Medical mayhem 7

After years of questions and complaints about surgeries that he carried out on breast cancer patients, British breast surgeon Ian Paterson has been found guilty in a criminal court of 17 counts of "wounding with intent" and three counts of "unlawful wounding."

The surgeon had denied all charges against him, and he sobbed when the verdict was announced, according to press reports. He will be sentenced next week and is expected to be imprisoned.

The verdict comes after a 7-week trial at Nottingham Crown Court, at which a sample group of nine women and one man gave evidence. The prosecution argued that the surgeries they had undergone had been unnecessary, inasmuch as they did not have breast cancer. One woman underwent 12 operations in 16 years. In other cases, a biopsy instead of invasive surgery would have been more appropriate, the prosecution argued.

The patients who appeared in court had been treated privately and were selected by the West Midlands Police, which began a criminal investigation of the surgeon in 2012. The criminal investigation involved only patients who had been treated by Mr Patterson (surgeons in England are traditionally addressed as Mr or Ms instead of Dr) in his private practice at private clinics run by Spire Healthcare, situated in Solihull and Little Acton (in the Birmingham area).

Separately, there were concerns over surgery that he carried out while working for the National Health Service (NHS) at Solihull Hospital in Birmingham; eventually this led to his suspension from the hospital post in 2011. The issue with his NHS work was that he was leaving behind breast tissue in an operation that he devised himself and described as a "cleavage-sparing mastectomy."

However, the issue with the surgery he carried out privately was that he was carrying out mastectomies on patients who did not need such extensive surgery because they did not have breast cancer.

A senior officer involved in the investigation, Department Chief Superintendent Mark Payne, said in a statement: "The procedures carried out by Ian Paterson on vulnerable patients were unnecessary and caused physical suffering, scars, and wounds to the patients.

"Also, as a result of his greed and arrogance, many of the patients have suffered psychologically, believing they needed to undergo the procedures because they were at risk from breast cancer."

But "none had breast cancer, and yet he led them to believe they were at risk," the officer is quoted as saying in the Birmingham Mail.

"Paterson was a renowned and experienced surgeon who instilled complete confidence in his patients and therefore abused his position of trust.

"This was cruel and unnecessarily led to many people suffering and living in fear," the police said. "Paterson was a controlling bully who played God with people's lives so he could live a luxurious lifestyle."

The 10 patients who testified at the criminal trial are just the tip of the iceberg. A further 350 patients who were treated by him privately (under Spire Healthcare) are also seeking compensation…

He acquired a reputation as being fast; he was able to complete two or three operations in a morning, whereas other surgeons would perform only one in that time.

In 2003, colleagues began to question why patients were being left with breast tissue after undergoing mastectomies.

One colleague, Dr Andrew Stockdale, reviewed 100 cases and raised concerns over relapse rates, but he said those concerns were "swept under the carpet."

In 2007, a newly appointed surgeon, Hemant Ingle, raised concerns with his managers, and as a consequence, two reports were commissioned. The investigators found "justifiable concerns" that the cleavage-sparing technique was leaving patients at risk for relapse, the BBC reports.

The Heart of England Foundation Trust (HEFT) stopped the cleavage-sparing mastectomies in 2007.

However, it was only after an external review of his surgeries, conducted by Sir Ian Kennedy and commissioned by HEFT, concluded that there had been irregularities that Trust suspended Mr Patterson in May 2011. At the same time, it invited all patients who had undergone a mastectomy with Mr Paterson "to see an alternative surgeon for a review of their treatment and care." That notice also said that he had used a technique that "was not usual procedure."

In an announcement on May 4, Secretary of State for Health Jeremy Hunt said there will now be a major inquiry into why the NHS did not stop the surgeon sooner (however, this is dependent on his party, the Conservatives, being reelected in the forthcoming general election). "The conviction of Ian Patterson, and the recent disclosures about the seriousness and extent of his malpractice, are profoundly shocking,” Hunt commented.

"No one has got to the bottom of his motive. The NHS issue was about not taking away enough tissue and leaving behind cleavage," Taft said. "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 armor," the lawyer commented.

http://www.medscape.com/viewarticle/879279