India-born US surgeon Jayant Patel, who faces charges of fraud, multiple manslaughter and grievous bodily harm in Australia, may be extradited from the United States with the process having being "confidentially" approved.
The move will trigger an arrest in Oregon, his hometown in the US, media reports said.
"The extradition of rogue surgeon Jayant Patel from the US has been confidentially approved by federal Justice Minister David Johnston in a move that will trigger an arrest in his home town in Oregon," The Australian newspaper said.
Sources close to the process informed the newspaper on Tuesday that the signing of the paperwork for Patel's extradition was the most significant development to date in the bid to have him returned to Brisbane for a criminal trial.
Federal justice minister David Johnston, who was in New Zealand, is believed to have approved the extradition and is expected to announce the latest step on Patel's return to Australia.
"The minister cannot confirm it and the minister cannot deny it - we cannot comment on this. I'm not saying it's right and I'm not saying it's wrong," Senator Johnston's chief of staff Chris Muir was qouted as saying from New Zealand.
Patel does not have access to his passport and Queensland police do not regard him as a flight risk.
The next steps, including an arrest, are matters for US justice officials and US marshals, who have been briefed on the case by their counterparts in the office of the Queensland Director of Public Prosecutions and federal government extradition experts, the report said.
It has been more than two years since the alleged fraud and negligence of Patel were exposed, and 18 months since a Royal Commission-style inquiry linked him to 17 deaths during his two years as director of surgery at Bundaberg Hospital.
A series of formal inquiries made damning findings against the Beattie Government, the public hospital system and Patel.
But a top US surgeon, who is defending Patel in his legal fight with Australian authorities, said the surgeon was adamant he had done nothing wrong and would fight "tooth and nail" for as long as it took to avoid being extradited.
"He will fight tooth and nail because he knows that when he goes to Australia, nobody in your system will protect him - he is (doomed) and he knows it," said Vijay Mehta, the chief of surgery at a US hospital and a graduate of the same medical college in India as Patel.
He urged US justice officials to reject any extradition application from the Queensland and Australian governments.
"When I look at Jayant Patel, I see a brilliant man in some areas, and I see a man who was lacking in integrity in other areas. But I think our (US) justice system should step in and declare that he can't get a fair trial. No matter how you deal with Patel, he cannot get justice. He is known as Death," he said.
Mehta said Patel's wife, Kishoree, a practising doctor in Portland, Oregon, would stand by her husband and help to fund his legal battle.
"But the way the Queensland Government is dragging its feet, they must know it's going to be a lot harder to bring him back," he said. "They should have taken his offer to return."
Premier Peter Beattie of Queensland state and the then Attorney-general, Linda Lavarch, rejected a confidential offer by Patel to return voluntarily to face justice before the state election in September.