Rogue surgeon Ian Paterson was today jailed for 15 years. Many of his ex-patients will be celebrating the news that his irresponsible actions over a period of many years have finally been punished. I believe this is the heaviest sentence ever passed on any medical professional in the UK for this type of offence. In the recent past other criminal behaviour such as NHS fraud or sexual assaults have seen doctors sentenced to many years in prison. Acts of criminal manslaughter have usually been punished with suspended sentences – this is because the courts recognise that these are tragic but often innocently made errors with no ulterior motive.
However, the actions of Ian Paterson were of course a pattern of very deliberate behaviour – partly driven by greed and partly by some kind of “God complex”. In some cases he miscoded surgeries to claim extra money from private medical insurers. In other cases he appears to have acted out of a deluded belief that he knew better than his peers as to how breast surgery should be performed.
By all accounts he was a very charismatic man whom patients liked very much. However, he refused to cooperate with his peers and his colleagues dreaded working with him. As a breast surgeon he failed to act in a collegiate fashion with colleagues in radiology and radiotherapy as well as plastic surgery. He appears to have refused to follow the rules and was allowed to be a maverick – acting without proper supervision – for many years. He bullied and intimidated many people around him and no one challenged his appalling behaviour until 2011.
I note that the government has today said it will hold an inquiry into Paterson’s conduct if they are re-elected. However, this overlooks the fact that there has already been two inquiries.
The first was the Kennedy Report. Sir Ian Kennedy’s report was primarily aimed at NHS mangers in terms of recommendations.
A separate report was undertaken by Spire Healthcare – as Paterson’s principal work was at the Spire Hospital Parkway and Spire Hospital Little Aston. The Verita report also made a number of recommendations.
It may not be that a lengthy review is again required but in the light of the conviction and sentencing these reports should be considered again. Their recommendations should be reviewed and it should be ascertained if (a) the recommendations have been implemented and (b) who is checking to ensure that this cannot happen again.
People like Paterson exist in all types of industries. The fact that they exist cannot be prevented. What can be prevented is their damaging behaviour. What needs to be put in place by the NHS and the private medical sector is a system that can stop mavericks like him before they become too powerful to stop.
Insurance cover for Paterson’s patients
One other issue that does need to be urgently addressed is the issue of indemnity for compensation claims. The Medical Defence Union (MDU) is the insurer for Ian Paterson and it appears that many of Paterson’s private patients will not receive any compensation This is because the MDU has said its cover for private patients is “discretionary” – it can be withdrawn at their discretion if they feel that “a surgeon’s practice falls outside of the insurance terms”.
Spire healthcare, which runs the hospitals where Paterson treated private patients, says that because he was not their employee, they are not liable, although this will no doubt be tested in court soon.
Paterson’s private patients thought they were receiving a higher level of care than the NHS – with a reputable hospital and a well-known surgeon. Clearly they have been let down. If the MDU and Spire succeed in refusing compensation payouts to Paterson’s private patients then the private medical healthcare sector has failed in terms of consumer protection.
The answer may well be to require all medical providers to pay into a central fund to cover uninsured doctors. This type of scheme exists for drivers and pedestrians injured in car accidents caused by uninsured drivers and it known as the MIB (Motor Insurers Bureau). This has operated successfully for many years. Anyone injured by an uninsured negligent driver receives proper compensation. Sadly, the same cannot be said for private medical patients. If a further review of Paterson’s conduct does take place then this is a key issue which needs to be urgently addressed.
Given the discretionary insurance cover provided by the MDU, a properly funded Doctor’s Insurers Bureau is now urgently required to maintain public confidence and protect injured patients.