Politicians must be honest about regional hospital limits, warns Dr Death inquirer

Politicians lack courage to admit to voters regional hospitals can't perform all surgeries, says the retired judge whose inquiry found 13 patients died under the care of the surgery director known as Dr Death.

Queensland’s Dr Death scandal should have been a wake-up call to the nation’s politicians to have the courage to admit to regional voters their hospitals cannot cater to all of their medical needs, the retired judge who led a major probe into the Jayant Patel case has warned.

In an interview with The Australian to mark Hedley Thomas’s latest investigative podcast, Sick to Death, former Queensland Court of Appeal judge Geoff Davies said he was shocked by the trail of deaths and injuries wrought by the former Bundaberg Base Hospital director of surgery and uncovered by the Queensland Public Hospitals Commission of Inquiry he led in 2005.

Mr Davies – who delivered his landmark 538-page report 20 years ago this weekend and is a former Queensland solicitor-general – conceded he was still surprised prosecutors failed to get a criminal medical negligence conviction to stand against Patel, and said the saga had revealed the “whole (health) system was defective”.

“The encouragement by the (state) government to these local hospitals to perform these complex operations, and the pressure on those doctors in the hospitals to do that to get funding … there was fault at every level,” he said.

“There was fault at the government level, there was fault at the administrative level in the hospital, and there was fault in some of the (other) doctors in the hospital, in not sufficiently complaining. There was one doctor who wouldn’t let any of his patients go near Dr Patel, but he didn’t do anything more about it than that.

“There’s a general duty on professional people to say ‘Hey, we should be doing something about this. We’ve got to stop this man from doing these operations and stop the hospital from encouraging him to do these operations’ and it was left to a poor nurse in the end to blow the whistle and she got punished for it.”

Retired judge Geoff Davies, who headed the Jayant Patel inquiry in 2005, says politicians have a duty to explain to regional Australians that their local hospitals cannot meet all of their medical needs. Picture: Glenn Hunt

The Davies commission of inquiry found the Indian-trained American citizen Patel “knowingly misled” the Medical Board of Queensland and Queensland Health in 2002 by hiding his American disciplinary record and falsifying his employment history before he applied to work in Australia.

Patel had surrendered his licence to practise medicine in New York in 2001 as a result of disciplinary proceedings against him there, and he had a serious red flag on his licence in Oregon from 2000, preventing him from performing surgeries involving the pancreas, resection of the liver, and a certain intestinal operation. He also had to seek a second opinion before performing any complicated operation, including oesophageal and gastric surgeries.

The Oregon Medical Board had investigated concerns raised by Patel’s own long-term employer, Kaiser Permanente, and found Patel had violated state legislation in treating four patients, including three who died soon after surgery, and once performing a colostomy “backwards”.

Mr Davies found that after deceiving Queensland authorities Patel “repeatedly” carried out surgeries at the Bundaberg hospital that he’d been banned from performing in the US, including procedures that were “beyond his competence, skill and expertise, beyond the capacity of the hospital and its staff to provide adequate post-operative care, and unnecessary”.

Crucially, Mr Davies found that as a result of Patel’s “negligence … 13 patients at the base died and many others suffered adverse outcomes”.

The 16-episode Sick to Death podcast series is based on Thomas’s 2007 book about the Patel case, and features a full cast of 200 voice actors.

The disgraced surgeon later pleaded guilty to fraud for lying to Australian medical authorities. He served two years and three months in prison for unlawfully killing three patients and maiming a fourth, but those convictions were later quashed by the High Court.

Two retrials failed to secure guilty verdicts, and prosecutors in 2013 dropped all criminal medical negligence charges against Mr Patel.

Mr Davies told The Australian that one of the key lessons of the Patel case was that politicians needed to “bite the bullet” and tell regional Australians that hospitals were not equipped to “solve all their medical problems” and that it was sometimes safer to perform some procedures in capital cities.

In late 2005, Queensland’s then Labor premier Peter Beattie, left, and health minister Stephen Robertson, right, received the Queensland Public Hospitals Commission of Inquiry report from retired judge Geoff Davies, centre, in the aftermath of the Jayant Patel scandal in Bundaberg. Picture: Tony Phillips

“There’s always going to be a public expectation in regional areas like Bundaberg that their local hospital will provide all their medical needs, from childbirth through to heart attacks. And of course, (the hospitals) can’t do that,” he said.

“There’s going to be some operations of such complexity that neither the medical staff nor the hospital itself can provide that care. They don’t have the specialist surgeon to do the operation, and they don’t have the quality of after-operation care of the sufficient intensiveness needed for that particular operation.

“There has to be someone who in government is prepared to bite the bullet and say these operations are too complex for say, Bundaberg hospital, that person has to be transferred to Brisbane. Whereas I think there’s a natural tendency in politicians, and you can’t blame them for this, to encourage the belief in the local community that their hospital is going to solve all their medical problems.

“You’ve got to say to those people (in regional Queensland) not only can we not provide this service, but we will ensure that it’ll be provided in Brisbane and we will fly the patient down to Brisbane to provide that service. That’s, in the end, more costly.”

Mr Davies said the commission of inquiry showed Patel was performing complex surgeries in Bundaberg that resulted in the public hospital receiving more state funding.

“Of course, that was a dangerous thing to do,” he said.

In 2010, the Queensland government revealed it had settled 296 compensation claims lodged by former patients of Patel.

After he delivered his commission of inquiry report in 2005, Mr Davies spent years on the Royal Australasian College of Surgeons council as its first non-medical member.

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Queensland Health Minister Tim Nicholls – who was first elected to parliament at the 2006 state election – rejected Mr Davies’ suggestion that politicians should tell regional Australians their hospitals could not solve all their medical problems.

“The terrible details of the Jayant Patel case remain etched in the memories of many Queenslanders, particularly those Bundaberg locals directly impacted. Many harsh lessons were learned by our health system which reverberate to this day,” Mr Nicholls said.

“With all due respect, Mr Davies’ views are outdated and insulting to our hardworking regional hospital and health service staff who give it their all every day to provide high-quality, innovative care in their local communities.

“The Crisafulli government is committed to delivering world-class healthcare for all Queenslanders no matter where they live, and is working hard to restore health services, including maternity services, in communities left in the lurch after a decade of Labor decline.”

David Crisafulli’s LNP government won the state election in October last year, and Mr Nicholls said the government’s recent Queensland Workforce Gap Analysis showed there was a current and predicted health workforce shortfall that meant Queensland Health needed an extra 46,000 staff by 2032.

He pointed to several advances since the middle of last year to help regional Queenslanders, including a new Queensland Telestroke service (operating in Hervey Bay and Bundaberg) for stroke patients, an AI-powered digital wound care service at the Hervey Bay Hospital, a stem cell transplant service at the Sunshine Coast University Hospital for treatment of blood cancer patients, and an Indian-born and trained transplant surgeon employed at the Townsville University Hospital.

A new Bundaberg hospital will be built with more than 410 beds, an emergency department and maternity services.

Do you know more? Contact Hedley Thomas and the team at [e-mail]

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