On 15 May 2015, the Queensland Civil and Administrative Tribunal (Tribunal) delivered its decision and reasons on disciplinary proceedings commenced against Jayant Mukundray Patel.1 The Tribunal decided to impose the maximum penalty, permanently precluding Dr Patel from seeking registration as a health professional.

The Tribunal’s decision concludes disciplinary proceedings commenced almost 10 years ago by the former Medical Board   of Queensland (Board) and closes a dark chapter in the provision of health services in Queensland.

This article considers the elements of Dr Patel’s conduct that were sufficient to convince the Tribunal that the maximum penalty was appropriate.  It also describes the pathway of the proceedings, including their conclusion after significant delay.

Background

Commencing in the mid-1980s, Dr Patel was disciplined by health regulators in the United States on several occasions, both in New York and Oregon.

On 7 September 2000, disciplinary action was taken by the Oregon Medical Board in response to Dr Patel’s admission that he had engaged in unsatisfactory professional conduct in the treatment of four patients. In 2001, as a consequence of the action taken in Oregon, the New York State Board for Professional Medical Conduct required Dr Patel to surrender his license.

In 2003, Dr Patel became the Director of Surgery at the Bundaberg Base Hospital, Queensland.

In 2005, the former Medical Board of Queensland decided to refer Dr Patel to the Tribunal for disciplinary action.

After the Board’s proceedings were commenced, Dr Patel was charged with several criminal offences. Given the necessity to ensure Dr Patel received a fair criminal trial, in 2007 the disciplinary proceedings were adjourned.

On 21 November 2013, the District Court delivered its sentencing decision on fraud charges for which Dr Patel had been convicted on a guilty plea.

The finalisation of the criminal proceedings enabled the Board to progress the disciplinary action.  In addition, the Board could now rely on the conviction.

On 11 May 2015, the matter was heard by the Tribunal in Dr Patel’s absence.

The referral

In late 2005, the Board formed a reasonable belief that there was a ground to commence disciplinary action on the basis that Dr Patel had engaged in unsatisfactory professional conduct.2 Unsatisfactory professional conduct includes misconduct in a professional respect and conduct falling below the standard expected by the public and the practitioner’s peers.3

The basis for the referral proceeded on two cases, the first being that Dr Patel had obtained his registration fraudulently by providing information and documentation that he knew to be false and/or misleading in a material particular.

The second case related to Dr Patel’s treatment of a number of patients who died after he performed surgery on them. Four of  the five patients had undergone surgery performed by Dr Patel that he would have been restricted from performing in Oregon, USA and/or which was beyond his surgical skill and competence and should not have been done at the Bundaberg Base Hospital. The fifth surgery was one that demonstrated Dr Patel’s inability to determine the correct surgical approach or approach that was in the best interests of the patient.

The hearing

On 11 May 2015, the disciplinary hearing took place before the Tribunal in Brisbane.

Dr Patel did not actively participate in the proceedings.

The Tribunal decided it was appropriate to hear the matter in Dr Patel’s absence.

At the hearing, the Board submitted, and the Tribunal accepted, that Dr Patel blatantly deceived the Board to gain registration as a medical practitioner and “deliberately sought the position as head surgeon at Bundaberg and calculatedly deceived [his] way into that position”.4

In relation to the treatment of patients, the Board relied upon independent surgical experts who provided evidence about the nature of treatment provided to the patients, the performance of the surgery, Dr Patel’s response to surgical complications, and the tragic consequences for the patients and their families.

The Board submitted this was a case where it would be appropriate to order the maximum sanction: an order that if Dr Patel was currently registered, his registration would be cancelled and that he not be permitted to seek registration in the future.

The Tribunal’s decision

The Tribunal wholly accepted the submissions of the Board in relation to Dr Patel’s conduct and found each of the grounds of referral were established.

In accepting the Board’s submission and permanently precluding Dr Patel from seeking registration as a health professional, the Tribunal took into account:

  1. the previous disciplinary action taken against Dr Patel in Oregon and New York, including prior dishonest conduct;
  2. Dr Patel’s dishonesty when seeking registration;
  3. the benefit of employment derived by Dr Patel from his dishonesty;
  4. the criminal conviction and the comments of Justice Martin of the District Court on sentencing in relation to the deliberate nature of the dishonesty in gaining registration and employment through fraud;
  5. the findings made in relation to each of the patients treated by Dr Patel;
  6. Dr Patel’s knowledge that he was not sufficiently skilled to perform the procedures he performed on four of the patients;
  7. the clinical incompetence demonstrated by the surgical cases referred to the Tribunal;
  8. the tragic consequences of Dr Patel’s clinical incompetence for each of the patients; and
  9. Dr Patel’s overall unsuitability to hold registration.

The Tribunal indicated that even if the matter had proceeded solely on the allegations pertaining to fraud, it would have made the same order.5    However, the Deputy President said that:

The clinical incompetence matters established by the further five grounds only serve to fortify me in that view.’6

There were many other surgical cases exposed by the Board’s investigation that may have also been referred to the Tribunal. However, the Tribunal’s findings demonstrate it is not necessary to refer every available case in order to establish incompetence and unsuitability, especially where there is an additional element of dishonesty.

The Tribunal’s comments about the number of allegations necessary to bring and establish a finding of professional misconduct is especially helpful for self-funded regulators. Referring an unnecessary number of clinical cases also imposes an unnecessary burden on the practitioner.

Criminal v disciplinary

The criminal proceedings determined by the District Court related to whether Dr Patel had committed an offence when he obtained registration and employment.  The outcome of those proceedings included a conviction on four counts of fraud7  and a sentence that took into account time Dr Patel had already served.

However, the criminal proceedings did not address, and were not designed to address, Dr Patel’s conduct as a then registered medical practitioner. This issue was left to the proceedings initiated by the Board in the Tribunal.

The Tribunal’s powers are limited to taking action that impacts a practitioner’s ability to practise as a health professional.  In contrast, the District Court had the power to punish Dr Patel for his unlawful actions.

Had the Board not finalised the disciplinary proceedings, there would have been no finding about Dr Patel’s conduct in obtaining registration and employment on the basis of false and misleading information, nor would there have been a finding about his treatment of patients at the Bundaberg Base Hospital. Without a finding on the grounds of referral, other regulatory authorities could not rely upon his conduct in Australia to restrict or preclude him practicing.

International consequences

In 2006, the Oregon Board of Medical Examiners made a stipulated order suspending Dr Patel’s Oregon medical license ‘pending the conclusion of the Australian criminal and administrative process and after all penalties/conditions imposed by that jurisdiction have been satisfied’.8

By operation of that order, Dr Patel was not permitted to practise medicine in the United States until the finalisation of the Tribunal proceedings.

It is anticipated the next and truly final step will be a decision   by the Oregon Board about whether Dr Patel is eligible to apply for reinstatement of his registration.  As at September 2015, Dr Patel’s registration remains subject to the 2006 order.

Comment

The Patel saga is a timely reminder to:

  • health organisations to ensure that they have adequate checks and balances so as to confirm that practitioners hold appropriate and legitimate accreditation and registration,
  • health practitioners of their professional and ethical responsibilities to protect and promote public health and safe healthcare by notifying AHPRA or a National Board of “notifiable conduct” by another practitioner in accordance with legislated mandatory reporting requirements.