Breast Surgery Butcher: A Sign Of Things to Come?
09 May, 2017
10 years ago Ian Paterson was an esteemed surgeon. Now, his career lies in ruins and he faces prison as a result of thousands of unnecessary and dangerous operations he carried out, both privately and through the NHS. Paterson was recently (28th April 2017) found guilty of needlessly operating on nine different women and one man, but it is believed that he operated unnecessarily on hundreds, if not thousands of other victims. His motives for these operations are unknown, although they are presumed to be financial as Paterson received money for carrying out these operations privately and from NHS funds.
Whilst he was found guilty of three counts of unlawful wounding, and seventeen counts of wounding with intent, the jury were not told that more than 250 patients of Paterson had already had their cases settled, with the NHS having paid out more than £9.5 million in damages, and £8.2 million in costs. A further 350 women are said to be now bringing a high court case against the NHS and Paterson. Nor were the jury told that he was suspended from Solihull hospital in 2011 for hundreds of dangerous operations he had carried out. His crimes took place in the West Midlands between 1997 and 2011, in two privately-run hospitals: Little Aston, and Parkway. The surgeon exaggerated or made up cancer risks and the need for operations in hundreds of patients, and was able to claim payments in some cases for expensive procedures. He also was paid extensively through the NHS and was able to fund a lavish lifestyle with multiple homes across the UK and the US. During the trial, jurors heard how Paterson had placed patients in danger of developing secondary cancer by inventing what he called a ‘cleavage-sparing mastectomy’, which left breast tissue behind in order to achieve a better cosmetic effect. However, this was not within the national guidelines of removing all tissue to prevent breast cancer from returning, without removing all tissue the risk of secondary cancer was doubled. Unfortunately, as a result of his ‘invention’ many did develop secondary cancer, and some patients later died.
However, despite the widespread nature of his crimes, there was a seven-year delay in stopping Paterson. Concerns relating to his work raised by a senior clinician in 2003 were not dealt with for another four years. Furthermore, he was suspended by a previous employer in 1996, yet 2 years later he was employed by the Heart of England NHS Trust. An internal report into his conduct in 2004 made recommendations, however these were not acted upon, neither by the NHS or the private hospitals he worked within. Spire Parkway was notified in 2004 that NHS investigators were looking into Paterson, yet he continued to work there until mid-2011 when he was excluded from the NHS trust, and he was finally suspended by the GMC in 2012. As a result of his suspension 642 patients had to be recalled. This meant that victims of Paterson who had believed they had survived breast cancer then faced the additional ordeal of being recalled by the NHS to see if their treatment had been enough. Of the 1207 patients who were given a mastectomy by Paterson, including ‘cleavage-saving’ operations, 675 have since died. Although the cause of death in these cases has not been released, it is assumed that the majority died due to Paterson’s negligence. A further 68 patients have seen a return of their cancer due to his methods.
A review by Professor Sir Ian Kennedy into the Heart of England NHS Trust found that if concerns that were raised by senior clinicians in 2004 about Paterson’s mastectomy procedures had been taken seriously then he would have likely ‘been required to stop operating on woman with breast cancer by the end of 2004 at the latest.’’ Instead, Sir Ian found that the case was covered with a ‘blanket of confidentiality’ as the NHS tried to contain the issue. This meant that Paterson was still operating, both privately and within the NHS, until 2011. Patients of Paterson were unaware that the procedures he was convincing them were necessary were anything but, and he was afforded a god-like status by many. One of his victims told the trial ‘we trusted Mr Paterson … he was God to us.’ This ambivalent status is often afforded to surgeons and doctors, meaning many are too afraid or unaware to challenge or complain, instead believing everything they are told. This was the case for many of Paterson’s victims, many of whom had multiple unnecessary surgeries because they believed Paterson at his word. 935 patients had a wide local excision (a surgical procedure which removes a small area of breast tissue which is either diseased or problematic) when they didn’t need any such operation, whereas others actually required more serious treatment and 238 have since died. Many victims are calling for a public enquiry due to the scale of his crimes.
Yet, under new fixed cost schemes proposed by the government, many of his victims may not even receive compensation for their suffering at the hands of Paterson. Patient safety groups have warned that this would deny them justice. The proposals suggest that there should be strict caps on the fees that can be claimed by lawyers for claims against the health service up to £25,000. The government argue that legal fees in medical negligence claims are spiralling, and this is the best way to prevent this from continuing and to save the NHS. However, this would prevent many from finding a solicitor, as most would not be able to afford to represent them if their case is not worth more than £25,000. And if they did manage to find a solicitor, they would likely lose a significant chunk of their damages to legal costs. Either way, the victim loses out, and these changes may apply to some of the victims of Paterson.
How can we rely on the NHS to prevent malpractice occurring if it took them so long to deal with Paterson despite concerns repeatedly being raised? If they were happy enough to sweep it under the carpet, or ‘blanket’ according to Sir Ian, then what’s to stop them from doing this again elsewhere? The ability to hold the NHS accountable through compensation motivates them to constantly improve and prevent widespread incidents occurring. In the 1970s the Health and Safety Executive was established due to huge numbers of workplace injuries. Since their introduction, there have been many improvements in legislation leading to a decline in accidents at work. The threat of legal action is often enough to make sure employers follow the letter of the law. This financial risk forces people to act and make it safer, and this can be applied to the NHS too. If the financial threat is not there, will the NHS still be as inclined to act? Or will there be more cases like Paterson if these fixed fees go ahead?