As patients, we place our full trust in doctors. When that doctor is a consultant surgeon with the confidence and reassurance we are desperate for when facing life-changing disease or illness, questioning their recommendations does not come naturally. Rarely do we go against the advice we are given on the best course of treatment and seldom do we seek a second opinion.
Ian Paterson was a consultant breast surgeon working both in the National Health Service and in private practice in two West Midlands hospitals in England. On 28 April 2017, he was convicted of 17 counts of wounding with intent after carrying out unnecessary surgeries on 10 patients over the course of five years between 1997 and 2001.
“He’s a psychopath. Why would anyone in their right mind do operations to people knowing that they didn’t need them?”
One month after his conviction at Nottingham Crown Court, Ian Paterson was sentenced to 15 years in prison for his crimes. Working for the Heart of England NHS Trust and Spire Healthcare, both have now had to pay out millions of pounds in compensation to patients who became victims of a surgeon tagged as ‘gone rogue’. The cases for which he was convicted related to his private patients, with the true number of people Paterson intentionally invented or exaggerated their risk of cancer and convinced into surgery still unknown.
The Journal of Medical Ethics wrote on their blog in May 2017 it is still not clear what the motives of Ian Paterson were. The private patient cases in his trial allowed the prosecution to focus on financial gain as a possible motive for his behaviour. They told the court that Ian Paterson carried out “extensive, life-changing operations for no medically-justifiable reason“. Patients under the National Health Service do not have to pay for medical treatment. Those who are private, however, are covered by medical insurance or they meet the costs personally, paying out to the medical professionals in charge of their care for the treatments needed, including expensive surgeries.
“All surgeons intentionally wound their patients but they do so in the patient’s best interests,” the Journal of Medical Ethics wrote. Harm is needed, i.e. surgery, in order to treat a patient in the best interests of their health. Ian Paterson, however, intentionally lied, misled and gave inaccurate information to his patients, gaining their consent to surgery they thought they needed. He then carried out surgery entirely unnecessary to their health and charged for his time. This intentional harm is what opened up criminal prosecution against him.
In previous UK cases of surgeons using questionable methods, the most common outcome is official removal from the General Medical Council, banning them from being able to practice medicine. In 1998, gynaecologist Rodney Ledward was struck off after it was found he had “bungled” 13 operations at the William Harvey Hospital in Ashford, Kent. Ledward maintained he had done nothing wrong and had made just as many mistakes in his operating career as any other surgeon. “I am a perfectly capable gynaecologist who has done a first class job,” he said in an interview with BBC Radio 4 in 2000. He was later described as “arrogant, conceited and deluded” by the Chair of the British Medical Association. Hundreds of his former patients said they were “left scarred or maimed by the consultant,” reported the BBC News.
The surgeries in question by Ian Paterson mostly involved removing a lump or diseased breast tissue and a controversial procedure referred to as “a cleavage-sparing mastectomy”. Here, cancerous breast tissue is removed but some tissue is left behind, increasing the risk of cancer returning in the future. Ian Paterson was first investigated in 2003 because of how often he was carrying out this procedure, against recommendations. Four years, later in 2007, a fellow surgeon raised concerns about his practices, with further complaints being made about him in 2008. He was eventually suspended by the NHS in 2011.
The actions of Ian Patterson resulted in a criminal prosecution against him and a jail sentence. Multiple concerns were raised about this surgeon and his actions, however, it took years for a full investigation to take place and uncover the damage he was doing, leading to many more patients falling victim to him. “A hierarchical and oppressive culture” environment prevented colleagues from coming forward and speaking openly, and senior bosses did not react and respond appropriately when complaints were made.
“A bad doctor with a God complex is a danger. A bad doctor with a God Complex who is allowed to keep practicing as a result of cover-ups and incompetence is a national scandal.”
Louise Allonby sums it up in her article in The Northwest Evening Mail, “Bad medics get away with incompetence because they are implicitly trusted and respected by society,” she wrote as Ian Paterson was sentenced. Patients, colleagues, and senior officials are hesitant to question medical professionals because of their status and the underlying want to believe that no one would enter into medicine and use their knowledge to intentionally harm people. Such cases are rare, with the case of GP Harold Shipman, often now referred to as Dr Death, who was convicted of murdering 15 of his patients in Greater Manchester between 1995 and 1998, but is suspected of killing over 200 across his career, being the case that rocked the UK prior to the actions of Ian Patterson being uncovered.
The reckless actions of such doctors cast a dark shadow over the medical profession and damage public confidence. It can only be hoped that lessons are learnt from this case and in the future, should complaints be made and concerns raised, proactive action is taken quickly to put a stop to such dangerous individuals before they can do more harm.