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 twenty four, The Outpouring October to November two thousand and four, Tony Hoffman finally lost patience with her smug
and unresponsive managers. Her more than enough about the merits of mediation. She did not want psychological counseling. She felt patronized by all the talk about personality conflict with Jon Patel, and she was angry that the nurse unit manager, Linda Mulligan believed the problems on the wards and in the intensive care unit might be fixed by a book called Coping with Difficult People. Doctor Darren Keating had convinced himself and others that much of the criticism of Patel was
the product of the surgeon's personality. Clash with Tony Hoffman. On eighteen October, doctor Keating, Peter Leck, and Linda Mulligan met to talk about the problems. They agreed that there needed to be mediation. The constant bickering was having an impact on the operations of the intensive care unit. Keating was fed up with the stream of complaints against the star surgeon. He made time in his diary to meet
Patel and Hoffman together. He doubted he could resolve their feud, but he might be able to placate them for a while. Keating had made no secret of his admiration for Patel. Hoffman believed that it verged on sicker fancy. As Keating told one of the ICU nurses in doctor Pateel's presence outside the hospital canteen.
When you get to be as great as this man, you can do what you want.
When Linda Mulligan again raised unresolved behavior and communication issues, shortly before lunch on twenty October, Tony Hoffman made her most forceful effort yet to bring about decisive action.
Doctor Petel's the patient for dying because of his care.
Hoffman knew that her career would probably stall or even end, but to hell with it. In an angry outburst, she spoke about Petel's dishonesty in describing the condition of patients, how doctor Peter Meak refused to let his patients undergo procedures by the Director of Surgery, and how the number of post operative complications was without precedent. A few hours later, in a hastily called meeting in Peter Leck's office, Tony
Hoffman repeated the serious allegations. She also told Lek about Petel's stubborn refusal to observe hygiene and how a probable consequence wound to Hastens from infection was not properly reported in the patient's notes because Patel knew it would give clues to his negligence.
Hoffman told Leck the death of mister Bramach was the last straw. They may come back and say he would have died anyway, but that isn't the point. It was about Dr Pateell interfering in the process that would have got the patient to Brisbane in time for him to have the best chance.
Hoffman reminded Leck of how she had gone to him eight months earlier with her concerns about doctor Petel's behavior, and how she and doctor John Joyner had warned doctor Keating about the dangers of the esophagectames. In mid two thousand and three, she repeated other disturbing clues to Petel's incompetence, including evidence of the harm caused to patients in the renal unit because of his ineptitude with the placement of catheters.
Hoffman gave the district manager an ultimatum unless there was a rigorous and independent audit of the outcomes for Petel's patients, she would be forced to take further steps. As she told Leck, I'm.
Quite happy to be proven wrong.
In an email to people two days later, she documented the details of unnecessary suffering by a dozen of Beateell's patients.
I spoke with doctor Dieter Barons and informed him the nursing staff were going to report their concerns with Dr Petell to an official source. He stated he would support us by telling the truth, but he was concerned he would lose his job and Dr patell would be the
one left behind. It is widely believed among the medical and nursing staff that Dr Petell was very powerful, that he was wholeheartedly supported by Peter Leck and Darren Keating, and was untouchable anyone who tried to alert the authorities about their concerns would lose their jobs. This perception was
indeed perpetrated by Dr Petell on a daily basis. Many of the principal house officers have expressed their concern doctor Alex Davis and doctor David Risen, but were unsure of what to do because of the wide spa read belief Dr Patel was protected by executive.
On the day Lek received Hoffman's written report, doctor Keating and doctor Miak had an angry row over Patel's competence, but still nothing was done to restrict any of Patel's work. The surgical wards were full of patients. They were still being led into theater like lambs to a slaughter. Leck briefly considered suspending Patel on full pay, but Patel was much too valuable to the hospital and the campaign to reduce the waiting lists for surgery. Lek brought time. He
decided to test Hoffmann's serious allegations. Lek and Keating interviewed doctor Dieter Bearns, one of the anesetus, who questioned Patel's competence and judgment in undertaking some operations. Doctor Barons bluntly described Patel as dishonest about his mistakes and so rigid he refused to consider alternative and safe clinical options for the patients. Doctor David Risson, a relatively junior doctor, revealed that he had concerns about the number of post operative
complications and infections. Patel's dismantling of one of the reporting mechanisms meant that the surgical audit process was a bad joke. When doctor Risson had previously raised a wounddhesiance, Peatel tried to change the definition of dhesiince Patel had said.
We should be careful what we call woundhesions and what we're class Woundehessins.
The director of surgery, was trying to minimize the number of complications being recorded. The next doctor to be interviewed, Martin Strawn, had nothing to lose for speaking his mind. He was a visiting medical officer who helped out at the hospital when he had time away from his full time job elsewhere. He described Patel's misdiagnosis of a woman upon whom the Director of surgery was determined to perform an extremely complex Whipple's procedure. She died several days later.
Martin Strawn was convinced that Patel believed he was invincible, a Johnny come Lately, as the doctor called Patel, but with aggressive trays, who was strongly supported by management to take a scalpel to the waiting lists. Doctor Strawn also emphasized the dangerous vacuum into which Patel had arrived. The director of surgery, who saw himself as a self declared expert from the first world to help the third world of Bunderberg, had been permitted to operate without any form
of peer review. Keating and Les did not bother asking doctor Meak, the most qualified and experienced specialist in the district, but in early November two thousand and four, doctor Meak handed to Keating another scathing indictment of doctor Patel. It was a letter written by doctor Jason Jenkins, a vascular surgeon at the Royal Brisbane Hospital who was held in high regard for his specialist skills and integrity. He sent
it to doctor Meak and to Patel. Only rarely would doctor's blast colleagues in writing over the care of patients, but doctor Jenkins was enraged after he examined Marylyn Daisy on one November for her diabetes problems. When he saw Marylyn Daisy, doctor Jenkins asked the.
Question, when did you get that done?
Doctor Jenkins asked, when he saw the bandage on her below knee amputation.
Six weeks ago, do you mind if I have a look at it? Has it not healed yet?
It was clear that not only had the wound not healed, the sutures were still in Daisy's amputation stump. Six weeks later, there was also an area of gangrene.
So have you seen the surgeon since the operation? What's you going to do about this? Did he offer you a chance of saving your leg?
I haven't seen the surgeon since the procedure. No, they just said that I need my leg off.
Patel had not offered Daisy the option of trying to save her leg with a bypass operation. In his letter, Jenkins wrote.
These suitures were heavily buried within the tissue and very difficult and painful to remove. I find it mind boggling that someone could leave sutures in for this long. It shows a complete lack of understanding of diabetic disease and how to form an operation. I have suggested to her that when she comes to Brisbane that she will require a de bridement of this stump, and if it fails to heal, then she may require an above knee amputation.
I think if procedures can't be performed appropriate with the Bunderberg Hospital, then they should not be performed at all.
In the months before days he sought help in Brisbane, Jenkins had noted a disturbing pattern in patients who underwent vascular surgery by Patel. Jenkins quickly determined that the director of surgery was doing more harm than good. He was astounded when doctor Peter Meak told him how he had tried to stop Patel, but to no avail. Patel would go and find patients in the wards and operate without
meac knowing. Before writing the letter, Jenkins telephoned Patel and threatened to report him to the medical board if he kept doing vascular work.
Look, you know, if you keep doing this then there are going to be consequences.
But Patel was unmoved. For as long as the hospital let him do such operations, he had no intention of stopping. Peter Meak gave doctor Keating the written complaint on the same day that the Health Practitioner's Tribunal in Brisbane was delivering its own verdict. The wheels of justice had turned slowly for Elise Neville, her parents, and doctor Andrew Donovan, who was pleading guilty to unsatisfactory professional conduct to save himself and his family further trauma and crippling legal fees.
In her findings, District Court Judge DeBie Richards wrote.
The tragedy has had an enormous impact on the Neville family and no doubt others who knew and loved young Elise. Doctor Donovan must have been fatigued by the hours he was working. It seems extraordinary in this day and age that anyone, let alone someone in a position of such responsibility, should be asked to work such long hours. One does not need medical evidence to know that anyone who's in the twentieth hour of a continuous duty must have reduced
capacity to assess the situation when it presents itself. If this tragedy leads to nothing else, it should lead to the abolition of such brutally long shift hours.
Judge Richards concluded that Andrew Donovan's treatment of Elease was deficient in a number of respects.
She ruled his interpretation of the history and physical findings based on limited examination and his lack of appreciation of the parents' concerns were wrong and errors of judgment which eventually denied at least the chance of survival. Accordingly, the Tribunal concurs with the board submissions that stringent conditions should be placed on doctor Donovan's continuing right now to practice.
The disciplinary orders compelled doctor Andrew Donoman to work in a supervised position for twelve months with ongoing assessment and reporting of his competence to assess patients. After the delivery of the judgment, I walked to a nearby cafe to talk to Gered and Lorraine. They still had unfinished business. Gered pledged the system was yet to reform itself. When the pain in Trevor Holter's stomach had become too much,
he went to see his GP doctor Ken Hornsby. At fifty four, Halter regarded himself as being in reasonably good shape, as fit as a Malley bull, he half jokingly boasted, but the pain was constant. Even Halter, a part time race caller who rolled beer kegs around the club where he did odd jobs, had to concede he needed help. Dr Hornsby wrote a referral letter for him to attend the patients department at Bunderberg Hospital. Trevor Halter had gallstones. Fortunately,
he learned that the condition was easily remedied. J. N. Patel spoke to.
Him, you're probably better off having your golde blooder out because you don't really need it, and so you may as well have it out. I do four to five a week and there's nothing to it. It's keyhold surgery.
The routine corrective procedure laparoscopic color systectomy was on a par with having your tonsils out. Trevor Halter learned that he would need to stay just one night in the hospital after the operation, he awoke in agony. He spent the next seven weeks in hospital. Two of those weeks were in the intensive care unit as he fought for his life. His children were told his lungs had collapsed, his liver had failed, and he contracted pneumonia and septo semia.
Then his heart went. He was finally transferred by helicopter to Brisbane on four December for life saving treatment, all from a routine gallbladder operation bungled by doctor Patel. Months later, Halter was still in pain and undergoing corrective surgery, Chapter twenty five, The blood Letting. December two thousand and four, when Judy and Jerry Kemps looked back on their lives and the fruits of a close marriage of fifty years,
they felt blessed. They were weared on twenty three October nineteen fifty four in Saint Patrick's Cathedral, rule in Melbourne. Judy had given birth to three healthy and happy children, Jackie, John and Bernie. They had relaxed into the gentle pace and tranquility of Bunderberg after a stint overseas. They set up a photographic studio and continued to raise their three children. The couple remained active as they aged. They went bushwalking
together and enjoyed regular tennis and golf. Kemps was one of those fortunate people who never had a sick day in his life, but by two thousand and two his health began to deteriorate. His blood pressure was erratic, he got gout, he suffered back pain. When he received a letter from Queensland Health offering a free checkup, an appointment was made at the local Burrham Street medical practice. The tests on his urine sample pointed to a problem as
they ate lunch. Ten days later, Judy told her husband, you look yellow.
You look anemic to me.
By six December, further tests at Bunderberg Hospital showed that Kemps was bleeding internally. The endoscope had identified a large malignant tumor about four centimeters in size in the lower esophagus. The CT scans showed that the cancer had spread beyond the esophagus. There were shadows on both lungs. There were enlarged lymph nodes where the trachea splits into the left and right main branches. Dr Dorge Smallburger was adamant that
Kemps needed to go to Brisbane for keyhole surgery. Nothing too radical was proposed. The cancer was such that the patient might have just twelve months to live. Under the circumstances, Dr Smalberger wanted to ensure Jerry Kemps received the best care and quality of life possible for the time he had left. He did not contemplate an aesophagectomy, even for a highly competent surgeon. Such a complex procedure was far too risky, but with the presence of secondary cancers, it
was also pointless. Dr Smolberger decided that the best course of action was a stent to make it easier for Jerry Kemp's to swallow his food. The protocol for a transfer of a patient from Bunderberg to another hospital surgical department required the decision to be signed off by a surgeon in Bunderberg. Unfortunately, for Jerry Kemps, he was seen by Jayan Patel. The safe and conservative course was suddenly
turned on its head by the director of surgery. Patel told the couple that the keyhole surgery recommended by doctor Smallberger was just patch up work, and that what he really needed was an esophagectomy. Patel explained how he would remove part of the stomach and part of the esophagus and join what was left back together again, no problems.
It is the big operation, but it is nothing because I've done hundreds of them.
His confidence was contagious. Neither Kemp's nor his wife was given any reason to doubt Patel. Theater nurse Damien Gadds went to work early to start preparing for the operation on Jerry Kemp's, but there was a problem. The intensive care unit already had two patients on ventilators. They would
be unable to cope with Jerry. Nurse Gads called doctor Deta Berens, who agreed the operation should be postponed, But when Gads reached Jayon Patel on his mobile telephone, the director of surgery was furious.
That brin dead beat and should have been switched off last night.
At eight pm. The day before, Patel had told a nurse to call doctor John Joyner and ask him to turn off the life support keeping a critically ill woman, Robin Turton, sixty three alive. Turton had slipped in the bath and hit her head on Saturday, suffering a cerebral bleed. Her family was aware that her prospects were poor. Her death would free up an ICU bed, and could tell
wanted it for Jerry Kemp's, but Joyner flatly refused. He was offended at the indecent haste to end the life of a woman who had not yet undergone formal brain death tests. Although it was probable from the CT scans that she was brain dead, doctor Joyner prudently decided to wait. Patel had little time for doctor Joyner, the anesthetist who eighteen months earlier had express concern to management about the risks of performing aesophagectamies in a small hospital with a
limited icee you. As Patel did his ward rounds on Monday morning, he bad mouthed doctor Joyner. Patel told Martin Brennan, one of.
The nurses, I have a theater chise to do.
The theater nurse was astonished at Patel's cavalier approach to ending Turton's life before the necessary brain death tests had been done. Martin Brennan did not trust doctor Patel. He had heard the surgeon intimidate and bully the nurses and threaten to harm their careers. Patel had created a climate of fear in the operating theater and in the intensive care unit. All the nurses doubted that they would be
bad by management. In a showdown, as Patel often boasted of his influence over Darren keating.
I can get what I want from Darren as I've just made this hospital five hundred thousand dollars.
Patel stormed into doctor Martin Carter's office and denounced doctor Joyner. He pressured Carter to end Robin Turton's life and free up a bed for the esophagectomy. Nurse Vivian Tapiolus witnessed Betel's insistence on the withdrawal of life support for Turton, whose children were in the waiting room at the ICU, as Pateel pressed doctor Carter to make a decision. After a review of the charts, Tapiolus and the two doctors
spoke to the family about ending Turton's life. Patel walked back into the ICU with a spring in his step.
Now I can perform the esophagectomy.
Doctor Carter switched off life support at eight fifty five am on Monday, despite the absence of the formal brain death tests. Carter decided that there was sufficient clinical evidence to show Turton had suffered massive and irreparable brain damage. He wrote, in view of the dreadful prognosis this lady has and following discussion with family, ventilator support is to be withdrawn. Importantly, for Patel, he now had a spare bed.
At nine to fifty two am on Monday, twenty December, less than an hour after the death of Robin Turton, the operation on Jerry Kemp's began. Patel was flanked in theater by the anesthetis doctor Dieter Behrens, two principal House officers, doctor Sanjeeva carr Owasam and doctor Anthony Athanasiov and the nurses. Doctor Karyoasam had spent much of his time at the hospital as Patel's shadow. They got along well. Patel was only too happy to explain the complexities of surgery to
his eager apprentice. Together they used to undertake what Patel would call a blitz. In one week, there would be a swag of colonoscopy procedures. In another week there would be a run of gallbladder operations. It was part of Patel's ongoing assault on the waiting lists, and it kept him in management's good books. Korea Withsam often heard Patel boasting about how successful he had been in reducing the lists and establishing rapport with Keating. The esophagectomy appeared to
go well at first. Jerry Kemps's abdomen needed to be opened to permit access to the esophagus and the stomach. Suddenly, however, he became unstable with plunging blood pressure and a rising pulse rate. Kemp's was turned onto his side for the thorochotomy part the opening of the chest cavity. As Patel resected the tumor in the chest. The blood continued to pour freely into the drain. The heavy bleeding in the abdominal cavity was obvious to everyone. Doctor Barons was worried.
Apart from the blood loss, he could see that the director of surgery lacked the skill to be attempting such an operation. Patel's roughness around the heart and the vessels was all too obvious, nor did he appear interested in the monitoring being done by doctor Barons of blood pressure and other vital signs. Barons was shocked. It was as if Patel could not acknowledge a major problem. Unless the blood stopped flowing, Kemps would surely die. Nurse Damien Gas
raised the alarm. Dr Patel, the Bellovac draine is over half full with no vacuum and is still draining freely.
That's what dreams are forward Demian.
To the amazement of doctor Barons and the theater nurses, who were alarmed by the obvious and heavy bleeding, Patel gave instructions for Kemps to go to the ICU. From that moment it was inevitable that he would not survive. At two PM, Patel called Judy at her home. He told her it was a great success. We've got it all. There's a little bit of bleeding there, but that's nothing.
When Judy went to the intensive care unit soon afterwards, she saw a nurse frantically pumping blood into her husband's body. Jerry Kemps received more than thirty bags of blood altogether. His abdomen was distended as bright blood drained away. Three nurses were needed at his bedside for fluid management, and one ran back and forth from the blood bank for products and to page the doctors. Doctor Barons was using large quantities of a drug to maintain blood pressure and
support the heart. Another nurse took Judy aside and told her Jerry is a very sick man and he is on life support. Judy, joined by her son John, went over to his bedside and gave Jerry a kiss. I love you, she said. He tried to sit up. At five pm, Judy was told of the need for another operation.
I have to take him back into theater again. It can only be the spleen. I'll dig it out because he doesn't need it anyway.
But Patel had begun another operation on a different patient, which led to another complication. Kemps was not taken back into theatre until after six thirty pm. The situation was critical when doctor David Risson, who had not been involved in the esophagectomy, came to theatre to help. Doctor Risson was surprised to see doctor Sanjeeva Carrio asam a junior doctor, identifying problems and tactfully pointing them out to Patel, who seemed out of his depth and at a loss to
pinpoint the torrential bleeding. Patel reopened Jerry's abdominal cavity and the chess cavity. As scout nurse Janelle Law's tasks included finding sutures, sponges, and anything else that might be needed for the operation. Janelle lost track of the amount of blood spilling from Kemps on the operating table, but she counted seventy five large sponges and fifteen gauze squares to absorb the blood. It was everywhere. As the nurses moved around theater, they left footsteps of blood on the floor.
This man's going to die. He's going to die on the deva. I can't do anything. Get the family, Get the family.
Janelle Law watched Patel becoming more agitated, defending his surgery and saying that the bleeding had nothing to do with him.
This isn't my fault. This has nothing to do with my surgery. This isn't my fault.
But Patel also had a rare moment of insight. He was shaken by the demise of Jerry Kemp's He said in the operating theater.
Maybe they're right. Maybe we shouldn't be doing aesophagectamies. Maybe I should start thinking about not doing these type of procedures anymore.
Janelle Law opened the theater door for Patel to go outside to talk to Judy and her two sons. Patel was covered in his patient's blood.
I've taken the spleen out, but it was all right. I had a look at the lungs and they were all right. So the bleeding must have come from the hot I can't do anything about it, but he will be lucky to last the.
Night, Patel repeatedly told the shocked Kemp's family that his surgery was perfect. The longest night in Judy's life was spent with her dying husband in Tony Hoffman's intensive care unit. Jerry's demise was inevitable. The equipment supporting him was gradually removed. Judy noticed something else. The nursing staff seemed strangely uncomfortable around her. Their body language was defensive, they avoided eye contact. Jerry Camps died at nine to twenty am on twenty
one December two thousand and four. Doctor Patel had notched up another lucrative procedure for Bunderberg based hospital, which received its financial bonus irrespective of whether the patient survived the operation, and the intensive care unit bed was vacant again already. Doctor Athanasiov, given the task of filling in the death certificate, was discouraged by Patel from referring the case to the coroner.
We know the cause of death. It was due to a bleed in the aoder.
The theater staff were furious with Patel. Doctor Barons was alarmed. He could not understand why Patel would send a bleeding patient to the intensive care unit, nor could he understand Patel's inability hours later to discover the source of the bleeding. Doctor Barons and doctor Martin Carter agreed the death should be reported for formal autopsy. The Coroner's act referred to a death being reportable where it was not reasonably expected
to be the outcome of a health procedure. But by the time the two anisthetis had come to this view it was too late. A notice in the Bunderberg news mail showed that Kemp's was being buried in a few hours. Doctor Barons was struck by the lack of interest from
doctor Darren Keating when it came to investigating. Even when doctor Carter explained his concerns about the survival rates of Ptel's patients, Nurses Janelle Law and Damien Gadds decided to make a formal complaint they believed doctor Petel had killed Kemps. In the afternoon after Kemps's death, Peter Lex saw a note blandly advising the outcome of the complex procedure performed by the director of surgery. Leck asked doctor Keating a question.
The esophagectomy concerns me somewhat. Have any of these patients survived.
Chapter twenty six, Life and Limb Late December two thousand and four to January two thousand and five, Shannon Mobs fell spectacularly from his friend's trailbike at ten am on twenty three December the day duty Kemp's farewelled her husband at his funeral in Bunderberg. The teenager had struck a tree stump hidden by long grass on a winding track at Woodgate south of Bunderberg. The fifteen year old was flown by helicopter to Bunderberg Hospital after his friend sped
ten kilometers along the track to raise the alarm. By the time he was in the operating theater for life saving surgery by Jayon Patel, the boy had lost a massive amount of blood from a deep slash in his groin an lacerated femeral vein in his thigh. His condition was so perilous that the boy was initially transfused with blood that did not match his type, but at least it kept him alive. After the first operation, Patella merged
from theater to reassure Mobs's mother, Karen Oriole. The surgeon talked about himself for the first ten minutes, falsely claiming that he had been in charge of the trauma and emergency ward of a New York hospital for a decade. Karen Oriole was relieved when the director of surgery told her he had stopped the bleeding. He assured her that her son was fine and would make a complete recovery, all thanks to Patel's vascular surgery. Over the next twelve hours,
Dr Pittell performed another two operations on Shannon Mobs. Despite the initial life saving surgery and then serious complications demanding more major surgery. Dr Pittell told the other doctors and Karen Oriole that there was no need to transfer the boy to Brisbane. Pettell left the hospital on Boxing Day to fly to the United States for annual leave, but not before instructing the medical staff to keep the boy in the surgical ward. He had extracted something from Darren
Keating on Christmas Eve. It was another Dear j letter. It set out the terms of a four year extension of his current contract. Keating wrote, I.
Would like to offer my congrettions on your ongoing appointment and hope that you'll work with the Bunderberg Health Service District will continue to be both beneficial and rewarding.
The many serious issues raised by Tony Hoffman were yet to be formally investigated. She was at home mourning the death of her grandmother at ninety eight, preparing for the funeral in Sydney and worrying about the condition of young Shannon Mobs. Although Tony was supposed to be on annual leave and entertaining her parents, her sister Marie and husband Matthew, and their two kids, she could not let go of
the problems with Patel. She stayed in touch with the hospital by telephone and repeatedly urged the nurses in the intensive care unit to do what they could to influence the transfer of Shannon.
You've got to get that boy to Brisbane.
Tony's brother in law, Matthew, was also worried. He could see the high levels of stress that she was under when she was supposed to be on holidays. Tony showed him the lengthy letter of complaints she had written and spoke to him about her pleas for a clinical audit. He told her that at least you will be able to sleep at night, but Hoffmann was finding sleep difficult For most of the nine days Shannon Mobs remained in the hospital. There was no pulse in his left foot.
The foot was dying. Contrary to the claims Patel had made in the notes about repairing Mobs's femeral vein, he had simply tied it off after doctor Pateell went on holidays, handing over to doctor Jim Gaffield. The boy was in excruciating pain, with a fractured pelvis, huge muscle tears in his thigh, raging temperatures, sepsis and gangrene. It took until one January and a snap decision by and appalled Dr David Risson on his return from leave, for Mobs to
be airlifted to the Royal Brisbane Hospital. There, doctor Mark Ray diagnosed him on New Year's Day as the sickest fifteen year old he had ever seen. Doctor Ray could smell the septic and grossly infected leg from the other side of the emergency department. He did not expect Mobs to survive the night. If he did survive, he would need more surgery to amputate his leg through the knee. The operation by doctor Jason Jenkins and doctor Ray showed that both ends of the femoral vein had been suture
legated instead of being reconstructed. Blood had been going to Shannon's limb through the femoral artery, but it could not drain away through the femoral vein. This had led to gross swelling and a range of serious life threatening implications. Steve Rashford, who organized the emergency airlift, and the two Brisbane surgeons Jenkins and Ray, were disgusted by the care Mobs had received in Bunderberg. There was no excuse for the failure to send him to Brisbane after the initial surgery.
They believed that the athletic two meter tall boy who wanted to be a professional basketballer might have kept his leg if he had been transferred immediately after the major operation. On four January, Michelle Hunter, the nurse who had alerted the doctors to Shannon's shocking condition on New Year's Eve, resolved to do something. She had come to the conclusion that Patel was a serial danger. She had never seen so many instances of woundehesince, and the Internet search she
had done months earlier was still on her mind. Patel's treatment of Shannon Mobs, the eyeing off of his feneral vein, which effectively destroyed his leg, persuaded Michelle Hunter to act. She went to see Tony Hoffman, who was back from Christmas leave, but the nurse in charge of the ICU had still not heard anything from Peter Leck or Darren Keating about an investigation. Despite her increasingly detailed and grave complaints made during two thousand and four, Hunter decided to
make her own complaint. She considered going directly to the Health Rights Commission. First, she sent a MIMO to Linda Mulligan setting out her concerns over the Mob's case.
My concerns are with the surgeon that performed his initial three operations. I'm concerned that if the patient had been transferred to Brisbane initially, he may not have lost his leg or be in such a grave condition. I would like his treatment the hospital investigated, as I fear his health and well being has now been compromised by inadequate substandard treatment by the medical team.
There was a similar expression of concern from doctor Rashford in Brisbane, who wrote to the most senior administrators in Queensland Health and he copied his memo to Peter Leck and Darren Keating. Pressure was mounting, but doctor Keating, who wanted Patel to return from holidays to a new four year contract, produced a report stating that no external probe was necessary. Linda Mulligan was now starting to worry. From
the beginning, she had downplayed Tony Hoffman's concerns. She believed that the nurse and the top surgeons simply loathed each other and that Hoffman's complaints were motivated by emotional rather than clinical issues. But on seven January, three distraught nurses from the operating Things Katrina's Wolak, Damien Gadd's a Janelle Law had decided to unite in an unprecedented complaint. They went to Mulligan and they told her that Patel was
a shocking surgeon whose patients were dying unnecessarily. Katrina and Janelle were weeping as they told of the falsification of patients' records by Patel and of how staff had felt powerless because of his claims to have management in his pocket. Linda Mulligan immediately tipped lek Off about this dramatic new development.
She told him they displayed different degrees of emotion to the point of one stating that the whole issue was keeping them from sleeping.
All of Tony Hoffman's claims were being corroborated, and still a clinical audit of Patel's work was not begun. Chapter twenty seven Executive Decisions thirteen to fourteen January two thousand and five. Peter Leck was showing the first signs of acute panic by the time J. N. Patel had returned to work in early January. Leck worried about his own failure to conduct any sort of review of Patel, despite a trial of dead and maimed patients and a string
of complaints. He had broken his own promise to Hoffman to have the concerns properly checked. He had not even told her what he was doing. Peter Leck had dithered. He had been indecisive, weak, and interminably slow. On thirteen January, Lek raised the concerns for the first time with the Acting Director General of Health, doctor John Scott.
I was just wanting to flag that I actually do have some concerns the outcomes of some of doctor Pateell's surgery.
He also told Scott about the nurses fears over injuries and deaths, adding that doctor Darren Keating believed that the concerns.
Were completely driven by the personality conflict. However, he has now expressed some concern although he still believes most of the issues are personality driven.
He was silent about the backing of Hoffman's concerns by the three doctors. Doctor Martin Carter, doctor David Risson, and doctor Dieter Behrens, who had been interviewed. Keating was angry that it had come to this. He did not like confrontations with Patel, particularly as he had exceeded the surgery targets and made Keating and the hospital look good, but the ICU and theatre staff were close to rebellion. Something had to give. Keating told Leck.
Look, we need to make sure that doctor Patel is aware of the investigtion and give him as much information as possible.
In a meeting in Lex's office on thirteen January, Patel was told for the first time about the complaints concerning his handling of Shannon Mobs as well as other patients. Patel was told that there would be an investigation and that in the meantime he could continue doing surgery, just not cases requiring admission to the ICU. Patel scoffed at the notion that his surgery was below standard, but for the third time in his career he faced a thorough
investigation with potentially grave findings. He was indignant.
I will be considering my position.
The next day, Patel told doctor Keating that he would not be taking up the four year contract after one April, but he had no plans to leave Australia. Patel still believed that he could remain as a surgeon on a special contract, despite the trouble he would be in if the easily discovered details of his past came to light. He chose not to flee, at least not yet.
He told Keating, I would like to thank you for your support over the past two years. My sted Bunderberg has been challenging at times, but mostly enjoyable and roareding.
Keating replied with a glowing appraisal of Patel's troubled time at the hospital, thanking him for.
His sustained commitment, ongoing enthusiasm and strong work ethic. I have greatly valued your advice, inside and support over the last two years, and I wish you well in the future in whatever endeavors you may take.
Patel kept Keating's note for his curriculum vitae. It was the sort of adulation not dissimilar to the praise bestowed by his peers in New York State and Oregon when he had been in trouble. Seeking further reassurance and comfort, Patel turned to the junior surgeons, doctor Anthony Athanasiov and doctor Sanjeeva Carrio Asam. They were upset at the story told by their mentor, the man who had bought their
meals and passed on his surgical prowess. They teamed up with three other junior doctors to lobby on Patel's behalf. In a note to doctor Keating, they wrote.
Doctor Patel is now in a position whereby he feels it is not in his best interest to stay at Bunderberg, and we believe the hospital should consider this very carefully. Doctor Petel's approach to his work is nothing short of admirable. He is dedicated, hard working, efficient and knowledgeable. His efforts to ensure his patients received the best care go above and beyond the call of his duties. He consistently goes out of his way to provide timely expert management for
a wide variety of surgical problems. In summary, we are concerned about the circumstances surrounding Dr Patel's departure and we believe his leading would be a great loss for the hospital and also for the Bunderberg community.
By the end of January, Keating had hatched a devious plan. He was annoyed that impertinent nursing staff had dashed his hopes of retaining Jon Patel as the director of surgery until two thousand and nine, Doctor Keating decided to flex his management muscle, panned to Patel and put the nurses
back in their place, all with one big decision. In early February, he offered Patel a senior surgical role with a daily rate of one thousand, one hundred and fifty dollars, a significant enhancement on his existing two hundred thousand dollars a year package. Keating had also given the medical Board another glowing appraisal of Patel's work.
Dr. Patel is a very committed and enthusiastically who has continued to be a very effective member of staff and director of surgery. He has a very strong work ethic, which is a model for others.
Keating told the board that there were nil significant areas for improvement in Pateel's performance, and he rated the surgeon's performance as excellent. Keating had paved the way for the four year extension offered previously. He wrote to the Department of Immigration and confirmed that the hospital planned to employ Patel until two thousand and nine, Patel was elated as he boasted to Nurse Janelle Law in the operating theater during an endoscopy procedure.
They're going to be me as much for three months as what I get in a year.
The nurse was appalled. She had been looking forward to seeing the back of Patel and all the problems he brought to the hospital. Now it seemed he was to be showered with money and kept on Chapter twenty eight the Investigation. February to March two thousand and five, Jerry Fitzgerald spread the email printouts, memos, reports and letters across his desk at Queensland Health Headquarters in Charlotte Street, Brisbane.
The Chief Health Officer of Queensland had given himself an unenviable assignment a clinical audit of Jon Patel's surgical outcomes. The documentary material was the first part of the puzzle. Doctor Fitzgerald had already been advised by Peter Leck that there were personality differences between Patel and his principal accuser, Tony Hoffman. Fitzgerald also knew how valuable Patel was too Burg hospital. The surgeon's role in slicing through the waiting
lists had been repeatedly stressed by Leck. Mindful of the sensitivities of the people involved, Fitzgerald made plans to visit Bunderberg to interview Patel as well as the nursing and medical staff. He wrote to Peter Leck.
At this point, we will be simply collecting information and not seeking to validate or evaluate any particular concerns raised. Would you mind asking Dr Patel if he can spare some time to meet with me to discuss any concern he may have. Dr Patel is definitely entitled under the principles of natural justice to be confronted with the details of the complaints made against him. He may decline to meet with me until he has had the opportunity to respond to the complaints. I hope he does not do so.
Our main intent is to find the facts and to seek a resolution asap.
Anyone else who risked being exposed as a clinical fraud would have skipped overseas on the eve of an investigation by the Chief Health Officer, but not Jaunt. Patel, his ego and self belief, refuse to entertain the idea that he might be found out. Patel also knew that the hospital still desperately needed him. On eight February, Keating had all but pleaded for Patel and other staff to work harder on those waiting lists. The hospital was ninety two
operations behind its target. Kidding wrote a memo to senior staff.
Should the target not be achieved, Bunderberg Health Service District will not get another chance to upgrade the target and hence lose flexibility and significant dollars. Therefore, it is imperished that everyone continue to pull together and maximize elective surgery throughput until thirty June. All cancelations should be minimal, with these cases pushed through as much as possible.
In the executive meeting room on fourteen February, Fitzgerald and Brisbane colleague Sue Jenkins began working their way through a list of about thirty nurses and doctors. Some of the interviews lasted just fifteen minutes, others went for over an hour. The nurse Karen Jenna wondered how seriously the investigation was being taken.
This is not an investigation of doctor Patel.
This is US.
Gathering information to find out whether or not it is important to have an investigation into doctor Patel.
When Patel strolled in, he acted as if he did not have a care in the world. He had spared about twenty five minutes for the chief health officer, who immediately identified and arrogance bordering on megalomania. Patel's self confidence was almost pathological. It was a personality that Fitzgerald, a naturally shy and disarming man, could not easily understand. Patel proceeded to boast about how much surgical experience he had in the United States. He repeatedly spoke of his expertise
in complex procedures. He was clearly agitated at the scrutiny being applied to his work, but he brushed it off as the product of flaws in other people.
He told Fitzgerald, nurses have been complaining about doctors for centuries. Some of them are lazy. They don't want to work hard.
Patel offered an olive branch.
Well, if you don't want to do these procedures anymore, we won't do them here.
After hearing from doctor Peter Meak and several mercers about the Catholic problems and the lack of hygiene, Gerald too was doubting the competence of the director of surgery at the Bunderberg Base Hospital, but was the hospital better off with Patel than with no senior surgeon at all. When Fitzgerald asked Tony Hoffman this question, she was certain of the answer. She told him that the patients would be
much better off if Patel were immediately suspended. As she told the chief health officer, we.
Don't like this guy, but that's not the issue. The issue is he's doing these things here and it's harming people.
He replied, well, we can't do anything because nothing's been proved at this stage.
Hoffman was chres fallen. She wondered, what on earth can we possibly do to stop this man. Fitzgerald asked Darren Keating, what do the patients feel?
What's the level of patient satisfaction? Have there been any complaints against doctor pateell by patients.
Keating had a folder of complaints, but he assured Fitzgerald that there were none. Patel had given an undertaking to stop doing the esophagectamies and other complex surgery needing intensive care unit support, but he was still causing serious damage. Three days before Fitzgerald's arrival at the hospital, Jenny White was the scrub nurse for a procedure to remove part of the cancerous bowel of a patient Jean Stuart Sutherland.
Patel cut the healthy part of her bowl. If he noticed his error, he did not acknowledge it until a junior doctor pointed it out. Nurse White shook her head in disbelief. How Patel could have overlooked the four centimeter cut was unfathomable. When the patient returned to theater in late February because of the inevitable complications from the earlier incompetence, Jenny White saw the terrible state of the bowl. It was leaking. More than one liter of bile stained fluid
needed to be drained. There was also a gross infection. The blood from the carotid artery of Harry petra Helos spurted in a fine but steady stream. It happened suddenly when one of the doctors in the coronary unit tried to put a central line into his neck, missing the vein but piercing the artery. Because arterial pressure is greater than venus pressure, petra Helos began losing blood fast. He
was already in poor shape. He had suffered a heart attack and was also battling severe kidney failure, which made him anemic, He took blood thinning substances for a condition called atrial fibrillation and irregularity of the heart. He had one more disadvantage. Petra Helos was a Jehovah's Witness, which meant he would not be a candidate for blood transfusion. His delicate condition and complications meant he had to be
handled with extreme care. Any operation was a grave danger because of the potential for petra Helos to bleed to death. When Jayon Patel saw the commotion on for March and asked what was going on, a nurse explained that Petra Helos was one of doctor Peter Meak's patients. Patel replied, okay, I won't touch him. Then. The rift between doctor Miak and doctor Patel had only widened in the years since the Director of Medicine banned the Director of Surgery from
handling certain patients. Doctor Miak had made it clear in his interview with doctor Jerry Fitzgerald in February that Patel was dangerous and incompetent. Miak had even taken the un usual step several months earlier of asking to see Patel's personnel file and CV. He flicked through it in a couple of minutes, expecting to find a red flag pointing to the incompetence of the man, but it seemed in order. Peter Miak had walked back to the ward perplexed, but
Patel could not walk away. He told the theater nurses to prepare for an operation. Patel wanted to operate on the punctured artery of Petra Helos. The nursing and junior medical staff were immediately alarmed. Someone called Dtor Miak and asked him to come to the ICU urgently. He walked into a bizarre and tense situation. Dr Patel, all scrubbed up in his surgical gear, was intent on taking Petro Helos into theater. The nurses were pleading with their eyes
and body language to prevent another death. Miak gave an instruction to one of the.
Doctors, just put pressure on it.
Patel loudly insisted on an operation to put a couple of stitches in the carotid artery. It was a delicate procedure under ideal conditions, but in the hands of Patel it promised to be a disaster. Doctor Meak refused to budge. He believed that there was absolutely no chance the man would survive the operation that Patel seemed determined to perform. He told Patel, look, the corota doesn't need fixing. His
priorities are his heart, his anemia, everything else. Miak knew that by maintaining pressure on the small hole in the carotid, the bleeding would eventually stop. He gave firm instructions to a junior doctor, but he still had to silence Patel, who was angry and embarrassed.
Look, this man is not going to theater and that's the end of it. He's going to Brisbane.
Tony Hoffman watched the drama with mounting alarm. Why had it come to this? She had prayed that an investigation by the Chief Health Officer would result in decisive and immediate action, but instead Patel was still wreaking havoc, still boasting about the renewal of his contract and his massive salary boost. Miac constructed Hoffman.
Whatever you do, don't leave this patient's bedside, and if doctor Patel goes near him, telephone me immediately.
As Hoffman stayed by Petro Helos to await the Royal Flying Doctor for an emergency flight to Brisbane, a leader of the Jehovah's Witness church in Bunderberg, came to the intensive care unit. Tony Hoffman already knew from contacts close to the church that Patel had ingratiated himself with the flock. She had been suspicious when first told of the charm offensive. Now one of the men who knew petro Helos as well as Patel, was in the intensive care unit. He
asked if doctor Patel was available. Hoffman was in a panic. If she put a call through to Patel, the patient's fate would be sealed. Hoffman knew how persuasive Patel could be. He would tell the church elder that an operation to repair Petrohelos's carotid artery was absolutely imperative, and he would prevail upon the elder to demand that the operation by Patel should go ahead. Tony Hoffman decided that she could not let that happen.
She told the elder, doctor Pateel isn't here at the moment, but the patient is going to be fine.
Ten days later, doctor Martin Strawn decided to use an endoscope to examine the stomach of Joan Cameron, who had been admitted to the medical ward with vomiting and bleeding, Strawn discovered an obstruction in the second part of her duodenum. He strongly suspected it was a secondary which would require further investigation and possibly surgery in Brisbane. In the corridor outside the theater, Patel asked Strawn about the finding. Patel told him.
Oh, well, that will be a primary toma in the duo Dunham. The patient needs an operation to remove it, and I'll put the patient in the surgical ward and I'll do it early next week.
Doctor Strawn suspected that Patel was wrong and would attempt more complex surgery after opening the patient up. He was determined to prevent Patel from operating, but how When Joan Cameron developed a chest infection a few days later, Strawn seized the opportunity to remove the patient from Patel's grasp. He spoke to Dr Miak, Doctor Martin Carter, and Tony Hoffman about a plan to hide the patient in the ICU,
a safe refuge. Since Petel no longer ventured there. From the ICU, Joan Ca could be quietly transferred to Brisbane. They were all in agreement behind Patel's back. At the time Strawn regarded it as outrageous behavior to have to resort to a ruse to keep an ill patient away from the director of surgery. He was also worried about how Patel might retaliate when he found out, But the bizarre episode had made a more profound impression on Tony Hoffman. Her mind was made up. Now she had to fully
expose Patel and worry about the consequences later. Sick to Death is written and presented by me Headley Thomas, the Australian's National Chief correspondent. Claire Harvey is The Australian's editorial director. Audio editing, production and music have been done by Jasper Leik, with assistance from Leah Sammaglu and Neil Sutherland. Our producer is Christin 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 Death podcast dot com and on Apple Podcasts. You can get exclusive access to photographs, videos, timelines and more at the website