Patel was a professor of surgery at the State University of New York at Buffalo in the 1980s, and he came highly recommended by several doctors in Oregon, where he also worked.

But almost immediately, after he declared a patient to be stable -- when, in fact, the patient was brain dead -- at least one nurse worried about his competence. Before long, nurses were hiding patients from him, according to testimony before a state commission. A doctor ordered that Patel not operate on any of his patients after he saw him perform a surgery without anesthesia. An anesthesiologist nicknamed him "Dr. Death."

On Monday, the state government commission of inquiry in Queensland will open a new round of investigation into whether Patel, an American citizen educated in India, is responsible in any way in the deaths of 87 patients. Not least, it wants to know how Patel was hired without anyone doing so much as researching his name using the Google search engine.

Manslaughter, Murder Charges Recommended

Such a search this year by a reporter in Brisbane showed that Patel had been disciplined in New York and Oregon, and that he admitted errors to the Oregon authorities after a review of 79 of his patients, three of whom died from surgical complications. Patel has returned to Oregon, though it was not clear whether he remains there.

His case is raising questions in Australia and the United States about how the medical profession regulates its doctors, especially those who evade troubled pasts by moving from state to state or from country to country.

The commission recommended on June 13 that Patel be charged with manslaughter and murder, saying that when "an impostor pretends to be a medical practitioner and kills a patient whilst attempting a surgical procedure," a murder charge was warranted.

Patel's lawyer in Portland, Oregon, Stephen Houze, called the recommendations "outrageous," noting that they came after just two weeks of testimony. Patel has not been charged with a crime, he said. If he is, it is hard to imagine how he could get a fair trial in Australia, Houze said.

"We have very grave concerns about this drumbeat of incessant and prejudicial publicity that is saturating all of Queensland, and indeed all of Australia," he said. Houze said he told the officials that Patel was not a fugitive, and that he was in constant contact. But he did not say where Patel was.

'Personality Problem'

Starting Monday, the Australian commission will hear from former patients and the families of deceased patients. So far, the principal testimony has come from Toni Ellen Hoffman, head nurse in the intensive care unit during Patel's tenure.

In testimony bolstered by the hospital's director of medicine, Hoffman told the commission that Patel had performed esophagectomies, surgeries to remove a cancerous growth on the esophagus, for which the hospital did not have follow-up facilities. Patel, she testified, retorted that he was bringing in half a million dollars a year in revenue for the hospital.

Hoffman said that patients had died because Patel refused to transfer them to the better-equipped hospital in Brisbane; that in many cases, a patient's surgical wounds came apart; and that he routinely refused to perform CT, or computerized tomography, scans on cancer patients, so they were operated on when other treatments would have been better.

Week after week, Hoffman said, she witnessed troubling episodes.

She registered her concerns in e-mails, letters and orally with her supervisor, the nurses union and hospital administrators. She was told it was a "personality problem," she testified.

Google Search

In July 2004, a man was brought to the hospital after being crushed by a camper van. At first, Patel said the patient, Des Bramich, was not in such serious condition that he needed to be taken to Brisbane. Then, he said Bramich was too ill to be moved. Bramich died.

"Dr. Patel screamed at patient's wife not to cry," Hoffman wrote in notes of a meeting she then sought with hospital officials. Bramich's 9-year-old daughter "watched her father die," she added. "This was the final straw."

She asked for an independent audit. The next month, the hospital named Patel employee of the month. "It was like a big slap in the face," she said in an interview.

Finally, when the hospital was offering Patel a new four-year contract, in March of this year, Hoffman contacted a Queensland state legislator. The legislator made a statement in Parliament, which brought the case to light.

Hoffman was vilified, as doctors and politicians rallied to Patel's defense. "It's an absolute disgrace that Dr. Patel has been forced to leave his job," said the president of the Queensland branch of the Australian Medical Association. "Bundaberg hospital has lost a surgeon when it could ill afford to do so."

The turning point came when a veteran investigative reporter at The Brisbane Courier-Mail, Hedley Thomas, did a search using the Google Web site and typing in "Jayant Patel." When he called the hospital and health department officials for comment, Thomas said, he was told that it was the first they knew of the disciplinary actions in New York and Oregon.

Now, Oregon medical authorities, too, are coming under criticism that they moved too slowly in acting against the doctor.

No Background Check

In 1989, Patel went to work in Portland for Kaiser Permanente, Jim Gersbach, a spokesman for the nonprofit health care company, said. He was voted teacher of the year, in 1991 and 1992, and he received one of the distinguished physician awards in 1995.

But by late 1998, questions about Patel's work from fellow surgeons led Kaiser to conduct a peer review and to bring his case to the attention of state authorities.

"We then hired consultants to investigate that case," said Dr. Joseph Thaler, chairman of the Oregon Board of Medical Examiners. "We acted in 2000 to restrict his license."

The board's findings focused on four operations. Three of the patients, ages 65 to 83, developed complications and were returned to surgery for internal bleeding. All three died. The other patient had to have a second operation to correct a colostomy that Patel had performed "backward," according to the board's findings.

The board prohibited the doctor from doing operations involving the pancreas or liver, and required him to get a second opinion in complicated surgical cases. Thaler said that the board sent notice of its decision to three national databases. All should be readily accessible to officials in Australia, he said.

This April, the board "inactivated" Patel's license. Patel left Kaiser in 2001. Eventually, he began looking abroad. He contacted a medical recruiting firm in Sydney, Wavelength Consulting, which had been asked by the hospital in Bundaberg to help find a surgeon. Wavelength, which was paid roughly $10,000, relied on the documents submitted by Patel.

"At that time an 'Internet search' was not considered a recognized or reliable tool for checking a doctor's history," the company said in a statement after the scandal erupted. "We, too, were deceived."

Ken Olsen contributed reporting from Portland, Oregon, for this article, and David Staba from Buffalo.