India-born American doctor Jayant Patel, facing accusations of botching operations and causing death of three patients, was reluctant to shift his patient to a bigger hospital despite recommendation from a specialist physician.
A Brisbane Supreme Court Tuesday heard that the accused was reluctant to shift his patients to Brisbane Hospital despite describing regional Bundaberg Base Hospital's intensive care unit as a "third world country".
Patel, 60, was treating a high risk cancer patient in Bundaberg Hospital. A specialist physician recommended to transfer the patient to Brisbane but he went ahead with an operation and the patient died a day later.
Giving evidence in the Court Tuesday, nurse Karen Stumer said on a number of occasions in 2004 she had overheard Patel discussing his reluctance to send his surgical patients to a bigger hospital.
However, she said Patel was critical of the intensive care unit (ICU) at the regional facility.
"A couple of times he said that the Bundaberg ICU was a third world country," Stumer said.
Patel is accused of causing deaths of three Queensland patients -- James Phillips, 46, Mervyn Morris, 75, and Gerardus Kemp, 77 -- and permanently injuring another when he performed operations as director of surgery at the Bundaberg
Base Hospital between 2003 and 2005.
Earlier Tuesday, specialist physician David Smalberger told the court one of the patients he believed should have been sent to Brisbane was Gerry Kemps, who died in December 2004 after Patel performed an oesophagectomy in Bundaberg.
Smalberger said he assessed Kemps in Bundaberg in late 2004 after the 77-year-old complained of difficulty swallowing.
He said that when he discovered a cancerous growth on Kemps' oesophagus he recommended the patient be sent to Brisbane, where major tertiary hospitals could provide a higher level of care.
"My advice at the time was that we should transfer him down to Brisbane for further assessment and multi-disciplinary treatment," he said adding he believed radiation therapy or
the insertion of an oesophageal stent would have been a good treatment approach for an "elderly man with significant further co-morbidities" like Kemps.
However, the court has heard evidence that Patel encouraged Kemps to instead have an oesophagectomy in Bundaberg.
Smalberger told the court that Bundaberg Hospital did not have sufficient resources to deal with this sort of major surgery.
"It could deal with certain levels of complexities but I think in this case, with it being an elderly patient who was a high risk for surgery... probably Bundaberg wasn't quite the
correct place to do that surgery," he said.
Patel, accused of manslaughter, has been dubbed as 'Dr Death' by the media here, and was extradited from the US for a trial last year.
He has pleaded not guilty to the manslaughter of Kemps, and of two other patients.