Rogue Breast Surgeon Refuses to Give Evidence at Opening Inquest

File photo of jailed breast surgeon Ian Paterson, on Feb. 21, 2017. Joe Giddens/PA

Disgraced breast surgeon Ian Paterson refused to attend the first of more than 60 inquests examining the deaths of his former patients because he believes the coroner’s investigation is “biased," the court heard.

The surgeon, who is serving a 20-year prison sentence after being found guilty of multiple counts of wounding in 2017, was ordered by coroner Richard Foster to appear remotely at Birmingham and Solihull Coroner’s Court on Tuesday to give evidence at the inquest of Chloe Nikitas, who died at the age of 43 in April 2008.

Foster issued a ruling on Monday saying he could “find no reason” why Paterson could not attend the inquest and give evidence remotely from prison and said it was “disappointing” to the families the deceased that he had chosen not to cooperate with the process.

Paterson, 66, had been 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, citing health concerns, a lack of legal representation and “inadequate facilities to prepare.”

Despite the ruling from the coroner, who said Paterson needed to hear the jailed surgeon’s evidence at all 62 inquests, Paterson did not attend the opening day.

A prison worker told the inquest he had had a 20-minute conversation with Paterson on Tuesday morning, in which the prisoner said he felt the “coroner isn’t investigating fairly” and that the proceedings are “biased.”

He said, “[Paterson] said he is not being disrespectful, but feels he is not being listened to.”

Possible ‘Contempt of Court’

Jonathan Jones, KC, counsel to the inquests, advised that Foster has a number of powers available to him, including imposing a fine of up to £1,000 on Paterson, a referral for possible prosecution for not appearing or a referral to the Attorney General for contempt of court.

Foster said he would reserve his judgment in the hope that Paterson might yet change his mind and attend future inquests.

He said: “I am disappointed that he has not complied with the Schedule 5 notice to attend today.

“It is a disappointment to me, but more importantly to the bereaved families who have questions that need answering.

“I said he should attend if only out of respect for the families of the 62 victims.”

The inquest will consider the role Paterson played in the subsequent deaths of his cancer patients. If the coroner eventually rules that any of the deaths were unlawful, it is possible that further criminal charges could be brought against the surgeon.

Paterson was found by an independent inquiry in 2020 to have carried out unauthorised and in some cases completely unnecessary surgery on more than 1,000 of his patients, who were mostly women but included some men diagnosed with breast cancer.

False Diagnoses

Some of his patients were falsely diagnosed with cancer and left disfigured and traumatised for no valid reason, sometimes living in fear of the return of a disease they had never had.

The coroner said he was satisfied he could continue to hear the rest of the evidence without input from Paterson, who pleaded not guilty to all charges during his 2017 trial and has maintained his innocence.

The opening day of the inquest heard that Nikitas was told she was “exceptionally unlucky” when her cancer returned.

Nikitas, who was diagnosed with grade two invasive ductal carcinoma in 2002, would never have agreed to the procedure, carried out by Paterson at the Little Aston Hospital, if she had known it would have left breast tissue behind and risked the disease returning, her partner of 18 years, Klaus Strohle, said.

Strohle told the court no other surgical options were offered to Nikitas, an environmental consultant from Tamworth, and they assumed the partial mastectomy on her left breast was the “best course of action” as it was touted as a “pioneering” surgery.

After undergoing the mastectomy, reconstructive surgery and chemotherapy and radiotherapy, Nikitas discovered a lump in the same breast in April 2005 and was initially told there was nothing to worry about until a PET scan in October that year revealed it was the same type of cancer she had before.

Strohle said they were left devastated after being told the diagnosis was now terminal, with his partner dying three years later.

‘Exceptionally Unlucky’

He told the inquest: “Chloe had had a mastectomy, the whole point of that is to remove tissue so it doesn’t come back. What was the point in her going through it?

“We were told we were just exceptionally unlucky, that it was a one in a million chance, that it was sheer bad luck.

“We were under no illusion that this was a death sentence. It was metastatic, and it was terminal.”

When Nikitas was first diagnosed with breast cancer after noticing discomfort, Strohle, a company director, said they saw Paterson on June 25. 2002,  and discussed the cleavage-sparing mastectomy.

“He explained what it was, he said it would leave skin behind so it would look normal and would be barely noticeable.

“He gave no warnings about the surgery, we weren’t made aware that there would be an increased risk of reoccurrence, absolutely not.”

He added: “If we were, I can assure you we wouldn’t have chosen that option. We assumed it was a new methodology for treating breast cancer. We were given no other options for surgery.

“You trust doctors and that they are going to do the best thing for you–they are the experts in their field.

“We were sure everything was done in a multi-disciplinary fashion and that there were many eyes on Chloe’s case, so why would we question it?”

After her surgery and reconstruction, Nikitas was referred to Dr. Tal Latief, a consultant oncologist, to arrange chemotherapy.

Low Survival Rate

Giving evidence via video-link, Latief, now retired, said he had no idea Paterson had been performing partial mastectomies as they were simply labelled as “mastectomies” on medical notes and correspondence and said he had never heard of a cleavage-sparing mastectomy.

He said he believed from everything he had seen that Paterson was a “good surgeon” and that he was “shocked” when he found out in the media that the breast surgeon was being investigated.

Paterson was employed by the Heart of England NHS Foundation Trust and also practised in the independent sector at Spire Parkway and Spire Little Aston, all in Birmingham, between 1997 and 2011.

A report by the NHS trust in 2017 found that 675 of Paterson’s 1,206 mastectomy patients had subsequently died, with survival rates for these individuals being less than 56 percent. In contrast, female breast cancer patients aged 50–60 have around a 90 percent chance of survival.

The inquiry into his malpractice, led by Bishop Graham James, concluded in 2020 and found a “dysfunctional” health care system that enabled Paterson to operate in both the state and private sectors for over a decade despite multiple concerns being raised about his work in the NHS.

The inquests are expected to last at least eight months.

PA Media contributed to this report.