DrWatson
Verified Thoracic and Vascular Surgeon
- Joined
- Jun 25, 2012
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Just a post regarding the Patel case, which is way off topic, I know, but which has been commented on in these threads as there is nowhere else on WS to comment. I posted this right at the end of the thread that has just closed, so if Marly will let me, I'll re-post it here in case anyone has more comments to make:
At the risk of straying way off topic, and regarding the Patel verdict - that was the ONLY verdict they could/should have brought down. I'm not commenting on whatever other charges he may or may not face, but I would respectfully disagree with the idea that they didn't understand the evidence. In fact I think the exact opposite - they were a good enough jury to demonstrate that the effects of social media and the media generally can be overcome by those who are able to weigh just the evidence.
As probably the only one on here qualified to comment professionally, let me try to summarize the problem. The prosecution alleged that Patel shouldn't have operated on Mr Morris because he was sick and had heart disease etc. That description applies to most of my patients! But of course, they omitted the obvious fact that if he DIDN'T operate, then Mr Morris was going to die anyway from his bleeding.
It is standard training and procedure, when faced with somebody bleeding heavily rectally, and with the cause unable to be determined (they don't have facilities in Bundaberg for selective angiography, for example, and the patient was far too sick to transfer, not to mention the delay), then you do exactly what Patel did - a laparotomy and if the sigmoid colon is full of blood (which it was) then you remove it. And 9 times out of 10 you will be right. And the bleeding did in fact cease.
Now I know that Patel's mortality rate was within acceptable limits, and that the whole "Dr Death" thing is pure media hype. And he almost certainly had problems with judgment and insight - eg doing oesophagectomies in Bundaberg where the infrastructure just isn't there to look after them post-op. And his infection rate was a bit higher than average. But given the number of patients that he operated on, many of whom were very sick to start with, his record is nowhere near as bad as the media portrays. Or the "Patient Support Group". And THAT is where the problem lies - he has been made a scapegoat, and most of the opinion is driven by the very emotive desire for vengeance, rather than accepting the facts.
As I said, I'm not commenting on the various other allegations - eg should he have been registered here. Different matter. But, based ONLY on the evidence in this case (and others, one of which in particular I'm very familiar with) he did NOT do anything wrong, let alone criminally wrong.
One other point to consider (and I'm NOT protecting a colleague, by the way - if he did wrong, then he should be found to have done so): But, if he HAD been found guilty, then that would have ENORMOUS repercussions and implications for every surgeon in the future, when faced with a similar situation. Let's just say, for example, that I were to be faced with a patient in emergency (as I have been on countless occasions) with a presumptive diagnosis of a leaking aortic aneurysm.
Now, if I operate, there is a 50-60% chance of survival. If I don't, the chance of survival is 0%. So what do I do? There is no time to faff about getting scans, or whatever. The patient with a hole in his aorta needs an operation, pronto. But now I have a problem - the patient has a 30-40% chance of dying even if I DO operate, and therefore I run the risk of being charged with manslaughter, despite trying to save him. So what do I do? The precedent would have been set by the Patel case.....
The Crown stuffed it up big time. They brought the wrong case (not that any of the others would have been any different), and they didn't present it well enough to get a conviction (the correct decision IMHO). Several expert witnesses (colo-rectal specialists etc) testified that what Patel did was exactly the right thing to do in the circumstances, and they would have done the same. So would I - and have in the past. The patient had a problem which was going to be fatal if he did NOT get operated upon. Patel tried. And the patient died of complications - it happens. It goes with the territory.
There has been WAY too much demonising by media and interest groups to enable most people see the facts from the hype, so I'm delighted that the jury, who were well-directed by the judge, were able to decide based purely on the evidence presented in court, and not be swayed by the hoopla!
OK - way off topic, I know, but I know that several people in here are interested. And as far as comments about the jury not understanding the evidence - all I would say is that those people who think Patel should have been convicted simply don't understand the evidence, or the situation.
Sorry for the long post - I hope it is allowed to stand, as it is off-topic. But WS doesn't have another thread where these points can be made.
At the risk of straying way off topic, and regarding the Patel verdict - that was the ONLY verdict they could/should have brought down. I'm not commenting on whatever other charges he may or may not face, but I would respectfully disagree with the idea that they didn't understand the evidence. In fact I think the exact opposite - they were a good enough jury to demonstrate that the effects of social media and the media generally can be overcome by those who are able to weigh just the evidence.
As probably the only one on here qualified to comment professionally, let me try to summarize the problem. The prosecution alleged that Patel shouldn't have operated on Mr Morris because he was sick and had heart disease etc. That description applies to most of my patients! But of course, they omitted the obvious fact that if he DIDN'T operate, then Mr Morris was going to die anyway from his bleeding.
It is standard training and procedure, when faced with somebody bleeding heavily rectally, and with the cause unable to be determined (they don't have facilities in Bundaberg for selective angiography, for example, and the patient was far too sick to transfer, not to mention the delay), then you do exactly what Patel did - a laparotomy and if the sigmoid colon is full of blood (which it was) then you remove it. And 9 times out of 10 you will be right. And the bleeding did in fact cease.
Now I know that Patel's mortality rate was within acceptable limits, and that the whole "Dr Death" thing is pure media hype. And he almost certainly had problems with judgment and insight - eg doing oesophagectomies in Bundaberg where the infrastructure just isn't there to look after them post-op. And his infection rate was a bit higher than average. But given the number of patients that he operated on, many of whom were very sick to start with, his record is nowhere near as bad as the media portrays. Or the "Patient Support Group". And THAT is where the problem lies - he has been made a scapegoat, and most of the opinion is driven by the very emotive desire for vengeance, rather than accepting the facts.
As I said, I'm not commenting on the various other allegations - eg should he have been registered here. Different matter. But, based ONLY on the evidence in this case (and others, one of which in particular I'm very familiar with) he did NOT do anything wrong, let alone criminally wrong.
One other point to consider (and I'm NOT protecting a colleague, by the way - if he did wrong, then he should be found to have done so): But, if he HAD been found guilty, then that would have ENORMOUS repercussions and implications for every surgeon in the future, when faced with a similar situation. Let's just say, for example, that I were to be faced with a patient in emergency (as I have been on countless occasions) with a presumptive diagnosis of a leaking aortic aneurysm.
Now, if I operate, there is a 50-60% chance of survival. If I don't, the chance of survival is 0%. So what do I do? There is no time to faff about getting scans, or whatever. The patient with a hole in his aorta needs an operation, pronto. But now I have a problem - the patient has a 30-40% chance of dying even if I DO operate, and therefore I run the risk of being charged with manslaughter, despite trying to save him. So what do I do? The precedent would have been set by the Patel case.....
The Crown stuffed it up big time. They brought the wrong case (not that any of the others would have been any different), and they didn't present it well enough to get a conviction (the correct decision IMHO). Several expert witnesses (colo-rectal specialists etc) testified that what Patel did was exactly the right thing to do in the circumstances, and they would have done the same. So would I - and have in the past. The patient had a problem which was going to be fatal if he did NOT get operated upon. Patel tried. And the patient died of complications - it happens. It goes with the territory.
There has been WAY too much demonising by media and interest groups to enable most people see the facts from the hype, so I'm delighted that the jury, who were well-directed by the judge, were able to decide based purely on the evidence presented in court, and not be swayed by the hoopla!
OK - way off topic, I know, but I know that several people in here are interested. And as far as comments about the jury not understanding the evidence - all I would say is that those people who think Patel should have been convicted simply don't understand the evidence, or the situation.
Sorry for the long post - I hope it is allowed to stand, as it is off-topic. But WS doesn't have another thread where these points can be made.
