BRISBAND, Australia — A doctor turned off a woman’s life support ventilator in an Australian hospital because the director of surgery, dubbed "Dr. Death," wanted her bed to operate on another patient, an investigation finds.
The surgeon, Jayant "Jay" Patel, 56, is the subject of an official inquiry in the Australian state of Queensland examining why the doctor was permitted to practice medicine in 2003 despite a nearly 20-year history of criticism and sanctions imposed by medical authorities in Oregon and New York as a result of his work practices.
Patel had been given glowing references by six colleagues in the United States despite having been cited for negligence there earlier, according to copies of the references obtained by The Associated Press.
Patel, who was educated in India and completed his residency in New York state, was first cited in 1984 by New York health officials for failing to examine patients before surgery.
He moved to Oregon in 1989 and began working for the Kaiser Permanente Hospital in Portland, Ore.
After reviewing 79 of his cases, Kaiser restricted Patel’s practice in 1998, banning him from doing certain types of operations — such as liver and pancreatic surgeries — and forcing him to seek a second opinion in complicated cases.
After reviewing four of those cases, in which three patients died, the Oregon Board of Medical Examiners made Patel’s restriction statewide in September 2000, and New York health officials forced him to surrender his license in April 2001. He was hired in Australia in 2003.
Nurses hid patients from Patel
Patel was director of surgery at Queensland’s regional Bundaberg Hospital in 2003-04, despite negligence findings against him in the two U.S. states that resulted in restrictions on his U.S. medical license.
Patel left Australia in March, 2005. His whereabouts are unknown. He has not commented on the allegations and has no legal representation at the inquiry.
Bundaberg Hospital’s head intensive care nurse, Toni Hoffman, told the inquiry in the city of Brisbane on Tuesday that hospital staff had tried to hide patients from Patel, whom they nicknamed “Dr. Death” because of his botched surgeries.
“All the nurses in intensive care were seeing these patients dying every day and we couldn’t do anything,” Hoffman told the inquiry according to transcripts available on Wednesday.
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“We’d taken to hiding patients. We just thought 'What on earth can we do to stop this man,' she said.
Recommendations from Kaiser doctors
The Medical Board of Queensland alleges Patel falsified his application to practice in Australia by removing his disciplinary history, but acknowledges that it failed to check his application against U.S. medical records.
But documents submitted to the inquiry by Queensland health officials and obtained by AP show that Patel came highly recommended by six former colleagues in letters dated more than seven months after his license was restricted by the Oregon Board.
Four of the letters were written on Kaiser Permanente letterhead, one was a copy of an internal Kaiser memorandum and another was on private letterhead from Portland.
In one letter, dated June 4, 2001, a senior Kaiser anesthesiologist, Bhawar Singh, wrote of Patel: “His balanced judgment, surgical skills and decisive steps, especially in the management of high risk complex procedures, has always been appreciated.”
When contacted by AP for comment on the letter, which was written on Kaiser letterhead, Singh said all questions had to be referred back to the organization.
Another physician, Joseph Leimert, head of Kaiser’s Department of Hematology and Medical Oncology, wrote a letter on June 4, 2001, saying aspects of Patel’s care were “unparalleled by any provider in any department at any time in my professional experience.”
“I profoundly regret Dr. Patel’s departure and recommend his services without reservation,” he wrote in the letter, which was also on Kaiser letterhead.
Leimert also refused to comment, saying he been instructed not to speak to the media.
Kaiser spokesman Jim Gersbach said the references were personal letters written on behalf of Patel by his colleagues.
“While some of the letters appear on our letterhead, Kaiser Permanente never approved or released these letters and did not then and does not now endorse the contents,” Gersbach said in an e-mail statement.
He said Kaiser was never approached for an official letter of reference and “our Human Resources Department, Medical Legal and Credentialing were never contacted by prospective employers about Dr. Patel.”
“While Kaiser Permanente cannot stop our physicians from writing personal letters of recommendations for their colleagues, we are reviewing our current process with our medical staff in an attempt to avoid situations like this in the future,” he added.
Another Kaiser surgeon who recommended Patel did not return a phone message seeking comment. The three others could not be reached for their views.
Linked to at least 87 patient deaths
Gersbach said Kaiser had made no secret of Patel’s disciplinary history, having filed an “adverse action” report with the National Practitioners Data Bank when questions about his treatment first arose in June 1998.
“Our main position has been that we did review his practice, his license was restricted and we reported it (to authorities),” Gersbach said.
Patel has been linked by the Queensland state health department to the deaths of at least 87 of the 1,202 patients he treated during his two years at the rural Bundaberg Base Hospital. Several dozen other alleged malpractice cases are also under investigation.
Queensland Premier Peter Beattie, who set up the inquiry, has written an open letter to Patel asking him to return to Australia to answer the allegations against him.
“On behalf of the Queenslanders who allege that you have harmed them or their loved ones, I ask you to come forward immediately...,” Beattie said in the letter posted on his Web site.
'Totally and utterly illegal'
In the inquiry, nurse Hoffman said the “pivotal case” for her occurred in July 2004 when Patel blocked the transfer to another hospital of a 55-year-old man who was critically ill with chest injuries after being crushed under a caravan.
She said another nurse had told her she had seen Patel try to drain blood in a “stabbing motion” from the man’s heart, using a hard needle some 50 times. The man died that night after Patel told the man’s family he was not critically ill.
Another case Hoffman gave evidence on involved a woman who had suffered a serious head injury. She said Patel ordered her life support ventilator turned off five days before Christmas, 2004, because he wanted to use her bed for surgery.
She said no formal tests were performed to determine whether the patient was already brain dead, although another nurse said the woman was "most probably brain dead." The other patient operated on by Patel bled to death after his jugular was cut.
Hoffman said death certificates were falsified and patients were refused transfers to other hospitals to cover up botched treatment and surgery, adding Patel was also known as "Dr. E coli," referring to the high number of his patients with infections.
“What was going on was totally and utterly illegal,” she said.
The inquiry continues.
The Associated Press and Reuters contributed to this report