Try, Try Again

The saga of Dr. Jayant Patel is that of a man who concealed his incompetence by never staying in one place long enough for consequences to catch up to him.  But though he buried his true track record, Patel took care to bring with him enough social proof to persuade a new set of victims to trust him.  As long as he could stay one step ahead, he was gold. It wasn't as if nobody suspected Patel wasn't all he claimed to be. One gets the sense that many of his patients had doubts even as they looked up to him from the operating table, but never enough to challenge him openly; to impel them to say the one thing that would have saved them: 'I don't want this doctor, get me another'. And yet the truth was that he was probably trying; trying hard to be a doctor. One of the charges against him was that he treated patients that's weren't even his. Maybe he figured he needed practice. If at first you don't succeed, try, try again. But that didn't help him because the basic problem was that Patel was incompetent. He should have been something else. And getting an incompetent to try harder only gets you more incompetence.

Patel killled 17 people and removed many more organs and limbs than can easily be counted, often for no medical reason whatsoever. Wikipedia has a summary of his career. At each stage, "Dr. E. Coli" as he came to be known in Australia, was suspected of being a dud. Yet such was the system of deference built into the medical system that he went on long after he should have been stopped.

Patel was born in Jamnagar in Gujarat, India. Whilst nearly all of his training was conducted from within the United States of America, he had undertaken his initial surgical studies at the M.P. Shah Medical College in Saurashtra University, and obtained a master's degree in surgery. After graduation he moved to the United States where he received further surgical training at the University of Rochester School of Medicine as a surgical intern and resident of surgery. Whilst Patel was working at a hospital in the city of Buffalo in 1984, New York health officials cited Patel for failing to examine patients before surgery. Patel was fined US$5,000 and was placed on three years' clinical probation. In 1989, Patel moved to Oregon and began working for Kaiser Permanente Hospital in Portland, Oregon. Medical staff alleged that he would often turn up, even on his days off, and perform surgery on patients that were not even his responsibility. In some cases, surgery was not even required, and caused serious injuries or death to the patient.

After a review, Kaiser restricted Patel's practice in 1998, banning him from doing liver and pancreatic surgeries and requiring him to seek second opinions before performing other surgeries. Further, after reviewing four cases in which three patients died, the Oregon Board of Medical Examiners made Patel's restriction statewide in September 2000, and New York State health officials required him to surrender his license in April 2001.

After this, Patel decided to leave Oregon for Queensland. The Queensland Health Department employed him without conducting due diligence regarding his qualifications and experience; and it allowed him to become director of surgery at Bundaberg Base Hospital in 2003, under the "area of need" program, which hires overseas trained doctors for regional areas. He continued to practice in a similar manner to which he did in New York, with his surgical work being described as "antiquated" and "sloppy", and some nurses even claimed that they hid their patients from him when they knew that he was in the hospital. He attracted the nickname "Dr. E. coli" as a result of these actions.

A BBC report alleges Dr. Patel killed as many as 87 people. His surgical technique was nothing short of remarkable. Even Dr. Frankenstein would have been impressed.

One charge relates to the care of Aboriginal woman Marilyn Daisy, who developed gangrene in her leg after she was allegedly left without treatment for weeks following an amputation. ...

In another case, a woman's life support machine was reportedly turned off because Dr Patel allegedly wanted her bed to operate on another patient.

Nurse Toni Hoffmann told the inquiry that Dr Patel had tried to drain blood from a man's heart with a "stabbing motion". The man died later that night.

"All the nurses in intensive care were seeing these patients dying every day and we couldn't do anything," Ms Hoffman told the inquiry in March.

"We'd taken to hiding patients. We just thought 'What on earth can we do to stop this man'," she said.

'What on earth can we do to stop this man?' The answer of course, was to get another doctor. But it never came to that until Dr. Patel fled Queensland to get away from the cops. He was arrested by the FBI and extradited to Australia where he is now facing charges. But that's no consolation to the scores of patients who now limp around without legs, sans arms, without stomachs,  missing an esophagus -- or dead.  However the New York Times and Maureen Dowd have another approach to incompetence.  They think that if a man isn't up the the job he just needs to get on message or try harder.  The subject of their exhortations is Barack Obama. It wasn't as if they didn't have their doubts from the first about whether he was up to the job, just that they suppressed them or thought that he wasn't trying hard enough. Holding back.  Dowd says: "Sometimes on the campaign plane, I would watch Obama venture back to make small talk with the press, discussing food at an event or something light. Then I would see him literally back away a few moments later as a blast of questions and flipcams hit him." So what he needs to do, in her view, is improve his press relations and everything will be "on message" again.

Obama refuses to deal with the media world as it is. He’s holding out for the media world that he wants. But that will never be. That disdainful attitude toward 24-hour cable culture is slowing his political reflexes. We’re seeing that in the oil spill. I don’t think it’s personal with him. It’s not that he despises reporters as human beings, like Nixon. He does scores of interviews and he doesn’t rage behind closed doors. But if he doesn’t make more concessions to Washington as it is, he’s going to hurt his presidency.”

Now that Obama has been hit with negative press, he’s even more contemptuous. “He’s never needed to woo the press,” says the NBC White House reporter Chuck Todd. “He’s never really needed us.”

"Obama refuses to deal with the media world as it is". It never occurred to Dowd that he couldn't deal with the world as it is, not just the media part of it. But she saw his failure to deal with them not as sample of his competence, but as an indicator that he didn't care enough. On the contrary he needed the Press very much, but in a negative way. He needed them to do nothing. Nothing, that is, except accept the social proof of his competence.  He was the proof they'd been waiting for. And just as the proof Dr. Patel knew medicine was because he was doctor, the President was presumed a capable executive because he ran a campaign. The proof was entirely circular, but through some peculiar myopia no real questions were asked. To demand the sealed transcripts, to ask about the absence of articles for the Harvard Law review, to raise the non-existent legislative record was deemed churlish.  UnAmerican. Bigoted.  The fact that he had come so far was proof that he was qualified to come so far. And there the matter rested.

Until the policy ICU began filling up. The BP problem isn't the first demonstration of the President's curious incapacity. Peggy Noonan wrote, "he was supposed to be competent. This is his third political disaster in his first 18 months in office. And they were all, as they say, unforced errors, meaning they were shaped by the president's political judgment and instincts." Like Dr. Patel's patients, the number of mangled policy cadavers has piled so high in the backroom that even New York Times is asking when President Obama finally shows the talent he's been hiding for so long. The Gray Lady writes:

The country is frustrated and apprehensive and still waiting for Mr. Obama to put his vision into action. ... Americans need to know that Mr. Obama, whose coolness can seem like detachment, is engaged. This is not a mere question of presentation or stagecraft, although the White House could do better at both. ... But a year and a half into this presidency, the contemplative nature that was so appealing in a candidate can seem indecisive in a president. His promise of bipartisanship seems naïve. His inclination to hold back, then ride to the rescue, has sometimes made problems worse. ...

These are matters of competence and leadership. This is a time for Mr. Obama to decisively show both.

Show me! Show me! What's he's decided to show, according to Jake Tapper, are his magnificent oratorical skills in the awe-inspiring setting of the Oval Office. "After returning from his two-day visit to Mississippi, Alabama and Florida on Tuesday, President Obama will address the nation from the Oval Office -- the first time he's done so. That the president has chosen the crisis in the Gulf of Mexico as the first time he uses the trappings of the Oval Office speaks volumes not only about the environmental and economic catastrophe caused by the oil spill, but about the political threat it potentially poses to the President."

And that may be the best that Barack Obama can do. Give a speech. He's good at that. It's not his fault that he has no executive experience. He never ran a company. Was never mayor of a city. Achieved nothing in his role at the Chicago Annenberg Foundation. He was never governor. The press knew that all from beginning. Like Dr. Jayant Patel, the President  walked into the room on his own say-so. And nobody wanted to say 'show me'.  So having failed at that it is slightly unfair to lay the blame entirely on him.

Barack Obama's incompetence, if indeed he is incompetent, results directly from a flawed political and media process that allowed such a candidate to go forward. It's a failure of quality control. It's an indictment of the gatekeepers and of the media in particular. They didn't look the gift horse in the mouth and now it turns out he's wearing dentures. It wasn't President Obama's fault that he aspired to a job he had no preparation for: a man's entitled to try for as much as he can get ... will you give a billion dollars, please ... but only a fool would let him. And the fools in this case would do well not to ask for him to try harder. At some point the only way they can redeem themselves is to stop digging and realize that they, not he, are to blame for this fix. Maybe  it's significant that Maureen Dowd, having facilely advised the President to improve the message, senses what it may come to in the end. Joe Biden. Dowd writes about the underappreciated Vice President.

It was the press that delighted in Biden’s foot-in-mouth syndrome in 2008 and played up the exacting Barack Obama’s occasional chagrin at the über-exuberant Joe as they began their odd-couple partnership. Yet the vice president is so lacking in any vengeful feelings for past reporting that left him for dead, I sometimes wonder if he’s really Irish. ...

One Obama aide remarked that Biden is “the most beloved person in the White House.” ... So, as The Washington Post’s Howard Kurtz writes, the more press-friendly, emotionally accessible, if gaffe-prone Biden has become “the administration’s top on-air spokesman.”

How ironic. Instead of The One, they’re sending out The Two.

It's innuendo so far. The time for Rahm Emmanuel to worry is when Biden becomes the most beloved man in Democratic politics.


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