Sick to Death: A Manipulative Surgeon and a Healthy System in Crisis-a Disaster Waiting to Happen

Sick to Death: A Manipulative Surgeon and a Healthy System in Crisis-a Disaster Waiting to Happen

by Hedley Thomas

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Dr. Jayant Patel, better known as “Doctor Death,” shocked a nation when the truth came to light that he may have killed as many as 87 people under his care. This true-life account told by the journalist who broke the story details the horrifying actions of this deviant doctor whose patients suffered serious infections, internal bleeding from nicked

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Dr. Jayant Patel, better known as “Doctor Death,” shocked a nation when the truth came to light that he may have killed as many as 87 people under his care. This true-life account told by the journalist who broke the story details the horrifying actions of this deviant doctor whose patients suffered serious infections, internal bleeding from nicked arteries, and the mutilation of healthy organs. Banned from surgical practice in the United States, the manipulative Patel managed to commit atrocities in an Australian hospital without consequences for two years. Finally, nurse Toni Hoffman exposed his horrifying behavior, which resulted in a Royal Commission investigation of Patel and the overall health system. This disturbing tale of grieving families and shattered lives challenges the faith that many have in medical systems.

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Kirkus Reviews
A richly peopled but wordy account of a breakdown in the health system in Queensland, Australia, and of the cover-up that followed. Thomas, an award-winning investigative journalist for the Brisbane Courier-Mail, exposes ugly details concerning the management of Bundaberg Base Hospital, where profits took clear precedence over patients. When Dr. Jayant Patel, an Indian physician trained in the United States, came to work at the hospital in 2003, he had already been disciplined by medical authorities in New York and Oregon. These reprimands, however, were overlooked at Bundaberg, where he was quickly made a director of surgery. Described variously as arrogant, reckless, a liar and a megalomaniac, Patel performed surgeries way beyond his competence, and, astonishingly, even refused to wash his hands, leading to the death or serious injury of numerous patients. Hospital administrators, happy with the revenue he was generating and with the reduction in the hospital's surgical waiting lists, dismissed the warnings of Toni Hoffman, a nurse who witnessed the havoc created by Patel. Hoffman turned whistleblower, Thomas' articles exposed the situation and Patel, also known as Dr. Death, fled the country. Two state inquiries revealed the official cover-up, fueling public outrage and leading to increased hospital funding and reforms in Queensland healthcare. Into his narrative of the cover-ups and the investigations Thomas weaves Patel's own story and the individual stories of several patients that he maimed or killed. The cast of characters is overwhelming, but a front-of-the-book overview of the Queensland health system helps to sort them all out and to clarify their role in events. The principalproblem-aside from Thomas's penchant for including a myriad of details that add color to the story but halt the narrative flow-is geography, for a crisis in the Queensland healthcare system is likely to be of only marginal interest to American readers. A thoroughgoing expose of an appalling situation, but primarily for an Australian audience.

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Sick to Death

By Hedley Thomas

Allen & Unwin

Copyright © 2007 Hedley Thomas
All rights reserved.
ISBN: 978-1-74114-881-7


Happy days

January 2002

GERARD Neville put the last bag in the family car as his wife Lorraine urged the three children to hurry downstairs. A fit, middle-aged public health physician for Queensland Health, Gerard ran beside the Brisbane River most mornings, even in the subtropical humidity of summer, before going to work to plan policy for the well-being of a few million men, women and children. They were known, in accordance with the corporate vernacular, as clients.

The years had been kind to Gerard. He remained free of the stress of providing clinical care in an organisation starved of funds. While his friends, many of them fellow graduates of the University of Queensland's Medical School in the leafy grounds of Herston, had opted for careers in operating theatres with late-night call-outs, long hours and, eventually, private rooms as highly paid specialists, Gerard enjoyed a steady public service routine. He was adept at his office job, never shirking unpopular assignments such as telling his political masters the unpalatable reality about the effect of their policies. He would never reach the top of a highly politicised bureaucracy. Nor did he aspire to.

They made a handsome couple, Gerard and Lorraine. A tall and softly spoken teacher, she met Gerard when he was a rural GP, five years after his graduation. Their motto might have been permanence and stability. They were stylish, but not flashy. Professional, but not elitist. They were Catholic with middle-class values, healthy children, secure careers and a comfortable, newly renovated house on a hill in the Brisbane middle class suburb of Toowong.

Laura, 14, Elise, ten, and Michael, eight, needed little encouragement to leave their Brisbane home at the height of the summer heat-wave. Across the city, thousands of people without air conditioning were seeking refuge in shopping centres and cinemas. Temperatures were about to soar into the high 30s with only limited relief from the scattered showers and afternoon storms. The Nevilles were going somewhere infinitely more appealing. In two hours they would arrive at Kings Beach in Caloundra for the start of an annual holiday ritual: exploring rock-pools, swimming in the surf, lazing around the pool and choosing from the dinner specials at nearby restaurants.

As Gerard nosed the car, one of the perks of his package with Queensland Health, down the neatly paved driveway and turned left onto Milton Road for the drive north, Lorraine felt uneasy. Usually, the Neville family would stay at Pandanus Court in Caloundra for the Christmas holidays. Their familiarity over the years with the old block of units closest to the beach was part of the fun. Returning to Pandanus was a bit like visiting a favourite aunty, notwithstanding her flaws. She was safe and would not produce any surprises.

When Lorraine had called months earlier to make the usual holiday booking, the woman at Henzell's Real Estate Agency explained Pandanus would not be available this time. The old block was being redeveloped and Aunty was to receive an overdue facelift. Instead, Lorraine was offered a unit in Monterey Lodge, a block not known to her.

The plan was to spend a week there, dash back to Brisbane the following Saturday, unload the car, water the garden, check the mail, feed the children, return calls, load the car again and drive across the city to catch the afternoon ferry from Cleveland to Stradbroke Island for a further seven days holidaying.

Lorraine's first impression of Unit 3 at Monterey Lodge confirmed her unease. The living space was long, dark and narrow. The floor throughout seemed to be hard concrete with a thin wood veneer surface. The place felt austere and uninviting. Before they had begun to unpack, before Lorraine could take in the natural beauty of the water beyond the buildings, she had regrets.

As Lorraine tried to bury her misgivings and put on a bright face, and Gerard carried the bags inside, Elise ran to the second bedroom and squealed with delight. As expected, there was a set of bunk beds. They were unspectacular: lightly-framed and well used, they stood exactly 1.43 metres high in one corner of the room. The top bunk had been promised days earlier to Elise, who excitedly told her friends and reminded Michael and Laura that she would soon be towering over them, morning and night. A bright girl with sparkling blue eyes, a cherubic face and a gift for bringing calm and laughter into awkward situations, Elise looked at the top bunk and beamed. She clambered up and bounced on the mattress.

A trundle bed had been stored under the lower bed. Lorraine dragged it out on the Saturday afternoon and put it against the wall, forming an L-shape with the bunks.

Lorraine frowned at the glass-topped table in the room. It was an accident waiting to happen. She carried it into the main bedroom where she and Gerard would be sleeping. Next she hauled a low set of wooden bedside drawers from the main bedroom to the children's room.

As Lorraine had feared, the unit was hot. Its bricks absorbed heat through the day. The windows missed the best of the sea breezes, and there were no ceiling fans. Lorraine put one of the electric fans she had brought from Brisbane on the bedside drawers. At least the children would be comfortable as they slept.

Lorraine took one more precaution before satisfying herself that she had made the best of things. She spread quilts and blankets along the floor below the bunk beds. Michael, who would be in the bottom bunk, was a restless sleeper though neither he nor Elise had any history of falling out of bed. But, just in case, the quilts might soften an unlikely accidental fall.

The family woke to a glorious Sunday morning and devoted it to the beach and the pool. Lorraine's worries eased. As the sun disappeared behind the Glasshouse Mountains, the family walked to Bulcock Beach for fish and chips at a sidewalk table. After they returned to the unit, Michael went to bed first. He was sleeping soundly by 9 pm when Lorraine checked on him. Elise, nestled beside her mother on the sofa, stayed contentedly reading her novel. From time to time she looked up at the TV.

An hour after Michael had turned in, Elise was ready for bed. She kissed her parents and smiled as Lorraine tucked her in for a second night in the top bunk.

Lorraine, who had made a point of picking the children's clutter off the floor to prevent a stumble in the dark, did not notice something amiss as she turned out the lights. The family had no experience with bunk beds. The safety rails that prevent a child rolling out were not there.

As they were on holidays, Laura was allowed to stay up with her parents until the late movie ended. Shortly before midnight they all went to bed and, within minutes, everyone was sleeping.

At 1.50 am Lorraine woke up suddenly. Gerard sat upright. They had both heard it, a loud noise. A heavy thud. In the seconds that followed, moaning noises drifted from the bedroom and, instantly, Lorraine guessed what had happened: 'Oh my God, Gerard, I think Elise has fallen out of bed!' They hurried to the bedroom where Elise was lying, curled up, on her right side. She was on the quilt on the floor with her head towards the narrow shelf and doorless cupboard in the room. Lorraine frantically moved the small drawers with the fan on top so she and Gerard could both fit in the room more easily to tend their stricken child.

'Elise, are you okay? Can you move your arms and legs?' asked Lorraine, who needed immediate affirmation that Elise had not broken any limbs.

Elise could move her limbs, but Lorraine's relief was tempered by a new fear: Elise was in great pain.

'My head hurts,' she cried in the half-light.

Gerard tried to contain his own anxiety in the gloomy bedroom as Elise lay on the floor with her Winnie the Pooh teddy bear, rubbing her head and whimpering softly. He took charge. He was the doctor. He might not have practised medicine for 18 years but he knew something about head injury.

'Try and keep calm. I'll take her to our bed and have a look at her,' he said in as measured a tone as he could manage.

Gerard checked her limbs, neck, chest and stomach for breaks or pain. He carried Elise to the main bedroom and brought the mattress from her top bunk. They lay her down on it on the floor in their room. She continued moaning in obvious pain. 'My head hurts a lot, here,' she said, touching the left side.

Lorraine, shaking with worry and fear, wanted to rush Elise to hospital. She was becoming frantic. Gerard resisted. He doubted Elise had been unconscious after the fall. He persuaded Lorraine that they could safely watch her in the unit for the time being.

'Stop panicking, everything will be okay,' Gerard said.

Elise piped up, 'Yes, Mummy, don't panic. You're making me worried.'

'I'm sorry. Everything will be alright,' Lorraine replied.

'No, it won't, Mum. There's something really wrong.'


The shift

January 2002

ANDREW Doneman looked at the clock on the wall above one of the Caloundra Hospital ward beds. Almost 3 am. He sighed with relief. He wouldn't wish the graveyard shift on his worst enemy. He knew exactly how long he had been going without a rest. Having come on duty at 8 am the previous day, he was at the 19-hour mark of a 24-hour shift. Doneman, a father of two young children, was exhausted. He would never touch alcohol while at work, but the effect of his fatigue equated to a blood alcohol reading of .05 per cent.

Long-distance truck drivers could be forced off the road if found working dangerously long hours. Economic necessity and demanding bosses forced the drivers to stay awake with amphetamines as they hurtled down the country's highways. Airline operators had much more to lose. The repercussions from carnage caused by a Mack truck colliding with a family car were nothing compared with those that might follow a Boeing 747 ploughing into a mountain due to pilot fatigue. Australian pilots were permitted a maximum number of hours in the cockpit on long-haul flights after which strict regulations stipulated a lengthy rest in the bunks. Nurses, too, were banned from working excessive hours. Yet doctors like Doneman in Queensland's public hospitals were given no choice. At this time of year, when many of the senior doctors were holidaying with their own families, those on the bottom rung were in greater demand than usual.

The chronic shortage of doctors nationally was worse in Queensland, which had the lowest number of registered doctors per head of population of any state or territory. There were about 2500 more doctors in Victoria, a state with a similar population but without the challenges unique to Queensland of decentralisation, poor working conditions and remote and Indigenous communities.

Doneman had few complaints. He would do the hours, a rite of passage, and move up the ranks. He was not the most junior doctor in Queensland, but he was the least experienced doctor to be put in charge of the 80-bed Caloundra Hospital overnight. For the duration of this shift, he was the only doctor on duty. A quietly ambitious 37-year-old, Doneman did not look like a newcomer to medicine. But he only began studying medicine in his late 20s. His confidence and age sometimes made his patients suspect, wrongly, that he was experienced. Just two years after receiving his Bachelor of Medicine and Bachelor of Surgery from the University of Queensland, he was making clinical decisions without having to defer to senior colleagues.

Doneman had worked in hospitals known as God's waiting rooms because they catered to a large population of elderly retirees who had moved to the Sunshine Coast for its warm climate, beaches and lawn bowls. As a junior house officer – almost the lowest-ranking doctor on the scale – he had treated worn-out knees supporting the overweight and the sedentary. He had treated gynaecological issues common to elderly women who had borne children. During rotations in paediatrics, orthopaedics, anaesthetics, obstetrics, gynaecology and emergency medicine, he had seen dozens of bright-eyed babies at the start of life and the old and frail who were soon to depart. Maybe they sensed in his bedside manner a contagious energy and enthusiasm for medicine.

After driving taxis to pay his way through medical school, Doneman had large bills and a meagre salary but he was doing what he loved. His colleagues had noted the positive feedback from his patients.

Somewhere within the Queensland Health bureaucracy, a secret document – headed 'Review of Emergency Services, Sunshine Coast Health Service District' – flagged potential dangers at Caloundra Hospital. The review had been compiled by a small team of experts who had been investigating the resources, safety and performance of emergency departments along the coastal strip. It was conducted on a confidential basis. Its author, Dr William Rodgers, found that the Caloundra Emergency Department needed a minimum of four principal house officers. Further, their responsibilities should not be stretched to looking after in-patients as well as those coming into the Emergency Department during normal working hours.

Doneman, who knew nothing of the three-month-old report and its unheeded recommendations, was two years away from being made a principal house officer when he began his fateful shift in early January. He had responsibility for the entire hospital.

The nurses in the Emergency Department, Beverly Duncan and Diane Forbes, who had come on duty at 10.45 pm, were taking a break after a busy few hours. The patients were presenting with relatively minor ailments, and certainly none with emergencies. Most simply sought free treatment.

Uniquely, with beds in short supply and resources strictly limited, the hospital also had a bizarre practice. It did not admit children.


We need help

January 2002

ELISE was talking a little as Lorraine held an ice-pack to her head. Around 3 am she became agitated, flailing her arms and crying out with the pain. Laura and Michael, who had woken in the frantic commotion after the fall, looked on helplessly. Elise vomited. It was the last sign Gerard needed. He knew then that she had to go to hospital urgently and would probably need a CT (Computerised Tomography) scan. With detailed two-dimensional computer-enhanced x-ray images, a CT scan could highlight any abnormalities such as bleeding in Elise's brain or a fracture in her skull.

He was about to tell Lorraine of his decision. She beat him to it as Elise moaned and complained about the yucky taste of vomit in her mouth.

'Right! We're going to the hospital now,' Lorraine said as they cleaned Elise's face and clothes and quickly got changed.

Gerard's appearance of calm had dissolved. Now he, too, was shaking. The fear was sensed by Laura and Michael, who huddled together on the trundle bed. They were frightened for Elise and worried about being in the unfamiliar unit alone.

Lorraine cradled Elise in the back seat of the car as her head rested on a pillow that had been snatched up on the way out. Gerard drove to the nearby Caloundra public hospital in West Terrace but later would not even remember the route he took. He jabbed the illuminated night bell outside the Emergency Department until Beverly Duncan answered through the intercom, then opened the door. Gerard quickly explained what had happened. A fall. A head striking a hard floor. Ongoing pain. Headache. Vomiting.

They were directed to a room in the Emergency Department where Elise lay, very quiet, on the bed during a brief examination by Duncan, a United Kingdom-trained nurse who scrawled details on a clipboard and peered at the frightened child's pupils while shining a torch. Elise's pulse rate measured 54, a low reading.

An oxymeter on her finger measured her oxygen saturation levels as Duncan made small talk with Gerard. He explained he was a nonpractising doctor, one of the 60 000 staff of Queensland Health. They were colleagues.

Duncan noted a child who was quietly spoken and unhappy. 'Where does it hurt?' she asked.

'I'm aching all over, but mainly I've got a headache,' Elise replied.

Duncan found the 'aching all over' answer strange. There was no obvious deformity to any limbs, no swelling and no specific pain suggestive of a fracture.

Lorraine was asked to leave the room to fill in forms at the front counter. 'I can hardly write as I'm shaking so much,' she breathed. Duncan, it seemed to Lorraine, ignored her and walked away, leaving the distraught mother wondering what she had done to receive such a cold reception at 3.25 am with an injured child.

Lorraine returned to the assessment room to remark to Gerard the lack of empathy. She weighed their options. They were in an open, functioning Emergency Department staffed by health professionals. Complaining might be counterproductive. It could lead to Elise being ignored. The alternative of leaving to find other medical help seemed impossible. So they waited.


Excerpted from Sick to Death by Hedley Thomas. Copyright © 2007 Hedley Thomas. Excerpted by permission of Allen & Unwin.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Meet the Author

Hedley Thomas is an assistant editor at the Brisbane Courier Mail. He has received three Walkey awards and the Sir Keith Murdoch Award.

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