My name is Headley Thomas.

Sick to Death is based on my book of the same name, and it's the true story of doctor Jayant 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 this story have read their words for us.

It is brought to you by me and the Australian Chapter eleven Memory Lane.

One evening in September nineteen eighty one, doctor William L.

Craver, chief of surgery at the Genesee Hospital in upstate New York, received a worrying telephone call.

He was accustomed to receiving calls outside normal working hours.

He dealt with trauma patients ripped apart with gunshot wounds, patients mutilated in serious car accidents.

The call he received on this particular evening was from a senior nurse.

She had an unusual problem involving one of the young doctors from his home near Rochester.

Dr Crab, who was retired, told me what happened.

She was concerned because she had been called by the floor nurse who had been caring for a patient admitted that afternoon for an operation the next morning.

Doctor Patel was one of the surgical residents who rotated through a hospital from the University of Rochester.

The patient had complained to the nurse that she was extremely tired.

I really would like to get to sleep.

Another house doctor is supposed to examine me first, and I wish she would hurry up.

The nurse looked at the patient's charts.

She saw that there was a complete write up and work up and record of a physical examination by doctor Pateell of the patient.

But he had never examined her.

He had not been to her room.

He had made it all up based on the notes of the attending surgeon.

I went there and talked to the woman.

The charts described a complete examination, including an examination of her breasts.

Craver has a vivid memory of questioning the woman about these examinations and her answers.

A nurse herself, the patient was adamant.

She told him, I know when my breasts have been examined.

I called doctor Pittell to my office to talk to him about it.

He denied doing anything wrong.

He was upset that anyone would question his judgments.

When Dr Craber talked to surgeons and supervisors in other hospitals affiliated with the University of Rochester.

He discovered that doctor Pateell had been the subject of several similar complaints.

Dr Craver decided that Patel was untrustworth worthy, a bad apple.

He did not want him having any contact with the patients.

He recommended that Patel be fired from the program.

The president of the university agreed.

I was calling it the way it should be called in surgery.

He was supposed to be honest and trustworthy with total integrity.

He showed total lack of integrity.

Doctor Petell had been working at our hospital for a couple of months at that point.

Until then, he had a good reputation.

He was considered a good training but the evidence against him held up.

We were not making it up.

I had no personal reason to be against doctor Pittell.

Official files document Patel's difficulties with regulatory authorities in New York State between nineteen eighty one and nineteen eighty three, two decades before he ventured to Bunderberg in Queensland, Australia.

The files and the record of discipline reaction are matters of public record and they have always been available from both the New York State Department of Health and the State Board for Professional Medical Conduct.

They corroborate the recollections of Dr Craver, who had not seen the material since the early nineteen eighties.

The documents show that the floor nurse was Mary Jackson.

They show Patel had diligently written a history, physical examination, progress notes, and admission orders into the medical record of the woman patient.

They show that she was deeply distressed.

Her surgeon, doctor Renee Mengui, recorded her comments.

On the same day, Patel had made similar entries in the medical records of two other women without personally having examined either of them.

He concocted similar lies in the medical records of a further two patients.

He had concocted the examination records to cover himself while he worked as a second job at the nearby Rochester Psychiatric Center, when he was rostered to be available to respond to emergencies and calls at the Genesee Hospital, a sprawling one hundred twenty year old institution on Alexander Street.

After realizing that both nurse Jackson and the surgeon, doctor Mengui were taking the complaints seriously and talking to the patients.

Patel turned on one of the patients.

She broke down crying when Patel accused her of trying to ruin his career.

Patel told the woman her complaint would put his job and schooling in jeopardy.

A rigorous year long investigation into Pateel's antics by the Office of Professional Discipline, the investigative body which compiles evidence for the board, produced more than thirty statements and exhibits.

After the fifth and final day of hearings on ten Mays nineteen eighty three in rooms at the Holiday Inn at Rochester Airport, the evidence filled more than seven hundred pages of transcript.

Three medical practitioners doctor Mengui, doctor Raymond Seaymoss and Dr Craver, as well as two nurses, Mary Jackson and Gary Nelson, and four patients testified on behalf of the prosecuting Department of Health.

Dr Patel, testifying on his own behalf, was supported by the character references of four medical practitioners, doctor James Williams, doctor Marguerite Dinsky, doctor William Farlow and doctor Raymond Hinshaw as four members, three of whom were doctors of the hearing committee of the State Board for Professional Medical Conduct weighed the evidence they had to determine if Patel's fabrication of the history of patients demonstrated what they called a moral unfitness to practice medicine.

The charges included practicing the profession of medicine fraudulently by entering items in various patients' medical records without personally examining the patient, as well as gross negligence and incompetence.

On more than one occasion, there was a charge of abandoning or neglecting a patient in need of immediate professional care without making reasonable arrangements.

Patel had also harassed, abused, and intimidated the first patient in an effort to coerce her not to cooperate with an official hospital investigation.

When most of the charges were approved, Patel's career hung by a thread.

The matters were serious, involving gross and repeated acts of deception and grave breaches of trust.

His conduct was analogous to a lawyer strapped for time fabricating a series of statements on behalf of five clients, but of course, a fictitious medical examination could have much more serious repercussions.

The committee's members were influenced by the glowing references and laudatory testimony from medical colleagues on doctor Patel's side, Betel's lawyer, John Frizell, from a law firm in Buffalo, where Patel was then living, emphasized his client's talents and abilities.

Doctor Williams called him an excellent clinician and very thorough, extremely dedicated.

In one prescient moment, doctor Williams suggested that Petel's ultimate contribution to the medical profession will be exceptional.

Doctor Dinsky described Patel as one of the best resident doctors she had had contact with in her capacity as a chief resident.

He was, she suggested, a person of high integrity who had made a mistake.

Doctor Hinshaw, equally effusive, described Patel as technically very gifted.

He rated his skills among the top three of the two hundred residents he had worked with, and although doctor Mengui was a witness for the prosecuting authority, he had written in a twenty July nineteen eighty one letter that Patel was by far the best resident who has rotated with me.

At the end of the hearings, the committee's chairman, doctor Paul de Luca, decided not to crush Patel.

He was censured and reprimanded instead of panelizing him with an immediate fine.

In July nineteen eighty three, the committee put him on probation for three years.

If he misbehaved again, he would be fined five th thousand dollars.

Two months later, doctor David Axelrod, Commissioner of Health in the state of New York, reviewed the decision and decided that the hearing committee had been too lenient.

He rejected the committee's findings where doctor Pateel was given the benefit of the doubt.

Doctor Axelrod stated that this way.

The failure to examine patients prior to surgery evidence is a disregard for and indifference to the results that may follow such failure, and thus constitutes gross negligence.

He decided Patel had clearly demonstrated his moral unfitness to practice medicine.

Patel's wrongdoing, according to doctor Axelrod, was.

A serious failure and should be punished by more than a censure and reprimand.

The effect of the tougher line was negligible.

All it meant was that Patel had to pay the five thousand dollars fine.

He was free to return to work, and he had a set of wonderful references from four respected doctors.

Those doctors and their references would open new doors.

Although fired from the Genesee Hospital where he had been doing his residency program, Patel had a springboard to a new job.

Working with Hinshaw as his research associate.

He entered the residency program of the University of Buffalo, where he completed his general surgery training In nineteen eighty eight.

Doctor Hinshaw helped Patel again.

Wanting to put his New York troubles a long way behind him, doctor Patel applied to work for the Kaiser Permanente Healthcare Group on the other side of the country in Portland, Oregon.

A laudatory letter dated twenty nine Novem nineteen eighty eight from doctor Hinshaw, then chief of Surgery at Rochester General Hospital, to the Board of Medical Examiners in Oregon avoided any reference to these serious convictions against Mattel.

When doctor Patel was a member of our residency program, he showed technical and professional brilliance When I operated on the chief of one of our specialty sections.

The doctor requested specifically that he be my assistant that in my experience is unique.

On twenty three January nineteen eighty nine, doctor Hinshaw, whose distinguished forty year surgical career at the University of Rochester was drawing to a close, received a letter from the Board.

The board's license administrator, Jan Bagenstross, had discovered something about Patel's dismissal from the University of Rochester's residency program.

Jan Bagenstross, curious about doctor Hinshaw's failure to this important chapter in doctor Pittell's career, sought more information.

Doctor Hinshaw's reply, on three February nineteen eighty nine, four months before his retirement, acknowledged the discipline reaction, but insisted that doctor Petell had been harshly treated.

He maintained that it was a case of the unfair harassment of a brilliant young surgeon.

Doctor Hinshaw's letter to Jan Bagenstrass says.

When I appeared before the State Health Department in doctor Petell's behalf, I was asked if I believe the charges against doctor Petel.

I gave my reasons why I did not believe them.

I was asked what I would think if I could indeed be shown that doctor Petell had written a physical examination without having examined the patient.

I stated that such behavior on his part would seem so bizarre to me from having worked very closely with him, that I do my best to find out what circumstances caused such an abberation of behavior.

Doctor Hinshaw died aged sixty nine in nineteen ninety three.

Dr Craver did not know until years later about the misleading letters of support for Pateel.

In his job quest, Dr Craver believed that Hinshaw's unwavering support of Patel during the earlier disciplinary process was inescapably wrong.

Dr Hinshaw's stand was a source of tension between the two senior surgeons for years afterwards.

Dr Craver told me.

I will never understand why, in the face of all this evidence, he would have applauded Doctor Pateell.

Has made me lose some respect for men.

Was a very fine surgeon.

Chapter twelve.

A tussle June and July two thousand and three.

In the days after James Phillips passed away in the intensive care unit, Tony Hoffman became increasingly confused she could cope with doctor j.

Petel's bombastic and patronizing attitude.

She could tolerate his kiss up and kick down approach to management and nursing staff, but she worried about his clinical judgment and expertise.

Patel had been telling the nurses ad nauseum how experienced he was in the United States.

One day he said he was a gold standard trauma surgeon, the next he was a cardiothoracic surgeon.

There was a different qualification every other day.

The nurses joked he had been doing complex surgery for twenty five years.

The next day it was thirty years.

Another day it was twenty years.

Hoffman feared something else in doctor Patel's character megalomania, a boldness bordering on recklessness.

He seemed to lack insight into the risks he created for the patients.

Tony Hoffman was also wondering about his knowledge of best practiced drugs for the patients.

He was demanding drugs like dopamine and buttamine that had been superseded years earlier when other doctors used modern drugs such as adrenaline and nora adrenaline.

Petel told the nurses to change the medication back to the obsolete drugs.

He thought so differently to the other doctors and to nurse Tony Hoffman that it was as if she confided to doctor Darren keating they.

Were from two different planets.

Her attempts to call a truce after the death of Phillips failed.

Dismally, Hoffman knew that doctor Patel now saw her as an enemy.

He started undermining her authority and credibility, criticizing her and the Intensive care Unit.

In talks with younger doctors and nurses, she realized that the less experienced doctors who relied on Patel to advance their own careers lacked the knowledge to see his flaws.

They would almost always back him, but Patel was now dividing the nursing staff to grow his support base and isolate her.

Having seen through Patel's grandiose claims early on, Tony Hoffman had also worked out that Patel was not everything he said he was.

She became a major threat to him.

She had to be discredited.

Patel began denigrating the ICU as third world.

He made it clear that he did not trust Hoffman nor several of the nurses in the unit.

On three June, he walked into the ICU to announce that he would be performing another esophagectomy.

The patient this time would be James Grave, aged sixty three.

I'd be in the unit for the hul dudes while my asophagectamy patient is inher until he leaves the unit.

Nurse k Boison recoiled as Patel continued running the unit down.

He made it known that he needed to be in the ICU for the two days because he thought so little of Hoffman's professionalism.

Doctor Patel knew that Tony Hoffman had voice concerns about the death of James Phillips to doctor Keating and to the Director of Nursing, Glennis Goodman.

The sixth June operation on Grave led to a string of complications.

Patel had paralyzed Grave's vocal cord, which made it difficult for him to clear his airway and breathe.

In the days afterwards, his wound fell apart twice.

The nurses rarely saw these instances of wound collapse or dehesiance, meaning to gape, but with Patel it was becoming common.

There was also leakage where Patel had clumsily rejoined Grave's gut.

Increasingly weak, the patient was wheeled in for three further operations by Patel on twelve sixteen and eighteen June.

While the anesthetist, doctor John Joyner, and the junior doctor James Boyd tried to arrange a bed for him in Brisbane, Patel stubbornly resisted the transfer.

The perilous condition of Grave was obvious as he was moved between the ICU, the surgical ward and the operating theater.

Hoffmann could not understand why he had not been transferred out His life hung by a thread, even when there was a bed of available in Brisbane.

On eighteen June, Patel refused to talk to the surgeons in Brisbane, making transfer impossible.

An incredulous doctor from one of the larger hospitals questioned Hoffman, why are you doing these big operations there when you can't care for these patients.

In her long career, Hoffman had never taken on a director of surgery, but she could see that Grave would die unless someone intervened.

She sent a note to Glennis Goodman explaining that doctors at the Princess Alexandra Hospital and the Royal Brisbane Hospital.

Have expressed their concern at why such surgery was done here when we don't have an intense first Meanwhile, the patient continues to deteriorate and we have no bed to transfer him too.

I think before any more surgery of this type is done here, we really have to examine whether we can offer the appropriate follow up care.

Some twenty four hours later, as Grave languished and Patel predicted that he would make a miraculous recovery if left in Thunderberg, Tony Hoffman went to Darren Keating.

She told him of Graves complications and how he needed increasing amounts of adrenaline because his condition was so unstable.

Hoffman told Keating there remains unresolved issues with the behavior of the surgeon, which is confusing for the nursing staff.

I believe we're working outside our scope of practice for a level one intensive care unit.

The ongoing issues regarding the transfer of patients and the designated level of this ICU may need to be discussed in more detail at a later date.

The behavior of the surgeon in the ICU also needs to be discussed, as certain very disturbing scenarios have occurred.

Hoffman was perturbed that Patel had not recognized a worrying feature in graves condition.

He had a kyler thorax, a build up of a milky fluid in the intercostal catheter in his chest.

Doctor Joyner was also worried he had found a bed for Grave in Brisbane, but when Patel discovered the arrangement, he was furious and immediately threatened to quit.

He confronted Joyner in the corridor between the ICU and theater and abused him.

Doctor Joyner regarded Patel as forceful, loud, and at times intimidating, but doctor Joyner also felt sure of his own position.

He had read a recent article in the British Journal of Anesthesia warning of high death rates for esophagectomy patience in smaller hospitals.

When doctor Joyner took his concerns to doctor Keating, there were more histrionics.

Patel had a tantrum and a again threatened to quit.

Finally he agreed to a compromise.

On twenty June, the patient Grave went to the Martyr, a leading Brisbane private hospital which also receives public patients.

Its director of Critical Care Services, doctor Peter Cook, was surprised at graves condition and shocked that a esophagectomy had been attempted at Bunderberg.

Dr Cook, an intensive care and anesthesia specialist, talked at length about the case to a surgeon colleague who shared his concerns.

They agreed that Patel's contemplation of such procedures in Bunderberg called inter question his competence and judgment.

The botching of the operation gave them even greater cause for concern.

There was another worry.

The charts for Grave showed the cancer had spread to lymph nodes outside his a sophot and stomach.

A large tumor was outside his bowel.

Because of the cancers spread, the esophagectamy was not only traumatic and potentially lethal, it was also fruitless.

Cook felt strongly that the doomed man should have been at home, comforted by loved ones, instead of in acute pain and distress from a failed to soophagectamy, which could only shorten his life.

On one July, unaware of nurse Hoffman's efforts, he telephoned Keating and explained the rocky future for the patient Grave and the risks for all patients having esophagectamese in Bunderberg.

The risks and the issues were identical to those already outlined by Tony Hoffman.

Keating gave an assurance that he would take the matter up with doctor Patel.

Cook decided to document his concerns he knew about the connection between public hospital funding and the frequency of operations.

He regarded it as an unhealthy policy which rewarded surgical volume instead of patient outcomes.

It produced a dreadful conflict of interest.

He questioned if Bunderberg was trying to widen its clinical practice to boost its coffers.

In a memo, he wrote.

Clearly, this is not appropriate surgery to be done at a center with such a small level of support services, particularly ICU.

But Patel remained determined to carry on.

He told the ICU staff, you will do.

What I see, or I won't go to Darren Keating.

I will go to Peter Lac the executive will do what I want them to do, because I'm making them so much money.

I'll resign if they don't let me keep my patience here.

It was all bluff.

Patel had nothing to return to in the United States except shame.

He had been reminded of this in a surprise telephone call from an investigator with the Oregon Board of Medical Examiners, who was doing a routine license check of discipline doctors.

Patel lied.

He told him, I'm retired and practicing medicine on a volunteer basis.

Only.

Keating had doctor Joyner, doctor Cook, and nurse Hoffmann in one ear telling him the esophagectamies were dangerous, while the forceful doctor Patel was angrily making a fierce case to keep his patients in Bunderberg and continue doing esophagectamies.

The operations were so complex they were generously rewarded in extra funds for the hospital, and Keating backed his director of surgery, doctor Patel.

Nurse Gail Dougherty was also becoming worried about Patel's insistence on the complex surgery when she questioned doctor Marson Carter, the director of anesthetics who headed the intensive care unit, he had no qualms.

Carter said, the patients are fit for anesthetic, and doctor Patel said he could do them, so we can't say no.

Meanwhile, Dorothy Bryan and Muriel Pancheri had fallen into Patel's hands.

On nine June, Pateel made a technical error, tearing Brian's bow while attempting to repair a hernia.

Her feces leaked internally, causing a serious contamination and contributing to her death.

On thirty June.

Pancheri was so disorientated she could not recall her date of birth.

The elderly woman's confusion extended to ignorance about the procedure Patel had arranged for her a colonoscopy, which involved inserting a scope into her anus.

He alarmed one of the doctors with his overly vigorous use of the device.

He appeared to be inexperienced with the procedure and had a tendency to push too hard, resulting in severe pain and an over inflation of the bow.

Pancheri succumbed weeks later.

Chapter thirteen Wounded Pride.

For his first five weeks as the director of surgery at Bunderberg's Hospital, j Patel was shadowed on patient rounds by Gail Aylmer.

The senior nurse, noticed an alarming pattern as she walked with Patel from bed to bed.

The doctor, sometimes with an entourage of young trainee doctors, was cheerfully removing bandages, handling different instruments, and poking around wet and fresh wound sights.

Gail Alma had no doubts about his work ethic, but his refusal to wash his hands between patients or to wear gloves made her blood boil.

Despite tactfully prompting him over several days to adopt basic hygiene, Alma had achieved nothing.

She spoke to him as firmly as she dared about the critical need for infection control techniques, he still refused to wear gloves or scrub the pathogens from his hands.

Gail Alma cringed every time she saw Patel handling the patients.

She feared contact could be transferring bacteria and unnecessarily causing infection.

It was madness.

Apart from the risk to the patients, she worried that the younger doctors whom Patel influenced, would pick up the dangerous habit.

Her next strategy was to walk around behind him with a box of gloves.

Each time he stopped at a bed, she removed a new, sterile pair of gloves.

I shouldn't have to be giving you these gloves.

I'm concerned about your practices with hand washing between patients.

It worked for a while, but Aylman knew that other nurses with less experience or confidence to push Patel would have no chance.

For the benefit of the other doctors, but mostly for the benefit of Betel's patients.

Gail Aylmer asked Judy O'Connor, the medical education officer, to run a lunchtime briefing session on the latest hand washing and infection control measures.

The idea was to do a glitterbug test.

It meant putting some fluorescent cream on the doctor's hands, rubbing it in, and then asking them to wash their hands under an ultraviolet line in a darkened room.

The parts of the hands that had not been washed thoroughly would stand out, but Pateel walked out to make a phone call.

He did not return.

Delicate tissue and organs can usually withstand gentle exploration, nudging and prodding in a surgical procedure.

Some surgeons, like doctor Brian Theel, are renowned as much for their soft touch as their technical prowess, but doctor Patel had a reputation for neither.

He ripped tissue, he battered organs when suturing the wounds.

He treated fragile tissue with disdain.

His rough handling inevitably bruised the tissue and organs, as well as being fertile beds for infection, the wounds were less likely to heal after being harshly treated.

Stitches would make little difference to a wound which was bruised, wet and angry.

Inevitably, these wounds would fall apart like an old and bruised piece of fruit, known as wound dehesiins.

It had happened twice to James Grave after his esophagectomy.

Before doctor Patel's arrival, post surgical injuries in Bunderberg had been extremely rare.

By early July two thousand and three, Gail Alma had encountered almost as many instances of woundhesince in the preceding months as she had seen in over twenty years of nursing.

She suspected that most of the abdominal wounds were falling apart due to poor surgical technique rather than infection.

There was gossip on the wards that Patel had told some of the junior doctors not to make reference todhesiins in the patient's charts.

Gail Alma wanted to ensure that the nurses were picking it up, even if occurrences were being misrepresented.

In an email to senior nurses, she wrote.

I am as I know you are as well, becoming increasingly concerned.

Read the number of woundhesents that have occurred over the last six to eight weeks.

While it does not appear that the dehesions is relating to infection, this needs to be investigated further to identify the causes.

Things to consider, for example, include how frequently is this occurring, what type of surgery is involved, how many days post op did the dehesions occur, Who the surgeon, assistant, scrub, nurses, etc.

Were, what theater did the surgery occur in what ward they were nursed on.

Four days later, Gail Almer compiled a report with patient charts on thirteen instances of woundehesins.

She included patients such as James Grave.

She noted the dehesients suffered by John Banks, whose bow was visible through the staple line.

After a diseased part of his colon was cut out, one staple had become embedded in his bow.

There was the case of June Ben whose greater omentum, an apron of tissue holding the bow together, was protruding from her wound.

Ayelma's report went to doctor Darren Keating later that day, she had an unexpected visit from Patel.

He stood over her and explained why most of the thirteen cases required no further analysis.

He gave a variety of excuses and explanations.

This is right, this is right, this is all accounted for.

Patel acknowledged in two cases that technique might have meant to blame, although he did not accept personal responsibility.

Junior doctors who worked alongside him in theater copped the blame.

If you do a lot of operations, you will have an increased likelihood of warndahessins.

Out of her depth and surprise that Patel, rather than doctor Keating, had been to see her.

Gail Alma felt she had nowhere to turn and no way of being sure of her ground.

She had expected the issues to be resolved by Keating after careful analysis.

It was why she gave him the report.

It was not her place to argue with the director of surgery about his clinical skills.

She was hearing disturbing feedback from others in the hospital.

Jenny White told her that Patel.

Did not seem to know his instruments well, using the wrong clan for frail tissue, and his technique was rough White.

Who had witnessed Patel's anger when the issue of wound ahesince was raised, was reluctant to document her concerns.

Alma brought it up with the director of Anesthetics, doctor Martin Carter.

She asked him whether Patel was a good surgeon.

Carter replied, I wouldn't let him operate on me.

On another occasion, when she was in the ICU staff room, Alma heard Carter refer to Patel as doctor Death.

Meanwhile, Tony Hoffman felt that she had been let down by Martin Carter.

She had wanted him to stand up to Patel in the beginning.

If Carter had bluntly told Patel, this is how this intensive care unit runs, Gail Alma would not have been in conflict with anyone.

Patel might have got the message.

Disillusioned by the handling of the woundehesion's report, Gail Alma wondered why she bothered escalating such issues.

Management did not want to hear about problems.

She believed that the hospital's executives took the view, if you're not going to deliver me good news, I don't want to know any news.

Theater nurse Damian Gaddy's was similarly frustrated.

A thoughtful and gentle care with a reputation for putting the patient's interest first, Gaddi's was shocked at Patel's techniques in major operations.

When it came to routine surgery procedures such as hernia repairs, Gaddy's had few qualms about Patel's proficiency, but for more complex operations such as bow resections, it was a different story.

Gaddies had watched dozens of surgeons do the same procedure hundreds of times.

When a ball is resected or the end of the intestine is cut, the surgeon should assume they are contaminated.

They should be held outside the abdominal cavity or swabbed with aquise el bettadine to minimize contamination risks.

But Gaddi's had often seen Patel leave the end of a bowel freely clammed and the other end flopping around inside the abdominal cavity, raising the infection risk.

Patel had extensive dermatitis, with small sare covering his arms.

Gaddie's watched Patel's haphazard gowning and gloving technique closely and concluded that contamination was often inevitable in the past.

When Gaddi's had raised an issue about a pethidine addicted doctor who was stealing drugs from the hospital's stores, a supervisor had threatened Gaddy's with dismissal.

He had no doubt that if a nurse had been discovered with empty ampules of pethidine and classic symptoms of addiction, there would have been immediate suspension.

Gaddi's resented the double standards.

It seemed to him that doctors in hospitals were a protected species.

He raised his concerns about Patel with Jenny White, the theater nurse in charge.

What do you expect me to do?

You can't expect me to tell a surgeon what to do.

Patient.

Ian Fleming, a father of war and a former police officer, had hit it off with doctor Patel when they first met in May two thousand and three.

Fleming put it down to Patel's friendly charm.

They also shared a love of cricket.

When Fleming asked him about India's youngest Test wicket keeper, eighteen year old Pathiv Patel, who was on the tour of Australia, Patel lit, up, is my nephew.

The doctor told him Fleming liked his easy manner.

He did not know that Patel was one of the most common surnames in India.

For months, Ian Fleming had been in pain due to the inflammation of tiny, multiple sacks or pockets known as diverticular forming part of his large intestine.

When an attack came on, he would double up in agony.

It took three attacks for Fleming to decide that surgery would be better than the pain.

Patel showed Fleming his chart and explained how he would cut out the growths.

On nineteen May, while Fleming was under a general anesthetic, his abdomen was cut from the navel to the groin at home.

Three days later, his stomach swelled and turned a bright, angry red.

The pain was excruciating.

Fleming could not eat, sleep, or walk properly.

On twenty eight May, when he returned to the hospital for treatment, Petel told him it was all in his head and that he was acting.

Go home, give the wife and kids a kiss, and have a great life.

Fleming did as he was told.

At nine point thirty pm the next night, he was sitting on the sofa at home when a hole in his wound blew out blood and pass poured from the gaping opening.

His wife had to use a sanitary napkin to cover it as they rushed to the emergency department.

Fleming needed further surgery to correct the and he was in hospital for a week with large doses of antibiotics for the infection.

The nurses wrote on Fleming's chart that the wound was sucking and blowing bubbles.

When he next saw Patel, the friendly rapport was gone.

The surgeons seemed angry about Fleming's complications.

Fleming believed that the nurses were more concerned than Patel about his welfare.

They suggested a suction pump to drain fluid from his wound site, but Patel angrily refused.

He was hostile to the nurse's suggestions that a different type of bandage be used.

Fleming's wound adhesiince was noted by the nurses in his charts.

In October, when Fleming complained to the hospital about Patel's handling of his case, Keating rang back and told him.

Who you've lodged a complaint against Dr Patel.

I must tell you that he is a fine surgeon with impeccable credentials and we are lucky to have him here in I understand you are bleeding internally since the operation, but this could be caused by many factors.

Back in the ICU, Hoffman was trying to look after a disorientated patient, John Breed, who had been living rough in parks around Bunderberg when he reached the hospital in early July.

He had a bleeding stomach ulcer and was in very poor condition.

After Patel's operation, Hoffman could see that Breed's red and swollen stomach wound was clearly infected.

He had no bowl sounds, and his condition was steadily worsening.

Hoffman believed he was showing classic science of postoperative sepsis.

The infection had spread through his bloodstream to the rest of his body.

Patel refused to acknowledge that there was any sign of stomach infection.

He put the problems down to a chest infection and a carrents, not uncommon for patients on ventilating equipment in an ICU.

Hoffman couldn't believe it.

She didn't know what Patel was talking about.

Adamant that there was no evidence of any chest infection, she knew that Breed should have been receiving intensive care in Brisbane for a week.

Patel refused to let the man go.

Hoffman had correctly identified Breed's stomach infection arising from Patel's surgery as the problem.

She heard nothing back from Patel.

They were no longer on speaking terms.

After the eventual transfer of John Breed to Brisbane, the nurses were told he had died.

They collected his personal effects, clothes, densures, and spectacles.

The spectacles were added to a collection for a worthy cause.

Days later, the nurses were relieved to discover that he had survived, and for a few hours there was a frantic search to recover his only pair of spectacles.

Chapter fourteen, Sex Lies and Doctor Kureshi, August to December two thousand and three.

In late August, Annette Arrowsmith went to Bunderberg Hospital suffering pain in her left breast.

She hoped a doctor would put her mind at ease, perhaps recommend medication for the pain and some tests to exclude cancer.

Instead, she was fondled for ninety minutes by a swarthy man with a mustache.

He played with her breasts, and he asked if he could examine the lower part of her body.

Arrowsmith refused.

She suspected doctor Tarik Kureshi, an overseas trained doctor from Pakistan, was not interested in clinical care.

She noticed his pants were wet in just two months in starting at the hospital with minimal supervision and orientation.

Kureshi's complete lack of basic clinical knowledge had raised eyebrows around the hospital.

He was regarded by doctor Peter Meak as unbelievably incompetent.

Miak, who could not understand how someone as ignorant about medicine could have been employed, doubted Korreeshi had ever been trained as a doctor.

Miak went to doctor Darren keating.

I don't want this chap to work here.

He's totally useless.

Look, if you want to pay him, put him in the library and get him to read a book.

But he's of no use to me.

Kureshi was also unwelcome in the ICU.

Doctor Martin Carter did not want him to have anything to do with the patients.

The nurses were wary of Kureshi for different reasons.

He kept bumping into them and squashing against their bodies.

Annette Arrowsmith's formal complaint went to doctor Keatie, who made a detailed note of the circumstances and of Kureshi's denial of anything untoward.

Several weeks later, Karen Mcinness came into the hospital for a deep vein thrombosis in her right calf.

She said of her experience.

Doctor Kureshi came to examine my leg.

After doing this, he started rubbing my inner thigh down to my knee in a way that made me feel very uneasy.

As I put my legs back under the blankets, he asked to listen to my chest.

I lifted my top to just under my breast.

He listened for a few minutes, and then he pulled my top above my breasts and started moving the left one in every direction he could.

I've never had a doctor do this to me before.

The examination made her skin crawl.

Mcinness wished that she could curl up and go away.

Keating told Korreeshi he faced dismissal if he did not have a chaperone in further consultations with female patients.

On twenty two October, doctor Keating told the Medical Board of Queensland about the complaints.

One of the staff later wrote back to say that an investigation might be mounted by September the following year.

The third complaint was more poignant.

Amanda Bully, undergoing neurological observations after seizures, became teary when Koreshi came into the cubicle.

The nurse Daniella Tarlington asked why she was so upset, and Bully explained that Koreshi had been in previously.

While she was having a seizure, Amanda Bully could feel him kissing her face and putting his hand down her shirt to touch her breasts while she was having convulsions.

Although able to see and feel the sexual assault, she could not respond.

But Kueshi continued to work at the hospital.

Or seven months after the first complaint of a sexual nature and some nine months after he had been rated as utterly incompetent by doctor Miak.

The failure of the hospital's management and of the medical board to suspend him immediately reinforced a perception among nurses and doctors that serious complaints were not dealt with appropriately.

Koreshi disappeared overseas in March two thousand and four, when police began to look for him to ask questions about an unrelated petty crime.

His destination was unknown.

Patel faced a less serious claim of sexual harassment.

He had asked nurse Patria Azlet for her home telephone number over the bed of a patient in surgery, and then called her at all hour seeking a relationship.

Aslet immediately regretted giving him the number, no matter how many times she told Patell she was not interested, he persisted.

The calls ended after Keating, tipped off by Tony Hoffman, took Patel aside one day and had a chat to him about the nurses forming the wrong impression.

The next day, Patel made a joke of the episode.

You can't do anything in Australia without getting into trouble.

Meanwhile, Hoffman had heard a disturbing rumor which might have explained the willingness of doctor Martin Carter, the director of anesthetics, to accede to Patel's refusal to transfer the patients.

Tony Hoffman related it to doctor Keating in a September email.

I'm told that Dr Patel and Martin Carter have come to an agreement by which doctor Patel will operate only if Martin Carter agrees to not transfer this page.

Hoffman believed the situation was dire.

Another patient, Mervyn Smith, was in a bad way with major chest and spleen injuries and five broken ribs after a road accident.

He had suffered a string of serious complications since surgery by Patel.

He needed long term intensivist management and the support of a cardiothoracic team.

Options available in Brisbane, not the regional town of Bunderberg.

Hoffman's latest email to Keating raised for the first time a possible explanation for Ptel's immunity.

It was the purported arrangement.

The email reiterated her concerns about what type.

Of surgery should be done here in relation to our follow up care and the services we can provide.

Although she had no reply from doctor Keating, he spoke about the matters to Patel and Martin Carter.

They deny they had done a deal over the care of patients and they strenuously defended the handling of Mervyn Smith.

Sick to Death is written and presented by me Headley Thomas, the Australians National Chief correspondent.

Claire Harvey is The Australian's editorial director, Audio, editing, production and music have been done by Jasper Leik, with assistants from Leah Sammaglu and Neil Sutherland.

Our producer is Christain Amias.

Production management by Stephanie Coombs, artwork by Sean Callanan.

Thanks to Ryan Osland, Matthew Condon, Karina Berger, Ellie Dudley, David Murray, Dominique McDermott, Zach Sculander and all our family, friends and colleagues who helped in this series and contributed voice acting and special thanks to Tony Hoffman and Rob Messenger.

Subscribers to The Australian here new episodes of Sick to Death first at Sick to deathpodcast dot com and on Apple Podcasts.

You can get exclusive access to photographs, videos, timelines and more at the website