So far, 27 inquests have been opened and adjourned - but there could be more, Stacey Foster reports
There are calls for all of the deaths of patients, who were operated on by the jailed breast surgeon Ian Paterson, to be reviewed by the coroner.
Since 2020, a coroner’s investigation has been active. So far, 27 inquests have been opened and adjourned but it has now been confirmed that more inquests could be opened before final hearings take place in the autumn of 2024.
Ian Paterson was jailed for 20 years in 2017 for carrying out unnecessary operations on patients in the private sector - some didn’t even have cancer.
He was suspended by the General Medical Council in 2012 after concerns were raised over unnecessary or incomplete operations, leading to the recall of 700 patients.
Subsequent investigations by the NHS found that Mr Paterson was also carrying out an unregulated type of mastectomy which has been called a “cleavage-sparing mastectomy” where some tissue was left behind to give the illusion of a cleavage for mastectomy patients. This left patients with an increased risk of their cancer returning.
Stacey Foster asked Ian Paterson if he had anything to say to his former patients before he was jailed in 2017
The Birmingham Coroner opened the first inquests in July 2020 saying the aim was to “identify whether there is reason to suspect that any former patients of Mr Paterson have died an unnatural death as a result of any of the care they received.” It was confirmed the actions of the surgeon, but also systemic problems in management were also being looked at.
In April 2023, His Honour Richard Foster took over the investigations due to the scale and complexity of the investigation.
An independent multi-disciplinary team of medical experts made up of consultant breast surgeons and consultant oncologists has been instructed to meet and review the patient records. A consultant pathologist and consultant radiologist are included as required.
Figures given to the inquiry into Ian Paterson’s surgery stated that in 2017 there were 1206 mastectomy patients in the NHS and 675 had already died. In the private sector, there were around 6500 patients seen by Ian Paterson, 1000 of which were dead. The coroner has not confirmed whether all of those deaths are subject to investigation.
In February 2020, the independent inquiry into the issues raised by Paterson made 15 recommendations to the Government to ensure patient safety in both the private sector and NHS. The government says “significant progress” has been made in implementing the changes.
Campaigner and former Ian Paterson patient Debbie Douglas says she wants all deaths to be looked at.
'There are other Paterson's out there': Former patient Debbie Douglas is calling on the recommendations from the inquiry to be implemented
She told ITV News: “For me, all the deaths should be looked at but ultimately there were 15 recommendations from the inquiry and they need to be implemented to stop another Paterson.”
A statement on the investigation website said “A two-stage test is applied before proceeding to open an inquest into a death.
"This involves first identifying whether there appears to have been any culpable human failing or system failing in the medical management of the patient’s breast cancer and, if so, secondly to establish whether, on the balance of probabilities, that failing has more than minimally, trivially or negligibly contributed to death.
"This is the established legal criteria for triggering the coroner’s duty to investigate under section 1(2) and therefore to open an inquest. Inquests can only be opened where there is reason to suspect that this two-stage test is satisfied.”
So far 27 inquests have been opened and adjourned.
Matthew Jones, conductor and arranger, lost his mother Eunice when he was 18 years old. An inquest was opened into her death in October 2022.
He told ITV News: “She died in 2004 aged 47, so for almost twenty years we’ve lived with what we thought was a tragedy so the only feeling I’ve ever felt was deep sadness and out of the blue we get a call from the coroner."
Matthew said it was like re-living his mother’s passing all over again
Matthew continued: “She had, we believe, a cleavage-sparing mastectomy which was totally unregulated. We know that now, at the time Mum was pleased that she still had a cleavage but it was a dreadful procedure and might be the reason Mum isn’t here today.”
The Coroner’s office confirmed that more inquests could be opened if the two-stage test is satisfied.
It is believed all deaths will have been reviewed by early 2024 and the first hearings will take place in the spring.
It is anticipated the final hearings will take place over a nine-month period commencing in the autumn of 2024.
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