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Breast surgeon is convicted of 20 counts of unlawful wounding and wounding with intent

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2134 (Published 02 May 2017) Cite this as: BMJ 2017;357:j2134
  1. Clare Dyer
  1. The BMJ

The rogue breast surgeon Ian Paterson, believed to have carried out negligent or unnecessary surgery on more than 1000 women, has been convicted of 17 counts of wounding with intent to cause grievous bodily harm and three counts of unlawful wounding.

Paterson, 59, who worked mainly at Solihull Hospital in the West Midlands, sobbed quietly as the verdicts were announced at Nottingham Crown Court and faces sentencing at the end of May. The maximum sentence for wounding with intent is life imprisonment.

The charges related to just 10 of his private patients, including one man. All underwent breast surgery that, prosecutors said, “no reasonable surgeon at the time would have considered justified.” Paterson misrepresented biopsy results to patients and GPs, played on fears raised by family histories, and claimed that mastectomies were essential to prevent the development of cancer.

But though the criminal case focused on unnecessary surgeries performed on healthy patients, most of the hundreds of civil claims against him involve insufficiently thorough mastectomies for real cancer.

Paterson specialised in “cleavage sparing” breast surgery, associated with a much higher recurrence rate than full mastectomies, and continued to practise this technique after he was told to stop, following an investigation at Heart of England NHS Trust in 2007. Eventually over 1100 of his patients would be called back for further tests and treatment.

The trust has since paid out nearly £18m (€21m; $23m) in damages and costs to settle 256 claims involving Paterson’s NHS work. Spire Healthcare, which owns the private hospitals where he worked, faces hundreds of claims, but compensation is uncertain because he was not employed by Spire and because the Medical Defence Union has refused to cover him for claims lodged after his commercial insurance coverage lapsed.1

Paterson’s motives remain “obscure,” said prosecutor Julian Christopher QC at his trial, “whether to maintain his image as a busy successful surgeon in great demand and at the top of his game, whether to earn extra by doing extra operations and follow-up consultations . . . or because Mr Paterson enjoyed the responsibility that came with helping people.”

Patients said that he had the perfect bedside manner and radiated competence. “Even though he was a consultant, he spoke on your level,” said one, interviewed for a 2013 report compiled by Ian Kennedy, former chair of the Healthcare Commission.

But colleagues had been raising grave doubts about Paterson for more than 10 years when the General Medical Council finally suspended him in 2012. By then he had been the subject of four investigations and reports.

Martin Lee, a surgeon asked by the trust to observe Paterson during surgery in 2008, compared his technique to a “whirlwind.” Lee added, “He would breeze into the theatre . . . and just try to get on as quickly as possible.”

Other staff described Paterson as “arrogant,” “aggressive,” “autocratic,” and “a bully.” This had meant that he often worked in isolation, which suited his purposes, one surgeon told Kennedy.

Paterson was able to keep working, Kennedy concluded, because the Heart of England Trust focused on “secrecy and containment,” rather than putting patients first, and because fellow clinicians failed to bring their concerns to the GMC.2

Chief Superintendent Mark Payne called Paterson a “controlling bully, who played God with people’s lives so he could live a luxurious lifestyle.”

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