Tissue committees and audit reports on histology would have exposed Mr Butcher. The iceberg of mismanagement is the real issue..

In several other health systems there is a committee in each Hospital: the Tissue Committee. It can be argued that this is the job of the “ethics” committee, but these are being centralised without sufficient IT linkage. The UK Health Services have not been able to initiate decent IT yet. Tissue committees and audit reports on histology would have exposed Mr Butcher. We do not have good enough IT systems, and the work involved in such audits does not happen.. If we had no fault compensation the bill would have been much less, and what is to come? The Shipman and Butcher incidents are notorious now, but the iceberg of mismanagement is the real issue.

When a family member went to collect a result they were given the wrong image on a CD. There was no “critical incident” reported, no letter of apology and no recognition of the systematic failure. We debated about asking for a “report” but decided not to as we did not want a junior scapegoated. It is if you let the smaller issues slip that the larger issues rise up, tand he iceberg overturns ….

Alexandra Topping repots in the Guardian 29th April 2017: NHS pays out millions to patients of surgeon convicted of needless breast operations – Consultant Ian Stuart Paterson carried out unnecessary procedures on 10 patients but could have more than 1,000 victims

The Times:

<img src=”//feeds.thetimes.co.uk/web/imageserver/imageserver/image/methode%2Ftimes%2Fprod%2Fweb%2Fbin%2F01954eae-2c43-11e7-ae85-aa7f1ff8d93b.jpg?crop=858,483,21,59&resize=320,” alt=””>

Breast surgeon who played God may have 1,000 victims

Katie Gibbons reports in the Times: Liar betrayed patients who adored him

With nearly 20 years experience of treating breast cancer, Ian Paterson was, at the height of his career, the consultant of choice for women in the West Midlands. Adored by his patients for his charming bedside manner, he instilled confidence when they were at their most vulnerable.

A family man, with a son and twin daughters, Paterson, 59, treated thousands of women — including three generations of one family. Beneath the charisma he was an accomplished liar. Exploiting women with a family history of cancer, he used favoured phrases to convince his “ladies” to have surgery. A lump was “nasty” and “sinister” and patients who underwent breast removals were “very, very lucky”.

An independent review of the Heart of England Trust in 2014 found Paterson was “charming and was much-liked by his patients” but not a team player. Former colleagues described him as “bullying and overbearing”.

He grew up in Glasgow, graduated in medicine from the University of Bristol in 1981 and moved to the West Midlands. He was a regular speaker at events led by Breast Friends, a local support group for women with cancer.

After his surgical malpractice he split from his wife Louise, 54, a physiotherapist, and sold their £1.25 million home in Edgbaston.

Throughout the trial he spoke directly to the jury. With his glasses on the end of his nose, he gesticulated enthusiastically, flipping through files and using a pen like a lecturer’s pointer. His contempt for the prosecution’s medical expertise was obvious.

The celebrated surgeon persona was back — but only briefly. Yesterday he sobbed as each count of guilty was read out, realising that he faced a life sentence.

The Times leader: Grievous Bodily Harm – Behind an appalling story of medical malpractice lies another of failed management

First, do no harm. This fundamental principle of medicine was turned on its head by Ian Paterson, a surgeon convicted yesterday of 20 counts of “wounding with intent” and “unlawful wounding”. These crimes were the tip of an iceberg of unnecessary surgery carried out over many years, mainly on women wrongly told that they were at risk of breast cancer.

Paterson’s modus operandi was to intervene first and deal with the consequences later. When these consequences required further surgery, he was only too willing to perform it. He told patients that they were in mortal danger when they were not. One underwent seven operations, including a full mastectomy and breast reconstruction, for no good medical reason. Another agreed to several excruciating procedures on her nipple when all she needed was a course of antibiotics. This patient tells The Times today that by the time she was told that the operations were unnecessary she had made plans for her own funeral.

Lawyers for the ten women who testified against Paterson believe that he operated pointlessly on up to 1,500 people in all. Few families in the area of the West Midlands where he worked do not know one of his victims.

It is impossible to take in the findings of his trial without bewilderment as well as anger. He worked partly at a private hospital but, given that police believe that money was by no means his only motive, what were the others? The eight-year gap between the time when concerns about his conduct were first raised and his suspension demand the question of why was he not stopped sooner?

The answers appear to involve a culture of deference to doctors, and especially surgeons, that should long since have been consigned to history. It appears to have survived in the Heart of England Foundation Trust (Heft) that paid Paterson’s £100,000 NHS salary, and to have enabled him to violate guidelines, laws and patients with impunity.

This was an extreme but not an isolated case of a medical professional with a God complex. Good surgeons are team players who are not threatened by the idea of second opinions and actively encourage patients to seek them out. This one was instead found by an inquiry before his trial to be a “road block” who forced others to work round him. Even so, none of those who should have intervened to stop him emerges with any credit.

Paterson first prompted colleagues to raise concerns about his methods in 2003 when two senior NHS oncologists questioned his use of a controversial breast surgery technique known as a cleavage-sparing mastectomy that can increase the risk of cancer returning. He was allowed to continue using it. By the time of his suspension in 2011 by Heft and the private Spire hospital, where he earned extra money, he had been the subject of more than 20 staff complaints, four internal investigations and several external reviews.

A 2013 report by Sir Ian Kennedy accused Heft of concealing Paterson’s malpractice with a “blanket of confidentiality”. Those who threw it around the case delayed justice for patients whose lives had been upended, and must be held accountable. The patients themselves deserve compensation. A civil trial looms at which damages will be assessed. Money alone will not make whole those who Paterson wounded, but it will help. Spire and Heft should brace themselves.

 

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This entry was posted in A Personal View, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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