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Appendix A – Dr Darren Keating
Commissioner (Mr Antony J. H. Morris, QC): What is your full name Dr Keating? — Darren William Keating.
And your occupation? — I’m the Director of Services at the Bundaberg Health Service District.
Are you presently acting in that capacity? — Presently I’m on leave with pay.
Right. What is your professional address, is it the Bundaberg Hospital? — It’s care of the Bundaberg Hospital.
Yes. What are your qualifications, Doctor? — I’ve got a medical degree, so I’ve got a Bachelor of Medicine and a Bachelor of Surgery. I have a Masters in Health Service Management and I’m also a Fellow of the Royal Australasian College of Medical Administrators.
In October last year did you receive from Dr Miach a document he described as an audit of the insertion of catheters by Dr Patel? _ Yes, I did.
And did that disclose a 100% failure or complication rate? — It showed, I think, five or six cases of Dr Patel’s, yes, of peritoneal dialysis catheters had not worked.
In your experience, was that a matter of concern? — It was of concern, Commissioner, but there was also no comparators relatively – in time or with other surgeons.
Well, did you ask Dr Miach? — When he handed me the piece of paper, he handed me the piece of paper. I didn’t ask him after that, no.
Did you take any other steps to ascertain whether it was a matter of serious concern? — No, I didn’t.
Was that the only concern brought to your attention by Dr Miach? — As regards?
As regards the clinical competence of Dr Patel? — At the moment, that’s… is what I can recollect, Commissioner.
At about the same time did it come to your attention that Ms Hoffman had been to see the District Manager and raised with him a series of concerns in relation to the conduct of Dr Patel? — Yes, I was made aware of that.
Was a decision made to conduct an investigation into Dr Patel as a result of those matters? — Yes, yes, that’s correct.
Was that decision made at an executive meeting involving yourself, the Director of Nursing and the District Manager? — I recollect that I’d received an email copy of the complaint from Tony Hoffman and that, thereafter, some further hard copies were required by Mr Leck than an investigation – that this needed to be further investigated.
Did you at any time suggest that it was a matter that didn’t warrant investigation because it was simply a personality conflict? — I – I – I – agreed that it needed to – it needed investigation but I was concerned that there was – several aspects to this complaint, including the personality conflict.
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Commissioner: On the 24th of December, Christmas Eve of last year, did you offer Dr Patel a further four years of employment? — A - a letter was given to Dr Patel with that information.
And that letter was signed by you? — It was signed by me.
So it’s right to say that on the 24th of December, Christmas Eve, you offered him a further four years of employent? — That is correct.
Why would you be doing that when the man was under investigation? — At that – at that stage there was a number of allegations. I was, at that stage, unaware of the – where that – where Mr Leck was as regards his inquiries with head office.
Did you discus with your District Manager that you were planning to offer him – offer Dr Patel another four years of employment? — he was, he was not aware that that – of that time frame in that letter. That time frame was put in that letter with a view to ensuring that we were able to get sponsorship and a visa for Dr Patel.
I don’t care why it was done. Did you speak to your District Manager before offering a further four years’ employment to a doctor who was then the subject of an investigation? — I spoke to him at – I spoke to him at – a number of occasions about Dr Patel and his ongoing employment.
And did you tell him that you were going to offer Dr Patel another four years’ employment? — That letter of offer was made with a view to - - -
Did you tell him you were going to offer Dr Patel another four years of employment? A very simple question? — Sorry, Commissioner, I don’t recall that I told him about four years.
Is it normal for you to offer extensions of employment to senior medical staff at the hospital without discussing that with the senior District Manager? — It is – I discussed – I said, there was a number of changes I discussed but I didn’t discuss the four-year period with him necessarily but I did discuss ongoing appointments with him as regards the medical staff.
Was it, so far as you were concerned, quite irrelevant that serious issues had been raised by another senior specialist at the hospital regarding Dr Patel’s level of competence? — I did not believe that it was irrelevant, Commissioner, no.
So you were quite happy to have a man on your staff as a senior surgeon who your senior physician regarded as incompetent? — Dr Miach had made me aware of the catheter situation but he had not made me aware of his overall impressions and the measures he’d taken as he described today. (Dr Miach had testified earlier that day.)
In January did you write a letter of, I don’t know how you would describe it, commendation, a sort of gushy letter saying to Dr Patel what a good bloke he was? — I wrote a letter in January. I don’t know exactly what date it is, Commissioner, but I did write a letter in response to a letter from him.
Well, he didn’t ask you for a commendation or a letter of approval or anything of that sort, did he? — He wrote his letter of resignation, saying he would not…
Yes? — He…
What prompted you to write such an effusive letter back to Dr Patel? — At that time – at that time I believed it was a normal response to a letter of resignation.
A normal response when the man resigning is the subject of a pending investigation? — He was – he was the subject of a number of allegations which were to be investigated, amongst the totality of the ICU. In retrospect…
I’m not asking you about retrospect. I’m asking you about at the time? — At the time…
With your knowledge that there were the allegations made by Ms Hoffman, the allegations or the issues raised by Dr Miach, surely it would have been a matter of concern to you? — I was concerned abut, yes, all the issues, including him leaving, and I – I wrote that letter – I wrote that letter.
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Commissioner: It didn’t come to your attention, for example, that nurses were hiding patients from Dr Patel so he couldn’t operate on them? — No.
Didn’t come to your attention again that your senior medical staff were recommending to patients that they seek transfer to Brisbane rather than go under the knife of Dr Patel? — No, Commissioner.
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Commissioner: If the people of Bundaberg were told by your hospital that the man who was wielding the scalpel on them was a surgeon, don’t you think those people were entitled to know that the man wasn’t qualified to be a surgeon under Australian law? — He was registered as a Senior Medical Officer in Surgery.
Well, whether or not you called him a specialist surgeon, don’t you think the people of Bundaberg were entitled to be told before he took the knife to them that this man is not a surgeon by Australian standards or in accordance with Australian law? — He was – yes – if you put it that way, Commissioner, yes, but…
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Commissioner: Could you tell me about the funding system by which the Bundaberg Hospital received extra funding as a result of elective surgery performed by Dr Patel? — I have an understanding of the elective surgery program which included surgery done by Dr Patel and by other surgeons done at the hospital.
Could you explain that program? — It’s an allocation of money by the Minister – by government direction related to the – to the performance of elective surgery with a view to reducing the waiting lists for all elective surgery across the state… There is an incentive scheme which relates to giving you a target of basically a number of patients that get elective surgery and you are funded to achieve that target. If you fail to achieve that target, you do not get all your allocation of funding.
Well, we’ve heard a lot of evidence so far about a procedure called an oesophagectomy. Is that ordinarily classified as elective surgery? — It is
So there was more money coming into Bundaberg Hospital for every oesophagectomy performed by Dr Patel, whether the patient lived or died? — I do not know the exact amount of what they call the waiting for that operation and therefore the amount of funding you would get for an oesophagectomy although it is a complex procedure and are based on… etc.
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