Report: Analysis of the Bundaberg Hospital Public Health Inquiry

This report analyzes the Bundaberg Base Hospital case study, focusing on the public inquiry concerning Dr. Jayant Patel, an overseas-trained surgeon. The inquiry revealed significant issues including inadequate scrutiny of Patel's credentials, lack of hospital budget, and insufficient patient complaint documentation. The report details the events, key individuals involved, and the reasons for the delayed detection of the misconduct, highlighting gaps in practice and failures in the system. It also provides recommendations for improvements, such as enhanced financial setups, rigorous credential checks, and a robust complaint management system, along with their implications for improving healthcare quality and patient safety. The analysis emphasizes the need for stringent recruitment processes, specialist qualifications, and continuous monitoring to prevent similar incidents, concluding with the importance of these measures in ensuring safer healthcare practices.

Running head: REPORT
Report
Name of the Student
Name of the University
Author Note

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Executive Summary
The report aims to analyse one public health inquiry based on the scandalous journey of Dr
Jayant Patel, an overseas trained surgeon who served Bundaberg Base Hospital during the
tenure of 2004 to 2005. The report mainly aims to highlight a summative review of the case,
followed by the recommendations in order to overcome such scenario further along with
implications of recommendation. The analysis of the case study highlighted lack of proper
budget of the hospital author, gaps in the practice area and lack of proper documentation of
the patient’s complain as the ain area of concern.

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Table of Contents
Introduction................................................................................................................................3
What happened?.........................................................................................................................3
How it happened?.......................................................................................................................3
Who was involved?....................................................................................................................4
Why did it got undetected for the period of time?.....................................................................5
Group of professionals involved................................................................................................5
Gaps identified...........................................................................................................................5
Recommendations and its implications......................................................................................6
Conclusion..................................................................................................................................7
References..................................................................................................................................9

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Introduction
The following report is based on public enquiry undertaken over the Bundaberg Base
Hospital and is conducted by Hon Geoffrey Davies AO under Queensland Public Hospitals
Commissions of Inquiry Report. The report mainly initiates with the summary of the key
information starting from the case or the issue that happened, how it happened, the people
who were found guilty in the case, reason behind why the report got undetected. At the end,
the report will highlight the gaps which are highlighted in the report which lead to the
occurrence of the public health threats followed by the recommendations and implications of
recommendation.
What happened?
The Queensland Public Hospitals Commissions of Inquiry (2005) for Bundaberg Base
Hospital mainly centres on the misdeed of Dr. Jayant Patel against the comments raised
during the tenure of 2004 and early 2005. Dr. Jayant Patel lacked the required skills in the
surgery section however, lack of assessment about his clinical skills lead to his appointment
in the hospital. This faulty appointment leads to a series of mishaps in the surgical ward of
the hospital which took a toll on the life of the patients. During his 24 months of service
tenure at Bundaberg Base Hospital, patients and staffs lodged 20 complaints against Dr Patel.
These complaints started registering immediately after he commenced his duty at the hospital
and continued until he ceased his work. The four main area of misconduct as highlighted by
Dr De Lacy include lack of inappropriate patient assessment, defective surgery techniques,
poor post-operative management and inadequate follow-up
How it happened?
According to Queensland Public Hospitals Commissions of Inquiry (2005), Dr Patel
was appointed as the Director of Surgery by Dr Nydam who was the then acting director of

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medical services at Bundaberg Base Hospital. He was registered by the Medical Board of
Queensland under the domain of need scheme1 as a senior medical officer in surgery.
However, about a fortnight after Dr Patel started his duty, Dr Keating was replaced by Dr
Nydam as the Director of Medical Services. Both Dr Keating and Dr Nydam failed to access
the competency skills of Dr Patel and this lead to tragic outcome. Though Dr Patel was
recruited one year of contract, his service tenure was renewed and extended till 2 years (2003
to 2005) and this highlighted lack checking of the competency skills of the doctors in the
Bundaberg Base Hospital.
Who was involved?
Queensland Public Hospitals Commissions of Inquiry (2005) report stated that the
main culprit was the administrators and medical board members of the Bundaberg Base
Hospital. It is their negligence which leads to gap in checking the credentials of Dr Patel at
the time of appointment. During the later period of time, it was negligence of Dr Nydam and
during the later part it was negligence of Dr Keating who failed to do proper assessment of
Dr Patel’s skills which gave rise of unprecedented outcome in the surgical results. Dr Patel’s
certificate of Licensure from Oregon, United States of America has restriction imposed on Dr
Patel as multidisciplinary measure towards performing specific types of surgery in Oregon.
Dr Patel also did not surrender his license of practice in New York which contained
disciplinary proceedings against him and he was suspended from the service for one year.
Queensland Public Hospitals Commissions of Inquiry (2005) report highlighted that
Dr Patel was appointed was Senior Medical Officer who position would ordinarily be
supervised but later was appointed as Director of Surgery, a position which is supposed to be
occupied by registered specialist. Thus the policy guidelines for recruitment was not followed
by the administrators of Bundaberg Base Hospital

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Why did it got undetected for the period of time?
Queensland Public Hospitals Commissions of Inquiry (2005) reported that the overall
controversy got delayed due to lack for surveillances and scrutiny of the clinical competency
skills and the experience reports of Dr Patel. Dr Patel was appointed was Senior Medical
Officer who position would ordinarily be supervised but later was appointed as Director of
Surgery, a position which is supposed to be occupied by registered specialist. Thus the policy
guidelines for recruitment were not followed by the administrators of Bundaberg Base
Hospital and there was negligence in the field of scrutiny.
Group of professionals involved
As per the reports of Queensland Public Hospitals Commissions of Inquiry (2005),
three main people were involved in highlighting the scandal of Dr Patel include Ms Toni
Hoffman. It was her courage and her prolong efforts which helped to highlight the face of
inaction of scandalous Dr Patel. The second person involved in unearthing the case of Dr
Patel includes Mr Rob Messenger MP. He helped to surface the complain of Ms Hoffman.
The third person was Mr Hedley Thomas of The Courier-Mail. His persistence authority,
investigative skills as a respected journalist ensured proper government action and attraction
of public notice towards taking noteworthy steps against Dr Patel.
Gaps identified
The main gaps identified in the case study of Bundaberg Base Hospital by
Queensland Public Hospitals Commissions of Inquiry (2005) report involving Dr Patel are
lack of proper budget in recruiting eligible professionals, failure to perform proper scrutiny
about the background of Dr Patel, failure to have Dr Patel credentialed and privilege and
failure of adequate complain in the system.

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Recommendations and its implications
The main recommendation that can be done in order to avoid this kind of situations in
future include proper financial set-up of the healthcare organisation. According to Australian
Government Department of Health (2012), the Director of Surgery should be a registered
specialist surgeon under Australian specialist qualifications and thus the required to offer a
salary and other job facilities which are more generous than Queensland Health would have
allowed the hospital authority to offer. Moreover, overseas trained specialist is required to
meet the criteria of Royal Australasian College of surgeons with his proper experience and
certificates. Proper funding will help in the promotion of the international recruitment
strategy and this help to increase qualified overseas professionals under the hospital
healthcare system and thereby helping to increase the overall competency of care both under
the cultural aspects and on the aspect of quality. Hayward and Charrette (2012) are of the
opinion that proper recruitment of the overseas trained healthcare professionals helps in
increasing the overall quality of care along with the decrease in the health-inequality.
It is required that the appointed medical board is required to conduct proper scrutiny
of the credentials, experience and the certificates before the recruitment of the healthcare
professionals under any domain. According to the Medical Board of Australia (2018),
international medical students who are seeking registration to practice in Australia must be
thoroughly scrutinised in the domain of eligibility, proper experience certificates and
competency skills. This scrutiny can be done through competent authority pathway, standard
pathway or specialist pathway. In case of Dr Patel, the pathway which will be applicable
include specialist pathway were an overseas trained international medical graduate is
applying for an area of need specialist level position in Australia. The study conducted by
Ross et al. (2013) highlighted that trained and qualified healthcare professionals are less
likely to take faulty decision towards procuring care for the patients. Moreover, Ashcroft et

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al. (2015) argued that a specialist trained doctors with proper qualification and competency
skills is expected to work more diligently during his or her service tenure and thereby helping
to reduce the healthcare care, unwanted stay in the hospital and improved patient outcome.
Proper maintenance of the complaint system must be made and regularly scrutinised.
According to the study conducted by Reader, Gillespie and Roberts (2014), proper
documentation of the patient complain under the healthcare system is regarded as a valuable
resource towards monitoring of the patient safety. The systematic review conducted by
Reader, Gillespie and Roberts (2014) stated that rigorous analysis of patient complain helps
in the identification of the problems in the domain of patient safety. However, in order to
achieve this, necessary standards for the documentation of the patient concerns or problems
must be made.
Conclusion
The analysis of the report highlighted that Mr Jayant Patel, an overseas trained
surgeon was recruited to the Bundaberg Base Hospital without proper scrutiny of his
qualifications, degrees and competency skills. This lack of proper scrutiny by the hospital
administrators, which was mainly headed by Dr Nydam and Dr Keating endangered
numerous life of the patient. Dr Patel was initially admitted as senior surgeon but later was
recruited as the Director of the surgery department. However, active intervention of three
healthcare professionals after 2 years of service tenure of Dr Patel surfaced the case to public
and leading to subsequent termination of the job role of Dr Patel in Bundaberg Base Hospital.
The main gaps which were identified in the case study include lack of proper funding of the
hospital, lack of proper scrutiny of the experience records of the doctors and lack of proper
consideration of the patient's record. Proper documentation of the patient’s complain and

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hospital budget along with diligent role of the hospital administrative authority might have
been helpful in side passing this fatal situations.

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References
Ashcroft, D.M., Lewis, P.J., Tully, M.P., Farragher, T.M., Taylor, D., Wass, V., Williams,
S.D. and Dornan, T., 2015. Prevalence, nature, severity and risk factors for
prescribing errors in hospital inpatients: prospective study in 20 UK hospitals. Drug
safety, 38(9), pp.833-843.
Australian Government Department of Health (2012). International Recruitment Strategy.
Access date: 23rd October 2012. Retrieved from:
http://www.health.gov.au/internet/main/publishing.nsf/content/work-pr-otd-recruit
Davis, H. G. AO. (2005). Queensland Public Hospitals Commission of Inquiry. Access date:
23rd October 2012. Retrieved from:
http://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/
2005/5105T5305.pdf
Hayward, L. M., & Charrette, A. L. (2012). Integrating cultural competence and core values:
An international service-learning model. Journal of Physical Therapy
Education, 26(1), 78-89.
Medical Board of Australia. (2018). International medical graduates (IMGs). Access date:
23rd October 2012. Retrieved from:
https://www.medicalboard.gov.au/registration/international-medical-graduates.aspx
Reader, T. W., Gillespie, A., & Roberts, J. (2014). Patient complaints in healthcare systems: a
systematic review and coding taxonomy. BMJ Qual Saf, 23(8), 678-689.

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Ross, S., Ryan, C., Duncan, E. M., Francis, J. J., Johnston, M., Ker, J. S., ... & McLay, J.
(2013). Perceived causes of prescribing errors by junior doctors in hospital inpatients:
a study from the PROTECT programme. BMJ Qual Saf, 22(2), 97-102.