Jayant Patel

Jayant Mukundray Patel (born April 10, 1950) is a surgeon who found himself at the centre of a scandal in early 2005 when he was accused of gross incompetence while working at Bundaberg Base Hospital in Queensland, Australia. He has been nicknamed "Doctor Death" in Australian media, particularly newspapers such as News Ltd's The Courier-Mail.

Career
Patel was born in Jamnagar in Gujarat, India. Whilst the vast majority of his training was conducted from within the US, he first trained at the M.P. Shah Medical College at Saurashtra University, and obtained a master's degree in surgery. After graduation he moved to the United States where he received further surgical training at the University of Rochester School of Medicine as a surgical intern and resident of surgery. Patel first began to raise alarm bells in 1984 at a hospital in the city of Buffalo where New York health officials cited Patel for failing to examine patients before surgery. Patel was fined US$5,000 and was placed on three years' clinical probation. In 1989, Patel moved to Oregon and began working for Kaiser Permanente Hospital in Portland. Medical staff alleged that he would often turn up, even on his days off, and perform surgery on patients that were not even his responsibility. In some cases, surgery was not even required, and caused serious injuries or death to the patient.

After a review, Kaiser restricted Patel's practice in 1998, banning him from doing liver and pancreatic surgeries and requiring him to seek second opinions before performing other surgeries. Further, after reviewing four cases in which three patients died, the Oregon Board of Medical Examiners made Patel's restriction statewide in September 2000, and New York State health officials forced him to surrender his license in April 2001.

After this, Patel decided to leave Oregon for Queensland, Australia. Queensland Health employed him without conducting any due diligence (regarding his qualifications and experience) and allowed him to become director of surgery at Bundaberg Base Hospital in 2003, under the "area of need" program, which hires overseas trained doctors for regional areas. His unprofessional behaviour continued, with his surgical work being described as "antiquated" and "sloppy", and some nurses even claimed that they hid their patients from him when they knew that he was in the hospital. He was referred to as "Dr. E. coli".

Patel is also alleged to have shown a poor regard for hygiene with claims that he responded to a nurse's concern over his unwashed hands with "doctors don't have germs". Overall, Patel is linked to at least 87 deaths out of the 1,202 patients he treated between 2003 to early 2005, 30 of whom died while under his care in Bundaberg. Hospital staff have also accused Patel of altering medical records to hide mistakes.

On March 22, 2005 Stuart Copeland, the Queensland Shadow Minister for Health, first raised the issue of Patel's clinical practices during Question Time in the Queensland Parliament. Two days later, Rob Messenger, the National Party Member of Parliament for Burnett also raised the matter of Patel's alleged incompetence in a speech to the Legislative Assembly and called for his suspension.

Journalist Hedley Thomas of The Courier-Mail, who won a Walkley Award for his part in uncovering Patel's past, gave attention to these allegations, and soon the newspaper and other media outlets were flooded with patient claims of incompetence, injury and death caused by Patel's poor clinical standards.

Patel soon left Australia using a business-class air fare paid for by Queensland Health and returned to his luxury home in Portland, Oregon, where he has recently been filmed by the Nine Network's current affairs program, 60 Minutes.

A warrant for Jayant Patel's extradition is being sought following his escape to the United States. A magistrate was asked on 22 November 2006 to issue a warrant for Dr Patel's arrest. It is likely that he will be charged with three charges of manslaughter, five charges of causing grievous bodily harm, four of negligent acts causing harm and eight charges of fraud. If issued, the warrant will allow the Federal Attorney-General's office to consider if extradition is appropriate.

Political fallout
The scandal has caused political headaches for Queensland's Labor Party government led by Peter Beattie, and especially for former state health minister Gordon Nuttall who was asked to resign by Beattie. Public meetings were held in Bundaberg where former patients of Patel angrily confronted Queensland Health officials and the Labor Party Member for Bundaberg, Nita Cunningham, who had originally defended Patel. Critics allege that Patel was protected by senior management within the Queensland Health Department, and that staff members raising concerns about Patel's performance were told to keep quiet, or risk their careers.

Further questions exist as to why Patel was even licensed to practice medicine in Queensland in the first place, given his poor record in the United States. This poor record was not sought by Queensland Health and he was hired on basis of a CV. Queensland relies on hiring overseas doctors to cover shortages in the number of locally-trained doctors in the state, and critics claim that this has led to a lower standard of qualifications being required for a foreign doctor to practice medicine. Defenders of the programme point out that the vast majority of overseas trained doctors in Queensland are competent and adequately trained, and that Dr Patel had been given glowing references for his work as a surgeon in the United States anyway.

Some of those treated by Patel have proposed to take the Queensland Government to court for not detecting his poor job performance earlier. However, with changes to state law originally intended to limit payouts to patients who sue their doctors on health matters, which were passed before the scandal broke, it is unlikely that they will receive any significant compensation.

Queensland Health has, however, arranged corrective surgery to all those who may have been affected by Patel's poor workmanship. Over one hundred patients have been said to have undergone corrective procedures since Patel fled Australia.

The Medical Board of Queensland has since introduced extensive measures for registration of Overseas Doctors, including receiving a certificate of good standing from each and every jurisdiction where a doctor has practised and getting the primary medical degree, registration and transcripts of applicants verified by the ECFMG's International Credentialing Service.

Morris Inquiry
In response to popular discontent over Patel's performance at Bundaberg Base Hospital, the Beattie Government called a Commission of Inquiry into the "Dr Death" scandal. The Inquiry with similar judicial powers to a Royal Commission commenced hearings in Brisbane on May 23, 2005 led by Tony Morris, a Queen's Counsel. The inquiry, formally known as the "Bundaberg Hospital Commission of Inquiry", was popularly known as the Morris Inquiry.

One of the first to give evidence at the Morris Inquiry was the Manager of the Nursing Unit at Bundaberg Base Hospital, Toni Hoffman, who has received popular praise for her efforts to bring Dr Patel's alleged incompetence to public attention.

On June 10, Morris released an interim report that was tabled on the same day in State Parliament by Premier Beattie. The report recommended, among other things, that Dr Patel be charged with murder or manslaughter in respect to one patient, with causing "a negligent act causing harm" to another patient, that he also be charged with fraud in relation to his registration at the Medical Board of Queensland to practice medicine and that extradition proceedings should begin. It also recommended changes to the Medical Practitioners Registration Act 2001.

The Morris Inquiry began hearings in Bundaberg on June 20. Nurses, local Queensland Health administrators and former patients of Dr Patel are all expected to give evidence. Public hearings in Bundaberg concluded on July 14. The Inquiry resumed public hearings in Brisbane on July 25 and also sat in Townsville from August 2 to August 4. Evidence was heard in Townsville about an alleged case of medical fraud in which a Russian with forged medical qualifications pretended to be a psychiatrist and practiced for some time at Townsville Hospital.

During the course of the Morris Inquiry, two senior Queensland Health bureaucrats in the Bundaberg region, Darren Keating and Peter Leck, filed a suit in the Supreme Court of Queensland calling for the inquiry to be shut down. Keating and Leck alleged that Morris had shown apprehended bias against them when they were giving evidence and therefore the inquiry did not have the necessary impartiality. On September 1, Justice Martin Moynihan of the Supreme Court ruled in favour of the plaintiffs, finding that the Commission of Inquiry was contaminated with ostensible bias against Keating and Leck, and that evidence gathered from other witnesses was entangled with the evidence given by Keating and Leck. On the morning of September 2, Justice Moynihan ordered that the Morris Inquiry be shut down.

Radio station 612 ABC Brisbane announced on September 6 that Premier Beattie has called for a full examination of the evidence given to the Morris Inquiry by a prominent former judge. Mr Beattie stated that this review would "in essence" be a new inquiry. He also issued a "six-point action plan" to deal with evidence gathered by the Morris Inquiry that may be biased.

Davies Inquiry
The new inquiry began on September 8. Former Supreme Court of Queensland judge Justice Geoffrey Davies QC was chosen to head a new inquiry. This inquiry, formally titled the "Queensland Public Hospitals Commission of Inquiry", is popularly known as the Davies Inquiry.

The report of the Davies Inquiry was handed down on November 30. It recommended that charges of manslaughter and other criminal offences be prosecuted against Patel. The report also apportioned much of the blame to two former Health Ministers, Gordon Nuttall and Wendy Edmond, as well as senior Queensland Health bureaucrats for allowing the existence of an organisational culture of secrecy and ostracising of whistleblowers that allowed Patel's misdeeds to go unpunished for two years.

An independent surgeon, Peter Woodruff, who was asked by Justice Davies to examine Patel's work believes that Patel negligently caused 13 deaths, and possibly up to 17.

One of the problems with the issue of medical negligance as opposed to manslaughter is that in the latter it will be necessary to achieve a high standard of proof demanded by United States courts that the accused wilfully caused the deaths of patients. It is a reflection on the quality of the Courts of Queensland and those persons tasked to run the inquiries, Morrison and Davies that insufficient attention was given to this distinction when making findings. The responsibility for a failure to extradite will be laid at their feet.

Other inquiries
The Queensland Government has commissioned two other inquiries in addition to the Morris and Davies Inquiries. These inquiries have few judicial powers or ability to summon witnesses and evidence and consequently have been receiving less media coverage than the Morris Inquiry.

The Forster Inquiry, headed by Peter Forster, is concentrating on the administrative structure of the Queensland Health bureaucracy, and how administrative procedures can be improved to ensure that similar events to those at Bundaberg Base Hospital do not occur again.

The other inquiry is an internal audit of Dr Patel's clinical and surgical practices that is being completed by Queensland Health. On June 30, 2005, The Courier-Mail published details of this audit before it was due for public release. The newspaper reported that there were seven patient deaths that were likely to have been caused by Patel and seven more that warrant further investigation. There has been some criticism that this audit relied too heavily on patient notes written by Patel himself, or by other Bundaberg Base Hospital staff who may have been interested in covering up Dr Patel's poor standards or minimising the hospital's liability for patient trauma and death.

The State of Oregon Medical Board is also investigating Patel a second time, this time for lying to it that he had retired while working full time as chief of surgery at Bundaberg Base Hospital, as well as lying to Kaiser Permanente about his previous disciplinary actions in New York state. Patel appeared before the state board September 2005, but declined to answer questions due to possible criminal charges in Australia. On October 6, the Board voted unanimously to issue a formal complaint against Patel. Disciplinary action against the doctor can include a fine of up to US$ 5,000 and revocation of his medical license.

The cases
The Davies Inquiry found that he had caused 13 deaths, and perhaps up to 17. Since the publication of this report, an additional four patients that he negligently treated have died.

He performed four oesophagectomies while at the hospital. Three of the four patients died as a direct result.

He removed a patient's large bowel after he was diagnosed with a hyperplastic (non-malignant) polyp.