The Butcher Surgeon: a missed opportunity.

On 14 December ITV Central broadcast a 30-minute Tonight documentary: The Butcher Surgeon: A scandal uncovered. The programme poses one burning question which must occupy the thoughts of all Ian Paterson’s victims and will, I presume, be central to the deliberations of the imminent government inquiry. How did he get away with it for so long?

I intend to focus on one specific aspect covered by the documentary, an opportunity presented to Spire to stop Paterson long before his last operation there in 2011. A missed opportunity. (This was not the only missed opportunity of course. There is clear evidence that he could have been stopped in 2003, eight years earlier.)

In 2008 Dr Eli Leyton, a local GP, discovered that one of his patients was seeing Paterson privately at Spire Parkway. Amidst growing concerns about Paterson’s practice Leyton had stopped referring patients to him. That’s the action of a good doctor concerned for his patient’s welfare. He contacted the patient who was due to be operated on by Paterson and told her he was not to be trusted and that she should cancel her operation. That’s a good doctor going out of his way to ensure his patient’s safety.

Leyton then arranged for his patient to have a second and a third opinion. That’s a good doctor going beyond the call of duty to protect his patient and to provide the evidence to support his actions. The second and third opinions were unequivocal. No disease was present. Paterson was about to embark on major surgery on a patient who had nothing wrong with her.

Leyton then went to meet Will Knights, hospital director at Spire Parkway, to apprise him of these facts. Again, a good doctor. Not only going out of his way to protect his own patients but also to prevent harm being done to others. After Leyton had presented his case the conversation went as follows:

Leyton: Paterson needs to be suspended pending an investigation.
Knights: There’s no way you can suspend him because he brings in too much money.
Leyton: That’s immoral.
Knights: I’m sure there’s a mistake that explains all this.

This last gasp of disbelief from Knights is a classic example of Upton Sinclair’s dictum: “It’s difficult to get a man to understand something, when his salary depends on his not understanding it.”

The following statement was sent to the Tonight programme by “a spokesperson for Will Knights”: who had “absolutely no recollection of making the comments attributed to him and is adamant he would not have said anything so wholly inappropriate”. I will return to these weasel words in a moment.

Next, Leyton asked Knights for an independent audit of Paterson’s patients by a breast surgeon. Instead, an in-house audit was conducted by the breast care nurse, “Paterson’s closest associate” (Verita report). At a later date consultants practicing at Spire informed management of Paterson’s misdemeanours and that in their judgement the breast care nurse was complicit in these. Some months later the breast care nurse’s review, surprise, surprise, showed that there was no problem with Paterson’s work.

It is worthwhile thinking about the two differing accounts of the meeting between Leyton and Knights. Dr Leyton, a General Practitioner with an excellent reputation, does everything in his power to protect his patient. He takes the risk of informing her that she should cancel her operation as Paterson was not to be trusted. Most people may not understand what extraordinary professional bravery that would take. He goes out of his way to get expert evidence from multiple sources that, as he suspected, the patient was about to have an operation for a disease she did not have. He takes the trouble to arrange a face-to-face meeting with the director responsible for governance at the hospital where this was to take place. He does everything he can to ensure that this is properly investigated and remedied. He fails. He appears in person on television to say in the clearest terms that the reason given to him for not suspending Paterson was the potential for financial loss to Spire. I can think of no reason for Dr Leyton claiming this other than that it was the truth.

Will Knights on the other hand is a senior executive in a private healthcare organisation that while it may provide much good care also exists to make a profit. He does not appear on TV in person to give a precise account of his meeting with Leyton. His “spokesperson” issues a statement that is clearly either written or approved by a corporate lawyer: He has absolutely no recollection of making the comments attributed to him and is adamant he would not have said anything so wholly inappropriate.

Words matter. Let’s look at these words. First, notice the robust qualifiers, absolutely and adamant. They are there to shore up what is otherwise a pretty vacuous statement. It isn’t possible to prove or disprove it. And yet at the same time it suggests that Dr Leyton’s account must be untrue. For many years I have believed that lawyers have a major responsibility for muddying the waters in cases of patient harm. And they are well paid to do that.

Two questions. First, why “absolutely no recollection of making the comments attributed”? Why not, “I didn’t say that”? Second, why “adamant he would not have said anything so wholly inappropriate”? Why not “I didn’t say that”? He is an intelligent man at the head of a large organisation. He knows what he said. He knows what he did not say. This proxy statement for Knights is tailor-made to prevent us understanding why he, as the Spire frontman, allowed Paterson to continue harming patients. Leyland reports a frank admission of the profit motive, presumably made in an unguarded moment. Knights gives no explanation. Who to believe? I have no difficulty.

In fact, it is now well-known that Paterson was strongly motivated by financial gain. That came out in the criminal trial and was widely reported. For years Spire gave Paterson the benefit of the doubt and failed to investigate evidence of his malpractice. The 2014 Verita report is informative at this point. Of Spire: “Although recognising that patients are the ultimate customer, consultants are promoted corporately as a primary customer.” (4:44) The customer is always right. That makes very good business sense. But no sense at all in this case when it comes to patient safety.

The government non-judicial inquiry to be overseen by the Bishop of Norwich, Graham James, is due to be established this month. A report is “anticipated” by Summer 2019. The Bishop has made a good start with his first public statement:

The actions of Ian Paterson and the grievous harm he inflicted on patients are deeply concerning, and they have given rise to some serious questions which remain unanswered.
“It is vital that the inquiry be informed by the concerns of former patients of Ian Paterson and their representatives. The interests of all patients, whether they seek treatment in the NHS or in the private sector, should be at the heart of this Inquiry and I will do my very best in the interest of those affected and the public.”

Unfortunately, the government has not made such a good start. It was the express wish of Paterson patients (who lobbied Jeremy Hunt to honour his pre-election promise of an inquiry) and their legal representatives that this should be a judicial inquiry. This has been ignored. Perhaps the example I have given above of the lack of transparency at Spire Healthcare, when it comes to its failure to take opportunities presented to it to protect patients, suggests that the new health minister should reconsider and ensure that the inquiry has the necessary powers to secure the truth. The whole truth. And nothing but the truth. When careers, corporate reputations and big bucks are at stake this might be beyond a non-judicial inquiry. Even one led by a Bishop. Who will no doubt be petitioning Heaven’s help. As will I.

David Drew
January 2018

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