A review into the clinical services at Queensland’s Bundaberg Hospital triggered by the deaths and injuries attributed to Jayant Patel (BMJ 2005;330:1468) has recommended sweeping procedural changes at the hospital and at Queensland Health, the responsible government department.
Dr Patel operated on about 1000 patients while he was at the hospital between April 2003 and April 2005. The department had informed the commission of inquiry into Patel’s service, headed by Tony Norris QC, that 88 of Dr Patel’s patients had died.
A clinical case review by Peter Woodruff, an associate professor, found that Dr Patel contributed to the deaths of eight of 221 cases reviewed and that "he may have exhibited an unacceptable level of care in another eight patients who died."
"In the comfortable majority of cases examined, Dr Patel’s outcomes were acceptable, and in some instances he retrieved patients from dangerous situations caused by other practitioners prior to his involvement in the patient’s management," he concluded. Despite this he found that "Dr Patel lacked many of the attributes of a competent surgeon."
The review also found major procedural problems in both the hospital and department. The review found that at the hospital "there was no clear and consistent link with the complaints management process and incident reporting."
"There was little evidence of hospital wide mortality audit and departmental clinical audits were variable particularly in general surgery," it said.
The review found that in eight instances an investigation into Dr Patel’s credentials or performance could have been triggered. However, he continued in his position until complaints by a nurse were raised in parliament. The review found that contributing factors to the lack of action earlier were "severe medical workforce shortages," a focus on financial management, and a lack of any "objective mechanism for monitoring the ongoing technical ability of a medical practitioner."
The report was also critical of "a medical culture of tolerating problems rather than addressing them." It said, "Several doctors withdrew, some did nothing, others hid patients or arranged alternative surgical support rather than providing clinical leadership to address the problem together with their nursing colleagues."
The report made 41 recommendations, including a comprehensive process for recruitment and training of doctors who are trained overseas and a performance review system for clinical staff. Queensland’s premier, Peter Beattie, has directed the department to implement the recommendations as a matter of priority.
A spokeswoman for the Queensland police said that Dr Woodruff’s report, along with additional information, will be assessed as part of its investigation into what charges, if any, will be laid against Dr Patel. This week Queensland detectives will visit the United States, where Dr Patel fled to in April, as part of their inquiries. Review of Clinical Services Bundaberg Base Hospital: Confidential Review Report is available at www.bhci.qld.gov.au/pdf/BHCI_Exhibit102.pdf