Bundaberg, Australia (CNN) -- Dr. Jayant Patel says he is broke. Many of his former patients, who refer to him as "Dr. Death," have little sympathy.
Five years ago, as director of surgery at the Bundaberg Base Hospital in Queensland, Australia, Patel earned a six-figure salary. Today, he says he can't afford to appeal his recent criminal convictions.
In July, the 60-year-old surgeon was sentenced to seven years imprisonment, for the manslaughter of three patients and causing grievous bodily harm to a fourth.
It was the culmination of a story that started with the concerns of "a nurse who put her neck on the line," says Hedley Thomas, a reporter at "The Australian" newspaper.
"And then it developed very quickly into one of the biggest stories in Australian medical history."
Nurse Toni Hoffman says "alarm bells were ringing" just weeks after Patel's arrival in 2003.
Video: 'Dr. Death' patients meet one last time Video: Preventing another 'Dr. Death'
I think he had an exalted opinion of his own abilities, and he perhaps was, as we like to describe, 'a legend in your own frontal lobe'
She recalls Patel performing an esophagectomy on 46-year-old James Phillips.
Phillips "came back to the Intensive Care Unit extremely ill. And Dr. Patel was saying that he was stable," Hoffman said.
Phillips died two days later. Hoffman filed a formal complaint against Patel.
"As time went on, we were seeing more patients with more complications," Hoffman said. "Perforated bowels and patients that went on to have big infections." And Patel became the subject of more complaints.
Shortly after celebrating his 50th wedding anniversary, 77-year-old Gerry Kemps was diagnosed with cancer of the esophagus. Patel performed an esophagectomy.
Patel "said the operation was a real success," Judy Kemps says. But her husband was bleeding internally. And hours later, Patel's confident demeanor changed.
"He said, "I don't know where the bleeding is coming from and there's nothing I can do about it,"" Mrs. Kemps said.
Gerry Kemps bled to death in the ICU.
Soon after, three nurses who helped care for Mr. Kemps filed complaints about Patel.
According to a government-appointed commission of inquiry that subsequently looked into the matter, Patel was the subject of more than 20 complaints from patients and co-workers during his two years at the Bundaberg Base Hospital.
But nurse Hoffman said her bosses considered Patel to be an industrious, dedicated surgeon. She worried the complaints were not being taken seriously.
At one point, "I put in a major letter of complaint to the district manager," Hoffman said. "And the next month they gave Dr. Patel the 'Employee of the Month' award."
She finally decided to make her complaints more public, by reaching out to reporter Hedley Thomas.
Thomas said Hoffman told him about "the dreadful surgical decisions that were being made, and the number of patients who were being injured or killed, she believed, as a result of Dr. Patel's incompetence and poor judgment."
He talked to more nurses, who told much the same story. Then one nurse made a crucial observation.
"You don't become such a bad surgeon overnight," Thomas recalls her saying.
So Thomas decided to research Patel's past, beginning with a simple Google search.
He quickly discovered that Patel had been disciplined while practicing in Portland, Oregon, several years earlier.
According to a stipulated order from the Oregon Board of Medical Examiners, Patel "acknowledged... that he made surgical errors" and was found to have committed "gross or repeated acts of negligence." His scope of practice was limited, to exclude certain types of surgeries, and he was ordered to obtain a second opinion before proceeding with other "complicated surgical cases."
Less than three years later, he was hired to work in Bundaberg. Australian authorities who vetted Patel's credentials never discovered his disciplinary history. "So the next day," Thomas says, "we published a very prominent front page story, 'Why didn't they check?'"
The ensuing public outcry resulted in the establishment of the commission of inquiry, a police investigation and a prosecution.
And Patel became widely referred to as "Dr. Death," a nickname he was first given by some of his own co-workers.
The commission of inquiry reported that "Dr. Patel's poor level of care contributed to, or may have contributed to" at least 17 deaths and 31 injuries. Patel was ultimately charged, tried and convicted in connection with four of those cases.
Patel did not testify during his trial. He has never given an interview, and his legal team would not make him available to CNN.
Thomas said: "I think for many people, that's part of the story that's still to be filled in. Why did he do what he did?"
"I honestly do not believe that he was doing anything maliciously," Hoffman said. "I think he had an exalted opinion of his own abilities, and he perhaps was, as we like to describe, 'a legend in your own frontal lobe.'"
Today, Patel is awaiting word on his application for legal aid to fund his appeal. He is arguing his conviction was unjust, and his seven-year sentence was too long. The state attorney-general has filed his own appeal, arguing Patel's sentence was too light.
Patel still faces one additional charge of grievous bodily harm, plus seven charges of fraud and one of attempted fraud, for allegedly concealing his disciplinary past.
Meanwhile, the Queensland state government has compensated nearly 300 former Patel patients. But some are agitating for more money. And some want others to be held more accountable, for allowing Patel to practice in Bundaberg.
"I actually moved the health minister, and sacked the [Health Department's] director-general, because I was unhappy about how this matter was handled," said former Queensland Premier Peter Beattie. And other administrators, he said, "were moved, they were demoted, other things happened to them."
The director of medical services at the Bundaberg Base Hospital during Patel's employment resigned in 2005. In 2009, he was banned by the Health Practitioners Tribunal from serving as a senior medical administrator.
No hospital or health department administrators were charged criminally.
Today, a small city that was once best known for its sugar cane fields, its inviting climate and its famous Bundaberg Rum, is now known around the world as the place Dr. Jayant Patel once practiced.
"A lot of people probably say, well, we've kind of put it behind us," Thomas concludes, "but it's always going to be associated with Bundaberg."
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