An American doctor accused of repeatedly botching operations and performing surgeries he was not capable of handling pleaded not guilty Monday in Australia to three manslaughter charges and one of grievous bodily harm.

Indian-born Jayant Patel replied “not guilty, your honor” when the charges were read to him in a crowded courtroom just before jury selection began in the trial that is expected to take four to six weeks and hear some 90 witnesses.

The trial comes more than 25 years after questions were first raised about his competency, and five years after a government inquiry found he may have directly contributed to patient deaths because of an unacceptable level of care at the hospital.

Patel, 59, has not spoken publicly about the charges. He faces life in prison if convicted.

Wearing a dark suit, white shirt and patterned blue tie, Patel arrived to a media throng about 15 minute before the start of his trial with his wife, Kishoree, clutching his arm. Flanked by his defense team, he refused to answer questions from dozens of reporters.

Prosecutors say Patel repeatedly performed surgeries he’d been banned from undertaking in the United States, misdiagnosed patients and used sloppy, antiquated surgical techniques while working in Bundaberg, a sugar industry town 230 miles (370 kilometers) north of Brisbane in Queensland state. Some of the accusations against him include unnecessarily removing a patient’s bowel and failing to stop internal bleeding in an elderly man who later died.

Patel was originally charged with more than a dozen counts, but will only be tried on four: three counts of manslaughter and one of grievous bodily harm. The charges relate to four patients he treated while working as director of surgery between 2003 and 2005 at a state-run hospital in Bundaberg.

Jury selection took about 30 minutes. Court officials then read to the jurors a list of potential witnesses, which included 76 doctors and 64 nurses.

The case has received massive media attention throughout Australia, and the trial was video streamed.

“There has been publicity in newspapers and on television about this accused and events that occurred years ago,” Brisbane Supreme Court Justice John Byrne warned the jurors. “In the light of this publicity, if you have or might fairly be thought by others to have already formed an opinion of the accused … then you should not be a juror.”

Patel was charged with the manslaughter of Mervyn John Morris, James Edward Phillips and Gerry Kemps. He is also accused of causing grievous bodily harm to Ian Rodney Vowles.

Prosecutor Ross Martin told a pretrial hearing last year that in 2004 Patel failed to stop internal bleeding after operating on the esophagus of 77-year-old Kemps, who later died of blood loss.

In another incident, Martin said, Patel found a benign cyst during a colonoscopy of Vowles. But rather than order a biopsy, Martin said, Patel removed the man’s bowel. The specimen later showed no sign of cancer.

One of those in the gallery Monday was Beryl Crosby, who runs a support group for patients at Bundaberg Base Hospital who claimed they were harmed by Patel.

“We’ve been waiting a long time for this day to begin,” Crosby said outside the courtroom. “It will be justice and some closure. Now we must be patient and let the judicial system take its course.”

Patel has faced complaints about his competency since the early 1980s, when he practiced in the U.S. In 1984, he was fined by New York health officials and placed on probation for three years for failing to examine patients before surgery.

He later worked at Kaiser Permanente Hospital in Portland, Oregon. Kaiser banned him from liver and pancreatic surgeries in 1998 after reviewing 79 complaints about Patel. The Oregon Board of Medical Examiners later cited him for “gross or repeated acts of negligence.”

Patel was hired by Bundaberg in 2003. Two years later he resigned and left for the U.S. after accusations of questionable practices were raised against him in state parliament. In July 2008, he was extradited to Brisbane from his home in Portland.

Associated Press