The rogue surgeon: “wounding with intent”
“First, do no harm.” That is the fundamental principle of medicine, said The Times, but it was “turned on its head” by Ian Paterson: he set out to cause harm. Last week, the 59-year-old surgeon, who practised in the West Midlands, was found guilty of 20 counts of “wounding with intent” and unlawful wounding; and those are just the cases he was charged over. He is believed to have carried out unnecessary procedures on hundreds of people, most of them women who were wrongly told they had breast cancer, or were at risk of getting it. One patient was persuaded to have a full mastectomy, for no medical reason: the lumps in her breast were benign warts. Another had several operations on her nipple that left her in constant pain, when all she needed was antibiotics. Paterson also gave at least 1,079 patients experimental “cleavage-sparing mastectomies” (CSMS), which leave some tissue for cosmetic reasons, although it increases the risk of the cancer returning.
Why did he do it? There may have been a financial motive, said Tom Rawstorne in the Daily Mail. He was employed by the NHS, but also worked at two private clinics, run by Spire Healthcare. They would have paid him more for more operations – and he lived an expensive life: married with three children (who were privately educated), he owned a holiday home in Florida, a Grade II listed mansion in Edgbaston, and some buy-to-let flats.
His patients just think he was a psychopath, said The Daily Telegraph – for good reason. His cruelty is “almost beyond understanding”. Yet the key question is not why he did it, but why he wasn’t stopped earlier, said the Daily Mail. Though serious concerns were first raised about him when he nearly killed a patient in 1996, he then landed a job at the Heart of England Foundation Trust (Heft), where he was valued for helping it “hit targets”: he operated fast. In 2003, two surgeons warned Heft about his use of CSMS, and the number of his patients having “multiple operations”. But a later inquiry focused on managerial issues, and commended him for his industriousness. Further concerns were raised in 2004. It was becoming clear that his cancer patients were suffering higher than average recurrences, yet he was able to carry on performing CSMS until 2007 – and he wasn’t suspended until 2011. As for his private sector work, two GPS warned Spire Healthcare that he was “over-treating” in 2008, but Spire refused to commission an audit of his work. The managers who enabled Paterson’s grotesque crimes have not been “brought to book”. Until they are, justice will not have been done.