My name is Hedley Thomas.
Sick to Death is based on my book of the same name, and it's the true story of doctor Jan Patel's lies and manipulation and the herculean effort it took to finally stop him. We've used voice actors throughout this series, and on occasion the real people from the story have read their words for us.
It is brought to you by Me and the Australian.
Chapter nineteen The Messenger, eighteen March two thousand and four. Rob Messenger wanted to start with a few home truths. He looked up and smiled at his supporters in the public Gallery of State Parliament in George Street, Brisbane. It had been a hard slog to arrive in this place.
He hoped it would be worth it.
Nobody had ever accused Messenger of being born with a silver spoon in his mouth. At four thirty pm on eighteen March two thousand and four, as the National Party's new member for Burnett prepared to deliver his first speech, he felt unbeatable.
I have to confess my journey to this historic chamber was not planned. As a child and teenager playing in the red did cane fields of South Clan. I never harbored dreams of becoming a politician, and I'll be the first to admit that I'm only standing here before you because of God's grace.
With a nod to the gallery, Messenger explained how he drew inspiration from his father Dez when self doubt and fatigue set in. Des had been a cane cutter in Bunderberg. Like the Kannakas a century ago. He had the backbreaking job of cutting and loading tons of caine a day for a meager one dollar sixty a ton. Rob Messenger still marveled at how his father Deares managed to feed, clothe, and shelter him and his two brothers.
Greg and Danny.
When Messenger was a teenager, he danced and sang to the evocative lyrics of Australian band Ganga Jang's anthem sounds of them about growing up in Bunderberg. Out on the patio we'd sit and the humidity we'd breathe, We'd watch the lightning crackover cane fields, laugh and think this is Australia. He remembered his mother Irene, laughing and joking with the other women of the district while they picked tomatoes in
thirty five degree tropical heat. Irene lived for Rob's regular visits to her bedside at Bunderberg Hospital in the weeks before she finally succumbed to a particularly aggressive bow cancer. In September two thousand and two. Messenger watched his well known mother die at the hospital after an eighteen month battle. He came to know the doctors and nurses. Some of them began confiding a few secrets and worries. The hospital
was running on empty. It had been managed to a standstill and starved of funds as the district manager, Peter Leck, enforced rigid budgetary controls. Specialists and the best doctors were leaving disillusioned and distressed at the deteriorating levels of care. All the while, public announcements and press releases from Queensland Health's Brisbane headquarters spewed positive but wholly misleading guff about
the hospital in which Messenger had been born. Messenger used his first speech to underline what he knew from his months on the campaign trail. The hospital was sick. It was a diseased limb of a very sick body, whose staff had been cowed into silence.
These dedicated professionals must be allowed to tell the truth while avoiding any possibility of placing their careers with Queensland Health in jeopardy. These workers' stories must be heard and acted on if the people of the Bernet are ever to enjoy the level of health care that they richly deserve.
The parless condition of the health system was a major feature of the state election campaign in early two thousand and four. The opposition coalition, of which Rob Messenger was a member, had paid for hard hitting advertisements depicting people who had waited years for straightforward surgery, while the Australian Medical Association ran a highly effective campaign to highlight secrecy
and underfunding in the health system. Stung by the constant stories and revelations from clinicians about how patients were so offfering because the hospitals could not cope with demand, Premier Peter Beatty threw money at the problems. The waiting lists for surgery were a significant part of Beattie's electoral strategy. He pledged a one hundred and ten million dollar injection of extra funds to pay for thousands of extra operations.
This new initiative will be the biggest effort to reduce elective waiting lists that Queensland has ever seen. People have made it clear to me over a period of time they want these lists tackled. We have done well, but clearly we can do better. We will be making health our number one priority.
The Health Minister Wendy Edmund had retired from politics. By then, Beatty had kept a straight face while commending her as the country's best health minister. The new Health Minister, Gordon Nuttle, was telling his executive team to put every public hospital
on notice the waiting lists were critical. In the internal confidential briefing paper he received after being sworn in, Nuttle was worn that Queensland Health had become extremely reliant on overseas trained doctors, who comprised thirty percent of the medical workforce.
Employment of overseas trained doctors provides a short term solution to doctor shortages. However, this approach brings with it a range of skill and competence issues.
Messenger hammered health issues as stubbornly and relentlessly as he had during his electoral campaign. He repeatedly called for an independent investigation into Bunderberg Hospital, its procedures and practices. The attempts by the Beatty government to silence him became farcical. At one point, Messenger had said.
Rather than pulling back from this issue, I intend to turn up the blow torch.
The metaphor was too much for Nuttle, who called for a formal investigation into whether Rob Messenger planned to commit arson or burn alive any bureaucrats. Messenger was industrious and highly effective. He uncovered figures showing the hospital had just one hundred and thirty six beds, eighty one fewer than in nineteen eighty nine, despite the region's steady growth. The door of his electorate office at Bagara, near Jayant Patel's home apartment, was always open to hospital staff with stories
of crises. Doctors came to tell him how they had been forced to work twenty four hour shifts, compromising patient care through sheer exhaustion. The regular outpourings were embarrassing for Nuttle, and they were infuriating the new Director General of Health, doctor Steve Bucklin, who had angrily banged the desk and
abused Messenger in one memorable meeting. During a short stint as acting Director of Nursing, Tony Hoffman was surprised to see Peter Leck, who read the speeches on the parliamentary website as soon as they had been posted, furiously denouncing something Messenger had said. Peter Leck and Darren Keating stood at the computer screen and ridiculed the politician. An unprecedented meeting of the executive staff was called by Lek to discuss what effect having a National Party member would have
on the hospital. Lek expected Rob Messenger to create trouble. Lek wondered if the parliamentarian was upset about the hospital's treatment of his mother. Hoffman realized that Messenger had become a major thorn in their side. She liked his courage and stamina. He was like a dog with a bone
in relentlessly exposing the hospital's ills. He spoke of patients dying unnecessarily due to a dangerous culture, borrowing from one of the maxims of Anglo Irish statesman, politician and philosopher Edmund Burke, a leading light in the House of Commons more than two hundred years ago. Messengers spoke of evil prospering while good men remained silent. Hoffman wondered if she might one day pluck up the courage to go to Messenger about Jayant Patel good.
Men had done nothing. It might be left to a good woman.
Chapter twenty The Catalyst, July two thousand and four. Dares Bramich liked to stay busy. If a job was worth doing, he wrecked it was worth doing straight away. A little after four point thirty pm on Sunday, twenty five July, Des Bramage, age fifty six, was doing one of those good deeds. It had been a glorious day in Agnus Water, a sleepy seafront community about.
An hour and a half's drive from Bunderberg.
Grammage, who ran an earth moving business with his son Mark, was beneath a caravan. He was helping to remove one of its tires for his youngest son Luke, before the sun disappeared. On one of the shortest days of the year.
Mark was walking back to.
The land rover to get some tools when the caravan fell from its supports. The muffled thud as the weight came down onto his father's chest sounded ominous. Mark looked back and saw his father conscious but gasping.
He was clearly having trouble breathing.
Unknown at the time, two of his ribs were badly fractured. A plural membrane lining the inside of the chest wall was torn on the right side. The upper part of his sternum was also fractured, probably damaging arteries running down either side of his breastbone. Mark rushed to get a jack from the car to try to lift the caravan off his dad's crushed chest.
In the panic and fading light.
On an afternoon that had become suddenly bleak and foreboding, he fumbled to grip and lift the heavy steel contraption.
Thankfully, help arrived quickly.
A local medic, doctor, Salassa Vouti, one of the town's overseas trained doctors, inserted a tube to help Bramwich breathe. The ambulance rushed to the accident site to provide emergency backup and transport. A rescue helicopter arrived to airlift him to Bunderberg Hospital. Quickly to his father's wife, pack.
Your bags and go to the hospital.
Tests dad's had an accident.
Test trembled with worry as her friend, Agnes Smythe gunned the white commodore, beating the helicopter by fifteen minutes. Tess was told her husband had suffered severe internal injuries, but that the prognosis was good. Once he had been stabilized in the trauma room, there were tests and scans of his chest. Des was thirsty, and, with a nurse's approval, test gave him an ice cube to wet his mouth. One of the doctors told Tess there was no reason why a fit, middle aged man, a non smoker and
non drinker would not make it. She was greatly comforted by the reassuring words. Even as they transferred her husband to the intensive care unit, she watched the nurses there hooking him up to machines to monitor and assist his.
Heart and breathing.
They gave him morphine intravenously and an oxygen mask. Tess, who was born in the Philippines, and Des had wed a decade earlier. Tess was DES's third wife. They often joked about how, at age thirty three, she was younger than Mark, even though she was step grandmother to Mark's kids. Des and Tess had not looked back. The Bramich father and son business was doing well. The couple had great
friends in the town where everybody knew each other. Their young daughter, Maria acquiet beauty with Tess's brown skin and smoldering dark eyes was a family treasure. Now At one am, Tess kept a vigil in the hospital. When Dez suggested that she should leave to get some sleep, the staff agreed, although they were more concerned about his rest. When Tess returned at six a m. And saw him smiling in bed with most of the color returned to his face, her spirits rose.
By nine a m.
Some of his extended family were perched around his bed in the ICU, Des spoke to Mark's visibly distressed wife, Fatima.
Don't cry, I'm all right.
He was making jokes at his own expense and wise cracking about being far too young to die.
I'm like a cat, I have nine lives.
After X rays and a cup of tea, he spoke about the accident. His son beamed when Des said that had it not been for Mark, the crush from the caravan would have put him in a coffin. Tony Hoffman was touched by the natural affection and love enveloping her patient, who exerted a cheerfulness she put down to genuine family contentment. She chatted freely to DEAs and Tess, their daughter, ten year old Maria, gazing at her Dad with those liquid
eyes was gorgeous. Hoffman gave her a soft white toy, the seal that she kept in the bottom of the filing cabinet for young children who came into the unit. At times like this, Tony Hoffman regretted some of the choices she had made. Hoffman wished things had turned out differently with some of the men she had loved. Her career had been fulfilling, but at home after the shift ended, she sometimes felt desperately lonely. By the time Tess returned
from lunch, the bed in the ICUU was empty. She was immediately worried, but Des was fine.
He was doing so.
Well that he had been wheeled into the surgical ward that afternoon. After he had been helped into the chair beside his bed, test stayed and chatted with him until evening. When she returned early the next morning, twenty seven July, Des was in a bad way.
Dahl, I really didn't have a good sleep last night because I was in pain all night.
Tess was confused. She had been assured that the morphine trickling into his veins would deaden the pain. She examined the intravenous connection and saw that it had become loose and it was dripping.
Could you just please fix that properly?
They waited impatiently for a junior doctor to come by and Reattach the line.
Des was encouraged.
To walk around the hospital corridors with a physiotherapist and an assistant. He hobbled in pain as they supported him under his armpits, then returned to bed and spoke by telephone to his worried mother and sister. When the Bunderberg News Males reporter arrived, Des recounted the accident.
Mike is my hero.
Tess returned from lunch to discover that he had suddenly collapsed and been rushed back to the intensive care unit. Hoffmann, shocked at how rapidly he had deteriorated, calmly organized her staff. The nurses rushed to save his life. Des could not breathe and his blood pressure had plummeted. His heart was racing, and the pain in his chest had become unbearable. He was slipping in and out of consciousness. Doctor if Ta Carr Eunus, one of the anesthetists, was attempting to resuscitate
him with the help of three nurses. Doctor Martin Carter, the anesthetist in charge of the ICU, was clear.
If the patient is going to need blood products, he'll need to be flown out.
Carter decided that as Bramwich might need thoracic surgery, long term ventilatory support and access to a blood bank, he should be rush to one of the larger hospitals in Brisbane. There were urgent efforts to find a bed in Brisbane. Prince Charles Hospital was full that a bed might be available at Princess Alexandra Hospital. The Royal Flying Doctor Servis
was ready for the mercy mission. Hoffman relayed the message from the bed coordinators in Brisbane to doctor Carter, doctor Jim Gaffield and doctor James Boyd, a principal house officer working under doctor Jayant Patel's supervision. Hoffman was ecstatically.
Relieved They've got a bed.
She could see that des Bramwich needed to be in a hospital which practiced thoracic surgery. Under no circumstances did she want to see Bramwich fall into the hands of Jayant Patel, the director of surgery, had been absent from the hospital for all of.
May and June.
He had had taken study leave and holidays to return to Jamnagar in India to see his mother, and then to Portland in the United States to spend time with his family. The run of complications, the conflict in the wards, and the fears of the staff had disappeared. Doctor Patel's holiday was a blessing for all. Tony Hoffman recalled the plight of Una Conners, whom Patel operated on for cancer of the sigmoid colon in April. The woman had to be rushed back by ambulance after a complete evisceration of
the wound and her intestines being almost fully exposed. Hoffman had grown unusually fond of Desbramach and his family in the few hours she had spent with them in the ICU. But his perilous condition was worsening. As doctor Eunice tried to put in a central line to convey drugs, the gravely ill man experienced ventricular standstill. His heart was refusing to pump blood. Doctor Gaffield asked Patel to look at
the X rays of his chest. Patel seized the offer and in his booming voice, started undoing the plans to transfer Brammage from Bunderberg.
The patient doesn't need to go to Brisbane. He isn't sick enough. If we can't care for such simple things as fractured ribs, there is no point in doing any sort of drama surgery at the hospital.
Hoffman, stricken with fear, waited.
For Gaffield to take charge. Brammage was doctor Gaffield's patient. Doctor Carter had already come to the view that the best course was urgent transfer. Doctor Eunice agreed arrangements had been made, but Patel's dominant personality was assuming control.
He doesn't need to be transferred. I've been a cardiothoracic surgeon for twenty years. If he needs anything, can do it here.
He repeated the confident boasts to members of Bramich's family, as Hoffmann quietly pleaded for the transfer to go ahead.
Please Dr Gaffield fin this man through to Brisbane, even if you think he doesn't need a cardiothoracic surgeon. I'm really afraid that he's going to die.
Dr Gaffield replied, No, that won't happen. He won't die.
He said he wanted to do a CT scan to provide definitive information for the handover to the surgeons in Brisbane, Patel disappeared back into the operating theater to perform a colonoscopy on a patient, but in the course of that procedure he perforated the bow. He insisted his injured patient should have a CT scan of the bowl before the gravely ill Brammage.
Patel yelled a perforated both takes precedence over a non urgency scan at all times.
The latest botch up a rarity for most doctors, but a common occurrence for Petel, meant that another doctor was needed to help him repair the bow. Tony Hoffman asked doctor Martin Carter, who was due to leave, to give a lecture to accompany Bramwich for the CT scan.
He agreed.
By the time they returned to the intensive care unit, the scan showed three liters of blood pooling in Bramich's chest. As Hoffman left the intensive care unit at seven point thirty pm to go home, the Royal Flying Doctor aircraft was being ready for the trip to Bunderberg. Hoffman had stayed back for three hours to ensure des Bramwich would get away for the help he so desperately needed. She
walked to the hospital car park. Confident that Bramwich would survive in Brisbane despite his problems, Hoffman felt sure he would wake up in the morning. Three hundred and seventy kilometers from tell chapter twenty one, the stabbing, late July two thousand and.
Four, Oh did mister Brammage get off all right?
Outside the hospital elevator At the start of her shift the morning after the frantic efforts to save his life and move him to Brisbane, Tony Hoffman had bumped into doctor Martin Carter. She popped the question. After a quick exchange of pleasantries.
No, he died.
When the Flying Doctor had finally arrived after ten pm with flight nurse Anita Carr and doctor Jackie Butler. Their patient was closer to death than he had ever been. Patel had remained in control and declared him to be too sick to be transferred. As Bramich died a little after midnight, despite frantic resuscitation efforts by doctor if T Carr Eunice, the nurses were in tears. The Flying Doctor staff wept. Tess, Maria and Mark huddled together, shocked, crying
and wondering what had gone wrong. Hoffman was devastated, she thought of the beautiful little girl who no longer had a father. She guessed immediately that Patel's decision to halt the transfer was all about Patel and his determination to flaunt himself. It had little to do with the welfare of patients. Despite mounting evidence of needless deaths and injuries, the director of surgery remained delusional about his own abilities.
The death of Bramich was the turning point. Hoffman decided from that moment to do everything in her power to highlight Petel's lethal menace. She told Martin Carter.
We have to do something about this, so we cannot let this happen any longer.
She went to her office and broke down in tears. The Bunderberg newsmail that day had a bright picture story about des Bramich's near death experience. He was sitting up in the photograph, looking larger than life. In the article, Bramwich says.
I thought I was going to die because I couldn't get any air. It never hit me until the next morning, the reality of it that I was in the hands of the gods.
Doctor Martin Strawn, a general physician in private practice who worked part time as a visiting medical officer at the hospital saw Hoffman sobbing and gently asked what was wrong. She told him about the Bramwich case and the circumstances of several other deaths, and she recounted the startling rates
of wound breakdowns and complications. She told him how doctor Carter referred to Patel behind his back as doctor Death, how the nurses were distraught with worry for the patients, how in the renal unit he had flouted basic anti contamination standards, and how the director of medicine, doctor Peter Meak, refused to let Patel anywhere near his patients. Doctor Strawn promised to go away and talk to some of his colleagues about Patel and his competence.
Two days later, he told her.
There's widespread concern, but nobody is willing to stick their neck out yet.
The untimely death of des Bramitch galvanized the nurses. Several of those nurses who had witnessed the last agonizing hours of his life, Karen Fox, Vivian Tapiolis, Daniel Aitken and Sandra Sharp, were appalled at the turn of events. The ICU staff mourned in the beginning and then they became angry as they reflected on all the patients Patel had harmed since he came to the hospital. They did not
know the extent of des Bramitch's internal injuries. It was probable that these injuries were so severe he may have died even if he had been transferred. But they understood that he had been robbed of at least a fighting chance by a bombastic surgeon who threw his weight around to prevent a transfer. First, Patel had insisted that Desbramitch was not sick enough to go, and then he was
too sick. They understood that Patel had spoken callously to the family, telling Tess that she should start praying because her husband would surely die, telling Tess and her daughter to stop crying at the bedside, telling anyone who cared to listen how his experience in trauma surgery made him better qualified than anyone in Brisbane to manage the care. At one point, another nurse, Sharon Cree, had to move away from Patel because he was talking so obnoxiously about
his wealth of experience and expertise. Karen Fox was tormented by the death she could not erase from her mind. An image of Patel's stabbing Brammage with a large needle. For some unexplained reason, Patel had decided that Bramach's critical condition might be due to blood between the two layers of the peri cardium, a protective sack around the heart. Although an ultrasound had already proved there was no fluid there, Patel had diagnosed a cardiac tamponade. He decided to perform
a peri cardio sentisis using a wide born needle. He wanted to puncture the sack to drain nonexistent blood. The invasive procedure requires skill and strength. Patel botched it. The needle is supposed to go in within a few attempts. Patel stabbed the needle violently and repeatedly into the semi conscious Brammage's chest. After flailing away in a frenzy, Patel finally extracted a minuscule few milli liters of blood. Nurse Fox had never seen anything like it. Doctor Carter and
doctor iftekar Unus were also confused. They knew the ultrasound results gave no indication of blood.
In the sack.
There appeared to be no good reason to be adding to des brahmages to stress and pain. Eunus was angry about it. He suspected Patel might have punctured a coronary vessel with his repeated stabbing motions. Nurse Fox told Hoffman.
During this procedure, doctor Pateel was loudly making comment that the patient will die and does not need to go to Brisbane. I asked doctor Peateell to mind what he was saying as the family were in the hallway.
Patel had told Fox that the family members needed to know the seriousness of the situation, but Fox replied.
They need to be told face to face, not overhearing what's being said behind the curtains.
Fox told Hoffman all the distressing details, including how Patel had inserted a chestrain and.
Poked and prodded using his fingers through the incision.
Tony Hoffman was so frustrated and worried about the situation she telephoned the acting coroner, Neil Lavering and explained the concerns over Patel's competence. She described the brammished death and the interference by Patel. Lavering replied, well, that confirms some of the things I've been thinking about what has been going on at the hospital. He said he would await the documentation. Hoffman also telephoned the Bunderberg police station and
was put through to a senior officer. He asked if the hospital held morbidity and mortality meetings or had any other mechanisms that would identify negligence causing deaths, but neither the coroner's office nor the police followed up. Hoffman next prepared a sentinel event report. This was a major step. According to the protocol, a sentinel event is rare, serious
and requires prompt and in depth investigation. Hoffman's accompanying memo to management described how Patel bullied staff, misused the intensive care unit, compromised care, and constantly threatened to quit because he did not want his patients transferred. Tony Hoffman wrote this.
The director of the union, Dr Carter, is usually supportive and proactive about transferring patients, except when doctor Petel's patients are concerned. Dr Patel creates such an atmosphere of fear and intimidation in the unit that his behavior is rarely challenged.
On several occasions, when doctor Petel's patients have been in the ICU, he has refused to transfer his patient to Brisbane, even when the patients have deteriorated and have been in ICU for much longer than twenty four to forty eight hours. He has done this when a bed has already been obtained. This has on several occasions placed the patient in jeopardy as they have further deteriorated.
Hoffman repeated the concerns that she had expressed more than twelve months earlier to Darren Keating about the dangers inherent in the esophagectomy procedures that Patel had been determined to perform. She said Patel's interference in the care of des Brammage may have led to his death. She ended the two page document by saying Patel.
Actually endangers the lives of the patients.
The acting Director of Nursing, Patrick Martin, who perused the document, gave Tony Hoffman some feedback.
Wow. Love, that's all pretty heavy. It's very good, though.
My experience with Darren is to stick to facts and figures and not be a motive.
He absolutely turns off a motive.
Approaches quote, percentages and figures to him, and he responds much more favorably.
Hoffman had lost confidence in her own line manager the new director of Nursing, Linda Mulligan. She was a stickler for the memo and formal appointments for meetings, but when it came to ward rounds, Mulligan was rarely seen by the nurses. She operated very differently to Glennis Goodman, who had retired.
A few weeks earlier.
When Hoffman went to Mulligan to voice concerns about Patel, she left the executive office feeling more powerless than ever. Mulligan had given her a book called Coping with Difficult People by doctor Robert Ranson to take home to read. She had suggested that Hoffman should consult a psychologist and undergo training in conflict resolution.
Chapter twenty two, Justice for Elise.
Late July two thousand and four, the files describing ten year old Elise Neville's final few hours moved me to tears in the public area of the District Court Registry in George Street, Brisbane, as Tony Hoffman and the other nurses at Bunderberg Hospital seethed and grieved over the death of Desbramitch. I became absorbed in the story of a little girl who had rolled the wrong way in her sleep and fallen out of a bunk bed during a
holiday with her family on the Sunshine Coast. Leaning over a large folder laid out on a chipped counter, I read hundreds of pages of witness statements and medical reports that helped reconstruct seven January two thousand and two and
the ensuing forty eight hours. Although some of the accounts differed, they documented the seriousness of Elisa's head injury when she was rushed to Caloundra Hospital shortly after three am, the deficiencies of the examination by doctor Andrew Donovan and Nurse Beverly Duncan's examination in the emergency department, the inevitable brain injury, and the agony of Elisa's parents, gered and the rain.
There was something primal about Jered's pain on raw display, as graphically as if he had spilled his own blood throughout the folder.
This is what he wrote.
We will pursue this while there is still breath in our bodies and blood flowing in our hearts. The whole episode is an absolute scandal, and there is no way that we will ever let them get away with it.
Jered believed he had failed in his duty as a father and as a doctor, to protect his daughter from palm, and he blamed himself, the fatigued doctor Donovan, the nurses, the system, and the hospital. Jered further wrote.
The doctor came probably about fifteen minutes after we first arrived at the hospital. His name was Andrew, as we recall, we didn't catch his surname. He took a very brief history. I told him that I was medically trained, but that I had not done clinical work for many years. Soon began a discussion about the need for a CT computerized tomography scan. He said, you can't see tee everyone who hits their head. We return to a discussion about going to Nambole hospital. We ask how far it is and
how long it will take to get there. He still hasn't really examined Lease, and he says something like lots of kids hit their head. Namble will probably send you home too. We say that Elise has vomited, and he says, lots of kids vomit at night. We say that Elise rarely vomits. He keeps reassuring, We keep sending signals of worry and concern. The discussions have gone on for some time and we are at an impasse. He then says something along the lines of look, I will do a
neurological examination if that would make you feel better. He gets a tendon hammer to go with his torch. Elise has her eyes closed and won't cooperate with him. She is in pain and acting nothing like her normal self. We tell him that she is not normal like this. He then says coldly in front of a lisea as well, she's a ten year old girl. It's late, she has had a disturbed night, and she is pulling the wool
over her parents' eyes. By this stage, we have a child with a head injury, a large contusion over her left temple, a history of vomiting, and developing uncoperation. He finishes with something like, I don't think there will be any problems in your case. You're a sensible father. Take her home and watch her. Even if she starts to have problems, there will be plenty of time to do what needs to be done. We didn't want to go home, but we had nowhere else to go, as he and
the hospital had totally rejected us. I kept checking Lisa's pulse, eyes, breathing, and movement as she lay next to me on our bed. She was restless and kept moaning, crying, and complaining about her sore head. I kept trying to diagnose what might be going on, but it was all a blur and nothing made any sense to me. Convinced myself that Elise must just have a minor concussion at the very worst, and we would see how she was a bit later
and probably get some more medical attention in the morning. Eventually, it was now some time after six am, Alise seemed to finally settle. Thinking that Elise was finally sleeping, I started a doze on and off as I lay next to her. I was never actually asleep, more just lying next to her with my eyes closed and trying to calm down. It had been a harrowing night. I suddenly jolted up from my dozing when I felt something was very wrong with Leise. So did Lorraine at the very
same time. I looked at Elise and screamed, oh my god, Oh my god. It looked like she had a rash down the left side of her body. I rolled a lease on her back and saw it there too. Elisa's eyes looked like they were popping out. Her jowel looked like it was rigid. I thought Elise was dead. I yelled to Lorraine get an ambulance. I was absolutely distraught from that moment. Lorraine couldn't turn on her mobile phone, so she ran to the next door unit for help.
I carried Lease from our room to the living room and then back to our bedroom. I didn't know what to do. At about seven thirty am, the ambulance took a Lease, Lorraine and me. The first face I saw was the same doctor from earlier in the night. He saw me and said what happened? He was visibly shocked and became very pale. I frantically said something like she's gone right off. She needs a neurosurgeon. At one stage she said was it to himself or to us? Something
like I'm so sorry, It's all my fault. What have I done?
Oh?
Fuck?
Anette Thompson, one of the nurses who helped with the resuscitation, saw Lorrain Neville lying on a bed in a waiting area for relatives.
The nurse recalled she was in a fetal position and was cuddling a stuffed toy, which I assumed.
To be Elise's.
Her eyes were shut in her fis appearance suggested that she'd totally withdrawn into herself. Missus Nevill was making no sound, but responded to my questions in a quiet voice. She told me that Elise was a lovely girl and things like this shouldn't happen to someone like her. She approached Lisa's bed and spoke in whispers to her. Doctor Nevill was very upset and cried loudly as the helicopter departed, missus Neville began crying as well.
From doctor Donovan's account of events, starting with Elisa's first presentation at three twenty five am, she had been lying on her side, facing away from him when he started a physical examination.
I coaxed her two to three times to turn and face me so that I could look into her eyes. Alise then rolled over and opened her eyes freely. I examined Elsa's pupils and noted that they were equal and reactive to light. I noticed some swelling and bruising lateral to her left eye. I felt the area of swelling and did not palpate a skull fracture. Alise then said words to the effect, I want some sleep, and pulled her sheet up and rolled back onto her left hand side.
I did not consider the swelling to the side of the head to be unusual, as in my experience it is not uncommon for children to suffer bruising to the head even after a short fall onto a soft surface. Mister Neville and I had a conversation regarding the indications for performing a CT scan and whether a lease required a CT scan. I had treated a few children with vomiting and diarrhea at Caloundra Hospital and had been told
that the hospital did not admit children for observation. Therefore, I was of the impression that Elise could not be admitted for observations, and I explained this to mister Neville. I told mister Neville to keep an eye on Elise for the next day or so. The Nevills left the hospital amicably. Mister Neville carried a lease from hospital. After the Nevills left the hospital, there were no further patients,
so I went to sleep. At about seven hundred hours, I rose and got dressed, and literally as I walked out of the room, mister Neville arrived in the emergency department in a very distressed state. He was followed by the ambulance officers with Elise on a trolley. I was shocked that Elise's condition had so radically deteriorated. Mister Neville was extremely distraught. While resuscitation procedures were taking place, he
said words to the effect of it's my fault. It's a curse being a doctor, and I fell asleep on two or three occasions. I assured mister Neville that it was not his fault, but my fault. In saying this, I did not intend it as an admission of fault, but as a feeling of personal responsibility as the last doctor to have attended Elise.
I had first read something about Elise in the Courier Mail in late two thousand and three. The description of her parents' relentless efforts to force Queensland Health, the Medical Board, the Nursing Council and the Health Rights Commission into rigorous self examination was a small part of a much larger story. I spoke about the case to doctor David mcloy, who had taken over from doctor Ingrid Tall as head of the Australian Medical Association in Queensland. Dr mcloy told me.
It is one of those tragic issues that brings everything to account.
The system.
The junior doctor at the end of a very long shift in a small hospital, the lack of supervision and the protocols. There is significant concern that in any hearing of this case, the system itself will be under scrutiny, and if so, Queensland Health will have to take a good hard look at its systems.
My earlier investigations into Queensland Health had made me deeply suspicious of its management and culture. In November two thousand and three, after my stories were published on the concerns over the standards of overt trained doctors in Queensland and the lack of checking of their credentials and skills, Jered Neville emailed me.
I am not seeking anything from you, but I certainly encourage you and the Courier Mail to keep the heat up in regards to professional health standards. I have absolutely no doubt there are real issues in regard to the competence of some health professionals. These issues are not being
given the attention required to protect the community. It's just part of the bigger picture about the effectiveness of the system of ensuring that health professionals, whether trained overseas or locally, are competent and not putting their patients' lives at risk.
Now we were in July two thousand and four and the Medical Board of Queensland had decided that doctor Andrew Donovan, who had treated a least Neville at Caloundra Hospital, would be prosecuted for unprofessional conduct in the Health Practitioners Tribunal,
a part of the District Court. Queensland Health's dangerous policies had forced Donovan to work a twenty four hour shift on the day Elease was brought into the hospital by her worried parents, Yet the same organization was now hanging him out to dry, having refused to fund his legal defense. The Director General, doctor Steve Buckland, was silent on the stupidity of the twenty four hour shifts and the hospital's policy not.
To admit children.
Nowhere in the file, a public document at the Court's registry was the confidential and damning Queensland Health Report by doctor William Rodgers about the need for several experienced doctors to staff the emergency department at Caloundra Hospital. By late July two thousand and four, there was enough material on the public record to write several balanced and detailed stories about the haphazard culture in Queensland. Health and its devastating
effect on at least one family. An emergency helicopter had taken a lease from Calandra Hospital to the pediatric intensive care unit at the Royal Children's Hospital in Brisbane, but even the transfer was bungled. It took twice as long as a road trip. In alease Neville's chart at the Royal Children's, doctor David Coman noted unstable day irretrievable brain injury, with brain death the most likely outcome. Not responding to
voice or head and neck stimuli. Jennifer Rich, a social worker who had been counseling Elisa's parents as well as her older sister Laura and younger brother Michael, wrote.
This father is experiencing a lot of guilt associated with the accident given his profession.
Jennifer Rich's last entry in the hospital's electronic diary reported the family's request.
That foot and hand prints, as well as a lock of hair, be taken for themselves.
One of the treating doctors would later break down over the waste.
Of young life.
A police officer wrote out a receipt for Elisa's property, a blue hat, white sox statue of Mary A.
Winnie.
The Pooh Teddy Bear, blue and white shorts, pink top, hair clips, hair bands, and a white ribbon.
Jerry wrote this.
Later that day, Lorraine and I decided to turn off for Lisa's life support. At Least died at five point five pm on the ninth of January two thousand and two. As she died, peace came to her tormented face, and her spirit and.
Beauty reigned over us.
All.
She showed us she had gone to somewhere nice and safe, where people care for each other.
Might be.
I know it is certainly not in Caloundra Hospital, a dangerous place that should be closed.
And the Lisa's mother, Lorraine added.
She shone with happiness and a beauty of nature and soul that are irreplaceable and which will continue to be our inspiration and guiding light.
There was a report by doctor Michael Redmond, a neurosurgeon, who wrote, it.
Is considered unacceptable for a patient following head injury to talk and die. At least Neville is one who talked and died in a responsible medical system such as we enjoy, with such access to hospitals of ascending levels of sophistication, it is tragic and unacceptable that an event such as this should occur.
And doctor Johannes Wenzel, a specialist in emergency medicine, wrote, I.
See it as a system problem that our public hospitals put junior doctors into positions where they have to deal with presentations beyond their expertise, combined with the fact that working long shifts reduces the decision making ability to a similar level as a person with point zero five percent alcohol blood content.
According to two independent medical experts who studied all the case notes and statements, doctor Donovan had made a tragic wrong call. He had done an incomplete examination of Elise, although he must have been fatigued after working nineteen hours of a twenty four hour shift. If he had thoroughly questioned and examined a lease or urged her parents to go to another hospital for a CT scan of her skull, its fracture and the hemorrhage would have been obvious.
There still would have.
Been time to relieve the pressure building from the accumulation of blood before her rain soft tissue was crushed. In his defense, doctor Andrew Donnoman wrote.
I would sincerely hope that doctors are not rusted on for any longer than a twelve hour shift. Twenty four hour shifts without a break are excessive and dangerous, and no patient or doctor should ever be put through the devastation that both the Nevills and my family have had to endure.
When I called Jared Neville to tell him that I planned to write several lengthy stories about the case, he agreed to a meeting. I went to the suburb of Tuwong and the rain served tea and biscuits as we talked about Elise in the family home, filled with her image and memory, but cloaked in quiet sadness.
We live with the ongoing trauma. We ask ourselves what could we have done, What did we miss? How could we let this happen? It is so cruel for Jared. He had the very best of intentions. Fate had something else in mind. We do not want to be seen to be vindictive and nasty to certain individuals in this It's more about the bigger picture and how it can be improved. Elise was just as perfect a child as
you could ever have. The last thing she would have remembered was putting her head on Daddy's shoulder as he carried her in from the car.
To the unit.
Jered's grief was still angry. He looked like a man who had lost much of his will to live.
I know people look at me and say, how did this happen? How did you let this happen? Of course I have blamed myself. I'm a doctor and I'm a father. It's tragic. It's a cancer. It eats away at you. I don't trust health at all. I don't respect health and I work there. It's a terrible dilemma. Now I have a more important job to do, trying to bring the Queensland health system into the twenty first century. I
want to see some honesty in the health system. If this can put pressure on the system to respond in a learning way, then it is worth it. Maybe I have been relentless, but I'm going to stay that way because the truth leads to findings and they will lead to recommendations that can improve things. We will get comfort knowing that something good will come out of this. I know for a fact that if we did nothing, nothing would change. Elise and I have made up, we have
worked it out. She's forgiven me. I know this sounds nuts, but one day, when I sat next to her grave, I saw her, and she was deliriously happy, but I still want her back. It shouldn't have happened. She wasn't given a chance.
The unfairness and emotion of it all made the stories difficult to write. I knew that doctor Donovan, a father of young children himself, was in agony and had been punishing himself over Elisa's death. I knew his sister, Paula, a colleague at the Courier Mail, was not in favor of me exposing her brother to public scrutiny. But as a fellow reporter, I hoped she understood it was unavoidable.
I talked over the angles with my wife Ruth. We pledged never to let our children, who yearned to know the story of the little girl, sleep in bunk beds. My daughter, Sarah, aged three, came home from kindergarten with a drawing of Elise. She had been asking me to tell her bedtime stories about Elise for a week. Sarah told her teacher the story of the tragic accident. Before anything was published. I spoke to doctor Steve Buckland, the Director General of Queensland Health, in his office with his
media manager, Lisa Schultz. Buckland did not appear concerned at the major systemic issues, the twenty four hour shifts, the rostering of inexperienced doctors to take charge of emergency departments. It occurred to me that it was easier for doctor Buckland and the regulatory system to punish Donovan than to look at glaring and fundamental flaws that would take courage and money to remedy. Before I went to see doctor Buckland,
he had a meeting with Jared Neville. Jered wrote this in his diary that day.
He clearly does not have a positive outlook on Headley Thomas or what his motives might be. Says he is a grub.
After seeing the photographs of Elise at her parents' home, I asked Jered and Lorraine for permission to publish one. They considered the request overnight, and Jered called me the next day to agree.
I want every health professional in Queensland to stare into her. Maybe it will cause them to search their conscience and appreciate what we are trying to do.
When the main feature and several accompanying stories were published prominently on Saturday thirty one July, the reaction was immediate and overwhelming. Many doctors were furious at the punishment of Donovan. Staff and users of the health system were furious at its obvious shortcomings. A number of readers called me to say that they had wept for Elise and her parents. The Australian Medical Association demanded action by the Beatty government
to stop unsafe practices in the health system. Tony Hoffman had never contacted a journalist before. She cried when she stared into the eyes of Elise Neville on the newspapers page, and then she sat down to write an email.
Dear Headley, I read your article in this morning's Career Mail with dismay. I am one of the nurses who continues to work in the environment you describe. This week, I stayed three hours after my shift finished to try and ensure a patient was transferred to Brisbane from the provincial hospital where I work. One of the surgeons involved in the case insisted the patient did not need transferred, despite the fact our hospital does not have the facilities
to care for such a patient. Finally, the retrieval team was on its way and I left. When I returned in the morning, I expected that the patient would have been transferred, only to find he had died two hours after the team arrived. The intimidating, bullying surgeon, of course, was not wrong. He had delayed a transfer for several hours, despite the pleas of the nursing staff. There is no
one we can complain to the hospital hierarchy. Believe this surgeon is doing a great job because his making the hospital money and keeping the waiting this down. If we complain, we're in danger of losing our jobs. No one will notice in the patient's notes the delay. It's not obvious except to those of us who were there. The nursing staff was so distraught the next day we are told to follow the proper protocol to deal with such issues, only to find no.
One supporting us.
The poor family of the patient will believe all was done for this patient when we know this is not the case. Keep up the good work at examining what's going on in our hospital. How dare Queen's that Health make Dr Donovan the escapegoat for a system which does not work.
There are so.
Many good, kind and caring people out there trying to do the best they can, but it is not working.
Tony Hoffman, Chapter twenty three, Suspicious Minds, Late July to October two thousand and four, Nurse Michelle Hunter was seeing too many surgical disasters with a common feature.
There were more wound.
Breakdowns, infections, and complications connected to the surgery of J. M.
Patel than all the other doctors in the hospital.
She asked died Jenkin, the manager of the surgical unit.
About it is anyone looking at what's going on here?
Nurse Hunter, back in Bunderberg after a stint in the vascular surgical ward of a large hospital in Bath in the United Kingdom, was stunned by some of Patel's decisions, such as when he ordered that a plaster be put on a man's amputated leg stump. After several days, she asked Patel to look at the wound. It had completely fallen apart. He casually told her to take out the stitches and remove the necrotic tissue, as there was little he could do. The man died a few weeks later.
Patel's lack of hygiene appalled the nurse.
She told him, I want you to go and wash your hands before you go to the next patient.
But when Hunter was not around, Patel went back to his old habit of moving from bed to bed and touching wounds without once washing his hands. Hunter, who was harboring serious doubts about Patel's competence, wondered if the surgeon had been involved in any negligence cases in Oregon, where he often boasted he had extensive experience. After a Google search linked her to the website for the Oregon Board of Medical Examiners, she put his name in the search field.
The information that appeared was amazing. Doctor j. I. Patel had been subjected to recent serious discipline reaction. He had been barred from performing a wide range of surgery because of his proven incompetence. Although shocked, Hunter decided that information so easily discovered had to be known to the Medical Board of Queensland and the hospital's managers if indeed it related to the same Jayant Patel. One evening, Karen Stumer, a nurse in the intensive care unit, received an unusual
request from a theater wardsman. He had rushed out of surgery and was in a state of mild panic.
Can we have some mouth swabs?
It's urgent.
Stumer wondered why they were needed in surgery. She went to the stockroom and removed a handful of the swabs, which were used in the ICU to clean patient's mouths.
What's the problem.
We need them because doctor Patel has flushed the bow backwards. We have to clean out the patient's mouth before he wakes.
Up physically sick.
Betel's bungled flushing technique meant the patient's fecal matter had gone the wrong way instead of being.
Washed out at the lower end.
By the end of July, amid serious disquiet among nurses and some of the doctors over dez Bramach's death, Patel had been the director of Surgery for sixteen months, yet he had steadfastly refused to seek fellowship of the College of Surgeons, even though it would have given him formal specialist status, a hefty rays, and more boasting rights. Patel kept making excuses. In truth, he must have known that fellowship would be granted only after a careful vetting and
accreditation exercise. His United States bands would be discovered. His managers, doctor Darren Keating and Peter Leck, did not twig. They were delighted that Patel had made such a sky significant dent in the waiting lists, but as both Tony Hoffman and doctor Martin Carter had made known their worries about the Bramwich case. Doctor Keating decided to look into it. He asked Patel, Carter, doctor Jim Gaffield, and doctor if Deca Eunice to supply reports on the care of Brammage.
Their accounts were in conflict. When Patel saw the Sentinel event report by Tony Hoffman, he denounced it as based on misinformation, misrepresentation and personal bias. The email Hoffman had sent to me after reading the thirty one July story about Elise Neville remained unopened until my return from a
family holiday. The cabin we had booked into near adam Innabee, a forty five minute drive from the ski fields at Mount Selwyn in New South Wales's Cosiosco National Park, was but when we saw the bunk beds for the children, we again thought of Alice. We covered the top bunk with suitcases and organized the betting to ensure Sarah and Alexander would sleep together on the bottom bunk. On my return to work in mid August, I emailed Hoffman. I wrote,
I'm very concerned by the situation you've described. How do you feel about me investigating it?
In a way?
Of course, that does not affect you, Tony replied.
I would be very grateful on behalf of Queensland Health patients if you would investigate the situation that currently exists in Queensland Health, especially in the provincial areas, where we are very much at the mercy of third world doctors and management who do not support the grassroots and who consistently lie to cover up what is really going on.
I have invested a lot of time, money and study in my career, but I am suddenly concerned about the state of affairs and just wish management would be accountable.
Hoffman had deliberately not disclosed the hospital or town in which she worked. She wanted to continue pressing her concerns about Patel through official channels. In relation to a patient's death, which she described, she said.
The surgeon continues to operate even though queens and Health are doing a preliminary investigation. The coroner is investigating. I really feel queens and Health is out of control with protecting incompetent doctors.
Regardless, the lack of feedback from management to Hoffman gave her little confidence. At the urging of other nurses, she pleaded for advice from Vicky smy and Kim Barry of the Queensland Nurses Union. Hoffman had been going back over the records looking at deaths and complications in the ICU in the previous sixty months. She revealed how concerned she had become. Kim Barry told Tony, you can't collect that
sort of information and not act on it. Antoine Gortray asked his friends and family to wish him well before going into the hospital in early September for a Whipple's procedure, an extremely complex operation to remove a tumor in the
head of his pancreas. Although it was a procedure Petel had bungled in Portland, Oregon, with fatal consequences resulting in him being specifically restricted from attempting it again, he decided to use Gortray as his guinea pig in a hospital ill equipped for the post operative care that would be needed. Gortray was a seriously unwell man when he came out of theater. The extent of his cancer was such that
the operation would almost certainly kill him. Before the disease took his life, Few, if any, surgeons would have operated on Gortray in his perilous condition but in his trademark cockshaw manner, Patel forged a head. Gortray died in late September after a stormy and prolonged stay in the intensive care unit. His death certificate stated clebsiella. Towards the end, a dark brown and sticky sputum that Gortray had been coughing up caused pneumonia and pockets of pass in.
The lining of his lungs.
The week after Gortray's death, Patel operated on In Vowels, a cabinet maker who had a polyop in the lining of his bowl. Instead of simply removing the fleshy growth, Patel opted for drastic action, removal of the entire bowel. Patel told him.
Well, the sisters attached to the wall of your bower, and I cannot see what's in behind it. Jo Bowel does not like your body.
We were work it out.
I've done a lot of these operations before. People After they get welligan, they go skiing. You'll have no worries whatsoever.
The operation was entirely unnecessary. The polyp was benign at the time Patel did the operation. There was nothing to suggest it might develop into cancer. At fifty seven Fowls was fitted with an illiostomy bag. There were serious post operative complications. His quality of life was never the same again. Glenn Tatham usually tried to inject humor into his deadly serious talks for Queensland Health.
A few jokes sprinkled.
Here and there made the subject ethical awareness less, foreboding for hospital staff. As a misconduct invests based in Brisbane, Tatham went to Bunderberg Hospital to remind the staff of their obligations under the Code of Conduct. Some people think that people who complain are dobbers.
Do you agree?
Tony Hoffman and the other nurses were increasingly alarmed as they watched one part of Tatham's PowerPoint presentation headed breach of confidentiality the small Town Scandal. Another part related to whistleblowing about serious threats to safety. Tatham and the explanatory material warned that a whistleblower who disclosed information to a union representative, the media or a member of parliament could be sacked and even imprisoned for committing a criminal offense.
Dahela Alma said to Hoffman.
I'm so glad you didn't do what you were going to do.
The nurses were alarmed at the timing of the presentation and the con Quince's for staff who spoke outside the system, even though the system was not properly responding to complaints made internally. Until Tatham's sobering warning, Tony Hoffman had been ready to go to Brisbane with a Union official to bring jay N Pateel to the Health Rights Commission's notice.
But now she was scared. She wondered if the timing of the talk was more than a coincidence, and whether she might already be in trouble for confiding information to me and the union. Sick to Death is written and presented by me Hedley Thomas, the Australian's National Chief correspondent. Claire Harvey is The Australian's editorial director. Audio editing, production and music have been done by Jasperlik with assistance from Leah Sammaglu and Neil Sutherland. Our producer is Christen Amias.
Production management by Stephanie Coombs. Artwork by Sean Callanan. Thanks to Ryan Osland, Matthew Condon, Karina Berger, Ellie Dudley, David Murray, Dominique McDermott, Zach Sculander and all our family friends and colleagues who helped in this series and contributed voice acting and special thanks to Tony Hoffman and Rob Messenger. Subscribers to The Australian Here new episodes of Sick to Death first at Sick to deathpodcast dot com and on Apple Podcasts.
You can get exclusive access to photographs, videos, timelines and more at the website