Greed, arrogance – or evil? Why DID the breast surge on butcher so many?
A sister’s haunting story casts intriguing new light on the motives of rogue consultant Ian Paterson
One particularly painful memory sticks in Shirley Moroney’s mind. Her older sister Marie is lying in a hospital bed, in pain and acute distress after a second botched double mastectomy by rogue breast cancer surgeon Ian Paterson.
She has woken from the anaesthetic expecting to see just skin and bone on her chest, but instead there is enough fatty tissue left to fill a bra C cup. When she looks at what remains of her 38 DD breasts, she not only feels devastated by Paterson’s handiwork, but mutilated, angry and betrayed.
Shirley’s voice quivers with grief as she recalls Paterson’s final examination of her sister: ‘I could hear his voice from behind the curtain, telling Marie as he examined her in the presence of a nurse: “excellent. Isn’t this nice? Doesn’t it look good?”
‘I had to swallow my anger. I could have stitched her up better myself. It looked so bad it could have been done by a two-yearold. Marie was left with what looked to her like two deformed breasts. She thought there would be nothing there at all.’
This was the second time in eight weeks Glasgow-born Paterson had operated on policewoman Marie Pinfield, who had been diagnosed with a cancerous tumour on the chest wall behind her left breast in 2006.
Both times he performed an experimental ‘cleavage-saving’ procedure — leaving some fatty tissue behind for cosmetic reasons — against Marie’s wishes and in breach of guidelines.
‘It was traumatic enough to know she had breast cancer: these two operations just added to her distress,’ says Shirley, 54.
‘If he’d done the first operation properly, Marie could have started chemo immediately, but it was delayed so she could give Mr Paterson another chance.
‘I was furious with myself for letting him get his hands on my sister a second time. I just wanted to get her out of the hospital and home.
‘Mr Paterson was this god-like figure on the ward. All the nurses and medical staff seemed to be in awe of him.
‘everyone must have known that Marie had complained about the first operation and we felt a distinct chill towards us.
‘She was in terrible pain with drains coming from her chest, but only the cleaner stopped to ask how she was feeling.
‘Marie was so angry that she wrote to the hospital trust to complain, but she received a glib letter back that effectively said: “We’ve looked into it, no case to answer, goodbye.” ’
With his charming bedside manner and reassuring air of authority, Marie Pinfield had confidence in Ian Paterson to help her beat breast cancer after her first consultation.
Marie was in no doubt she wanted a radical bilateral mastectomy to remove both breasts after she was told the invasive tumour was grade 3 — the fastest-growing cancer. She hoped this drastic surgery, followed by chemotherapy and radiotherapy, would give her at least another ten years or, at worst, five. In the end, she lasted just two. Marie died in October 2008 after the cancer spread to her lungs. She was just 50. Perhaps no doctor could have saved Marie, but today — almost nine years on — her family are haunted by the thought she might still be alive if she hadn’t placed her trust in Ian Paterson. Shirley fears her sister’s ordeal may have hastened her death. ‘I believe that my sister would have lasted longer if Ian Paterson had never touched her,’ says Shirley. ‘He messed up her first operation and when Marie gave him a second chance to put it right, he messed it up again. ‘We’ll never know if the cancer would have come back anyway, but Marie was so traumatised by what she’d been through she wanted Ian Paterson stopped.’ Marie was due to retire the year she died. Divorced with no children, the child protection officer had devoted almost 30 years to West Midlands Police. Shirley says her sister believed in right and wrong, putting things straight. She had great faith in the justice system. Had she lived, Shirley says Marie would have welcomed Paterson’s conviction last week. Following a seven-week trial, he was found guilty of 17 counts of wounding with intent and three counts of unlawful wounding after the jury heard harrowing testimony from ten of his private patients, nine women and one man.
He denied carrying out unnecessary operations from 1997 to 2011 for financial gain — in some cases, the court was told, performing mastectomies on patients without cancer.
Shirley attended Paterson’s trial four times in memory of her late sister. West Midlands Police launched its criminal investigation after the consultant was accused of botching more than 1,000 operations.
‘I didn’t want to go to the trial because it emotionally cripples me,but I could feel Marie willing me on,’ says Shirley.
‘Listening to [Paterson] give evidence, his arrogance shone through and I felt so angry. He thought he was right and everyone else was wrong.
‘He didn’t give the impression he was sorry at all or that he even considered he’d made mistakes. I can only put it down to a god complex. I think he wanted women to see him as some kind of saviour — and it was very painful to watch him ratcheting up the sadness of those who’d suffered at his hands.
‘He tossed files to the floor, made flippant jokes and admitted some medical notes were shredded. It’s unforgivable.’
SHIrLey says she gave West Midlands Police a statement during its investigation, hoping Marie’s case would be included in the prosecution.
But she says: ‘There were hundreds of cases and if they’d included them all, the trial would have gone on until Doomsday.
‘There are hundreds of people who Ian Paterson treated on the nHS and he didn’t do right for them and I would have liked to see justice for them, too.’
With the trial at an end, Shirley is hoping that Paterson will
be struck off by the General Medical Council.
Marie Pinfield was 48 when she went to her GP in the summer of 2006 complaining of breast pain. Referred to Solihull Hospital in the West Midlands, she was distraught when a scan revealed the tumour on her chest wall.
Terrified the cancer would kill her, she decided she wanted a double mastectomy, telling Shirley: ‘I’m scared my breasts will be the end of me.’
Solihull Hospital insisted she undergo a psychiatric assessment to ensure she was of sound mind and was fully aware of the consequences, showing her pictures of what she might look like after the operation.
Marie did not waver for a second and was mentally prepared to wake from the NHS operation with a completely flat chest, ready to begin chemo and radiotherapy.
She thought the loss of her breasts was a small price to pay for her life and did not want a reconstruction. But Ian Paterson had other ideas.
With no prior discussion, he performed the ‘cleavage-sparing’ procedure to excise the tumour and a margin of fatty tissue around it and the mammary glands.
This was not standard procedure and some experts say leaving any tissue behind after a mastectomy increases the risk of cancer recurring by up to 50 per cent.
Marie was beside herself when she came round from the operation to see breasts big enough to fill a DD bra cup.
She thought Paterson had found so much cancer he’d simply stitched her back up. When Marie, supported by Shirley, expressed distress rather than gratitude when Paterson did his postoperative rounds, his charming bedside manner evaporated.
‘He became very irritable and arrogant with us, as if he thought we were questioning his competence. It seemed more an issue of professional pride than what Marie wanted,’ says Shirley, who thought Paterson might be a ‘frustrated cosmetic surgeon’.
‘But we weren’t criticising him. At that point we just thought he’d simply misunderstood what Marie had wanted. We still trusted him, so Marie gave him a chance to put it right.’
Eight weeks after the first operation, Marie went through a second double mastectomy performed by Paterson. She was traumatised to wake to find he had ignored her wishes once more. But as the surgeon examined her, loudly admiring his own handiwork, Shirley says that Marie — physically and emotionally shellshocked — stayed silent.
‘She was very angry with him, but we both recognised that he didn’t work alone, did he? People knew he was wrong, but they all kept going, backing him up,’ says Shirley. ‘When Marie complained to the Trust about her treatment, she felt she was fobbed off.’
But that wasn’t to be the end of the matter.
In 2007, the year before she died, Marie received an unexpected phone call out of the blue.
A colleague of Ian Paterson’s from Solihull Hospital, who she’d never met, asked to meet Marie to talk about her operations.
This breast specialist had reviewed her case and was so disturbed by it he wanted to help.
HE SUGGESTED they meet secretly at a local car park, rather than the hospital, where questions might be asked.
The surgeon offered to rectify the botched surgery to improve her appearance. He also asked if Marie would help him launch a complaint to the Trust about Paterson’s surgical procedures.
‘Marie had been through two very traumatic operations and was in the middle of chemo and radiotherapy. She couldn’t face any more surgery,’ says Shirley.
‘But she agreed to give a statement and, later that week, went to the hospital to have medical photos, and to undergo an MRI scan and further examinations.
‘At that point we thought Marie was one of just a few, not one of so many.’
Marie died unaware that the Trust had, indeed, launched an investigation in 2007 as a result of serious concerns raised by some of Paterson’s surgical and breast care colleagues.
But it was shrouded in secrecy until an external review by Sir Ian Kennedy, commissioned by Heart of England NHS Foundation Trust (HEFT) in the wake of the scandal, was published in 2013.
The review revealed that Paterson, employed by HEFT since 1993, had been ordered to stop the cleavage-sparing procedure, but was not suspended or banned from operating.
This was despite concerns about his clinical work and management style dating back to 2003.
Spire Healthcare, which has private clinics in Solihull and Little Aston, where Paterson had worked as breast cancer surgeon since 1993, said it was unaware of the NHS investigation.
Paterson carried on operating there until 2011, when the GMC imposed conditions, and then suspended him in 2012.
‘After Marie died, I thought she’d been unlucky and one of a few isolated cases,’ says Shirley. ‘But there were so many doctors trying to warn about him, breast cancer nurses mumbling, yet he carried on operating until 2011.
‘In 2009, I met a woman who was due to have an operation with Mr Paterson. She’d heard about Marie and said to me: “Shirley, you’ve got him all wrong.”
‘She invited me to a meeting for cancer patients at the Spire and a woman stood up in front of 200 people and told them Mr Paterson was the victim of a witch hunt.
‘People in Mr Paterson’s world fall into two camps, either complete devotees who believe he can do no wrong because he is so charming or people like Marie, who didn’t get what they want and are suffering or dead.’
Shirley was one of the first complainants to sue HEFT for damages. Marie’s tragic story — told for the first time by the Mail in 2012 — prompted hundreds of other women, NHS and private patients, to come forward.
In 2013, Shirley received £60,000 in damages from the Trust, which accepted that Marie had been through an unnecessary second operation, but denied liability for on-going events.
Most of the NHS claims are believed to have been settled — with awards ranging from as much as £250,000 to less than £10,000 — but Paterson’s private patients may never see a penny in compensation after the Medical Defence union withdrew Paterson’s personal indemnity insurance.
Shirley says of her settlement: ‘It was never the point. If I didn’t go down the legal route, I was told he wouldn’t stop and I couldn’t allow that to happen. There isn’t a figure that could bring my sister back.
‘I’m happy Paterson has been convicted and I hope I can finally put Marie to rest.’
Solicitor Ally Taft, partner at Medical Accident Group at Harrison Clark Rickerbys, acted for Marie’s family and is pursuing claims on behalf of some of Patersons private patients.
She welcomes Paterson’s conviction and adds: ‘No one has got to the bottom of his motive. The NHS issue was about not taking away enough tissue and leaving behind cleavage.
‘It was quite the opposite in the private sector, taking too much away and doing multiple, unnecessary operations.
‘I think it must have been financial and possibly he even had a bit of a god complex. He had patients hanging off his every word. He was pulling strings and coming to the rescue, almost like a knight in shining armour.’
Solicitor Kashmir uppal, of Access Legal, who has settled more than 100 cases on behalf of NHS claimants, says: ‘Ian Paterson was a surgeon with a fantastic reputation and women who rushed to support and defend him now feel stupid for being deceived by him. Is he deluded? Was it the money? We still don’t know.’