In 1980, Patrick began reffing for World Championship Wrestling (WCW). He eventually moved up to become the Senior Referee in WCW.
When the nWo formed in 1996, he joined and became their official referee. He would allow the nWo wrestlers to cheat and he would show a clear bias towards the nWo. Because of this, he was forced into a match against Chris Jericho at the World War 3 pay-per-view on November 24, 1996 in Norfolk, Virginia. Jericho had one arm tied behind his back and still defeated Patrick.
Patrick's biggest night with the nWo was refereeing every single match on the nWo Souled Out pay-per-view on January 25, 1997 in Cedar Rapids, Iowa.
His nWo tenure came to an end at Spring Stampede 1997. Scott Hall and Kevin Nash were scheduled to defend the WCW World Tag Team Titles against The Steiner Brothers. Due to out-of-ring attacks and such, combined with Hall failing to show for the event, the title match eventually became a singles match between Nash and Rick Steiner. Nash was allowed to appoint a referee and he chose Patrick. During the match, Nash removed the padding over the turnbuckle and dropped Steiner's face on it. Nash covered an unconscious Steiner and Patrick quickly counted to three, awarding the contest to Nash. After the match, Nash kept performing the maneuver on Steiner. Patrick had a change of heart and attempted to get Nash to stop. Fellow nWo associate, Ted DiBiase, also had a change of heart and attempted, with Patrick, to get Nash to stop. When Nash refused, both Patrick and DiBiase left to get help for Steiner. Later that evening, Patrick served as referee for the main event match between nWo member Randy Savage and Diamond Dallas Page, counting a proper pin for Page. After the match, Nash came out and attacked Patrick, for all intents and purposes kicking him out of the nWo.
On the April 21, 1997 edition of Nitro, he unexpectedly appeared in the announce booth with Tony Schiavone and Larry Zbyszko. Wearing a green WCW polo shirt, he cut a promo explaining that he was sick of Eric Bischoff and the way the nWo did business. He explained that he never wanted to fight fellow referee Randy Anderson and asked for his job back. Both Schiavone and Zbyszko were skeptical, especially Zbyszko, who was intensely critical. They went to a commercial break with Patrick and Zbyszko arguing. The next week on Nitro, WCW executive J.J. Dillon announced that Patrick was being re-hired on a probationary basis. Patrick was a neutral referee from that point on and never sided with the nWo again.
Patrick created massive controversy over the WCW World Heavyweight Championship at Starrcade 1997 when he made a "fast count" in the Sting and Hollywood Hogan match; although that was the planned finish to the match, Patrick botched it by counting three at normal speed. Bret Hart stopped Patrick from giving Hogan the title, claiming the fast-count, and restarted the match claiming that he didn't want to see Sting get screwed like he was. After a subsequent rematch, the title was declared vacant. Patrick would referee another rematch for the vacant belt, taking over for Charles Robinson (who had been knocked out during the bout). Sting would win that match and WCW management upheld Patrick's ruling.
When WCW was bought by the WWF, he was one of three WCW referees who had their contracts purchased, along with Charles Robinson and Billy Silverman. He became a referee for The Alliance of WCW/Extreme Championship Wrestling (ECW) wrestlers trying to take over the WWF. He even had a match against Earl Hebner at the WWF Invasion pay-per-view on July 22, 2001 in Cleveland, Ohio. Patrick lost to Hebner and Mick Foley, the special guest referee, gave him "Mr. Socko" after the match.
During the time of the Alliance, Patrick would continue to play a heel referee, siding with the Alliance wrestlers over the WWF wrestlers. For example, during a WCW Championship handicap match between The Rock and Booker T and Shane McMahon at Unforgiven 2001, Patrick would refuse to count when the Rock had Booker or Shane pinned down. At Survivor Series, Patrick knocked out Hebner to take over as referee during the "Winner Take All" elimination tag match. After he gave a normal "slow count" for The Rock, Stone Cold Steve Austin became enraged, knocked Patrick out, and brought Hebner back in as referee. After the Alliance angle ended, Patrick became an official WWF referee. At first he was a heel referee, refusing to count to three for face wrestlers as Steve Austin and Rock, and favoring wrestlers like Chris Jericho and Kurt Angle. After WrestleMania X8, Patrick started portraying a down-the-middle, neutral referee once again.
After the brand extension, Patrick was used as the head referee on the SmackDown! brand. Patrick officiated the World Heavyweight Championship match at ECW One Night Stand 2006 between champion Rey Mysterio and Sabu.
Patrick left the SmackDown! brand on February 9, 2007 and Mickie Henson took over as senior referee.
Patrick returned to the SmackDown! brand on February 8, 2008 and refereed a tag team match between Jesse and Festus and Deuce 'n' Domino. However, he quickly disappeared again due to his injuries.
Patrick was released from the WWE on August 8, 2008 after seven months of inactivity due to a chronic back injury.