Queensland Judgments
Authorised Reports & Unreported Judgments
  • sclq logo
  1. Caselaw
  2. QCAT
  3. 2015
  4. Medical Board of Australia v Patel - [2015] QCAT 133

Authorised Reports & Unreported Judgments
Exit Distraction Free Reading Mode
  • Unreported Judgment

Medical Board of Australia v Patel[2015] QCAT 133

Medical Board of Australia v Patel[2015] QCAT 133

CITATION:

Medical Board of Australia v Patel [2015] QCAT 133

PARTIES:

Medical Board of Australia

(Applicant)

 

v

 

Jayant Mukundray Patel

(Respondent)

APPLICATION NUMBER:

HPF001-05

MATTER TYPE:

Occupational regulation matters

HEARING DATE:

11 May 2015

HEARD AT:

Brisbane

DECISION OF:

His Honour Judge Horneman-Wren SC, Deputy President

Assisted by

Dr Diana Khursandi

Dr Brian Kable

Mr David McKenzie 

DELIVERED ON:

15 May 2015

DELIVERED AT:

Brisbane

ORDERS MADE:

  1. Pursuant to s 243(2)(vi) of the Health Practitioners (Disciplinary Proceedings) Act 1999 the Tribunal indicates that if Dr Jayant Mukundray Patel were currently registered the Tribunal would have cancelled his registration.
  2. Dr Jayant Mukundray Patel must never be registered as a registered health practitioner in the medical health profession.
  3. Dr Jayant Mukundray Patel is to pay the costs of the Medical Board of Australia, including any costs of the former Medical Board of Queensland, of and incidental to the proceedings as assessed on a standard basis for matters in the District Court of Queensland.

Health Practitioner (Disciplinary Proceedings) Act 1999 (Qld), s 233, s 241, s 243, s 244

Criminal Code (Qld), s 408C(1)(d)

Medical Board of Australia v Bham [2006] WASAT 190.

Medical Board of Australia v Putha [2014] QCAT 159.

Nursing Midwifery Board of Australia v Clydesdale [2013] QCAT 191.

Patel v General Medical Council [2003] UKPC 16.

CATCHWORDS:

HEALTH CARE PROFESSIONALS – MEDICAL PRACTITIONERS – DISCIPLINARY PROCEEDINGS – PROFESSIONAL MISCONDUCT AND UNPROFESSIONAL CONDUCT – CONVICTION OF OFFENCE – where registrant applied for special registration in an area of need – where the registrant dishonestly caused false and misleading information to be given to a registration board to obtain special registration – where registrant had previously had conditions imposed on his registration by a foreign Board that were undisclosed – where the registrant was convicted on criminal charges of fraud due to the misleading application for special registration – where the registrant performed surgical procedures contrary to restrictions imposed by a foreign board and thereby exposed patients to an inappropriate level of risk – whether the Tribunal would have cancelled the registrant’s registration if he were currently registered –whether permanent preclusion appropriate – where relevant earlier decision of a foreign disciplinary body – where earlier decision and penalties have not acted as a deterrent – where permanent preclusion is appropriate

APPEARANCES and REPRESENTATION (if any):

APPLICANT:

Dr Ian Freckelton QC and Mr Chris Wilson i/b Lander and Rogers Lawyers

RESPONDENT:

No appearance

REASONS FOR DECISION

  1. [1]
    The Medical Board of Australia (Board) has brought disciplinary proceedings against Dr Patel on 9 grounds arising under section 124 of the Health Practitioners (Disciplinary Proceedings) Act 1999 (Qld). Dr Patel had not participated in the proceedings. He no longer resides in Australia, but all material relevant to these proceedings has been served upon him in the United States of America.
  2. [2]
    The first 4 grounds relate to allegedly false and misleading material being provided to the former Medical Board of Queensland (Former Board) by Dr Patel in his application for special registration and his subsequent application for renewal of that registration.
  3. [3]
    It is alleged that he dishonestly answered questions on his registration application and dishonestly caused the Board to be given an incomplete document in support of his initial application for registration. The Board further alleges that he obtained and maintained his registration by this fraudulent dishonest conduct.
  4. [4]
    The Board alleges that Dr Patel’s conduct in this regard constituted unsatisfactory professional conduct as defined by the Disciplinary Proceedings Act in that it was misconduct in a professional respect; conduct discreditable to his profession; fraudulent and dishonest behaviour in the practice of his profession; or other improper or unethical conduct.
  5. [5]
    The remaining 5 grounds relate to medical procedures Dr Patel performed upon patients.
  6. [6]
    In respect of 4 patients, it is alleged that the decision to perform the procedure, and the manner in which it was performed, involved a clinically inappropriate increased level of risk to the patient of which Dr Patel, knew or ought to have known, because of conditions imposed upon him in another jurisdiction in which he practiced, (the United States).
  7. [7]
    In respect of each of those 4 patients it is alleged that Dr Patel’s conduct constituted unsatisfactory professional conduct in that it was professional conduct of a lesser standard than that which might reasonably be expected by the public or his professional peers; professional conduct that demonstrates incompetence, or lack of adequate knowledge, skill, judgment or care in the practice of his profession; misconduct in a professional respect; and/or other improper or unethical conduct.
  8. [8]
    In respect of the fifth patient the Board alleges that Dr Patel’s performance of an inappropriate procedure and his incorrect diagnosis and failure to undertake a preoperative procedure constituted unsatisfactory professional conduct, because it was of a lesser standard than that which might reasonably be expected by the public and his professional peers, and demonstrated incompetence or lack of adequate knowledge, skill, judgment or care in the practice of his profession.

Doctor Patel’s former Registration in the United States of America

  1. [9]
    Dr Patel was formerly, before his registration in Australia, a licensed physician in the United States of America. He held licenses in both the States of Oregon and New York.
  2. [10]
    By an order by the State of Oregon’s Board of Medical Examiners (Oregon Board), of 7 September 2000, disciplinary action was taken against Dr Patel for violations of that jurisdiction’s ‘Medical Practice Act.’
  3. [11]
    The grounds for action were based upon that Act’s definition of;

Unprofessional or dishonourable conduct; and

Gross or repeated acts of negligence in the practice of medicine.

  1. [12]
    The Oregon Board had conducted an investigation after Kaiser Permanente Northwest had restricted Dr Patel’s surgical practice to exclude certain surgeries. That action had followed an extensive peer review of 79 patient charts. Dr Patel admitted to the Oregon Board that he had made surgical errors. He had been questioned by the Oregon Board about the peer reviewed cases, particularly 4 of them. It is noted in this Order that Dr Patel admitted to unprofessional conduct and agreed to the conditions. The conditions were amended by an Order of 1 November 2000.
  2. [13]
    The conditions, as amended, and as agreed to by the Oregon Board and Dr Patel, were as follows:

4.1 Licensee’s scope of practice will exclude surgeries involving the pancreas, any resections of the liver, and any construction of ileoanal pouches.

4.2 Licensee will obtain a second opinion preoperatively on complicated surgical cases from a surgeon who has a full, unrestricted license in Oregon and is board certified, fully credentialed and privileged at the institution where Licensee will care for the patient. This second opinion will be documented in the patient charts. 

4.3 Upon demand, Licensee will make available a list of patients upon whom he has performed surgery to the Board’s Compliance Officer. Licensee will also provide patient charts from this list for inspection.[1]  

  1. [14]
    ‘Complicated surgical issues’ were defined as:

Major Surgeries are defined as:

  • Abdominal-parineal resection, esophageal surgeries, and gastric surgeries.
  • Soft Tissue malignancies.

High risk patients with:

  • Severe co-morbidities, including uncompensated heart failure, severe chronic obstructive pulmonary disease, and renal failure, or
  • Classification of 4 or 5 in accordance with the American Society of Anesthesiologists.

Post-operative Patients with:

  • More than two-days stay in Intensive Care Unit, or
  • More than eight-days stay in the hospital, or
  • Onset of clinical deterioration[2]
  1. [15]
    On 5 April 2001, the New York State Board for Professional Medical Conduct (New York Board) issued an order, to which Dr Patel consented, requiring Dr Patel to surrender his licence as a physician in the State of New York. This action was taken by the New York Board as a result of the findings made by the Oregon Board, as outlined above.

Dr Patel’s Registration and Employment in Australia

  1. [16]
    Bundaberg Base Hospital engaged Wavelength Consulting Pty Ltd, a medical recruitment firm, to assist them fill a vacant position for a Surgeon. Wavelength notified potential candidates of this position via their database. Dr Patel contacted Wavelength informing them of his interest in working in Australia in this advertised position.[3]
  2. [17]
    Wavelength facilitated communications between the Hospital and Dr Patel and was subsequently made aware that the Hospital wished to hire Dr Patel. Wavelength then began the process of facilitating this employment.[4]
  3. [18]
    John Hugh Bethell, Director of Wavelength, states in his affidavit that upon receiving Dr Patel’s CV he was concerned as to Dr Patel not having worked since September 2001. Mr Bethell was informed by Dr Patel that this was due to him considering early retirement and wanting to work overseas.
  4. [19]
    Dr Patel sent Wavelength the material relevant to supporting his application as required by the Former Board. This material was then forwarded by Wavelength to the Former Board.
  5. [20]
    Included in these documents was a document purporting to be Dr Patel’s Oregon Verification of Licensure. A copy was faxed to Wavelength by Dr Patel which was subsequently followed by the original. Mr Bethell notes that neither were sent with any attachment, which I will come back to in due course. Mr Bethell did not notice this omission at the time.
  6. [21]
    The Former Board received Dr Patel’s original application for Special Purpose Registration to fill an area of need, as submitted by Wavelength. Queensland Health endorsed Dr Patel’s application as it was submitted.
  7. [22]
    On 11 February 2003 the Former Board approved Dr Patel’s application and on 1 April 2003 Dr Patel was granted Special Purpose Registration.[5]
  8. [23]
    In December 2003 Dr Patel applied for renewal of his registration, by then, as Director of Surgery at the Bundaberg Base Hospital. The application was approved for the period of 1 April 2004 to 31 March 2005.[6]

Dr Patel’s Misleading and Dishonest Application Information – Grounds 1 to 4

  1. [24]
    Dr Patel, in the process of applying for registration as a medical practitioner in Queensland, was required to answer a number of questions and provide numerous supporting documents.
  2. [25]
    In the application for registration, under the heading ‘Fitness to Practice’, were seven questions which Dr Patel was required to answer.
  3. [26]
    To a question asked of Dr Patel as to whether he had ever been registered in another country which registration had been “affected either by an undertaking, the imposition of a condition, suspension or cancellation’; Dr Patel responded with the answer ‘No’.[7]
  4. [27]
    To a question asked of Dr Patel as to whether his registration as a health practitioner had ever been, or was currently, cancelled or suspended as a result of disciplinary action in any State, Territory or other country; Dr Patel again responded with the answer ‘No’.[8]
  5. [28]
    With regard to the supporting material supplied by Dr Patel, inclusion was made of the document purporting to be a Verification of Licensure from the Medical Board Examiners of the State of Oregon.[9] Next to the heading ‘Standing’ there is a note, ‘Public Order on File See Attached’. As noted by Mr Bethell, when this document was provided by Dr Patel (twice), no attachment was received. Mr Michael Demy-Geroe, in investigating Dr Patel’s approval for special purpose registration in 2005, also noted in his subsequent report that there was no attachment.[10] However, the omission of the attachment was not noticed at the time at which it was received and considered.
  6. [29]
    Dr Erica Mary Cohn, then Deputy Chairperson of the Former Board at the time of Dr Patel’s registration,[11] in an affidavit outlines the Registration Advisory Committee’s response in the circumstances had the attachment been included;

If Patel had ticked ‘yes’ in response to the questions [mentioned above] about whether he had had any action taken against his registration in another country, the former Board would have made a different decision.

I believe the RAC would have recommended the former Board not grant Patel’s application as it related to a position of Senior Medical Officer, Surgery, at the Bundaberg Base Hospital which requires a level of surgical skill and ability to work unsupervised. The action taken against Patel and the conditions imposed by the registration boards in the United States Supported the former Board finding they could not be satisfied of Patel’s skill and experience to work independently in such a role.

For this reason, I believe the former Board would have refused Patel’s application for special purpose registration linked to the area of need as Senior Medical Officer, Surgery given the restrictions imposed upon his registration in connection with surgical skills in the United States.[12]

  1. [30]
    Mr O'Dempsey’s report outlines his view that the attachment to the Verification of Licensure was purposely removed and withheld by Dr Patel when he gave the relevant document to Wavelength to then forward onto the Board. He further notes;

It is undeniable however that had a thorough check been made of the verification of licensure document, and the notation queried, Dr Patel’s registration is unlikely to have been approved, at least, in an unsupervised setting.[13]                         

  1. [31]
    The evidence suggests that the reason Dr Patel’s failure to provide the attachment to the Verification of Licensure was not appreciated and further investigated by any of the relevant bodies related to his registration, was in part a result of differences in Oregon’s certificate to those of other Jurisdictions, as this document is supplied instead of a usual ‘Certificate of Good Standing’. It is explained by Mr O'Dempsey’s report that the usual ‘Certificates of Good Standing’ are “a traditional assurance tool used by registration authorities to assist in considering the fitness to practice of an applicant for registration”.[14] He states that the notation ‘Public Order on file –see attached’ would not be as conspicuous to a processing officer as the lack of a certificate of good standing would be. He views this in combination with workload pressures of registration staff at the material time and provides this information as further explanation towards the approval of Dr Patel’s registration. It is also to be noted that, on its face, the Verification of Licensure also has an entry: “Limitations: None”. However, Mr O'Dempsey notes, consistently throughout his report, that such oversights and lack of further investigation as to why there was no attachment were ‘inexcusable.’[15]

Related Criminal Proceedings against Dr Patel

  1. [32]
    In the District Court of Queensland on 15 November 2013, Dr Patel pleaded guilty to 4 counts of fraud and was sentenced by his Honour Judge Martin SC on 21 November 2013.
  2. [33]
    Each of the 4 counts arose under section 408C(1)(d) of the Criminal Code. In each instance, the crime was that Dr Patel dishonestly gained a benefit or advantage. The factual grounds giving rise to these criminal charges were that Dr Patel fraudulently gained registration in Queensland as a medical practitioner, which fraud was replicated 12 months later to continue his registration for another 12 months.
  3. [34]
    The convictions have been proven in these proceedings.[16] That is proof that Dr Patel committed the acts and possessed the state of mind that at law constitutes the offence Dr Patel’s dishonesty is established.
  4. [35]
    In sentencing Dr Patel upon the 4 counts of fraud, Judge Martin SC  remarked:

To gain registration and employment in Queensland, your deceit was substantial. You falsely answered the Medical Board’s questionnaire to conceal your licence restrictions and cancellation in the United States. You deceitfully crafted your CV to avoid such disclosures. You also dishonestly altered your CV to assert that you ceased medical employment in the States in September 2002, when, in fact, you had not been engaged in medical practice since February 2001.

Further, upon being asked on behalf of the Medical Board of Queensland to provide a Certificate of Good Standing from the Oregon Board of Medical Examiners, you produced a document which was a Verification of Licensure. However, the document provided to you by the Board, naturally enough, came with an attachment setting out your licence restrictions. You bastardised the document so that the attachment was not produced.[17]

  1. [36]
    His Honour further said:

The replication of offending is significant. There was a second episode of blatant fraud. It enabled you to continue in employment to which you were not entitled.

In my view, the seriousness of this offending cannot be overemphasised. The restrictions on your licence in the United States bespeak serious deficiency in your competence as a surgeon. Yet you deliberately sought the position as head surgeon at Bundaberg and calculatedly deceived your way into that position.[18]

  1. [37]
    The Tribunal may adopt, as it considered appropriate, decisions, findings or reasons for judgment of another court that may be relevant to this hearing.[19] His Honour’s findings and reasons are relevant. With respect, I adopt them.
  2. [38]
    Grounds 1 to 4 are clearly made out.
  3. [39]
    In Nursing Midwifery Board of Australia v Clydesdale[20] the Tribunal examined the meaning of the expressions “misconduct in a professional sense” and “conduct discreditable to the registrant’s profession” as used in the definition of unsatisfactory professional conduct in section 125 of the Disciplinary Proceedings Act. The Tribunal need not here repeat what was said in Clydesdale.
  4. [40]
    Dr Patel’s conduct was a clear and serious breach of the rules of the profession which would rightly incur the strong reprobation of his professional colleagues. He gained his very entry into the profession by dishonest and fraudulent means. His dishonesty and fraud was intended to conceal matters which went to his fitness and suitability for registration in the profession.

Dr Patel’s Medical Incompetence – Grounds 5 to 9

Expert Evidence of Dr Phillip Truskett

  1. [41]
    The expert evidence in these proceedings, upon which the Board relies, is, primarily, by way of a series of reports, produced by Dr Philip G Truskett AM, in July 2014.
  2. [42]
    Dr Truskett is a Senior General Surgeon at the Prince of Wales Hospital, having worked there for over 30 years. He is a foundation member of the ANZ Hepatobiliary Surgical Association and the ANZ Gastro Oesohagel Surgical Association. Dr Truskett is also a Senior Lecturer of the Conjoint School of Surgery at the University of New South Wales.
  3. [43]
    Dr Truskett’s reports relate to Dr Patel’s treatment of the five patients identified in the referral. Dr Truskett has produced these reports by review of each of the patient’s medical records.

Independent Evidence of Dr John Rodney Allsop

  1. [44]
    Further to Dr Truskett’s reports, independent opinion has also been expressed by Dr John Rodney Allsop in relation to the medical treatment of Patient JP and Patient GK.
  2. [45]
    Dr Allsop was, at the relevant time, employed as consultant to the Medical Defence Association of Victoria. His professional history includes his employment as Surgeon to the Burns Service, Assistant Surgeon and Senior Consultant at the Royal Melbourne Hospital. Dr Allsop’s medical career further includes lecturing in Surgery at Oxford University and being a Clinical Research Fellow in Surgery at Harvard Medical School.
  3. [46]
    These experts are well qualified to express opinions in respect of the medical cases.

Surgical Procedure upon Patient JP

  1. [47]
    The Board contends Dr Patel performed an oesophagectomy Patient JP, on or about 19 May 2003, in circumstances where Patient JP was a high risk patient with severe co-morbidities. The Board further contends that Dr Patel; performed this procedure without obtaining a second opinion from a surgeon prior to its performance; in circumstances where the patient should have been referred to specialist  oesophagectomy unit; should not have adopted transhiatal approach in performing the procedure; and did not administer adequate post-operative treatment.
  2. [48]
    The Board alleges that, given the Oregon restrictions, to which he had consented, and Patient JP’s high risk status, in deciding to perform and in performing this particular procedure upon Patient JP, which is a procedure which came within the Oregon restriction’s definition of “complicated surgical cases”, Dr Patel knew, or ought to have known, that his actions involved a clinically inappropriate increased level of risk to the patient because of his lack of competence identified in the Oregon restrictions.

The Oesophagectomy performed upon Patient JP

  1. [49]
    Patient JP is described as having a ‘complex history’,[21] having had chronic renal failure and being on haemodialysis for his condition. It is apparent Patient JP had a long standing difficulty with vascular access.[22]
  2. [50]
    A CT scan performed on Patient JP’s chest and abdomen demonstrated “slightly enlarged lymph nodes to the right lower oesophagus, but no other abnormality.”[23]
  3. [51]
    Dr Patel saw Patient JP in Surgical Outpatients. Dr Truskett observes the assessment note was only partly legible but that it was, “apparent Dr Patel recommended an oesophagectomey by transhiatal approach.”[24]
  4. [52]
    Patient JP was admitted to Bundaberg Base Hospital on 19 May 2003 to be operated on by Dr Patel, assisted by Dr Igras.
  5. [53]
    On Dr Truskett’s review of the operation and post operation he notes that a total of 7 units of blood were transferred to the patient, 4 of those units were intraoperative.
  6. [54]
    Patient JP died on 21 May 2003. The cause of death states as hyerkalaemia, due to renal failure.

Findings and Conclusions made upon the Oesophagectomey performed on Patient JP 

  1. [55]
    Dr Truskett expressed the view that Patient JP suffered from a T1-lesion. He states that the management of Patient JP was ‘predictably very complex’ due to his chronic renal failure requiring haemodialysis and first degree heart block.[25]
  2. [56]
    Dr Truskett believed it “appropriate to proceed with surgery” however he questioned the Bundaberg Hospital’s ability to cope with a complex patient such as Patient JP.[26]
  3. [57]
    Dr Truskett believed the T1-lesion to be curable but, due to his extraordinarily complex co-morbidities, Patient JP’s case would have been “best managed in a dedicated high volume unit, such as Princess Alexandra hospital or another specialised Oesophagectomy Unit.”[27]  He notes that although surgery did need to be done in a timely fashion there was no clinical emergency requiring surgery to be done at the Bundaberg Base hospital.[28]
  4. [58]
    Dr Truskett’s assessment of Dr Patel’s involvement in the treatment of this patient resulted in his opinion that;

It is clear that Dr Patel did review the patient frequently. He demonstrated lack of insight in his perioperative plan.

There may be lack of operative technique, based on his lack of lymph nodes in dissection.[29]

         And:

Although this patient posed considerable management issues, in an appropriate environment in a high volume unit with experience in intensive care, this procedure should have been survivable.[30]

  1. [59]
    Dr Truskett noted that the tumour was clearly at the cardio oesophageal junction in a young patient. He opined: “the ability to perform this procedure with a transhiatal anastomosis is quite remote. This demonstrated lack of insight.”[31]
  2. [60]
    Dr Allsop’s opinion, with regard to Patient JP, was that “this operation should be restricted to tertiary institutions and only performed by surgeons with committed special interest in oesophageal surgery.”[32]
  3. [61]
    More specifically, in regard to the choice of procedure itself, Dr Allsop was of the opinion that “very few surgeons would have regarded Patient JP as a candidate for gastro-oesophagectomy.”[33] He went on to outline alternative treatment options to the procedure taken that would, in his opinion, have been less invasive options. Other options included, chemotherapy, radiotherapy, photodynamic therapy, endoscopic laser therapy and endoscopic diathermy electro coagulation. Options that he believed needed to be ‘seriously considered’.[34] Dr Allsop does note that failure to perform an oesophago-gastrectomy at the outset may reduce chances of an indefinite cure but he qualifies this in saying that this must be viewed “in the context of overall 5 year survival rates of 5%-30% with radical surgery”.[35]
  4. [62]
    As to the appropriateness of undertaking the procedure at the Bundaberg Base Hospital, Dr Allsop was of the view that a “Full level 3 ICU backup” was essential; which he observes the Bundaberg Base Hospital does not have.[36]
  5. [63]
    When assessing what the patient’s likely outcome and prognosis would have been had Patient JP undergone the oesophagectomy at a tertiary hospital, Dr Allsop states:

In a tertiary hospital the patient had a good prospect of having his disease more accurately staged. I would expect that after a full medical work up there would have been a round table conference between various specialists (surgeon, oncologist, radiotherapist, renal physician, cardiologist, anaesthetist and intensive care physician). I think it is likely that a gastro-oesophagectomy would have been ruled out as a visible treatment option for this man. If radical surgery were advised by the tertiary institution then I would have expected the procedure to have been performed with much more expertise than displayed by Dr Patel. The patient may have been able to survive an extremely carefully performed gastro-oesophagectomy with level 3 ICU backup.[37]

  1. [64]
    This ground is established. Dr Patel’s competence to perform complex surgeries had been found to be lacking. As a result his practice in Oregon had been restricted to prevent him from performing complex surgery. He knew this. He had agreed to it. He also knew that a professional regulatory body had also deemed it necessary that he obtain second opinions in respect of all complicated surgical cases. He had agreed to this also. He can only have known that the need to obtain second opinions was to protect against potential risk to patients. The corollary is that he knew, or ought to have known, that to fail to observe those protective measures, either in the planning for or performance of surgery, would expose patients to inappropriate increased level of risk.
  2. [65]
    Any such failure by Dr Patel, given his registration history, was unsatisfactory professional conduct. His conduct was of a lesser standard than that which might reasonably be expected of him by the public or his peers. It clearly demonstrated incompetence, and lack of adequate knowledge, skill, judgment and care. It was misconduct in a professional sense. It was improper and unethical.

Surgical Procedure upon Patient AJ

  1. [66]
    The sixth ground for disciplinary action arises out of Dr Patel performing a gastric surgery upon Patient AJ, on or about 30 June 2003. The circumstances were such that Patient AJ presented with a complex surgical history and, in performing the procedure upon Patient AJ, the Board allege Dr Patel;
    1. (i)
      Failed to obtain a second opinion from a surgeon before performing the procedure;
    2. (ii)
      Should have referred the patient to a tertiary hospital for assessment and treatment.
  2. [67]
    The Board contends that, given the Oregon restrictions to which he consented, and that such a procedure fell within the Oregon restriction’s definition of “complicated surgical cases”, Dr Patel knew, or ought to have known, his decision to perform the procedure and the manner in which it was to be performed involved a clinically inappropriate increased level of risk to the patient because of his lack of competence in procedures as identified in the Oregon restrictions.

The Gastric Surgery upon Patient AJ

  1. [68]
    The medical history of Patient AJ is noted by Dr Truskett as ‘very complex’. He outlines, in his report of 23 July 2014,[38] her medical history, which included a Whipple’s procedure being performed at the Royal Brisbane Hospital, and subsequent post-operative complications resulting in a protracted time spent in that hospital’s intensive care ward.
  2. [69]
    On 18 May 2002 Patient AJ was admitted to the Bundaberg Hospital, under the care of Dr Sam Baker, with ongoing sepsis until 5 June 2002. When imaging demonstrated fluid collection under the patient’s abdominal wound, on readmission to the Bundaberg hospital on 12 September 2002, Patient AJ was transferred back to the Royal Brisbane Hospital.
  3. [70]
    Dr Truskett identifies this transferring of Patient AJ to the Royal Brisbane Hospital was an understanding by the Bundaberg surgical staff that Patient AJ’s case was complex.
  4. [71]
    On 15 December 2002 Patient AJ was again admitted to the Bundaberg Hospital due to abdominal pain. A collection in the retroperitoneum required the insertion of a pigtail catheter to drain the collection which was noted as containing infected material with pseudomonas.
  5. [72]
    Patient AJ was first seen by Dr Patel in Surgical Outpatients on 20 May 2003. On Dr Patel’s examination Patient AJ had lost weight, had a poor appetite, and appeared thin and pale. A CT scan was performed.
  6. [73]
    On review of the CT scan, Dr Patel stated the scan had demonstrated, “a 5-6cm cyst in the lesser sac posterior to the stomach.” From this review Dr Patel planned to perform a cyst gastronomy on Patient AJ.
  7. [74]
    On 30 June 2003 Patient AJ was operated on by Dr Patel, assisted by Dr Igras. She died two days after surgery. The cause of her death is uncertain.

Findings and Conclusions made upon the Cyst Gastronomy performed on Patient AJ

  1. [75]
    On the evidence of Dr Truskett, “the clinical decision to do a cyst gastronomy was not appropriate”.[39] He notes that the complexity of Patient AJ’s particular case was such that Patient AJ should have been referred to the Royal Brisbane Hospital, as had been done the past.
  2. [76]
    On Dr Truskett’s findings, drainage into the stomach was not appropriate as it would have been apparent in the circumstances Dr Patel was not dealing with a simple pseudocyst, “but was likely dealing with infection, of which drainage into the stomach would have been inappropriate.”[40] Again, this results in, “a very complex surgical situation” not to be done at the Bundaberg Hospital but in an appropriate tertiary institution. [41]
  3. [77]
    Dr Trustkett notes the decision to operate was neither urgent nor likely to improve Patient AJ’s quality of life.
  4. [78]
    This ground is established for the same reasons as identified in respect of the surgery performed on Patient JP. It seems tolerably clear that had Dr Patel sought a second opinion the course of treatment of this patient would in all likelihood have been quite different, and attendant with less risk.

Surgical Procedure upon Patient AG

  1. [79]
    The seventh ground for disciplinary action arises out of Dr Patel performing a surgical procedure, namely a Whipple’s procedure, on the Patient AG on or about 9 September 2004.
  2. [80]
    The Board alleges that Dr Patel, in performing this procedure, did so in circumstances where CT scanning showed a carcinoma of the pancreas to be inoperable and, in persisting with the resection, it should have been obvious to him intraoperatively that the resection would be incomplete.
  3. [81]
    It is the Board’s contention that, given the Oregon Restrictions to which he consented, which precluded him from performing surgery involving the pancreas, Dr Patel knew, or ought to have known, his decision to perform the procedure and the manner in which it was to be performed involved a clinically increased risk to the patient because of his lack of competence in such procedures identified in the Oregon restrictions. 

The Whipple’s Procedure performed on Patient AG

  1. [82]
    On 3 September 2004 Patient AG presented at the Bundaberg Hospital at 6:00pm and was assessed by Dr Kariyawasam. At the time of this assessment, Patient AG was 76 years of age, with right upper quadrant pain and deep jaundice. Patient AG had a recent history of pale stools and dark urine and past history of transitional resection of his prostate and right knee replacement. Upon examination Patient AG was afterbile, deeply jaundiced and had a palpable gaulbladder.
  2. [83]
    Patient AG was referred to a CT scan, to be followed up by Dr Patel in out patients.
  3. [84]
    Patient AG was seen by Dr Patel on 7 and 8 September 2004, at which times Dr Patel formulated and discussed with Patient AG a treatment plan which included him undergoing a Whipple’s pancreaticoduodenectomy. An operation performed on the pancreas.

Findings and Conclusions made upon Patient AG’s CT Scan Results

  1. [85]
    On 6 September 2004, the CT scan was performed on Patient AG, which showed;

…an irregular mass approximately 5 cm in size in the head of the pancreas. There was marked dilation of the extraphate and intrarepatic bliary tree, There was standing of the perpancreatic fat planes consistent with localised extension of the malignancy and there was displacement and encasement of the mesenteric artery and vein. There were no lier metastases.

There was also extension of tumour into the small bowel mesentery.[42]

  1. [86]
    It is Dr Truskett’s evidence that such a finding on Patient AG’s CT scan should have led to the professional conclusion that:

On this description alone this would indicate that, due to the encasement of the mesenteric vessels and extension tumour into the small bowel mesentery, this tumour was likely to be inoperable and incurable.[43]

  1. [87]
    In a clinical note of Dr Patel’s, in determining a Whipple’s procedure was required, he notes the mass in the head of the pancreas, as demonstrated by the CT scan, but states that the mesenteric vessels are free.
  2. [88]
    It was Dr Truskett’s conclusion that it was “clear from the outset this man had inoperable carcinoma of the pancreas on CT scanning.”[44]
  3. [89]
    Dr Truskett went on to opine that the appropriate medical procedural response to the CT scanning was:

This man required biliary drainage from his obstructing pancreatic head tumour. This could have been done by endoscopic means by insertion of a biliary stent.[45]

Findings and Conclusions made upon the Whipple’s Procedure Performed on Patient AG

  1. [90]
    In early September 2004 Patient AG was operated on by Dr Patel, assisted by Dr Kariyawasam.
  2. [91]
    Dr Kariyawasam, in an affidavit filed on 6 January 2015, details the procedure as follows:

[Patient AG] underwent the Whipples procedure on 9 September 2004, performed by Dr Patel. I assisted Dr Patel with the surgery. The operation commenced at 12.15pm and finished at 4.43pm. The procedure also included a cystoscopy and the insertion of a supra-pubic catheter. Dr Dieter Berens was the anaesthetist of the operation.

During the course of the operation, it became apparent that the tumour was adhering to the superior mesenteric artery and that it could not, therefore, be resected in its entirety. It is my understanding that there is always some prospect of adherence in a mass of the size of [Patient AG’s] pancreatic mass. However, it is also my understanding from my discussions with Dr Patel that he felt that the tumour was an operable tumour, capable of being completely resected.[46]

  1. [92]
    The procedure involved Dr Patel performing an R2 resection, meaning the resection was through obvious and visible tumour.
  2. [93]
    Dr Truskett is of the view that, consistent with the CT scan results, Patient AG’s inoperability should “have been noted if a trial of dissection at the time of Whipple’s procedure had been done properly.”[47]
  3. [94]
    With regard to the R2 resection, Dr Truskett noted that the division through tumour at the time of surgery was not necessary and in no way improved Patient AG’s likelihood of survival.[48]
  4. [95]
    Dr Truskett outlines the appropriate procedural response in the circumstances of this operation:

If he found himself operating on an inoperable pancreatic cancer, which can occur, he should have performed a biliary bypass and not proceeded with resection.[49]

  1. [96]
    This ground is established. This was surgery of the very kind which Dr Patel had been precluded from performing under the Oregon restrictions due to his lack of competence. To perform this surgery was to turn a blind eye to his own lack of competence identified in those restrictions, and further to demonstrate that very incompetence. It was incompetence against which the restrictions were intended to protect the public. It was also to expose this patient to an associated increased and inappropriate level of risk.
  2. [97]
    It was unsatisfactory professional conduct. His conduct was of a lesser standard than that which might reasonably be expected of him by the public or his peers. It clearly demonstrated incompetence, and lack of adequate knowledge, skill, judgment and care. It was misconduct in a professional sense. It was improper and unethical.

Surgical Procedure Performed on Patient GK

  1. [98]
    The eighth ground for disciplinary action arises out of Dr Patel, on or about 20 December 2004, performing the surgical procedure of an Ivor Lewis oesophagectomy on Patient GK.
  2. [99]
    The Board alleges this procedure was undertaken in circumstances where:
  1. (b)
    Patient GK was a high risk patient with severe co-morbidities, in that he suffered from chronic renal failure and previous aortic aneurysm repair, and possible metastatic disease in the right lung;[50]

And that, in performing the procedure, Dr Patel;

  1. (i)
    Failed to obtain a second opinion pre-operatively from a surgeon;
  2. (ii)
    Performed an incomplete resection;
  3. (iii)
    Failed to stop post-operative bleeding[51]
  1. [100]
    The Board contends that, given the Oregon Restrictions to which he had consented, Dr Patel knew, ought to have known, his decision to perform the procedure, and in the manner in which it was performed, may involve a clinically inappropriate increased level of risk to the patient because of his lack of competence in procedures subject to the Oregon restrictions.

The Ivor-Lewis oesophagectomy performed on Patient GK

  1. [101]
    In December 2004 Patient GK had an endoscopy because of dysphagia and was also suffering from gastrointestinal bleeding.
  2. [102]
    A referral letter from Dr Jennifer Crane stated Patient GK had had aortic aneurysm surgery in 2002 and progressive renal failure since 2004. Dr Truskett also notes that there may have been evidence of metastatic disease in Patient GK right lung the nature of which was never pursued.[52]
  3. [103]
    On 20 December 2004 Patient GK was operated on by Dr Patel, assisted by Dr Karamawasam. The procedure was an Ivor-Lewis oesophagectomy involving a laparotomy. The proximal resection margin was not clear of tumour and this was an incomplete resection.
  4. [104]
    On arrival at the intensive care ward bright blood was coming from the drains and Patient GK was returned to theatre.
  5. [105]
    On return to the operating theatre Dr Patel performed a laparotomy, right thyracotomy and splenectomy. Dr Truskett notes that it then appeared no attempt to stop the bleeding was made as “no bleeding could be found.”
  6. [106]
    Patient GK had had 12 units of blood and 4 units of fresh frozen plasma and on 21 December 2004 he died.

Conclusions and Findings based upon the Ivor-Lewis oesophagectomy performed on Patient GK

  1. [107]
    Dr Truskett’s assessment of the procedure performed on Patient GK by Dr Patel was that it was clear it was poorly performed. After the incomplete resection Dr Truskett believes it likely that Patient GK had bleeding from the thoratic aorta. This bleeding Dr Patel was “incapable” of stopping and resulted in Patient GK’s bleeding to death.[53]
  2. [108]
    Dr Truskett stated that whilst Patient GK’s disease was quite advanced and the tumour did require treating, it was not an emergency procedure. Due to Patient GK’s significant co-morbidities, which complicated the operation to be performed, Dr Truskett notes that Dr Patel’s “surgical performance and patient management falls well short of what should be expected by a competent surgeon”.[54] He further notes that the bleeding was surgical bleeding which, although recognised, “was incompetently managed.”[55]
  3. [109]
    Dr Truskett referred to Patient GK’s death resulting from blood loss as avoidable.[56]
  4. [110]
    Dr Allsop came to the following opinion with regard to Dr Patel’s treatment;
  1. The preoperative assessment of [Patient GK] was inadequate for offering proper advice on what was the best treatment plan.
  1. I do not regard bleeding to death within the first 24 hours as a usual or “acceptable” cause of morality after oesophagectomy.
  1. There was a missed window of opportunity to re-explore [Patient GK’s] abdomen either at the completion of the thoracotomy or almost immediately after the first return to ICY when ongoing bleeding was evident.
  2. The underlying problem was a mechanical one of the surgeon creating the bleeding and failing to obtain proper haemostasis at the first operation.
  1. There was a lack of personal involvement by Dr Patel in supervision the resuscitation of a patient that was bleeding heavily following the operation he had performed.[57]
  1. [111]
    This ground is established. The whole surgical procedure was redolent with Dr Patel’s incompetence. It was unsatisfactory professional conduct. His conduct was of a lesser standard than that which might reasonably be expected of him by the public or his peers. It clearly demonstrated incompetence, and lack of adequate knowledge, skill, judgment and care. It was misconduct in a professional sense. It was improper and unethical.

Surgical Procedure Performed on Patient KW

  1. [112]
    The ninth ground for disciplinary proceedings relates to a major surgery, comprising a bile duct resection and removal of the gall bladder, which Dr Patel performed on Patient KW, on or about 29 December 2003.
  2. [113]
    It is the Board’s contention that Dr Patel;
    1. (i)
      Performed the bile duct resection when a pancreaticoduodenectomy was appropriate;
    2. (ii)
      Incorrectly diagnosed hepatorenal syndrome post-operatively
    3. (iii)
      Failed to undertake ERCP preoperatively[58]

The bile duct resection and removal of Patient KW’s gall bladder

  1. [114]
    On 22 December 2003 Patient KW attended Bundaberg Outpatients on an urgent direct referral to Dr Patel on the basis Patient KW had a one week history of dark urine and jaundice. A CT scan performed on Patient KW suggested cholangiocarcinoma of his biliary tree, but that he was otherwise in good health. An ultrasound was also performed. Dr Patel’s conclusion based on the CT scan was that it most likely represented a cholangiocarcinoma just distal to the cystic duct.[59]
  2. [115]
    Dr Patel advised Patient KW that he had a bile duct tumour. Patient KW consented to have a resection of the bile duct, a cholecystectomy and a hepaticojejunostomy. Dr Truskett notes that, on review of the records, it was apparent that ‘endoscopic retrograde cholangiopancreatogram (ERCP) was not performed.’[60]
  3. [116]
    On 24 December 2004 Dr Patel performed open surgery upon Patient KW, specifically, Dr Patel performed a bile duct resection and the gall bladder was removed and decompressed.[61] Patient KW was returned to the general ward.
  4. [117]
    Post-operative observations made by nursing staff and Dr Risson and Dr Kingston note reduced urine output from Patient KW and a drop in blood pressure.[62]
  5. [118]
    At 12:05pm on 30 December 2003 Dr Patel assessed Patient KW and made the diagnosis of hepatorenal syndrome. He noted the ‘surgical findings were extremely poor’ and that if there were a cardiac arrest there was to be no CPR, intubation or ventilation. Patient KW was declared dead at 5:57am on 31 December 2003.

Findings and Conclusions made upon the bile duct resection and removal of Patient KW’s gall bladder

  1. [119]
    Dr Truskett confirms that Dr Patel’s assumption that CT scanning and ultrasound suggested the presence of a bile duct obstruction above the gallbladder. However he further notes that, ‘the feasibility of an isolated bile duct obstruction in this context is remote’.[63] He states that:

If the disease is operable in this context it usually requires a pancreaticoduodectomy or a technically complex bile duct resection.[64]

  1. [120]
    Dr Truskett ‘had some concerns’ from reading the operation report. He notes that upon opening the patient it should have been clear to Dr Patel that he was dealing with metastatic cancer and that;

I can find no real justification for cholecystectomy, as it may have been possible to use the gallbladder as a biliary bypass conduit. It was however removed.[65]

  1. [121]
    When asked whether the surgery performed by Dr Patel was indicated, Dr Truskett comments that it was reasonable to perform an ERCP which may have given some indication that surgery was not feasible. He notes that, if the ERCP did demonstrate such infeasibility, the patient may have been palliated by the insertion of a biliary drain endoscopically and, therefore, the surgery would have been avoided.[66] Dr Truskett says this approach “would have been much preferable”.[67]
  2. [122]
    As to Dr Patel’s post-operative management of Patient KW, Dr Truskett is of the view that it was inappropriate “as he was not suffering from hepatorenal failure”[68] and that he did not support Dr Patel’s diagnosis.[69]
  3. [123]
    As Dr Truskett explains;

Hepatorenal syndrome is a specific form of renal failure which occurs in the context of jaundiced patients. It is characterised as being oligurcic with very low urinary sodium.[70]

And that;

The rapidity of his demise does not support the diagnosis, nor does it reflect the pattern of hepatorenal syndrome.[71]

  1. [124]
    On Dr Truskett’s review of the clinical notes, considering the deterioration of Patient KW within the first 24 hours after surgery, is that it appeared Patient KW “developed a tachycardia with progressive hypotension and eventual death, associated with oliguria.”[72]
  2. [125]
    This ground is established. It is professional conduct of a lesser standard than might reasonably be expected by the public and Dr Patel’s peers. It also demonstrates incompetence and a lack of adequate knowledge, skill and judgment.

Sanction

  1. [118]
    Dr Patel has not been registered as a medical practitioner in Australia for a number of years.  That is no bar to these proceedings, nor to a disciplinary sanction being imposed upon him. 
  1. [119]
    Section 9(3)(c) of the Disciplinary Proceedings Act permits the Tribunal to conduct disciplinary proceedings about any aspect of a person’s conduct or practice, or another matter relating to the person when the person was a registrant, as if he was still a registrant.  If the Tribunal decides under s 240 of the Disciplinary Proceedings Act that a ground for disciplinary action has been established against a former registrant it can take action under section 243.  That action includes to indicate a form of disciplinary action which could have been taken by the Tribunal if the person were registered.[73]
  1. [120]
    The action which can be taken against a person who is registered includes cancelling the registrant’s registration.[74]  If the Tribunal indicates that if the person were currently registered it would have cancelled the person’s registration, the Tribunal must also decide the period during which the person must not be registered by the person’s board.[75]  That includes the power to order that the person must never be registered in the relevant profession.[76]  That is the course which the board urges that the Tribunal take in this matter.
  1. [121]
    In deciding what action to take, the Tribunal must have regard to the purposes of disciplinary proceedings mentioned in s 123 of the Disciplinary Proceedings Act.  Those purposes are to protect the public, to uphold the standards of protection within the health professions, and to maintain public confidence in the health professions.[77]
  1. [122]
    The Tribunal may also have regard to any relevant previous decisions against the person by a foreign disciplinary body.[78]
  1. [123]
    Both the orders of the Oregon Board in September 2000 imposing restrictions on Dr Patel’s registration and the order of the New York State Board in April 2001 striking him off the roster of physicians in that State are previous decisions of disciplinary bodies for the purposes of s 244(1)(c).  A “foreign disciplinary body” is defined by the Disciplinary Proceedings Act to be an entity established under the law applying in a foreign country having functions similar to the functions of a disciplinary body established under the Disciplinary Proceedings Act.  Clearly each of the Oregon Board of Medical Examiners and the State Board for Professional Medical Conduct are foreign disciplinary bodies.
  1. [124]
    Earlier findings of fact of State Board for Professional Medical Conduct as adopted by the Board of Regents and the State Education Department of New York in an order made on 5 March 1984 are also a decision of a foreign disciplinary body.[79] 
  1. [125]
    By that decision Dr Patel was found to have practiced the profession of medicine fraudulently. He was found not to have examined patients before surgery, but to have entered notes of their history, physical examination and progress. He was also found to have harassed a patient. His failure to examine patients prior to surgery was found to have evidenced a disregard for, and indifference to, the results that may follow such failure and thus constituted gross negligence. It was also found that Dr Patel had evidenced his moral unfitness to practice medicine through his failure to examine patients and his harassment of one patient. For this conduct he was fined $5,000 and was suspended from practice for six months. His suspension was stayed provided that he complied with the terms of probation he was required to enter into.
  1. [126]
    In my view, these earlier decisions by foreign disciplinary bodies are very relevant to this matter. Those earlier decisions were taken for reasons which included admitted unprofessional conduct, including gross or repeated acts of negligence and incompetence. The finding that his fraudulent practice evidenced a disregard for, and indifference to, the results that may follow have a particular resonance in these proceedings.
  1. [127]
    The New York order of March 1984 related to conduct which occurred in 1981. The Oregon order of August 2000 related to conduct which occurred, it would seem, in or about 1998. His fraudulent application for registration was furnished to the Medical Board of Queensland only 17 months after he was stricken from the roster of physicians in New York and 29 months after the Oregon conditions significantly limiting his practice in that State were imposed.
  1. [128]
    No medical practitioner completing an application for registration in one jurisdiction could fail to appreciate the purpose of questions directed to “fitness to practice” which concerned the practitioner’s practice in another jurisdiction. No medical practitioner could fail to understand that such questions, directed towards his or her registration history in another jurisdiction, are intended to ensure that only suitably qualified and experienced practitioners of demonstrated competence attain registration. No medical practitioner could fail to understand that the ultimate purpose of such enquiries is the protection of those members of the public who may call upon the services of registered medical practitioners, and the maintenance of the public’s confidence in such an important profession.
  1. [129]
    The significance of such matters to a doctor who has had his registration cancelled, and who has had conditions imposed upon his rights to practice, would be fully understood. It would be understood that full, frank and honest disclosure may result in refusal of registration, or registration limited by conditions. It can only have been with this understanding that Dr Patel committed his fraud.
  1. [130]
    Indeed, as the criminal charges of which he was convicted establish, his dishonesty was to gain a benefit or advantage. That benefit or advantage was his ability to practice medicine, unburdened by conditions. What would follow from that registration were all the rights and privileges of being a member of the medical profession. Of course, what also would flow from registration was the substantial income stream which he would subsequently enjoy.
  1. [131]
    His fraud must also have been committed in the knowledge that it would subvert the protective purposes of the registration process.
  1. [132]
    In my view, these matters strike at the very heart of the system of registration by which it is intended that only those truly suitable and competent to do so are permitted to practice in health professions; a system which protects the public from the enormous risks associated with the unsuitable and incompetent being allowed to practice, and a system which facilitates the public having confidence in those professions.
  1. [133]
    In Medical Board of Australia v Putha[80] Mr James Thomas AO sitting as a Judicial Member of the Tribunal observed that cancellation of registration would seem to be a very appropriate order in most cases where registration has been obtained by fraud. Respectfully, I concur with the Judicial Member’s observations.
  1. [134]
    Had Dr Patel been currently registered, the Tribunal would have cancelled his registration pursuant to section 241(2)(i) of the Disciplinary Proceedings Act. 
  1. [135]
    In light of Dr Patel’s dishonesty in his initial fraudulent application for registration being repeated in his application for renewal, and in light of the fact that he had been found guilty of practicing the profession of medicine fraudulently over 20 years before that, and given that his dishonesty involved a failure to disclose both the cancellation of his registration in one jurisdiction and the imposition of significant conditions of restriction in another jurisdiction, I am of the view that Dr Patel has demonstrated a clear unsuitability to hold registration as a medical practitioner. One could have little, if any, confidence that he would ever in the future possess the qualities of integrity, honesty and trustworthiness so essential for the practice of medicine.[81]  He does not appear to have been deterred by his earlier disciplinary experiences. His having engaged in fraudulent activity associate with the practice of his profession on occasions more than twenty years apart is particularly troubling. As is his apparently cavalier preparedness to disregard, or to be indifferent to, the potential serious consequences of his fraud upon others.
  1. [136]
    Even if the disciplinary proceedings were limited to the grounds of unsatisfactory professional conduct relating to the four grounds of dishonesty, I would order that Dr Patel must never be registered as a medical practitioner.
  1. [137]
    The clinical incompetence matters established by the further five grounds only serve to fortify me in that view.
  1. [138]
    In Medical Board of Western Australia v Bham[82] Justice Barker of the State Administrative Tribunal of Western Australia said:

“… the failure of the practitioner to be other than perfectly frank with the Medical Board in his dealings with the Board suggests an inability to be honest with colleagues in his profession and also with patients and others with whom he may be called upon to deal as a practitioner.”

  1. [139]
    In my view, his Honour’s observations there could be adapted to this case to say that Dr Patel’s failure to be perfectly frank with the Medical Board created an inability on his part to be honest with his colleagues in the profession and with his patients. By failing to disclose that his surgical practice had been severely restricted by the Oregon restrictions and that those conditions had required him to obtain a second opinion in all cases, he created a situation in which he was unable to observe those conditions in his practice in Australia because to have done so would have exposed his deceit.
  1. [140]
    What then followed was incompetent clinical decision making, the performance by him of procedures which were beyond his scope of competent practice, and his failure to consult to obtain the opinions of other practitioners when the only prudent course would have been to have done so. It is clear from the evidence in this case that had he sought the opinions of other surgeons, as he ought to have known that he should have in light of the Oregon restrictions, some of these procedures would not have been performed at all, and others would not have been performed in the manner, at the location, and with the tragic outcomes that they were.
  1. [141]
    The five grounds relating to his incompetent practice are the manifest and tragic result of his obtaining unlimited registration by his deliberate fraud.
  1. [142]
    Dr Patel should never again be registered to practice medicine. The Tribunal will order that he not be registered.

COSTS

  1. [143]
    The Medical Board of Australia should have its costs of and incidental to the proceedings assessed on the standard basis for matters in the District Court.

Footnotes

[1] Bundle of Material Filed on Behalf of the Medical Board at 216.

[2] Bundle of Material Filed on Behalf of the Medical Board at 214.

[3] Bundle of Material Filed on Behalf of the Medical Board at 105.

[4] Bundle of Material Filed on Behalf of the Medical Board at 106.

[5] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 22.

[6] Ibid.

[7] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 43.

[8] Ibid.

[9] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 33.

[10] Ibid.

[11] Erica Mary Cohn served as Deputy President for the former Board from about April 2003 and was appointed chairperson for the Board for a term of four years.

[12]  Bundle of Documents Filed on Behalf of the Medical Board of Australia at 129.

[13] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 30.

[14] Ibid.

[15] Ibid.

[16] Exhibit 1, Certificate of Conviction.

[17] R v Patel [2013] QDC 21/11/2013 [15]-[30].

[18] R v Patel [2013] QDC 21/11/2013 [35]-[45].

[19] Health Practitioner (Disciplinary Proceedings) Act 1999 (Qld), s 233.

[20] [2013] QCAT 191 at [28]-[45] –the decision also examined the meaning of “infamous conduct in a professional respect.”

[21] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 306.

[22] Ibid.

[23] Ibid.

[24] Ibid.

[25] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 309.

[26] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 309.

[27] Ibid.

[28] Ibid.

[29] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 311. Dr Truskett identifies the lack of lymph nodes may also be reflective of poor histological assessment.

[30] Ibid.

[31] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 310.

[32] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 339.

[33]  Bundle of Documents Filed on Behalf of the Medical Board of Australia at 339.

[34] Ibid.

[35] Ibid.

[36] Ibid.

[37] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 341.

[38] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 312.

[39] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 316.

[40] Ibid.

[41] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 318.

[42] ;Bundle of Documents Filed on Behalf of the Medical Board of Australia at 320.

[43] ;Ibid.

[44] ;Bundle of Documents Filed on Behalf of the Medical Board of Australia at 321.

[45] ;Bundle of Documents Filed on Behalf of the Medical Board of Australia at 322.

[46]&          Bundle of Documents Filed on Behalf of the Medical Board of Australia at 299.

[47]&  Bundle of Documents Filed on Behalf of the Medical Board of Australia at 322.

[48] Ibid.

[49] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 323.

[50] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 13.

[51] Ibid.

[52]          Bundle of Documents Filed on Behalf of the Medical Board of Australia at 327.

[53]  Bundle of Documents Filed on Behalf of the Medical Board of Australia at 327.

[54] Ibid.

[55] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 326.

[56] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 348.

[57] Ibid.

[58] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 14.

[59] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 330. 

[60] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 331.

[61] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 331 and 333.

[62] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 332.

[63] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 333.

[64] Ibid.

[65] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 334.

[66] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 335.

[67] Ibid.

[68] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 336.

[69] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 334.

[70] Ibid.

[71] Bundle of Documents Filed on Behalf of the Medical Board of Australia at 335.

[72] Ibid.

[73] Health Practitioners (Disciplinary Proceedings) Act 1999 (Qld) s 243(2)(vi).

[74] Health Practitioners (Disciplinary Proceedings) Act 1999 (Qld) s 241(2)(i). 

[75] Health Practitioners (Disciplinary Proceedings) Act 1999 (Qld) s 243(3).

[76] Health Practitioners (Disciplinary Proceedings) Act 1999 (Qld) s 243(4).

[77] Health Practitioners (Disciplinary Proceedings) Act 1999 (Qld) s 244(1)(a).

[78] Health Practitioners (Disciplinary Proceedings) Act 1999 (Qld) s 244(1)(c).

[79] See Exhibit LMN4 to the affidavit of Louise Nixon filed 5 May 2015.

[80] [2014] QCAT 159 at [35].

[81] Compare Patel v General Medical Council [2003] UKPC 16 at [10].

[82] [2006] WASAT 190 at [54].

Close

Editorial Notes

  • Published Case Name:

    Medical Board of Australia v Jayant Mukundray Patel

  • Shortened Case Name:

    Medical Board of Australia v Patel

  • MNC:

    [2015] QCAT 133

  • Court:

    QCAT

  • Judge(s):

    Horneman-Wren DP

  • Date:

    15 May 2015

Appeal Status

Please note, appeal data is presently unavailable for this judgment. This judgment may have been the subject of an appeal.

Cases Cited

Case NameFull CitationFrequency
Compare Patel v General Medical Council [2003] UKPC 16
2 citations
Jump To
Cite 1 - [2003] UKPC 16
Cite 2 - [2003] UKPC 16
Hughes v Impulse Entertainment Pty Ltd & Workcover Queensland [2013] QDC 21
2 citations
Jump To
Cite 1 - [2013] QDC 21
Cite 2 - [2013] QDC 21
Medical Board of Australia v Putha [2014] QCAT 159
2 citations
Jump To
Cite 1 - [2014] QCAT 159
Cite 2 - [2014] QCAT 159
Medical Board of Western Australia v BHAM [2006] WASAT 190
2 citations
Jump To
Cite 1 - [2006] WASAT 190
Cite 2 - [2006] WASAT 190
Nursing and Midwifery Board of Australia v Clydesdale [2013] QCAT 191
2 citations
Jump To
Cite 1 - [2013] QCAT 191
Cite 2 - [2013] QCAT 191

Cases Citing

No judgments on Queensland Judgments cite this judgment.

1

Require Technical Assistance?

Message sent!

Thanks for reaching out! Someone from our team will get back to you soon.

Message not sent!

Something went wrong. Please try again.