Missed opportunities and key dates of Ian Paterson’s time at Spire Parkway and Little Aston hospitals as highlighted by the Verita report:
December 2007/January 2008:
The chief executive of HEFT writes to Ruth Paulin, hospital director at Parkway, on December 20, 2007 to tell her that the trust is investigating Mr Paterson’s practice, specifically ‘cleavage sparing mastectomies and shaves with mastectomy,’ and that he has been told to stop carrying out this procedure.
Ruth Paulin instructs Mr Paterson to stop performing the procedure in early January 2008. She confirms the instruction in writing on January 14 and copies the letter to the chairman of the Parkway Medical Advisory Committee (MAC).
Veritas found no evidence that Ruth Paulin notified a wider audience of HEFT’s review and the fact that Mr Paterson had been instructed to stop performing incomplete mastectomies.
Nor did she make any arrangements to monitor Mr Paterson’s clinical practice to see if he was complying with her instruction.
Verita believes if more people had been told that Mr Paterson’s practice was under review in January 2008 and systems put in place to monitor his performance, it would have been harder for him to continue to carry out inappropriate treatment.
January 7, 2008:
The MAC chairman at Parkway writes to Mr Paterson to tell him to stop performing colonoscopies because he did not carry out this procedure in the NHS and his appraisal did not include it.
Mr Paterson ignores the instruction and continues to carry out colonoscopies despite repeated requests from the MAC chairman and Ruth Paulin.
The failure to tackle his persistent non-compliance sent the wrong signal to both Mr Paterson and his colleagues, and is illustrative of a collective failure to manage him.
September 9, 2008:
Two GPs from the same practice complain about Mr Paterson’s treatment of a patient, in particular that he gave misleading information about pathology reports, was over treating patients and disregarded the multidisciplinary team meeting process.
Will Knights, hospital director at Parkway, asks the MAC chairman to investigate the complaint.
Mr Paterson claims that there had been a misunderstanding about histopathology results which he blamed on the breast care nurses accepting results over the phone.
The MAC chairman largely accepts Mr Paterson’s version of events and responds to the complaint accordingly.
The GPs ask Will Knights to commission an independent audit conducted by a breast surgeon.
As far as Verita knows this was never commissioned.
Instead, an audit that was generally reassuring was produced by breast care nurse Bethan Lloyd Owen, Mr Paterson’s closest associate at Spire, and presented to the GPs.
Given that Mr Paterson’s practice was under review by HEFT, and that he had a history of challenging Spire’s policies and processes, Verita considers that the GPs’ complaint should have been taken much more seriously and an independent audit commissioned.
This might have identified issues that are only now coming to light.
June 11, 2009
Having told Mr Paterson on numerous occasions to stop performing colonoscopies at Parkway, Ruth Paulin discovers that he continues to do them at Little Aston. She writes to Mr Paterson instructing him to stop performing colonoscopies at Little Aston and notifies Will Knights at Parkway.
Both hospital directors viewed Mr Paterson’s refusal to stop performing surgery outside his scope of practice as no more than him being a difficult consultant.
Verita says there is no evidence they thought him to be a serious risk to patients.
It also believes that at this point, if not before, the hospital had good grounds to consider withdrawing his practising privileges but found no evidence to suggest that they did so.
September 7, 2009
HEFT’s medical director writes to Ruth Paulin to tell her that West Midlands Cancer Intelligence audit found that the five-year recurrence rates for invasive cancer for Mr Paterson’s patients were within acceptable limits.
At the time these findings were accepted by Spire as assurance that Mr Paterson’s practice was safe.
In Sir Ian Kennedy’s Review of the response of HEFT to concerns about Mr Ian Paterson’s surgical practice (2013) he reported that HEFT’s medical director had been advised by the director of the West Midlands Cancer Intelligence Unit (WMCIU) on a number of occasions before 2009 that Mr Paterson’s rates of recurrence were not accurate because the WMCIU did not have all of Mr Paterson’s data.
The director of the WMCIU also told HEFT’s medical director on a number of occasions that the three to five per cent parameters 6 proposed by the Association of Breast Surgery had no scientific basis. HEFT’s medical director was therefore aware that the information he was providing to Spire was not complete and was therefore unreliable.
December 15, 2009
‘Patient A’ first raises concerns about her treatment with Mr Paterson in August 2009.
This escalates over the next few months, culminating in the patient making a formal complaint to Mr Paterson on December 15, 2009 which she forwarded to Ruth Paulin on March 5, 2010. The patient complains about:
• having a general anaesthetic against her wishes
• being given misleading information
• Mr Paterson’s bullying approach
• Mr Paterson’s proposal on how to get around having her breast reconstruction carried out by a surgeon who at that time was not registered with her insurance company.
The benefit of doubt was given to Mr Paterson and no action was taken.
December 16, 2010
The General Medical Council (GMC) notifies Ruth Paulin and Will Knights about acomplaint it had received from one of Mr Paterson’s NHS patients who had had an incomplete mastectomy in May 2006.
This was the first of four GMC complaints.
Despite the mounting evidence that there were serious concerns about Mr Paterson’s practice, no measures were in place to monitor his performance at Parkway or Little Aston.
January 6, 2011
HEFT’s (Heart of England Foundation Trust’s) acting medical director writes to Will Knights to inform him that a patient reviewed at the trust is believed to have had an incomplete mastectomy at Parkway hospital in January 2009 after Mr Paterson was told to stop in January 2008.
He asks Will Knights to investigate the matter.
There is no evidence that he does so, or that he tells Ruth Paulin at Little Aston about the allegation.
In the same month HEFT starts to investigate whether Mr Paterson carried out incomplete mastectomies at the trust after December 20, 2007.
By this time the warning signs were clear there were serious issues that needed to be investigated, but checks were not in place to see if Mr Paterson was complying with the restrictions on his practice that were already in place at Parkway and Little Aston.
February 2, 2011
The GMC notifies the hospital directors about a complaint it has received from one of Mr Paterson’s patients.
February 7, 2011
The GMC notifies Will Knights that it has received a complaint from one of Mr Paterson’s patients who alleged that she had had an incomplete mastectomy at Spire Parkway in 2009.
Verita believes that at this point Spire has sufficient information to realise that there were serious concerns about Mr Paterson’s practice.
May to June 2011
HEFT excludes Mr Paterson for two weeks from May 13 while it carries out further investigation into his practice.
Mr Paterson was allowed to practice as normal at Parkway and Little Aston for a week after being excluded from HEFT.
We think that Spire should have suspended him on May 13.
Instead he was allowed to continue working at Parkway and Little Aston and although he was instructed to limit his practice and not perform surgery he continued to perform breast surgery until May 31 and general surgery until June 8, 2011.
July 8, 2011
The GMC notified Spire that it had placed restrictions on Mr Paterson’s breast practice.
August 12, 2011
Mr Paterson’s last outpatient clinic was on August 12, 2011. The same day Will Knights and Ruth Paulin confirmed to insurers that his practising privileges had been suspended.