The New Zealand health boss embroiled in an expenses scandal was once in charge of a health authority in Canada where 84 patients died in two years from infection.
Dr Nigel Murray was the highest paid British Columbia health authority chief executive when the deaths from Clostridium difficile occurred between 2009 and mid-2011 at Burnaby General Hospital.
Murray was head of Fraser Health at the time when a letter from eight senior doctors revealed concerns over the deaths, according to a February 2012 report in the Vancouver Sun.
Rates of the infection ranged between two to three times the national average, the letter said.
When Murray was appointed CEO at Waikato District Health Board in July 2014 a British Columbia-Government ordered review of Fraser Health Authority found it was the worst performing in Canada.
At the same time the patients began dying at Burnaby General, Murray received a $30,000 performance bonus and was paid a $466,000 annual salary to oversee the $2.1 billion a year health authority, according to Vancouver Sun.
He was also in charge of slashing services at Fraser Health to meet budget constraints.
This included cutting thousands of surgeries, closing operating rooms, limiting MRI scans, downgrading an emergency room, closing a teen psychiatric unit in Abbotsford and a detox unit in Chilliwack, cutting mental health, seniors and domestic violence programmes, and laying off 12 hospital chaplains and counsellors to avoid the projected $160 million deficit.
When the deaths at Burnaby Hospital came to light in 2012 Murray hired a senior medical director to help reduce rates of infection, but not before an external review found Fraser Health's regional infection-control programme did not meet modern staffing recommendations.
In another letter, released by Burnaby Hospital infection-control committee chairman Dr Shane Kirby and sent to Murray, Kirby expressed his disappointment at the little progress that had been made.
"The measures to date for control of [C. difficile] at Burnaby Hospital have been and are frankly insufficient," he wrote, according to the Vancouver Sun, adding the situation had improved marginally, going from "horrific to horrible".
"There is significant discrepancy between the understanding of yourself and the Fraser Health Authority Executive and the reality of what is actually taking place on the ground in terms of Infection Control Practice," Kirby wrote.
"Such is the degree of concern, I question whether the scope of these problems needs to be brought directly to the attention of the Minister of Health for British Columbia."
C. difficile bacteria causes symptoms ranging from diarrhoea to life-threatening inflammation of the colon.
It is antibiotic resistant and lives in the stool of an infected person. Hospital overcrowding, where patients have to share bathrooms, was a big risk factor in spreading the infection.
Murray also came under fire in October 2013 when a 90-year-old legally blind woman was discharged from Delta Hospital in the middle of a raining night dressed only in pyjamas and no shoes.
Murray defended the processes which led to the discharge but was forced to apologise to Vivian Fitzpatrick over the incident.
When Murray eventually left in June 2014, interim board chairman Wynne Powell said it took 12 months to turn Fraser Health around.
Murray resigned from Waikato DHB in October after an investigation found he spent $218,000 of taxpayer money in three years largely on travel for work, with some of the expenses unjustified or unauthorised.
A DHB spokeswoman said Murray had still not paid back the less than $50,000 he owes the DHB.
Murray was unable to be contacted and his lawyer, Chris Scarrott from Peter Cullen Law in Wellington, said he could not comment.
"As we have previously stated, it would be inappropriate for Dr Murray to give comments to the media whilst investigations are ongoing."
Meanwhile the board has postponed recruitment of a new CEO, a process expected to take 18 months, until the latter half of next year.
In a memo to staff on December 1 interim chief executive Derek Wright said the board decided not to commence recruitment for a permanent CEO until then, and he would stay in the role until at least January 2019.
A spokeswoman said the board wanted a period of stability after the prolonged scrutiny following Murray's actions, and Wright was popular with staff.
A State Services Commission investigation into Murray's spending is expected early in the New Year.
The Deputy Auditor-General has also launched an investigation into the DHB's procurement of services from HealthTap, the American company used to power its virtual health app SmartHealth which was championed by Murray.
Who is Nigel Murray?
Dr Nigel Murray hails from a family of doctors.
Murray's father was a cardiologist, his mother a microbiologist by background, his younger sister was an infectious disease expert, and his younger brother was an epidemiologist, according to an interview Murray gave to the Vancouver Sun in November 2008, a year after he took up the top job at Fraser Health Authority in Canada.
It explains why on his curriculum vitae, now removed from the Waikato DHB website, he lists 13 studies he co-authored in the 1970s and 80s, published in such journals as the Lancet, where every researcher is named Murray.
Born in New Zealand, Murray immigrated to the United States as a child when his father took a job at the Mayo Clinic in Rochester, then at the University of Minnesota as a professor of medicine, according to the question and answer style article.
Murray's interest in medicine was first piqued in the 1970s when his father took a sabbatical opportunity to work in Niger, Africa, near Lake Chad at a local hospital that had no doctors.
"It was a brand new hospital built by Americans but with no staff so we [mother, father, siblings] ran the hospital," Murray said.
"I was a physician's assistant and it was a tremendous experience. It really locked in my interest in medicine."
Murray trained in New Zealand, getting a medical degree in 1982. He worked as an intern for two years and thought he would specialise in oncology.
Instead he went into the Army reserves as part of the officer training corps.
"It offered university students a wage and stipend to help pay for education so I signed up for that. My father had done the same thing," Murray told the newspaper.
The Army sponsored Murray's post-graduate education at Harvard University where he completed a master's degree in occupational health.
Murray, a father of four adult children, received an MBE in 1995 for his services to the New Zealand Defence Force for stints in Iraq and Bosnia.