When Ian Paterson first started working at the Heart of England NHS foundation trust in Birmingham in 1998, the organisation had significant waiting list problems. The only breast surgeon was struggling to deal with the increasing numbers of patients, and Paterson’s appointment was seen as “a significant blessing” by managers.
After he applied for the job, a senior manager at his previous employer, Good Hope hospital, telephoned one of the medical directors at the trust to tell him that Paterson had been the subject of an investigation and temporarily suspended in 1996 following an operation which had “exposed the patient to a significant risk of harm”. The trust hired him anyway.
“To be honest, when we heard he was coming … it was, you know: ‘What’s gone on then?’” one senior radiologist told Sir Ian Kennedy, in his 2013 report into Paterson’s practice. “His reputation was well-known as being difficult and having open rows with a colleague at Good Hope … It’s always a surprise to us why they took him on when they knew he was trouble.”
As early as 2003, Paterson’s colleagues started raising serious concerns that he was not removing enough breast tissue during lumpectomies and mastectomies, increasing the risk of cancer recurring. But it took four investigations, four reports and nine years before Paterson was suspended by the General Medical Council in October 2012.
The first of hundreds of civil claims against the trust came around 2010. So far, 256 cases have been settled, with 25 still outstanding. The trust has paid nearly £9.5m in compensation to date, with the highest single settlement being around £250,000. A criminal investigation into Paterson’s practice was launched in 2012 and criminal charges were brought in January 2016.
Paterson, who received his medical degree from the University of Bristol in 1981, was described by his patients as having a good bedside manner. Mike Diskin, who was treated by Paterson in 2006, described him as “an incredibly likable man, great bedside manner, very personable, a great listener”.
Jo Luton, a patient in 2007, said Paterson was well-spoken and empathetic. “He had a brilliant bedside manner and really seemed to know his stuff.”
Another patient said: “Even though he was a consultant, he spoke on your level.”
His colleagues were less complimentary. According to the Kennedy report, Paterson was “not a team player”, and was given to being “autocratic and high-handed to the point of being dismissive of colleagues”. The words “arrogant”, “aggressive” and “bully” were used by several staff members and two surgeons left the trust after run-ins with Paterson.
“He didn’t want anyone to get in his way,” said a surgeon who had trained and worked with Paterson. “Because of his personality he tended to be isolated and he quite liked that, so people would avoid him, go around him and not deal with him, so he never got questioned or hauled up.”
One of the explanations given in the Kennedy report for the inconsistent amount of breast tissue that Paterson was removing during surgery was the speed at which he worked. Dr Martin Lee, a surgeon who was asked to observe Paterson’s surgeries in 2008, likened his technique to a whirlwind.
“He would breeze into the theatre, a sort of constant impatience with things and just try and get on as quickly as possible and that is something I have not seen very often,” he said.
At the time, Paterson lived with his wife, Louise, a physiotherapist, and their three children in an eight-bedroom grade II-listed Georgian house in Edgbaston. The family sold the house for around £1.25m in 2013, after accusations of Paterson’s malpractice were first published in the press.
Former neighbours in Edgbaston described the Patersons as a lovely family. “She was nice and very gentle,” said one neighbour of Louise Paterson.
She said she rarely saw Ian Paterson, but was shocked when she saw police parked outside the family’s home. “They were a very nice family, with very nice children, and one morning I was going out early, about 8.15am, and there were all these policemen and police cars.”
In his report, Kennedy says Paterson saw himself as “a good patient advocate [...] pushing for a good cosmetic result from surgery as well as effective treatment”. He says other surgeons took the view that “curing the patient’s cancer is paramount”, with any cosmetic outcome being secondary.
Dr Misra Budhoo, who worked with Paterson for several years, summed up the difficulty of dealing with him: “[Paterson’s] personality is such that he lacks insight into what his problem is [...] The very first thing [needed] to change somebody is they have to understand that there is a problem. I do not know if Ian has actually accepted he has a problem anyway.”
Ian Paterson: the "likable" breast surgeon who wounded his patients
