Rogue breast surgeon Ian Paterson snubbed the coroner investigating the death of 62 of his patients by refusing to appear at the first of their inquests today.
Ian Paterson, 66, is currently serving 20-years in prison after it was revealed he carried out over 1,000 unnecessary procedures on breast cancer patients over 14 years.
Inquests into the deaths of 62 of his patients began this morning, where their deaths may have been ‘unnatural’ — and more than 560 patient deaths have been considered so far by a multi-disciplinary team of medical experts.
This morning, the court heard, staff were asked to bring him to a video link in order for him to take part in the hearing remotely and the 66-year-old refused to attend.
Mr Foster resumed the inquest into the death of Chloe Nikitas, 43, an environmental consultant from Tamworth, Staffordshire, who died at the age of 43 in 2008 after undergoing a ‘cleavage-sparing mastectomy’.
John Burgess, an offender supervisor at the prison – which was not identified – told the coroner: ‘He told me he feels that the coroner is not investigating it fairly and that procedures are biased.
‘He told me he had not had full disclosure of material, and had limited input due to insufficient funds. He also said that he is not represented by the lawyers at the moment as the lawyers are catching up with the work that has been allocated to them.
‘He said he’s not being disrespectful and he understands the courts point of view. However he feels proceedings are biased and he’s not being listened to.’
The court heard that solicitors to the inquest had written to Paterson last Friday to inform him of the coroner’s ruling that he was required to attend remotely today.
Ian Paterson (pictured) is currently serving 20 years in prison after being found to have carried out unnecessary procedures on more than 1,000 breast cancer patients over a period of some 14 years
Yesterday his solicitor set an email to the solicitors to the inquest stating it was his understanding that Paterson would not be giving evidence.
Coroner Richard Foster said he was ‘disappointed’ that Paterson had not complied with a witness summons to appear. ‘It’s a disappointment to me and more importantly to the bereaved families who have questions that need answering. ‘
He added: ‘That obligation to provide evidence and attend this inquest is an ongoing obligation. I have given permission from him to appear remotely at the prison where he is being held, that is at his request. I hope that he will review and reconsider his position in order to assist me to investigate these deaths.’
The coroner said the powers now open to him were a fine, a referral to the Director of Public Prosecutions for potential prosecution or a referral to the Attorney General with a view to bringing contempt of court proceedings, an action that would only carry a maximum sentence of 28 days.
He said he would reserve judgement on how to proceed ‘in the hope of him (Paterson) attending future inquests’.
Mr Foster added: ‘I will return to this issue in due course.
Paterson was employed by the Heart of England NHS Foundation Trust and practised in the independent sector at Spire Parkway and Spire Little Aston in Birmingham
Coroner Richard Foster was told how a new mother was diagnosed with cancer after noticing discomfort while breast feeding.
Chloe Nikitas fell under Paterson’s care in 2002 after having a biopsy which uncovered a Grade 2 ductal cancer and was recommended a ‘skin-sparing mastectomy’ by the rogue surgeon.
Jurors heard he carried out ‘cleavage-sparing’ mastectomies on patients, which left behind breast tissue and risked a return of cancer.
Ms Nikitas died in April 2008 aged 43. The court heard she had been breastfeeding their toddler, Max, who was then aged two, when she experienced discomfort and realised something ‘isn’t quite right’.
Today, her partner of 18 years told the court that Paterson ‘certainly mentioned a cleavage-sparing mastectomy’ during a consultation a month after her diagnosis in June 2002.
Klaus Strohle, a commercial director, told the inquest Paterson spoke as though ‘it was a sales job’ and had boasted that the cleavage-sparing mastectomy ‘was a new (procedure) – something I have pioneered’.
He added that the breast looked ‘very natural’, post-reconstruction.
Mr Strohle earlier told coroner Foster his partner ‘was young and she cared about what she would look like after the operation. This (the cleavage-sparing operation) was one of the positives we took away (from the diagnosis).
‘Even though she was going to lose a breast it would be barely noticeable.’
Mr Foster asked if the surgeon used that specific term, and if Paterson explained what a cleavage-sparing mastectomy was.
Mr Strohle said: ‘He did. He said skin will be left behind so that the cleavage will be looking normal. He said he worked with an excellent cosmetic surgeon.’
When asked if Paterson gave any warning about potential risks to the surgery Mr Strohle said: ‘Absolutely not. If we had been warned I can assure you we would not have (opted for this procedure’).
Mr Strohle said they assumed the cleavage-sparing mastectomy was the ‘new state of the art methodology’, adding: ‘We were not aware this (procedure) had not been sanctioned. We were not given any other options.’
He said the couple put their trust on the doctors, who were the ‘experts in their field’, adding: ‘I assumed this was the best course of action.’
Mr Strohle said the couple were both ‘devastated’ by the diagnosis, and having had their son in 2000, wanted to have more children.
The court heard Ms Nikitas had reconstructive surgery, but did not want silicone implants because she was ‘against putting foreign bodies’ in her body.
By early 2003 she had undergone radiotherapy on her reconstructed left breast.
But Birmingham Coroner’s Court heard that in the spring of 2005, she noticed a lump in the same area.
Despite seeking a check-up, the court heard there was a ‘hiatus’ until she underwent a biopsy that October, which found that her cancer had returned.
Mr Strohle said the couple couldn’t understand how that could have happened.
He told the coroner: ‘Chloe had a mastectomy – the whole point of that is to remove the breast so that it (the cancer) didn’t come back. So what is the point of that massive surgery?’
Paterson (pictured arriving at Nottingham Crown Court) refused to give evidence into the inquest of 62 of his patients deaths ‘inadequate facilities to prepare’
He said the couple made these arguments to medics at the time, but were told Ms Nikitas had been ‘exceptionally unlucky’ – and the victim of a ‘one-in-a-million occurrence.’
Earlier, the court heard Ms Nikitas described as a ‘beautiful, petite woman’ who was ‘passionate and compassionate’ and who became one of the first women to graduate with a first class degree in chemistry from the University of East Anglia, in the 1980s.
In the pen portrait by Mr Strohle which was read out by the coroner, the court heard Ms Nikitas went on to work in Germany for a number of years and was an excellent pianist and flautist.
Ms Nikita’s death is the first of 62 being investigated at judge-led inquests in Birmingham into deaths of Paterson’s patients. She died at the Priory Hospital in Birmingham on April 13, 2008.
Paterson, 66, was accused of attempting to delay the hearings after lodging an application to have his witness summons revoked the day before the first inquest was due to start on October 10.
The consultant breast surgeon’s lawyer argued that health concerns – including Paterson’s ‘anxiety’ — a lack of legal representation and ‘inadequate facilities to prepare’ meant his witness summons for the judge-led inquests should be withdrawn.
In a ruling published on Monday, Mr Foster, a crown court judge, said he could ‘find no reason’ that Paterson could not give evidence remotely at the inquests.
He had been employed by the Heart of England NHS Foundation Trust and the private Spire Parkway and Spire Little Aston hospitals, all in Birmingham, between 1997 and 2011.
An independent inquiry later found Paterson carried out unnecessary and unapproved procedures on more than 1,000 breast cancer patients over 14 years before he was stopped.
In many cases the surgeon, from Altrincham, Greater Manchester, invented or exaggerated the risk of breast cancer to persuade them to have surgery, which sometimes involved several operations.
Mr Strohle described his wife’s initial diagnosis as ‘harrowing’ for the young family, and it was a ‘bombshell’ when the family were told cancer had returned in 2005.
He added: ‘We were under no illusion that this was a death sentence. It was metastatic cancer, it would be terminal.’
Dr Talaat Latief, a consultant oncologist involved in Ms Nikitas’ care told the court was asked what his impression was of Paterson he said: ‘As far as I could tell, as a surgeon with his hands, he was very good.’
He said he was first aware of concerns about Paterson’s surgical practice ‘when it became public and it was in the media’. He added: ‘I was really shocked. I had never heard this term ‘cleavage-sparing mastectomy’, and never read about it anywhere. Other surgeons I worked with never mentioned it and never did it.’
He said he asked another surgeon about it and the surgeon couldn’t explain the procedure, except to say it means ‘leaving part of the breast behind’.
The doctor, who retired in 2014 after 34 years as a consultant oncologist, worked at the Queen Elizabeth NHS hospital in Birmingham and four private hospitals in the city, including the Priory hospital. He said Paterson referred private patients to him but that the pair never held patient clinics together.
He said in referring letters, Paterson only talked about ‘mastectomies’, not ‘cleavage-sparing mastectomies’.’
Asked if he was surprised to hear his patients were being treated with this kind of surgery he said: ‘I was very surprised…that’s why I went to my colleague at the Queen Elizabeth Hospital to ask what is meant by this (‘cleavage-sparing mastectomy’).
He said Paterson ‘never told’ him that his procedure involved leaving breast tissue behind.
Paterson was jailed in 2017 and is serving 20 years after being convicted of multiple counts of wounding in 2017.
Last year, Judge Foster was appointed as the coroner to carry out investigations because of their complexity, scale and time commitment, with a series of individual inquest hearings expected to last two years in total. The hearings at Birmingham and Solihull Coroner’s Court are being held without a jury.
The coroner said in September that a further 20 inquests are due to be opened while hearings are under way.
Earlier this month, the Sunday Times reported that Health Secretary Wes Streeting had decided to strip Paterson of his taxpayer-funded £1m pension, under rules that allow NHS benefits to be forfeited in the case of criminal, negligent or fraudulent acts.
The married surgeon was motivated by boosting his reputation and making cash from private work.
He spent the money on homes and trips, telling a victim: ‘I have to pay for holidays somehow.’
Father-of-three Paterson sold his mansion in leafy Edgbaston, Birmingham, for £1.25m after his arrest and was living in a barn outside Altrincham with his wife until he was jailed.
Paterson also owned properties in Cardiff and Manchester and a Florida holiday home.
But despite his wealth, the doctor was granted £216,000 in legal aid to fight prosecution.
Concerns were first raised about the surgeon in 2003 but it was eight years before he was suspended. Between 1998 and 2011 he treated 11,000 patients.
The inquest continues.