First New York, then Oregon, and now Australia. Dr. Jayant Patel has left a bloody trail of mistakes as a surgeon, finally resulting in manslaughter charges.

His arrest Tuesday morning started the legal clock ticking on an extradition request by Australia, where he was director of surgery at Bundaberg Base Hospital in Queensland from 2003 to 2005.

Patel made a brief appearance Tuesday afternoon in U.S. District Court, where a judge scheduled a release hearing for Thursday afternoon.

The extradition complaint charges Patel under Australian law with three counts of manslaughter, three counts of grievous bodily harm, two counts of negligent acts or omissions causing harm, seven counts of fraud and one count of attempted fraud.

Police photo

Dr. Jayant Patel

If convicted, he could face three life terms -- more than 100 years -- in prison.

The complaint also said that Patel "actively hid his history of professional misconduct and lied repeatedly on forms required for registration in Australia."

In a separate memo filed by the U.S. Attorney's office in Portland, prosecutors said that once he was hired in Australia, "Patel bungled surgeries with tragic results."

Bungled Surgeries

The list included: failure to stop internal bleeding in one patient who later died; removing a healthy gland from one patient and leaving behind a cancerous gland; tearing one patient's esophagus; and performing unnecessary surgery on patients in poor health when there were less risky alternatives.

The three patients identified as manslaughter victims were James Edward Phillips, Mervyn John Morris and Gerardus Wilhemus Gosewinus Kemps.

Sandra Ickert’s 73-year-old mother died on the operating table in 1997 at the hands of Patel. Sandra said Patel had assured the family he could help her while she was suffering from pancreatic cancer.

The Ickert family was shocked when she died six hours later.

Even now, 11 years later, thinking about that time in her life brings Sandra to tears at her home in Vancouver, Wash.

"Our family's been torn up ever since my mom's been gone," she told KGW. “Our family will never be the same without her. We always used to laugh and cut up and when we'd get together at Christmas or Thanksgiving there'd be 40 people… He took it away. And it'll never be the same."

Patel, wearing a plaid sweater and slacks, told U.S. Magistrate Judge Dennis Hubel "most likely not" when asked whether he could afford an attorney, so he was represented by a federal public defender, Susan Russell.

The FBI said Patel was taken into custody without incident Tuesday morning at his home in an affluent community in Washington County.

Background: Born to wealth

Born in India to a wealthy family, Patel had been represented by one of the leading defense attorneys in Portland, Stephen Houze, but Houze withdrew from the case.

A family friend, Dr. Vijay Mehta, a Texas surgeon, compared a trial for Patel in Australia to Osama bin Laden going on trial in the United States.

"His wife has told me the best chance he has got is to fight extradition because they are not sure that they can even expect a fair trial in Australia with all the publicity and the demonizing," Mehta told Australian Broadcasting Corp. Radio.

Russell told the judge that Patel came to the United States in 1977 and became a naturalized citizen in 1982. He surrendered his Indian passport because India does not allow dual citizenship and has lived with his wife in Portland since 1989, she said.

FBI agents arrested him shortly after 7:30 a.m. at his home in an affluent Portland neighborhood, marking the latest step in a lengthy extradition process that involves the U.S. State Department.

Russell said Patel voluntarily surrendered his U.S. passport in 2006 after negotiations between Houze and Australian authorities, and since has been involved in community service.

"Mr. Patel does not present a flight risk to this court," Russell said.

Hubel, however, said he would consider arguments for release at the next hearing.

News of the arrest was welcomed in Australia, where an organizer of a Bundaberg Hospital patient support group immediately phoned former Patel patients to inform them after first hearing the news about 3 a.m.

"We made a pact that they were to be told and they were very excited and relieved," Beryl Crosby said.

It was not known what Patel has been doing since he left Bundaberg in 2005, but an Australian TV news crew did spot him in November in the parking lot of a Portland convenience store, having bought an Oregon Lottery ticket.

Things Began to Go Wrong

Patel was welcomed at first at the hospital in Bundaberg, a town of about 50,000 on the east coast of Australia known for sugar cane and as the tourism gateway to the Great Barrier Reef.

But then things began to go wrong for the American-trained surgeon.

Despite glowing references from fellow doctors in Oregon, complaints about his professionalism and his standard of patient care -- even his personal hygiene -- were emerging in Australia. At one point, some nurses at Bundaberg claimed they hid patients from him.

By the time he left, a scandal was brewing over whether Australian health officials had bothered to check on his record of disciplinary action and malpractice lawsuits in the United States dating to his residency in upstate New York in the 1980s.

While training at the University of Rochester School of Medicine, Patel failed to examine some patients before operating on them -- a "serious failure" that "clearly evidenced his moral unfitness to practice medicine," according to the New York Commissioner of Health at the time, Dr. David Axelrod.

Yet Patel was defended by senior doctors, including Dr. J. Raymond Hinshaw, a University of Rochester chief surgeon, who rated Patel among the top surgical residents he had ever trained.

Based partly on the strength of such recommendations Patel was hired by Kaiser Permanente Hospital in Portland in 1989 after serving a three-year disciplinary probation.

By 1998, Patel had been sued several times and the Portland hospital had severely restricted his practice after reviewing 79 complaints. He left the hospital in 2001 after the Oregon Board of Medical Examiners cited him for "gross or repeated acts of negligence" and extended the restrictions on his practice statewide.

He surfaced in Australia in 2003 and soon began to build a reputation for sloppy care and poor hygiene.

Toni Hoffman, a nurse who worked with Patel at Bundaberg, said he regularly failed to wash his hands between patients, and another nurse, Gail Aylmer, an infection control specialist at the hospital, said he once claimed "doctors' hands don't have germs."

He treated more than 1,200 patients during two years in Australia, and 87 deaths were initially blamed on his care.

Eventually, he was charged with three counts of manslaughter and five counts of grievous bodily harm after a government inquiry concluded in 2006 that he may have contributed directly to 13 deaths due to an "unacceptable level of care."