Editor's note: We have correct the number of patient deaths to 417.
Birmingham—A judge has promised that he will "leave no stone unturned" as he investigates the deaths of 417 patients who were treated by rogue surgeon Ian Paterson.
Mr Paterson, who worked at NHS and private Spire hospitals in the West Midlands, was jailed for 20 years in 2017 after he was convicted of 17 counts of wounding with intent and three counts of unlawful wounding against 10 patients.
An inquiry later concluded that more than 1000 patients were subjected to damaging and unnecessary operations over 14 years before he was finally stopped.
Mr Paterson was found to have exaggerated patients' cancer symptoms and performed needless mastectomies when less-invasive treatment was more appropriate. He also carried unregulated 'cleavage-sparing' mastectomies, which left behind breast tissue and increased the risk of cancer returning in patients.
'No Stone Unturned'
West Midlands Police asked coroners to investigate the deaths of Mr Paterson's breast cancer patients to ascertain if they suffered an unnatural death as a result of his actions. Preliminary investigations began in 2020 and, thus far, 27 inquests have been opened where coroners "believe there is evidence to have reason to suspect that some of those deaths may be unnatural" but others are anticipated.
Judge Richard Foster, who will conduct inquests due to the "scale and complexity" of the investigations, led a pre-inquest review hearing in Birmingham on Friday.
Addressing family members and next of kin of the deceased, he said: "Although much of today's proceedings will focus on the wider systemic issues, I want to reassure you that throughout, you will remain at the heart of my investigations.
"And I will leave no stone unturned in that endeavour," he said.
36 Inquests Planned Thus Far
The judge explained that a multi-disciplinary team had been reviewing cases and reporting to HM Coroner, who then applied a two-stage test for an inquest which involves 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, whether, "on the balance of probabilities, that failing has more than minimally, trivially, or negligibly contributed to death".
He said 417 cases where breast cancer was given as the main cause of death had been considered so far, with 27 inquests being opened and another nine to be opened on July 14. Of those 36 inquests, the judge said, 29 involved NHS patients and seven involved private patients. There 21 cases where the multi-disciplinary team felt the two-stage test had been met, but he was waiting on reports.
A further 36 cases were due to be reviewed and, in addition, there were 130 cases where breast cancer was included in part two of the death certificate and a "selection" would be reviewed in due course. He added that there were other cases where the cause of death was unknown as it had been impossible to obtain a death certificate, therefore he urged any next of kin to come forward.
Judge Looking at 'Systemic Failings'
The judge said "systemic failings" would form part of his investigations, and his duty was to ensure relevant facts were "fully, fairly, and fearlessly" investigated, in which case he said it is likely he'll consider a report to prevent further deaths.
"I will not hesitate to refer any evidence of further criminal liability by any person to the Director of Public Prosecutors," he said.
The judge said the scope of the inquest would include failings in the recruitment and supervision of Mr Paterson, whether his colleagues should have been put on notice that he was treating patients improperly and informed the appropriate authorities, and systemic failures by hospital management and board of governance in addressing and responding to concerns raised about Mr Paterson.
It would also look at any inaction or failure of supervision by regulatory agencies and other NHS bodies and failings in the culture of hospitals where he worked.
The remainder of the hearing, which Mr Paterson attended via video, dealt with other procedural and legal matters.
The judge asked Mr Paterson, who represented himself, if he any comments about the inquest proceeding without a jury. Mr Paterson replied: "There are practical considerations which I need to raise with your honour at some stage but not I'm legally qualified or au fait with the law.
"If you feel there's no need for a jury, I'm not sure that any of us should feel there's a need for a jury," he added.
The judge said he would fix a further pre-inquest review hearing for later this year. It's anticipated the final inquest hearings will start in autumn 2024 and they are expected to last 9 months.
In 2020, an independent inquiry investigated how Paterson was able to carry out unnecessary surgeries undetected for so many years. It found 1000 women were subjected to needless surgery between 1997 and 2011 and he was allowed to carry on performing harmful procedures due to "a culture of avoidance and denial" in a "dysfunctional" healthcare system where there was "wilful blindness" to his behaviour.