The late great Coach John McKay was once conducting a postgame postmortem after a dismal performance by his Tampa Bay Buccaneers. Legendary sportswriter Hubert Mizell of the St. Petersburg Times called out a question: “Coach, would you care to comment about your team’s execution?” McKay never missed a beat: “Yes. I’m all for it.” Generally, though, we do not advocate the death penalty for underperforming employees. But what about doctors, whose lack of execution actually causes the execution of others?
When we entrust our bodies to practitioners of the physician’s craft, we imagine that the life-and-death struggle features the doctor wearing the white hat over his white coat, battling to wrest us from the dread grasp of disease. This is the governing paradigm of our role as patient; it tends to override our sales resistance as consumers of a service and our leeriness at allowing fingers and metallic implements to poke and prod in private areas. The last thing on our mind is the notion that the gravest danger to our health might be posed by this poised professional.
The story of Dr. Jayant Patel serves as a grim cautionary tale. The entire country of Australia is glued to the proceedings of a special commission of inquiry investigating the horror of this man’s tenure as chief of surgery at Bundaberg Hospital in Queensland. He is being blamed for as many as 87 deaths in his two-year tenure, 2003 and 2004. A macabre trail of infected and maltreated patients has earned for him the monicker of Doctor Death. This is no deluded Kevorkianesque mercy-killer, nor even a Mengele clone practicing sadism; it is simply buffoonery become butchery.
Someone gave this guy a diploma that he did not deserve. That original mistake begat countless others. Perhaps he was good at retaining information and scored well on written exams. Apparently he has a confident, charismatic manner that both interviewers and patients find appealing. But the skill was never there: “the voice is the voice of Jacob but the hands are the hands of Esau.”
In 1984 the New York State Medical Board for Professional Conduct fined him, but he still was recertified. He moved to Oregon and worked for Kaiser-Permanente in Portland, until they fired him in 1998 and filed an “adverse action” report in the National Practitioners Data Bank. The figures were never officially released, but it is believed that Kaiser blamed him for forty or more mishandled cases. In 2000 Oregon stripped his license to practice and New York followed suit in 2001. Yet his Portland employers wrote a strong letter of recommendation to support his application for the position in Australia.
How does something like this happen? How is incompetence perpetrated and then perpetuated in this way?
My friend Dr. Victor Schmelczer, one of the great heart surgeons of our time, explained to me how this transpires. He was in a surgery unit in a midsize hospital that hired a Chief of Surgery who came highly recommended from a smaller hospital. As soon as he was hired and began operating, all the capable surgeons realized that he was a butcher. They began trailing and tracking him, trying to stop him from cutting where possible, running to clean up the mess afterward when he did operate. In one case, the staff begged him not to make the incision for a tracheotomy too low on the neck; he sneered at them and did it his way. Sure enough, the man immediately began strangling on his own phlegm after the surgery, and they were lucky to repair it in time.
The administrators put their heads together and decided that it would be too difficult to try to build a case for firing this man. It would require extensive hearings with doctors being forced to testify against their superior; if they did not succeed in bringing him down, he could make their lives miserable afterwards. Additionally, the bias in any hearing would favor the credentialed Chief over the resident surgeons. Their solution: giving him a glowing reference to help him get a higher-paying job in a still bigger hospital. As Victor put it, they “fired him upwards.” Presumably, Patel benefited from a similar pattern, upwards to “down under.”
It’s time for greater courage among individuals and institutions to stand up to killers like this and protect innocent citizens. The old joke goes: “What do you call the person who scores last in his class in Medical School?” “I don’t know. What?” “Doctor.” Well, it ain’t funny. It’s time to call those guys “Mister.” And in the case of a man like this who persists in his labors despite havoc piling up all around, we should call him by the special name that he has richly earned: “Convict.”