New development (June 16, 2005): "Meanwhile the Australasian College of Surgeons says it is premature to comment about a report into Dr Patel's performance. A team of medical experts has been auditing surgical outcomes at the Bundaberg hospital. Newspaper reports suggest the draft study shows the medical error rate of Dr Patel may be within acceptable limits. College president Russell Stitz says the full analysis is yet to be done". For details please read ABC News

The audit, headed by Associate Professor Peter Woodruff, finds (June 30, 2005) Dr Patel" did not intentionally cause harm to any patients but his actions contributed to the death of eight patients and possibly a further eight - a significantly fewer than the 87 deaths previously linked to him (by Mr Morris). The Audit identified another five patients whose deaths were contributed to 'by doctors other than Dr Patel'. And it found that Dr Patel 'rescued or attempted to rescue five patients from major iatrogenic injury caused by other medical practitioners' ". Of the eight death, four had terminal illness.

Mr Jim Soorley, an ex-Lord Mayor of Brisbane, wrote in the Sunday Mail (June 19, 2005): "Well, the first substantive analysis on Dr Jayant Patel's surgery has taken place. It shows that both his death rate and transferrals to other hospitals were about the norm. In other words, an independent audit shows medical error rate within acceptable limits. While this won't provide any comfort to patients who feel badly treated, it should send a message to the Premier to stop his grandstanding and concentrate on fixing the prlblems in Queensland health. It should also slow down Commissioner Tony Morris with his over-the-top talk of murder charges."

Quick Links:
(1) "Partnership between Morris Inquiry Committee, Journalists and Dr Patel's 'Victims'"
(2) "All doctors in Queensland become victims of the Dr Jayant Patel event - Articles from the Sunday Mail (June 19, 2005)
(3) "Overseas trained doctors in Queensland public hospitals become victims of strangled relationship between some hospital employees and administration officers"
(4) "The Creditability of the Morris Inquiry"
(5) "Did whistleblower Ms Toni Hoffman tell us the truth"

In the past few weeks, the media played prosecutor and Ms Toni Hoffman played medical expert witness. Dr Jayant Patel, a US trained general surgeon, became the No. 1 news in Australia (especially in Queensland). Are we told the truth?On 1/5/2005 Channel Nine night news broadcasted interviews with one of Dr Patel's classmates, a former colleague as well as a medical professor in India. All of them believed Dr Patel was excellent clinically and academically and questioned what was going on in Australia. Well, let's go through all of the cases published by newspapers to see if we can find an answer.

[Note: Some official websites may have been used as a spy tool to tract down Dr Patel, as some politicians believed that he was visiting these sites to get information. It is possible that if you click on these websites, your IP address and computer info will be recorded thus your whereabout will be easily located. As a result, Dr Russ Faria of Oregon, USA came forward and told the Sunday Mail that he was the one who visited Queensland Government website.]

Following cases appeared mainly on the front page of the Courier-Mail on 16/04/05.
Warning: if you are a medical doctor, don't feel surprised that most of the cases in the Courier-Mail don't make sense to you because it was possibly written for politicians. To read original article, click here .

Case 1, Shirley Brooks went to the hospital "for a half day visit to remove gallstones", and " Dr Patel cut the tube connecting the liver to her stomach instead of cutting the tube connecting the gall bladder to her stomach". According to her description it is likely that the common bile duct was injuried during the surgery. This is one of the complications likely to occur during cholecystectomy, and it is included in the standard consent form designed by the Queensland. I am sure that Ms Brooks had read and signed the consent for the surgery and maybe she still kept the patient's copy. For more information on potential complications related to gallbladder surgery, please read informed patient's consent at http://www.health.qld.gov.au/informedconsent/).

I would like to emphasize here that gallbladder surgery is NOT a "half day visit". After laparoscopic cholecystectomy, patients stay in hospital overnight and are discharged next day.

Case 2, Felice Pirovani's chemotherapy for his stomach cancer "was delayed for eight weeks". Providing Chemotherapy is the job of oncologists but not surgeons. Dr Patel is not a oncologist. Most importantly chemotherapy can NOT cure stomach cancer or prolong life. Chemotherapy has dreadful side effects which can make people very sick!

Case 3, Terry Bellamy "entered hospital for an overnight hernia operation" "after his small intestine fell down into his scrotal area". Apparently he had urgent surgery that night due to small bowel obstruction / strangulation caused by hernia. Because the bowel was trapped in the hernia, the wall of the bowel became ischaemic, enabling bacteria in the bowel penetrating through the wall. As the wound was contaminated with bacteria, infection was no surprise.

Also, as both vas deferens and the hernia locate in the same anatomical area (within the spermatic cord), "half a vasectomy" may occur during surgery for strangulated hernia. The surgery is NOT a simple one but a complex life saving surgery. Without it, Mr Bellamy would have died.

Mr Bellamy also complained that he "developed a blood clot". It is a common post-op complication. People who are smokers, who have family history, who suffer from cancers or undergo any kind of surgery are at a high risk.

Case 4, Trevor Halter . It is very hard to understand the description he gave to the newspaper about his gallbladder and later on "two gallstones". However, "a collapse kidney", "pneumonia" and "a weakened heart" are more likely related to his previous existing medical problems. Again, these complications are included in informed consent forms for surgery which should be signed by Mr Halter prior to the surgery. Please read informed patient's consent on Queensland Health's consent form webpages (http://www.health.qld.gov.au/informedconsent/)

Case 5, Barry Johson died of pancreatic cancer. Quite often the pancreatic cancers are in late stage at the time of presentation and therefore are inoperatible. The size of a tumour is not a major determinant in surgical decision making but the nature of the cells. A small cancer can aggressively invade nearby structure early, rendering resection impossible. Quite often this may only be evident during surgery in the theatre where surgical staging is done. If a pancreatic cancer is inoperatible, sometime other alternative procedures are performed in order to minimise symptoms.

Case 6, Ian Fleming had "inflammation of the colon from diverticular disease". It is a common practice in public hospital to discharge patient with wound infection. Patients may come to hospital's wound clinic or blue nurses may visit the patients. I am not exactly sure what surgery he had, but according to his description, he might have had drainage of abscess related to acute diverticulitis and the diseased colon was left untouched. If it is the case, I can't see anything wrong with it.

Case 7, Judy Pettitt had bowel cancer and "the hole made for the colostomy bag was too small". This complication can happen no matter who did surgery. If the hole is too small, serial dilation with metal dilators may be used to treat the problem.

Case 8, Nelson Cox's "liver and heart were cut and a bone in his shoulder was cracked during gall bladder surgery" and "he carries large scars over his torso". As in the case 1, injury to nearby structure can happen to any surgery, so injury to the liver during cholecystectomy sometimes can occur. All patients undergoing laparoscopic cholecystectomy are routinely warned that the key hole surgery may be converted to open surgery during the surgery, this means patients will have a bigger scar. This potential complication is also included in informed consent form designed by the Queensland Health (http://www.health.qld.gov.au/informedconsent/)

Also if the patient is a smoker, diabetic or has other chronic medical conditions, post-operative complications are more likely to occur.

The claim that his heart was cut and shoulder was cracked during the gallbladder surgery doesn't make sense to me because they are far away from the gallbladder.

Case 9, Des Bramich died of chest injury. I can't make any comment on this case as no details were provided in the newspaper. My own experience is that patients with severe injuries are initially treated and stabilised at the Emergence Department by ED doctors who then arrange transport to transfer patients to tertiary hospitals in Brisbane. It is very important to stabilise patients before transferring them, otherwise they would die on the way to major hospitals Remember what ambulance officers or flying doctors/nurses can do is very limited. Stabilisation includes intubation, chest drainage for severe traumatic pheumothoraces / haemothoraces, aspiration of pericardial fluid for rapidly increasing cardial tamponade, blood transfusion, X-ray, CT scan and ultrasound, etc. These are all life-saving procedures and time-consuming.

Case 10, Han Huhsmann had a hernia operation. Again, as I mentioned in Case 8, diabetics are more likely to have various complications such as infection after surgery.

So, if you are overweight, you should do something to lose weight.
If you are a smoker, quit smoking now.
If you drink too much bear or alcohol, give alcohol anonymous a call.
If you spend too much time lying in the couch and watching TV, go out and do some exercise.
Otherwise, don't blame doctors for surgical complications.

Mr Huhsmann stated "a GP found a metal object had been left in Mr Huhsmann's stomach" but no details were given as what and where metal object was. It is routine in the theatre that nursing staff count all the tools prior to the completion of surgery.

Following cases were published on page 5 of the Courier-Mail

Case 11, Len Boller said his "cancer has spread to both lungs" since "reversing a colostomy bag operation" by Dr Patel. He is "now lethargic and in pain" and he "has been diagnosed terminal and may have only days to live". I don't understand and can't imagine how Dr Patel spread Mr Boller's cancer to the lungs. Are surgeons responsible for cancer spread after surgery? Are doctors responsible for the death and pain of cancer patients who have had surgery, chemotherapy or radiotherapy? I think the accusation is ridiculous and laughable.

Case 12, Doris Hillier "was admitted for a gall bladder operation" and "suffered a series of massive infections and placed in emergency surgery". What "massive infection"? - no details were given.

Case 13, Horace Powell was "referred by Dr Patel to Mental health Services in October 2003 because he (Dr Patel) believed Mr Powell's back pains were 'all in his head'. In November 2004, a Brisbane doctor diagnosed that vertebrae had been pinching his back nerves for several years. He was told he was lucky not to have been in a wheelchair". I doubt about accuracy of the accusation because I couldn't answer this question: Who referred Mr Powell to Dr Patel, a general surgeon? I don't believe that his GP referred him to a general surgeon rather than an orthopaedic surgeon or neurosurgeon because the GP should know general surgeons don't treat back pains! If the GP did refer him to Dr Patel, did he fail to refer Mr Powell properly? Bundaberg Hospital does have an orthopaedic department.

To me, Mr Powell was also telling the public indirectly that Mental Health assessment team and psychiatrists at the hospital were not doing right job as well, as they didn't reject Dr Patel's believe.

Mr Powell said he "has since taken private medical insurance because he is still in pain and needs another operation." Apparently he has had surgery somewhere else for his back pain. Maybe he should seek compensation from the surgeon who did unsuccessful surgery for his back in order to fund next surgery. (I am curious whether any surgeon who has read Mr Powell's story would take the risk and operate on him in the future.)

An interesting case (Marilyn Daisy) from the Courier-mail (26/05/2005):

The hospital's director of medical, Peter Miach, told the health inquiry yesterday that when he came across the woman (Marilyn Daisy) - a severe diabetic - she was semi-comatose because her renal problems had been ignored. The stump was also later found to be gangrenous. "He just forgot about her ... (she was) just left in her bed," Dr Miach, the woman's former physician, said. "I was quite aghast." The woman, 43, who had been admitted by Dr Patel for the amputation without Dr Miach's knowledge - underwent immediate treatment in the hospital's renal unit before being transferred to Brisbane for further surgery. Dr Hason Henkins, the surgeon who treated her during her Brisbane stay, wrote to Dr Miach: "This was performed on 20.9.2004, it is now 01.11.2004 and she still has sutures in her amputation stump some six weeks following the procedure." "I find it mind-boggling that someone could leave sutures in for this long."

Do you think the criticism from Dr Henkins was directed toward Dr Patel only? Think again. Nurses are responsible for primary wound care and removal of stitches. The poor woman was taken care of 24 hours a day and 7 days a week by nursing staff, how come nobody noted that the stitches were there for so long. If nurses were not sure when the stitches should be taken out, they should discuss with surgical residents or registras / principal house officers. Surgical regiatras / PHOs are responsible for pre-and post operative care. It is now too easy to blame Dr Patel because there is no proper cross examination and people with different views on Dr Patel are too scare to speak out.

ABC reported on June 30, 2005:" Dr Miach has been cross-examined at the inquiry about the treatment. The woman was Dr Miach's patient but Dr Patel performed the amputation. The inquiry has heard the woman did not have her stitches taken out after surgery and was left for six weeks in the hospital with her wound unattended. Dr Miach said it could be possible Dr Patel thought that a patient was no longer his responsibility once they were out of his ward, because of different practices in the US. But he said it was the surgeon's responsibility to ensure the patient was followed up after surgery." So, it is obviously clear that Dr Miach forgot about his patient who had diabetes and kidney problems but NOT Dr Patel. We know now who has been lying about the truth !!!

The complications described by "victims" of Dr Patel could happen anywhere no matter which surgeon is involved. This is why the investigation into two Fijian surgeons at Harvey Bay Hospital took so long and the investigators requested more time and indemnities (to avoid deformation charge, I suppose) from the Queensland Health. If these two are found guilty of causing surgical complications, then many surgeons and surgical registras should be banned from practice as well because of similar complications and thus many surgical departments would be shut down. For example, one patient's hip explored in the theatre, while another patient's femur was fitted with a nail which is longer than the femur by an Australian trained orthopaedic registra about one year ago in Toowoomba Hospital. I am sure nothing will happen to him because he is Australian trained.

Dr Jayant Patel got into trouble because he was from overseas. Australian trained doctors are main force of the health system. However, in Australia more than 50 patients are killed by medical mistakes every day. How many Australian trained doctors or nurses have faced murder or manslaughter charges?

Another trouble Dr Patel had is that he made enemies in the hospital which is evident that he was described by some individual nurses and possibly a few others as "delusional" and "psychopathic" (see "Dr Death now pretending to be his brother" in the Courier-Mail(16/04/05)) while many other nurses and medical staff praised for him and "regarded him as a 'lovely man'" (Page 5, The Courier-Mail, 14/04/2005). The Courier-mail reported "Ms Hoffman also told the inquiry that Dr Patel antagonised intensive care nurses so much that they made excuses to avoid caring for his patients. She said he had upset the nurses with his disparaging comments about their work soon after he was appointed director of surgery at the hospital in 2003. Ms Hoffman said Dr Patel's distrust of the ICU nursing staff was so acute that at one point he even commented he intended to sleep in the unit by his patients' bedsides. However, he never carried through with the plan." It's time for Ms Hoffman to make up stories to retarliate, isn't it?

I overheard a group of nurses in a public hospital who were chatting about Dr Patel. They said that "it's nothing wrong with the clinical competency, but the way he treated nurses".

I have to say that most of nursing staff are very friendly in Australia but some individuals are very nasty and bullying. These individuals believe they know much more than you and they try to tell you what to do from time to time. If you ignore them, they complain to their bosses behind you. I had a 20 yrs old patient coming to A&E department one day. He had asthma attack but he wasn't distressed. I gave him 50mg prednisone orally and Ventolin / Atrovent neb. A nurse came to me and told me to give him intravenous hydrocortisone. I said I had given oral steroid already and no need to give more steroid. She became agitated because I refused to do what she wanted me to do. So she came to me every 5 mins, nagging me repeatedly. Then she complained to her team leader about me. One may think she was really caring of the patient. But it is definitely not the case because she wouldn't give the patient Ventolin continuously as I recommended in the medication chart and I had to stay with the patient and repeatedly add Ventolin to the nebuliser chamber when it became empty. Next day, I photocopied the Asthma Management Guideline published by National Asthma Council Australia, which clearly shows when patients need oral steroid and when patients need intravenous steroid. She responded:"we here give intravenous steroid to all asthma patients". This is crap. Just a few day ago a consultant of the department said iv steroid is not necessary better than oral steroid and iv steroid is only used if the patient cannot swallow tablets - This is consistent with the Guideline.

Some nurses are engaged in unethical and potential dangerous practice. While ago I worked in orthopaedics of a public hospital. The nursing staff frequently sent post-op patients to their usual residence prematurely. What they did was they booked ambulance one or two days beforehand, then told the doctors that the patient had to be discharged because ambulance had been booked for today. I do understand that they are under pressure to vacant beds in order to accommodate new patients from the theatre and A&E department, but that kind of practice is unacceptable. If anything happens, possibly they would say "look, you doctors discharged the patient, that's your fault".

Another lesson we learned from the event is: less surgical procedures, less surgical complications; no surgical procedures, no surgical complications. It makes sense, isn't it? If Dr Patel had realised this, he would have slowed down and spent his afterhours somewhere else rather than Bundaburg Hospital. Of course I also wish he had not described Australian medical facilities as "third world standard" - remember Mr Peter Bettie (Queensland Premier) said that Queensland had the best medical facilities / services "in the world".

The Creditability of the Morris Inquiry

The Courier-mail published an article titled "Breathless inquiry is evidence that Morris is no Fitzgerald" by Mr Dennis Atkins on 18/06/2005. Mr Atkins wrote:

"This is an inquiry that looks and feels like it's made for the 24-hour news channel. And Peter Beattie, a Premier who can't get enough of the news cycle, is running along just as fast."

"The speed with which Morris has brought the murder charge recommendation forward is causing plenty of whispered comments in legal circles and, according to those who mix with police and Crime and Misconduct Commission personnel, an equal amount of chatter among those likely to pursue any arrest or prosecution."

"Other aspects of the Morris inquiry which lawyers are questioning include the treatment of witnesses and questioning during hearings.

Morris took great offence when former Queensland health chief executive Rob Stable was asking private questions about the commissioner meeting potential witnesses before an appearance before the inquiry, saying the ex-bureaucrat had sought to detail the commission.

It was a heavy handed statement, but an equally valid point of criticism is why is morris meeting with some selected potential witnesses - albeit in the presence of counsel assisting? one legal authority, with plenty of inquiry experience, remarked this was the kind of work counsel assisting should be doing without the involvement of the commissioner.

Other witnesses were not afforded such courtesy, with two Bundaberg Base hospital officials called with notice of an hour or less and thrust in the witness box. Morris then effectively took over the role of counsel and engaged in aggressive, prosecutorial questioning from the bench.

And for one star witness, it was very friendly. The whistle-blower Toni Hoffman enjoyed a handshake from the commissioner after he stepped down from the bench. It's almost as if the commissioner is dividing witnesses into good guys and bad guys.

It may be Morris will get the job done quickly and successfully. Most people wish him the best of luck in his quest. But any suggestion he's another Tony Fitzgerald doesn't measure up."

On TV we saw all the time that Mr Morris frequently and inpatiently interruptted the answers given by the state Health Department officers, Hospital manager, Director of Medical Service, nursing director and other Hospital Administration officers if he didn't like the answers. He thinks he can abuse his power to bully some others during the hearing.

The bias of Morris is obvious. As a result, lawyers for Dr Darrent Keating (Director of medical Service) and Mr Peter Leck (District Manager) are to lodge an application to the Supreme Court. Mr Morris responded with threatening that he would consider disqualifying himself in order to "starve off the Supreme Court action designed to have him formally removed". Apparently the threat worked. Premier Peter Beatie, who uses the Inquiry as a mean of political survival, openly warned the pair (scapcoats) not to go ahead and ordered the pair to pay legal fees incurred by the Supreme Court challange.

Some truth ignored by the Morris Inquiry:

(1) Toni Morris QC has collected some information at Bundaberg Hospital, but he failed to analyse the complaints in order to reveal the truth around Dr Patel case. For example, he believed that Dr Patel was responsible for abandonning Ms Marilyn Daisy after he amputated her legs (The Courier-Mail 11/06/2005). I have included my analysis above.

I am not sure whether Mr Morris is aware the fact that Bundaberg Hospital had more than one doctor in the surgical department or he deliberately ignore the fact in order to single out Dr Patel. If Mr Morris didn't know this structure, he should learn more before making any judgement and recommandations.

In surgical department of Bundaburg, there were two surgical principal house officers (PHO) under Dr Patel. Surgical PHOs did ward round every day and they were responsible for pre-op and post-op care. Before they started ward round they printed out their patient lists which enabled them to locate all their patients. If they were unable to manage patients with medical problems such as renal impairment and diabetes, they should directly consult medical teams - they didn't need permission from Dr Patel to do that. Nurses in the hospital are responsible for taking care of the wound and taking stitches out when the time is due. It was Dr Patel's PHOs failing to look after Ms Daisy's diabetes and kidneys after the amputation, and it was nurses failing to take care of Ms Daisy's wound. Moreover, some "minor" precedures in the theatre, such as sterilising patient's skin and stitching up wound might be done by PHOs rather than Dr Patel. Also Mr Morris ignored tha fact that Ms Marilyn Daisy was actually Dr Miach's patient. Dr Miach, who didn't have a specialist registration in Queensland, practiced in Bundaburg Hospital Queensland as a nephrologist (It seems to me that he's not going to have trouble due to unregistered medical practice because he's Australian trained). Nevertheless it's unfair to blam Dr Patel for everything happened.

Is Mr Morris scapgoating Dr Patel for the troubled public health system? Medical mistakes kill more than 18,000 of Australians, permanently disable 50,000, and cost $4.17 billion taxpayers' money every year. Can Mr Morris tell us who are responsible for the rest of the death and injuries and how he is going to bring those responsible to the justice? Australian trained or overseas trained doctors?

In his report, Mr Morris recommended Dr Patel be charged of murder. It doesn't make sense to many of us at all. Mr Jim Sooley, an ex-Lord Mayor of Brisbane, wrote in the Sunday Mail that he "very much doubt that murder is the appropriate charge". I completely agree with Mr Sooley.

Mr Morris also recommanded in his immature report that "Queensland Health be stripped off its powers to declare 'areas of need' ". Dr Patel's event has nothing to do with "area of need" declaration by the Queensland Health but how overseas trained doctors were recruited. Like many backpacker doctors from many western countries, Dr Patel got the job offer before he entered Australia. He didn't have a job interview. Before his appointment, we had had trouble with backpacker doctors mainly from UK. They applied and got their jobs on the Net or via mail without being interviewed, then they packed up and disappeared after they messed up in hospitals here. Moreover it was federal Health Department which established a special fund to recruit more backpacker doctors in the past three - four years. This is really a back door for disaster to happen. If Mr Morris really wanted to fix the system properly (not so called "quick fix"), he would familise himself with the clinical system and analyse the whole situation thoroughly without bias.

Ms Hoffman (an ICU nurse) stated that "he (Dr Patel) was not washing his hands in the renal unit when when putting in the catheters" - "a simple explanation for Patel's 100 per cent complication and infection rates when inserting catheters in patients.

I doubt about what she claimed:
(1) Inserting catheters are nurses' job. If nurses couldn't put it in due to difficulty, then resident doctors are usually called to do the job. If the resident fails, he/she should consult his/her registras who may have a go or ask urological registra to put a suprapubic catheter in. It's extremely unusual for a general surgeon to be involved in catheter insertion.

(2) There is no point to wash the hands before inserting catheters because we always wear sterile gloves. If you suspect the quality of the gloves, you may wear two. I have seen many nurses here doing the same way. In deed, Patients with catheters are at high risk of infection. This is why some doctors routinely give gentamicin intravenously right after the procedure.

<3> Patients (no matter they are originally from medical or surgical departments) in the ICU are basically under the care of ICU doctors and nurses, I don't understand why Dr Patel went there.

The Courier-Mail reported in "Nurses horrified as Patel kept 'stabbing' patient" (22/04/2005) that "nurses have told of being traumatised after seeing Dr Patel 'stab' Mr Bramich as many as 50 times with the widebore needle in an apparent bid to drain suspected fluid from a sac near his heart". The report also stated that "understood Ms Hoffmann, the main whistleblower in the scandal, did not witness the traumatic stabbing incident".

I very much doubt about this allegation. Who actually witnessed it and who actually counted and recorded as to how many attempts Dr Patel actually tried? Is Ms Hoffman 100% sure that the number of the attempts was NOT 49 or 51 but exactly 50? A claim like "he stabbed so many times that I lost count" would be more convincing.

ABC reported on 23 June 2005: "Whistleblower nurse Toni Hoffman has told the Bundaberg hospital inquiry some nurses refused to care for controversial doctor Jayant Patel's patients because they were perturbed by his behaviour." So, were these nurses responsible to the death of Dr Patel's patients due to lack of appropriate post-op care?

Ms Hoffman claimed that nurses hid patients from Dr Patel. How? There is no way they could hide patients. It is every day routine for doctors to print out patient lists which show which ward and bed patients are allocated to.

Statement: I have no relationship with any doctors mentioned above and know none of them. I publish this webside because I am not convinced by what the media and politicians said. Like many others I do not trust newspapers and politicians. I wish they had let the court decide whether Dr Patel is guilty or not. I agree with the Civil Liberty Australia that Dr Patel will not be able to get fair trial in Australia.