffman knew that her career would probably stall or even end, 0:03:01.240 --> 0:03:04.520 but to hell with it. In an angry outburst, she 0:03:04.600 --> 0:03:09.040 spoke about Petel's dishonesty in describing the condition of patients, 0:03:09.760 --> 0:03:13.520 how doctor Peter Meak refused to let his patients undergo 0:03:13.639 --> 0:03:17.360 procedures by the Director of Surgery, and how the number 0:03:17.400 --> 0:03:23.040 of post operative complications was without precedent. A few hours later, 0:03:23.200 --> 0:03:26.880 in a hastily called meeting in Peter Leck's office, Tony 0:03:26.919 --> 0:03:32.440 Hoffman repeated the serious allegations. She also told Lek about 0:03:32.480 --> 0:03:37.119 Petel's stubborn refusal to observe hygiene and how a probable 0:03:37.200 --> 0:03:42.440 consequence wound to Hastens from infection was not properly reported 0:03:42.720 --> 0:03:46.360 in the patient's notes because Patel knew it would give 0:03:46.480 --> 0:03:48.040 clues to his negligence. 0:03:48.600 --> 0:03:52.600 Hoffman told Leck the death of mister Bramach was the 0:03:52.680 --> 0:03:56.280 last straw. They may come back and say he would 0:03:56.280 --> 0:04:00.240 have died anyway, but that isn't the point. It was 0:04:00.280 --> 0:04:04.480 about Dr Pateell interfering in the process that would have 0:04:04.520 --> 0:04:07.360 got the patient to Brisbane in time for him to 0:04:07.440 --> 0:04:08.600 have the best chance. 0:04:10.400 --> 0:04:13.520 Hoffman reminded Leck of how she had gone to him 0:04:13.640 --> 0:04:17.560 eight months earlier with her concerns about doctor Petel's behavior, 0:04:18.279 --> 0:04:21.719 and how she and doctor John Joyner had warned doctor 0:04:21.800 --> 0:04:25.680 Keating about the dangers of the esophagectames. In mid two 0:04:25.680 --> 0:04:31.480 thousand and three, she repeated other disturbing clues to Petel's incompetence, 0:04:31.960 --> 0:04:35.680 including evidence of the harm caused to patients in the 0:04:35.720 --> 0:04:39.800 renal unit because of his ineptitude with the placement of catheters. 0:04:40.720 --> 0:04:45.360 Hoffman gave the district manager an ultimatum unless there was 0:04:45.440 --> 0:04:50.279 a rigorous and independent audit of the outcomes for Petel's patients, 0:04:50.680 --> 0:04:54.039 she would be forced to take further steps. As she 0:04:54.160 --> 0:04:55.760 told Leck, I'm. 0:04:55.640 --> 0:04:57.559 Quite happy to be proven wrong. 0:04:58.800 --> 0:05:02.640 In an email to people two days later, she documented 0:05:02.680 --> 0:05:07.520 the details of unnecessary suffering by a dozen of Beateell's patients. 0:05:08.560 --> 0:05:11.599 I spoke with doctor Dieter Barons and informed him the 0:05:11.680 --> 0:05:14.960 nursing staff were going to report their concerns with Dr 0:05:14.960 --> 0:05:19.160 Petell to an official source. He stated he would support 0:05:19.279 --> 0:05:22.560 us by telling the truth, but he was concerned he 0:05:22.560 --> 0:05:25.279 would lose his job and Dr patell would be the 0:05:25.320 --> 0:05:29.960 one left behind. It is widely believed among the medical 0:05:29.960 --> 0:05:33.520 and nursing staff that Dr Petell was very powerful, that 0:05:33.600 --> 0:05:37.360 he was wholeheartedly supported by Peter Leck and Darren Keating, 0:05:37.560 --> 0:05:42.040 and was untouchable anyone who tried to alert the authorities 0:05:42.080 --> 0:05:45.960 about their concerns would lose their jobs. This perception was 0:05:46.000 --> 0:05:50.200 indeed perpetrated by Dr Petell on a daily basis. Many 0:05:50.240 --> 0:05:54.560 of the principal house officers have expressed their concern doctor 0:05:54.600 --> 0:05:58.279 Alex Davis and doctor David Risen, but were unsure of 0:05:58.320 --> 0:06:00.800 what to do because of the wide spa read belief 0:06:01.279 --> 0:06:04.479 Dr Patel was protected by executive. 0:06:05.160 --> 0:06:09.040 On the day Lek received Hoffman's written report, doctor Keating 0:06:09.200 --> 0:06:13.919 and doctor Miak had an angry row over Patel's competence, 0:06:14.800 --> 0:06:18.640 but still nothing was done to restrict any of Patel's work. 0:06:19.320 --> 0:06:23.400 The surgical wards were full of patients. They were still 0:06:23.400 --> 0:06:27.800 being led into theater like lambs to a slaughter. Leck 0:06:27.920 --> 0:06:32.560 briefly considered suspending Patel on full pay, but Patel was 0:06:32.680 --> 0:06:35.760 much too valuable to the hospital and the campaign to 0:06:35.839 --> 0:06:41.039 reduce the waiting lists for surgery. Lek brought time. He 0:06:41.160 --> 0:06:47.400 decided to test Hoffmann's serious allegations. Lek and Keating interviewed 0:06:47.400 --> 0:06:52.200 doctor Dieter Bearns, one of the anesetus, who questioned Patel's 0:06:52.240 --> 0:06:58.480 competence and judgment in undertaking some operations. Doctor Barons bluntly 0:06:58.520 --> 0:07:03.200 described Patel as dishonest about his mistakes and so rigid 0:07:03.320 --> 0:07:07.360 he refused to consider alternative and safe clinical options for 0:07:07.400 --> 0:07:13.320 the patients. Doctor David Risson, a relatively junior doctor, revealed 0:07:13.360 --> 0:07:16.960 that he had concerns about the number of post operative 0:07:17.000 --> 0:07:22.520 complications and infections. Patel's dismantling of one of the reporting 0:07:22.600 --> 0:07:26.920 mechanisms meant that the surgical audit process was a bad joke. 0:07:27.880 --> 0:07:33.480 When doctor Risson had previously raised a wounddhesiance, Peatel tried 0:07:33.520 --> 0:07:38.040 to change the definition of dhesiince Patel had said. 0:07:38.680 --> 0:07:41.600 We should be careful what we call woundhesions and what 0:07:41.680 --> 0:07:43.840 we're class Woundehessins. 0:07:44.640 --> 0:07:48.080 The director of surgery, was trying to minimize the number 0:07:48.120 --> 0:07:53.320 of complications being recorded. The next doctor to be interviewed, 0:07:53.800 --> 0:07:57.600 Martin Strawn, had nothing to lose for speaking his mind. 0:07:58.320 --> 0:08:01.040 He was a visiting medical officer who helped out at 0:08:01.040 --> 0:08:03.760 the hospital when he had time away from his full 0:08:03.760 --> 0:08:08.920 time job elsewhere. He described Patel's misdiagnosis of a woman 0:08:09.080 --> 0:08:12.600 upon whom the Director of surgery was determined to perform 0:08:12.680 --> 0:08:18.480 an extremely complex Whipple's procedure. She died several days later. 0:08:19.480 --> 0:08:24.360 Martin Strawn was convinced that Patel believed he was invincible, 0:08:25.280 --> 0:08:29.320 a Johnny come Lately, as the doctor called Patel, but 0:08:29.440 --> 0:08:33.320 with aggressive trays, who was strongly supported by management to 0:08:33.400 --> 0:08:37.920 take a scalpel to the waiting lists. Doctor Strawn also 0:08:38.120 --> 0:08:43.400 emphasized the dangerous vacuum into which Patel had arrived. The 0:08:43.440 --> 0:08:47.320 director of surgery, who saw himself as a self declared 0:08:47.400 --> 0:08:50.400 expert from the first world to help the third world 0:08:50.440 --> 0:08:54.480 of Bunderberg, had been permitted to operate without any form 0:08:54.559 --> 0:09:01.680 of peer review. Keating and Les did not bother asking 0:09:01.800 --> 0:09:06.880 doctor Meak, the most qualified and experienced specialist in the district, 0:09:07.360 --> 0:09:11.040 but in early November two thousand and four, doctor Meak 0:09:11.240 --> 0:09:16.840 handed to Keating another scathing indictment of doctor Patel. It 0:09:16.960 --> 0:09:20.559 was a letter written by doctor Jason Jenkins, a vascular 0:09:20.600 --> 0:09:23.680 surgeon at the Royal Brisbane Hospital who was held in 0:09:23.800 --> 0:09:28.760 high regard for his specialist skills and integrity. He sent 0:09:28.840 --> 0:09:32.840 it to doctor Meak and to Patel. Only rarely would 0:09:32.920 --> 0:09:37.040 doctor's blast colleagues in writing over the care of patients, 0:09:37.840 --> 0:09:42.400 but doctor Jenkins was enraged after he examined Marylyn Daisy 0:09:42.600 --> 0:09:47.439 on one November for her diabetes problems. When he saw 0:09:47.480 --> 0:09:50.079 Marylyn Daisy, doctor Jenkins asked the. 0:09:50.120 --> 0:09:53.360 Question, when did you get that done? 0:09:54.240 --> 0:09:57.480 Doctor Jenkins asked, when he saw the bandage on her 0:09:57.559 --> 0:09:59.920 below knee amputation. 0:10:00.640 --> 0:10:02.800 Six weeks ago, do you mind if I have a 0:10:02.800 --> 0:10:05.960 look at it? Has it not healed yet? 0:10:07.040 --> 0:10:10.200 It was clear that not only had the wound not healed, 0:10:10.480 --> 0:10:15.360 the sutures were still in Daisy's amputation stump. Six weeks later, 0:10:16.040 --> 0:10:18.439 there was also an area of gangrene. 0:10:20.320 --> 0:10:24.520 So have you seen the surgeon since the operation? What's 0:10:24.559 --> 0:10:26.680 you going to do about this? Did he offer you 0:10:26.720 --> 0:10:28.280 a chance of saving your leg? 0:10:28.800 --> 0:10:32.000 I haven't seen the surgeon since the procedure. No, they 0:10:32.080 --> 0:10:33.800 just said that I need my leg off. 0:10:34.559 --> 0:10:38.160 Patel had not offered Daisy the option of trying to 0:10:38.280 --> 0:10:42.439 save her leg with a bypass operation. In his letter, 0:10:42.840 --> 0:10:46.920 Jenkins wrote. 0:10:45.200 --> 0:10:48.760 These suitures were heavily buried within the tissue and very 0:10:48.800 --> 0:10:52.640 difficult and painful to remove. I find it mind boggling 0:10:52.720 --> 0:10:56.360 that someone could leave sutures in for this long. It 0:10:56.440 --> 0:10:59.360 shows a complete lack of understanding of diabetic disease and 0:10:59.559 --> 0:11:03.040 how to form an operation. I have suggested to her 0:11:03.080 --> 0:11:05.880 that when she comes to Brisbane that she will require 0:11:06.280 --> 0:11:09.040 a de bridement of this stump, and if it fails 0:11:09.040 --> 0:11:12.800 to heal, then she may require an above knee amputation. 0:11:13.640 --> 0:11:17.160 I think if procedures can't be performed appropriate with the 0:11:17.160 --> 0:11:24.000 Bunderberg Hospital, then they should not be performed at all. 0:11:24.040 --> 0:11:26.959 In the months before days he sought help in Brisbane, 0:11:27.120 --> 0:11:31.200 Jenkins had noted a disturbing pattern in patients who underwent 0:11:31.320 --> 0:11:36.720 vascular surgery by Patel. Jenkins quickly determined that the director 0:11:36.760 --> 0:11:40.680 of surgery was doing more harm than good. He was 0:11:40.760 --> 0:11:44.120 astounded when doctor Peter Meak told him how he had 0:11:44.160 --> 0:11:49.040 tried to stop Patel, but to no avail. Patel would 0:11:49.080 --> 0:11:52.440 go and find patients in the wards and operate without 0:11:52.520 --> 0:11:57.880 meac knowing. Before writing the letter, Jenkins telephoned Patel and 0:11:58.040 --> 0:12:00.680 threatened to report him to the medical board if he 0:12:00.800 --> 0:12:02.360 kept doing vascular work. 0:12:03.679 --> 0:12:05.959 Look, you know, if you keep doing this then there 0:12:06.000 --> 0:12:07.600 are going to be consequences. 0:12:08.840 --> 0:12:12.280 But Patel was unmoved. For as long as the hospital 0:12:12.360 --> 0:12:16.440 let him do such operations, he had no intention of stopping. 0:12:22.240 --> 0:12:25.560 Peter Meak gave doctor Keating the written complaint on the 0:12:25.600 --> 0:12:29.640 same day that the Health Practitioner's Tribunal in Brisbane was 0:12:29.679 --> 0:12:33.680 delivering its own verdict. The wheels of justice had turned 0:12:33.760 --> 0:12:38.400 slowly for Elise Neville, her parents, and doctor Andrew Donovan, 0:12:38.480 --> 0:12:43.320 who was pleading guilty to unsatisfactory professional conduct to save 0:12:43.440 --> 0:12:47.800 himself and his family further trauma and crippling legal fees. 0:12:48.760 --> 0:12:53.199 In her findings, District Court Judge DeBie Richards wrote. 0:12:53.280 --> 0:12:56.000 The tragedy has had an enormous impact on the Neville 0:12:56.000 --> 0:12:59.600 family and no doubt others who knew and loved young Elise. 0:13:00.200 --> 0:13:02.640 Doctor Donovan must have been fatigued by the hours he 0:13:02.760 --> 0:13:06.040 was working. It seems extraordinary in this day and age 0:13:06.080 --> 0:13:09.920 that anyone, let alone someone in a position of such responsibility, 0:13:10.360 --> 0:13:13.400 should be asked to work such long hours. One does 0:13:13.440 --> 0:13:15.959 not need medical evidence to know that anyone who's in 0:13:16.000 --> 0:13:19.319 the twentieth hour of a continuous duty must have reduced 0:13:19.360 --> 0:13:23.120 capacity to assess the situation when it presents itself. If 0:13:23.160 --> 0:13:26.240 this tragedy leads to nothing else, it should lead to 0:13:26.280 --> 0:13:29.000 the abolition of such brutally long shift hours. 0:13:30.080 --> 0:13:35.000 Judge Richards concluded that Andrew Donovan's treatment of Elease was 0:13:35.080 --> 0:13:37.400 deficient in a number of respects. 0:13:38.120 --> 0:13:42.559 She ruled his interpretation of the history and physical findings 0:13:42.600 --> 0:13:46.079 based on limited examination and his lack of appreciation of 0:13:46.120 --> 0:13:49.880 the parents' concerns were wrong and errors of judgment which 0:13:49.920 --> 0:13:53.800 eventually denied at least the chance of survival. Accordingly, the 0:13:53.840 --> 0:13:57.600 Tribunal concurs with the board submissions that stringent conditions should 0:13:57.600 --> 0:14:02.080 be placed on doctor Donovan's continuing right now to practice. 0:14:02.160 --> 0:14:06.120 The disciplinary orders compelled doctor Andrew Donoman to work in 0:14:06.160 --> 0:14:11.000 a supervised position for twelve months with ongoing assessment and 0:14:11.080 --> 0:14:16.320 reporting of his competence to assess patients. After the delivery 0:14:16.320 --> 0:14:19.480 of the judgment, I walked to a nearby cafe to 0:14:19.560 --> 0:14:24.240 talk to Gered and Lorraine. They still had unfinished business. 0:14:24.640 --> 0:14:33.480 Gered pledged the system was yet to reform itself. When 0:14:33.520 --> 0:14:37.040 the pain in Trevor Holter's stomach had become too much, 0:14:37.400 --> 0:14:41.560 he went to see his GP doctor Ken Hornsby. At 0:14:41.600 --> 0:14:46.480 fifty four, Halter regarded himself as being in reasonably good shape, 0:14:47.080 --> 0:14:50.440 as fit as a Malley bull, he half jokingly boasted, 0:14:51.200 --> 0:14:55.680 but the pain was constant. Even Halter, a part time 0:14:55.840 --> 0:14:58.720 race caller who rolled beer kegs around the club where 0:14:58.760 --> 0:15:02.240 he did odd jobs, had to concede he needed help. 0:15:03.640 --> 0:15:07.080 Dr Hornsby wrote a referral letter for him to attend 0:15:07.080 --> 0:15:14.360 the patients department at Bunderberg Hospital. Trevor Halter had gallstones. Fortunately, 0:15:14.720 --> 0:15:19.160 he learned that the condition was easily remedied. J. N. 0:15:19.280 --> 0:15:20.280 Patel spoke to. 0:15:20.320 --> 0:15:23.960 Him, you're probably better off having your golde blooder out 0:15:24.000 --> 0:15:25.920 because you don't really need it, and so you may 0:15:25.960 --> 0:15:28.280 as well have it out. I do four to five 0:15:28.360 --> 0:15:31.040 a week and there's nothing to it. It's keyhold surgery. 0:15:32.920 --> 0:15:38.800 The routine corrective procedure laparoscopic color systectomy was on a 0:15:38.880 --> 0:15:43.160 par with having your tonsils out. Trevor Halter learned that 0:15:43.280 --> 0:15:46.080 he would need to stay just one night in the 0:15:46.120 --> 0:15:52.120 hospital after the operation, he awoke in agony. He spent 0:15:52.200 --> 0:15:56.400 the next seven weeks in hospital. Two of those weeks 0:15:56.440 --> 0:15:59.080 were in the intensive care unit as he fought for 0:15:59.160 --> 0:16:03.200 his life. His children were told his lungs had collapsed, 0:16:03.440 --> 0:16:07.920 his liver had failed, and he contracted pneumonia and septo semia. 0:16:09.000 --> 0:16:13.680 Then his heart went. He was finally transferred by helicopter 0:16:13.800 --> 0:16:17.960 to Brisbane on four December for life saving treatment, all 0:16:18.080 --> 0:16:24.320 from a routine gallbladder operation bungled by doctor Patel. Months later, 0:16:24.760 --> 0:16:35.760 Halter was still in pain and undergoing corrective surgery, Chapter 0:16:35.840 --> 0:16:40.520 twenty five, The blood Letting. December two thousand and four, 0:16:45.720 --> 0:16:49.040 when Judy and Jerry Kemps looked back on their lives 0:16:49.080 --> 0:16:52.000 and the fruits of a close marriage of fifty years, 0:16:52.280 --> 0:16:56.520 they felt blessed. They were weared on twenty three October 0:16:56.680 --> 0:17:01.760 nineteen fifty four in Saint Patrick's Cathedral, rule in Melbourne. 0:17:02.080 --> 0:17:06.760 Judy had given birth to three healthy and happy children, Jackie, 0:17:07.040 --> 0:17:11.800 John and Bernie. They had relaxed into the gentle pace 0:17:12.000 --> 0:17:16.480 and tranquility of Bunderberg after a stint overseas. They set 0:17:16.560 --> 0:17:20.200 up a photographic studio and continued to raise their three children. 0:17:21.760 --> 0:17:25.600 The couple remained active as they aged. They went bushwalking 0:17:25.640 --> 0:17:30.520 together and enjoyed regular tennis and golf. Kemps was one 0:17:30.560 --> 0:17:33.480 of those fortunate people who never had a sick day 0:17:33.560 --> 0:17:36.320 in his life, but by two thousand and two his 0:17:36.440 --> 0:17:41.199 health began to deteriorate. His blood pressure was erratic, he 0:17:41.280 --> 0:17:45.040 got gout, he suffered back pain. When he received a 0:17:45.119 --> 0:17:49.040 letter from Queensland Health offering a free checkup, an appointment 0:17:49.240 --> 0:17:53.800 was made at the local Burrham Street medical practice. The 0:17:53.920 --> 0:17:58.000 tests on his urine sample pointed to a problem as 0:17:58.040 --> 0:18:01.720 they ate lunch. Ten days later, Judy told her husband, 0:18:04.040 --> 0:18:04.800 you look yellow. 0:18:05.280 --> 0:18:06.359 You look anemic to me. 0:18:08.400 --> 0:18:12.320 By six December, further tests at Bunderberg Hospital showed that 0:18:12.440 --> 0:18:17.919 Kemps was bleeding internally. The endoscope had identified a large 0:18:18.000 --> 0:18:22.560 malignant tumor about four centimeters in size in the lower esophagus. 0:18:23.520 --> 0:18:27.080 The CT scans showed that the cancer had spread beyond 0:18:27.160 --> 0:18:32.040 the esophagus. There were shadows on both lungs. There were 0:18:32.200 --> 0:18:36.240 enlarged lymph nodes where the trachea splits into the left 0:18:36.320 --> 0:18:42.600 and right main branches. Dr Dorge Smallburger was adamant that 0:18:42.720 --> 0:18:47.879 Kemps needed to go to Brisbane for keyhole surgery. Nothing 0:18:47.960 --> 0:18:51.960 too radical was proposed. The cancer was such that the 0:18:52.080 --> 0:18:57.159 patient might have just twelve months to live. Under the circumstances, 0:18:57.600 --> 0:19:01.560 Dr Smalberger wanted to ensure Jerry Kemps received the best 0:19:01.600 --> 0:19:04.919 care and quality of life possible for the time he 0:19:05.000 --> 0:19:11.560 had left. He did not contemplate an aesophagectomy, even for 0:19:11.840 --> 0:19:16.080 a highly competent surgeon. Such a complex procedure was far 0:19:16.200 --> 0:19:20.359 too risky, but with the presence of secondary cancers, it 0:19:20.480 --> 0:19:25.280 was also pointless. Dr Smolberger decided that the best course 0:19:25.280 --> 0:19:28.159 of action was a stent to make it easier for 0:19:28.280 --> 0:19:33.119 Jerry Kemp's to swallow his food. The protocol for a 0:19:33.160 --> 0:19:37.240 transfer of a patient from Bunderberg to another hospital surgical 0:19:37.280 --> 0:19:40.639 department required the decision to be signed off by a 0:19:40.680 --> 0:19:47.040 surgeon in Bunderberg. Unfortunately, for Jerry Kemps, he was seen 0:19:47.200 --> 0:19:52.400 by Jayan Patel. The safe and conservative course was suddenly 0:19:52.440 --> 0:19:56.560 turned on its head by the director of surgery. Patel 0:19:56.680 --> 0:20:00.399 told the couple that the keyhole surgery recommended by doctor 0:20:00.480 --> 0:20:04.600 Smallberger was just patch up work, and that what he 0:20:04.720 --> 0:20:10.240 really needed was an esophagectomy. Patel explained how he would 0:20:10.240 --> 0:20:13.640 remove part of the stomach and part of the esophagus 0:20:14.000 --> 0:20:18.879 and join what was left back together again, no problems. 0:20:19.520 --> 0:20:21.880 It is the big operation, but it is nothing because 0:20:21.880 --> 0:20:23.440 I've done hundreds of them. 0:20:24.040 --> 0:20:29.919 His confidence was contagious. Neither Kemp's nor his wife was 0:20:29.960 --> 0:20:35.480 given any reason to doubt Patel. Theater nurse Damien Gadds 0:20:35.560 --> 0:20:38.600 went to work early to start preparing for the operation 0:20:38.720 --> 0:20:42.520 on Jerry Kemp's, but there was a problem. The intensive 0:20:42.600 --> 0:20:47.640 care unit already had two patients on ventilators. They would 0:20:47.640 --> 0:20:52.320 be unable to cope with Jerry. Nurse Gads called doctor 0:20:52.400 --> 0:20:57.240 Deta Berens, who agreed the operation should be postponed, But 0:20:57.320 --> 0:21:01.399 when Gads reached Jayon Patel on his mobile telephone, the 0:21:01.480 --> 0:21:05.119 director of surgery was furious. 0:21:04.680 --> 0:21:06.639 That brin dead beat and should have been switched off 0:21:06.720 --> 0:21:07.160 last night. 0:21:08.320 --> 0:21:11.520 At eight pm. The day before, Patel had told a 0:21:11.640 --> 0:21:14.919 nurse to call doctor John Joyner and ask him to 0:21:14.960 --> 0:21:18.320 turn off the life support keeping a critically ill woman, 0:21:18.640 --> 0:21:24.439 Robin Turton, sixty three alive. Turton had slipped in the 0:21:24.520 --> 0:21:29.040 bath and hit her head on Saturday, suffering a cerebral bleed. 0:21:30.200 --> 0:21:33.880 Her family was aware that her prospects were poor. Her 0:21:33.960 --> 0:21:37.240 death would free up an ICU bed, and could tell 0:21:37.400 --> 0:21:43.360 wanted it for Jerry Kemp's, but Joyner flatly refused. He 0:21:43.560 --> 0:21:46.679 was offended at the indecent haste to end the life 0:21:46.720 --> 0:21:49.720 of a woman who had not yet undergone formal brain 0:21:49.840 --> 0:21:55.040 death tests. Although it was probable from the CT scans 0:21:55.080 --> 0:21:59.840 that she was brain dead, doctor Joyner prudently decided to wait. 0:22:01.640 --> 0:22:05.720 Patel had little time for doctor Joyner, the anesthetist who 0:22:06.000 --> 0:22:09.679 eighteen months earlier had express concern to management about the 0:22:09.840 --> 0:22:13.600 risks of performing aesophagectamies in a small hospital with a 0:22:13.640 --> 0:22:21.000 limited icee you. As Patel did his ward rounds on 0:22:21.160 --> 0:22:26.920 Monday morning, he bad mouthed doctor Joyner. Patel told Martin Brennan, 0:22:27.119 --> 0:22:27.480 one of. 0:22:27.440 --> 0:22:29.960 The nurses, I have a theater chise to do. 0:22:31.080 --> 0:22:34.600 The theater nurse was astonished at Patel's cavalier approach to 0:22:34.760 --> 0:22:38.560 ending Turton's life before the necessary brain death tests had 0:22:38.640 --> 0:22:43.760 been done. Martin Brennan did not trust doctor Patel. He 0:22:43.840 --> 0:22:47.640 had heard the surgeon intimidate and bully the nurses and 0:22:47.760 --> 0:22:52.160 threaten to harm their careers. Patel had created a climate 0:22:52.200 --> 0:22:55.639 of fear in the operating theater and in the intensive 0:22:55.720 --> 0:22:59.720 care unit. All the nurses doubted that they would be 0:22:59.760 --> 0:23:04.000 bad by management. In a showdown, as Patel often boasted 0:23:04.080 --> 0:23:06.720 of his influence over Darren keating. 0:23:07.640 --> 0:23:09.520 I can get what I want from Darren as I've 0:23:09.600 --> 0:23:12.320 just made this hospital five hundred thousand dollars. 0:23:13.440 --> 0:23:18.080 Patel stormed into doctor Martin Carter's office and denounced doctor Joyner. 0:23:18.960 --> 0:23:22.760 He pressured Carter to end Robin Turton's life and free 0:23:22.800 --> 0:23:28.040 up a bed for the esophagectomy. Nurse Vivian Tapiolus witnessed 0:23:28.040 --> 0:23:32.000 Betel's insistence on the withdrawal of life support for Turton, 0:23:32.359 --> 0:23:35.600 whose children were in the waiting room at the ICU, 0:23:36.000 --> 0:23:40.679 as Pateel pressed doctor Carter to make a decision. After 0:23:40.720 --> 0:23:44.680 a review of the charts, Tapiolus and the two doctors 0:23:44.680 --> 0:23:49.840 spoke to the family about ending Turton's life. Patel walked 0:23:49.880 --> 0:23:53.080 back into the ICU with a spring in his step. 0:23:54.320 --> 0:23:56.280 Now I can perform the esophagectomy. 0:23:57.640 --> 0:24:01.359 Doctor Carter switched off life support at eight fifty five 0:24:01.440 --> 0:24:06.399 am on Monday, despite the absence of the formal brain 0:24:06.520 --> 0:24:11.080 death tests. Carter decided that there was sufficient clinical evidence 0:24:11.119 --> 0:24:15.879 to show Turton had suffered massive and irreparable brain damage. 0:24:16.440 --> 0:24:20.720 He wrote, in view of the dreadful prognosis this lady 0:24:20.800 --> 0:24:25.399 has and following discussion with family, ventilator support is to 0:24:25.400 --> 0:24:31.960 be withdrawn. Importantly, for Patel, he now had a spare bed. 0:24:33.560 --> 0:24:36.959 At nine to fifty two am on Monday, twenty December, 0:24:37.280 --> 0:24:39.959 less than an hour after the death of Robin Turton, 0:24:40.359 --> 0:24:44.960 the operation on Jerry Kemp's began. Patel was flanked in 0:24:45.080 --> 0:24:50.320 theater by the anesthetis doctor Dieter Behrens, two principal House officers, 0:24:50.480 --> 0:24:57.080 doctor Sanjeeva carr Owasam and doctor Anthony Athanasiov and the nurses. 0:24:58.400 --> 0:25:01.760 Doctor Karyoasam had spent much of his time at the 0:25:01.840 --> 0:25:07.119 hospital as Patel's shadow. They got along well. Patel was 0:25:07.119 --> 0:25:11.040 only too happy to explain the complexities of surgery to 0:25:11.160 --> 0:25:15.840 his eager apprentice. Together they used to undertake what Patel 0:25:15.880 --> 0:25:19.520 would call a blitz. In one week, there would be 0:25:19.520 --> 0:25:23.880 a swag of colonoscopy procedures. In another week there would 0:25:23.880 --> 0:25:27.879 be a run of gallbladder operations. It was part of 0:25:27.920 --> 0:25:31.879 Patel's ongoing assault on the waiting lists, and it kept 0:25:31.960 --> 0:25:37.040 him in management's good books. Korea Withsam often heard Patel 0:25:37.200 --> 0:25:40.840 boasting about how successful he had been in reducing the 0:25:40.880 --> 0:25:46.879 lists and establishing rapport with Keating. The esophagectomy appeared to 0:25:46.920 --> 0:25:50.639 go well at first. Jerry Kemps's abdomen needed to be 0:25:50.760 --> 0:25:56.520 opened to permit access to the esophagus and the stomach. Suddenly, however, 0:25:56.680 --> 0:26:00.840 he became unstable with plunging blood pressure and a rising 0:26:00.960 --> 0:26:05.600 pulse rate. Kemp's was turned onto his side for the 0:26:05.680 --> 0:26:11.160 thorochotomy part the opening of the chest cavity. As Patel 0:26:11.280 --> 0:26:14.959 resected the tumor in the chest. The blood continued to 0:26:15.000 --> 0:26:19.159 pour freely into the drain. The heavy bleeding in the 0:26:19.200 --> 0:26:24.480 abdominal cavity was obvious to everyone. Doctor Barons was worried. 0:26:25.040 --> 0:26:27.560 Apart from the blood loss, he could see that the 0:26:27.640 --> 0:26:31.120 director of surgery lacked the skill to be attempting such 0:26:31.119 --> 0:26:36.160 an operation. Patel's roughness around the heart and the vessels 0:26:36.359 --> 0:26:40.720 was all too obvious, nor did he appear interested in 0:26:40.760 --> 0:26:44.160 the monitoring being done by doctor Barons of blood pressure 0:26:44.520 --> 0:26:49.879 and other vital signs. Barons was shocked. It was as 0:26:49.960 --> 0:26:54.399 if Patel could not acknowledge a major problem. Unless the 0:26:54.480 --> 0:26:59.920 blood stopped flowing, Kemps would surely die. Nurse Damien Gas 0:27:00.480 --> 0:27:04.800 raised the alarm. Dr Patel, the Bellovac draine is over 0:27:04.880 --> 0:27:08.320 half full with no vacuum and is still draining freely. 0:27:09.480 --> 0:27:11.360 That's what dreams are forward Demian. 0:27:12.600 --> 0:27:15.800 To the amazement of doctor Barons and the theater nurses, 0:27:15.880 --> 0:27:19.960 who were alarmed by the obvious and heavy bleeding, Patel 0:27:20.040 --> 0:27:24.760 gave instructions for Kemps to go to the ICU. From 0:27:24.800 --> 0:27:28.440 that moment it was inevitable that he would not survive. 0:27:29.800 --> 0:27:33.920 At two PM, Patel called Judy at her home. He 0:27:33.960 --> 0:27:37.679 told her it was a great success. We've got it all. 0:27:38.440 --> 0:27:40.639 There's a little bit of bleeding there, but that's nothing. 0:27:42.240 --> 0:27:45.880 When Judy went to the intensive care unit soon afterwards, 0:27:46.000 --> 0:27:50.320 she saw a nurse frantically pumping blood into her husband's body. 0:27:51.359 --> 0:27:55.200 Jerry Kemps received more than thirty bags of blood altogether. 0:27:56.119 --> 0:28:01.440 His abdomen was distended as bright blood drained away. Three 0:28:01.520 --> 0:28:05.560 nurses were needed at his bedside for fluid management, and 0:28:05.680 --> 0:28:08.359 one ran back and forth from the blood bank for 0:28:08.480 --> 0:28:13.200 products and to page the doctors. Doctor Barons was using 0:28:13.359 --> 0:28:16.879 large quantities of a drug to maintain blood pressure and 0:28:16.920 --> 0:28:21.920 support the heart. Another nurse took Judy aside and told 0:28:21.960 --> 0:28:25.600 her Jerry is a very sick man and he is 0:28:25.640 --> 0:28:30.880 on life support. Judy, joined by her son John, went 0:28:31.040 --> 0:28:35.199 over to his bedside and gave Jerry a kiss. I 0:28:35.280 --> 0:28:40.520 love you, she said. He tried to sit up. At 0:28:40.560 --> 0:28:44.760 five pm, Judy was told of the need for another operation. 0:28:45.720 --> 0:28:48.000 I have to take him back into theater again. It 0:28:48.040 --> 0:28:50.800 can only be the spleen. I'll dig it out because 0:28:50.800 --> 0:28:51.840 he doesn't need it anyway. 0:28:52.960 --> 0:28:56.640 But Patel had begun another operation on a different patient, 0:28:56.920 --> 0:29:01.520