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Dr Patel and the need for a Royal Commission into medical administration

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Dr Jayant Patel

After the recent acquittal of Dr Jayant Patel from medical negligence charges, it may be that only a Royal Commission can get to the bottom of what ails medical administration in Queensland and nationally, writes Dr Leong Ng.

“Crime is to be expected since humans are never perfect but the failure of justice may be more damaging to society than crime itself.”

~ Clarence Darrow

Autocracy, Bullying and Lawless Medical Maladministration (Part 2)

[Read Part One.]

Recently, for the Patel case, the QLD DPP announced the dropping of the charges for medical negligence. But a twist of events occurred almost immediately before that — Patel pleaded guilty to 4 counts of fraud whilst registering himself as a medical practitioner in QLD.

This part of the discussion is not about the fraud which Patel pleaded guilty to, but rather about plea-bargaining.

One will never know whether plea-bargaining had taken place within the convoluted and dysfunctional system, but I suspect that it had been so for 10 reasons.

  1. The timing of the pleading was sudden and not earlier.
  2. Dr Patel had been already falsely imprisoned for 2.5 years and psychologically falsely imprisoned for even longer (for criminal negligence).
  3. The previous Queensland premier, Peter Beattie, had a generous elaborate pay off scheme for ‘victims’ of Dr Patel whilst refusing to admit or deny liability. (It had been reported that Queensland Health (QH) had ignored concerns about Dr Patel for over 2 years.)
  4. All the time, the Queensland Medical Board (QMB) has/had never investigated Dr Patel’s professional or performance issues despite knowing that the registration may have been fraudulent. Only now, long after the event, AHPRA initiates what which may appear to be “protecting the public”  or more propaganda.
  5. As Patel’s appointment was an Area of Need one, the Royal Australasian College of Surgeons would have been involved — should they now be included in the due diligence accountability line with QH and QMB despite their being a registered company?
  6. Dr Patel was employed by QH on a non-immigrant visa in an Area of Need position. This allowed him, as a Specialist Medical Practitioner to access full Medicare Benefits (i.e. outside s19AB of the Health Insurance Act 1973 (Cth). In the case of the Queensland Health business model, 100% of the Staff Specialist and Senior Medical Officer claims would have been assigned to the employer (i.e. QH) for all daily procedures performed — a well-known practice Queensland-wide. It is technically called double-dipping — unless there is an exemption given by a COAG Health Ministers’ Council Agreement. If this is true, in the case of Dr Patel, it was a crime against the taxpayer and the Commonwealth, allegedly perpetrated and orchestrated by the state, using Dr Patel as the instrument (the “cash cow”). This also happens in NSW Health if a Staff Specialist is a Level 1 appointee. Equally beneficial to QH, performing complex and high-risk procedures in a willing hospital, leads to separate incentive grants from the Commonwealth Government — never mind the risk to the patient.
  7. The difference between an Overseas Trained Doctor (on a sponsored visa) applying for a Medicare Provider Number and that of a permanent resident/citizen doctor doing the same is that details of the business model agreement are private and unavailable to Medicare. This is not so for a non-immigrant visa holder’s applications for provider numbers (usually finalised in hospital manager’s office where fraud and error may occur).
  8. Recently, the Queensland Audit Office had recommended ‘recovery’ of overpaid monies related to rights of private practice from various parties — suggesting that something is not quite regular in the system.
  9. There continues to be controversy with attempts to cleanse the system and Fair Work Australia and the AMA negotiation of the new QH Visiting Medical Officer Specialists and Senior Medical Officers Award Agreements – not being fully accepted by all – as there will not be any more double dipping and thus, higher personal incomes for non VMO doctors.
  10. Mr Ken Fleming, QC, Dr Patel’s Barrister (and, independently, retired U.S. surgeon, Dr V Mehta) was quite confident stating publicly that ‘he will be home soon’ on the day the charges were dropped. Dr Patel’s airfare was also borne by the QLD Government.

Additionally, and of curious interest, Thomas Hedley, the prize-winning journalist who ‘uncovered’ the Patel saga discreetly left the profession in 2008 to move into a public relations role. The brightest voluntarily leave a sinking ship earliest.

However, whistle-blower Toni Hoffman (rightly or wrongly ‘decorated’ but still compensated and not part of the QH machinery), continues to “express disappointment” — but chooses not to ask the fundamental question whether she had a serious personality conflict with Dr Patel and whether she had used the dysfunction she knew about to “dob him in”.

If plea-bargaining had taken place, it smells of concealment.

In Australian law – both State and Commonwealth, concealment is improper and may be called non, mis or even malfeasance – all individually corrupt acts.

Plea-bargaining, whilst rampant in the USA, is neither unlawful nor lawful in Australia. An Australian contemporaneous expert opinion on criminal cases takes the view it should be refined – in order that matters of public interest should not continue and deplete resources and harm the general populace – e.g. the ‘victims’ of Dr Patel.

Given the situation, one must realise that Patel’s false physical imprisonment (for criminal negligence) of over two years (with false psychological imprisonment for nearly a decade) may be traded for a spent (or suspended) -sentence for any guilty plea. If this is so, it confirms the Queensland Government’s emboldened attempts in eroding judicial independence.

Time may reveal the truth, but we believe that the public must insist – as a matter of public interest – on the truth. The focus must not be on Patel’s “victims” but, rather, that of the system’s. Or would they be concealed, like another matter in another jurisdiction?

Could the Patel saga be a major surrogate marker of chronic serious illness with wider nationwide Medical Board maladministration? I believe so.

The objective evidence is set out below. However, as always, there is the possibility of flaw(s) caused by fraud, error and/or incompetence.

Two Australian Parliamentary Inquiries took place in 2010.

Both have opened a Pandora's box, with the Lower House Inquiry still awaiting a government response nearly 20 months after the Report — aptly named “Lost in the Labyrinth” .

The Australian Senate Inquiry appears, in my view, to be hurried and perfunctory.

The first was triggered not by the Patel debacle but the less known Dr Chatoor case in Cairns. It also revealed and further enhanced chronic and massive fallout in the way many overseas trained doctors have been mistreated for years.

The second arose out of dissatisfaction with the National Agency’s general performance on the whole.

The 2008 Garling Inquiry in NSW is no different — being sidelined and concealed. A key finding was a widespread and entrenched bullying culture. The only clear outcome was Mr Garling’s elevation to the bench.
A similar 1998 NSW government commissioned inquiry by Mr S Kerkyasharian, AO – and privately published The Race to Qualify ‒ is not easily available reading material. Bullying was also featured.
Essentially these scathing reports have all been ignored. These inquiries all lacked scope in dealing with the heart of the matter.

NSW claims progress whilst implicitly denying all their serious errors and Machiavellian atrocities of the past and continuing into the present, with its continuing propaganda slogan of “protecting the public”. 

It is of serious public concern that the NSW Medical Board (AHPRA) and NSW Medical Council are the caretakers of the functions of the disbanded Queensland Medical Board during its transition period to an equally concerning Health Ombudsman.

A possible solution?

The matters include, in my opinion, the over-politicisation of the administration of medical practice in Australia.

This continues to be revealing and of concern with alleged corrupt practices being surreptitiously discovered. The present system allows private and privatised entities to influence important public policy without or with minimal serious consultation — principally because representatives from private entities hold conflicts of interest in public policy machinery. Legislation has been hurried through QLD Parliament with widespread public dissent.

For medical administration, this may mean that private enterprise — for example, the private Australian Medical Colleges can continue to easily interfere with statutory functions of medical boards and other aspects of medical practice regulation (i.e. bullying). This also means that Government entities that may be privatised offer greater opportunities to be allegedly corrupt e.g. Queensland Health.

It may be that only a Royal Commission will be able to fully and comprehensively probe these diverse issues in the public interest and to urgently recommend reforms.

But, in the meantime, must we (both the public and some doctors) continue to suffer patiently? Now all eyes on the Springborg reforms in Queensland, more currently, the PCMC, and last, but not necessarily a total closure, the Patel debacle.

The truth must prevail – in the public interest – and for now, Tony Fitzgerald gets the last say.

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