THE MAN WHO LOVED TO PLAY GOD

Blunders, secrecy and botched investigations ... how hospital bosses allowed doctor to maim women for 15 years

AN extraordinary series of blunders and missed warning signs meant Ian Paterson’s appalling malpractice carried on for 15 years.

Whistleblowers who tried to raise the alarm were not taken seriously or were ignored.

A string of NHS bosses deemed protecting his reputation more important than addressing the medical needs of his patients.

When an inquiry was belatedly launched into his ‘cleavage saving mastectomies’ (CSMs), in which he left a small amount of tissue, it was shrouded in secrecy.

Later, NHS chiefs tried to block a full recall of his breast cancer patients, whose lives were at risk.

Campaigners fear scores of women died needlessly. The incompetence in the NHS was mirrored in two private hospitals. Here the Mail details the errors that allowed Paterson to carry on operating.

HIRED TO HIT TARGETS

In 1996 Paterson was a surgeon at Good Hope Hospital in Sutton Coldfield, Birmingham. He was suspended after a botched operation which exposed a patient to ‘significant risk of harm’.

Gill Dallow, 54, almost died when he accidentally sliced through three major blood vessels during a routine procedure in 1996.

But in 1998, Paterson landed a job at the Heart of England Foundation Trust (Heft). He was regarded as a ‘highly effective’ surgeon capable of helping it hit targets. He specialised in vascular surgery but also performed operations on women with breast cancer.

In a 2013 report into the Paterson scandal in the NHS, Sir Ian Kennedy suggested Heft had been desperate to recruit him because it had ‘waiting list problems’.

ONCOLOGISTS IGNORED

In 2002-03, two cancer experts, Dr Andrew Stockdale and Dr Indy Fernando, became concerned about how the surgeon was carrying out breast operations.

Dr Stockdale carried out an audit of 100 patients, from January 1, 2003, and found a number had breast tissue remaining after mastectomies by Paterson. What worried him particularly were ‘patients having multiple operations’.

Along with Dr Fernando, he went to see Mark Wake, Heft’s lead cancer clinician, who launched an investigation. But Mr Wake focused on the lack of teamwork rather than the bungled mastectomies – and even ‘commended’ Paterson’s ‘industry’. ‘So Mr Paterson continued to operate on women for three more years,’ Sir Ian said. In his report, Sir Ian said of Dr Stockdale’s treatment by managers: ‘He had blown a whistle. Whistleblowers do not fare well in the NHS.’

INVESTIGATED IN SECRET

A number of oncologists continued to see worrying effects of Paterson’s CSMs – women who had ‘discernible volumes of tissue’ remaining after mastectomy.

Breast surgeon Mr Hemant Ingle, – along with Dr Stockdale and Dr Fernando – wrote in 2007 to Heft medical director Ian Cunliffe to complain about Paterson’s ‘personal conduct and clinical competence’. An investigation was set up but was kept confidential.

The decision led to a ‘complete clamp-down on communication’ between senior managers who received the reports and the rest of the staff. ‘Confidentiality descended to consign everyone to ignorance for years to come, except for the knowing few,’ said Sir Ian.

A consultant general surgeon from a different trust who reviewed the case notes of 63 patients concluded 54 cases ‘raise some issues’. Colm Hennessy’s report was strongly critical of Paterson’s surgical practice and of Heft’s response to concerns raised.

INADEQUATE RECALL

In December 2007, Paterson was banned from carrying out CSMs but was allowed to continue operating. In 2009, NHS bosses were made aware of official data suggesting his overall surgical performance was poorer than his peers’. But just 12 of the 4,424 NHS patients Paterson would treat for breast symptoms were recalled.

Sir Ian said: ‘The approach was misguided. Women had clearly been exposed to a risk … scale was important because of the consequences if the increased risk turned into reality. The only sure way was to recall all patients. This view was rejected by the chief executive [Mark Goldman] and Ian Cunliffe in favour of a limited recall.’

He accused NHS chiefs of ‘a failure to realise how serious the problem was’ and a ‘desire to safeguard the reputation of the trust’.

In 2011, the decision was taken to recall all patients who had had a ‘simple mastectomy’ by Paterson. Months later this was extended to include all who had a mastectomy with immediate reconstruction.

But the process was dogged by delay, exposing patients to greater risk. Paterson was suspended by Heft in May 2011, eight years after Dr Stockdale’s audit and 15 years after Mrs Dallow nearly died. As of March 31 this year, 675 of the 1,207 patients who had NHS mastectomies by Paterson had died.

Determining how many died prematurely or unnecessarily as a result of his bungled operations is difficult. According to Sir Ian’s report, ‘local recurrence rates’ of cancer were significantly higher in women treated with CSM. Ann Butler of the Survivors Support Group said: ‘I believe a significant number of women died unnecessarily following his surgery. There needs to be a wider inquiry, detailed analysis of the data concerning death rates of his patients.’

NHS BOSSES PASS BUCK

Sir Ian said the list of those responsible for the scandal at Heft was ‘long’. ‘Senior managers did not respond effectively to concerns about Mr Paterson’s surgical practice until late December 2007 … their response was neither sufficiently robust nor sufficiently rigorous.

‘Other clinicians in the breast team…did not go to the GMC or the regulator…Mr Goldman, as chief executive, appeared to leave the problem to others, but was clearly closely involved. Mr Cun-

liffe, in conjunction with Mr Goldman, clamped down on communication, sought to contain the fallout, chose not to stop Mr Paterson…and chose to initiate a very limited recall.’

PRIVATE SECTOR SCANDAL

While working in the NHS, Paterson had ‘practising privileges’ at two private hospitals in the Midlands: Spire Parkway from 1998 and Spire Little Aston from 1993. It was there that he is said to have carried out at least 450 unnecessary or botched operations.

Spire Healthcare group bosses gave Paterson the ‘benefit of the doubt’ when complaints were made. In December 2007, Heft told Ruth Paulin, then Parkway director, it was investigating Paterson’s CSMs and he had been told to stop carrying them out. Mrs Paulin instructed him to stop performing them, but did not make arrangements to ensure he complied.

In September 2008, two GPs complained to Spire that the surgeon gave misleading information and was ‘over-treating’. But Paterson’s version of events was ‘largely accepted’ and a requested independent audit of his work was not commissioned. A 2014 independent report into Paterson at Spire said the GPs’ complaints should have been taken ‘much more seriously’.

In December 2009, a patient raised concerns about her treatment with Paterson, including having a general anaesthetic against her wishes, misleading information and about his ‘bullying approach’.

The report by consultants Verita found: ‘Despite the mounting evidence that there were serious concerns … no measures were in place to monitor his performance … We believe that if these missed opportunities had been taken there could have been a difference to the out-turn of events.’

Paterson was suspended by Spire in 2011. His ‘practising privileges’ were finally withdrawn in 2012 when the General Medical Council suspended him.