A care assistant who had advanced disease when she was diagnosed with breast cancer underwent “inappropriate” surgery carried out by disgraced surgeon Ian Paterson, an inquest has heard.
Giving evidence from prison, where he is serving 20 years for wounding 10 patients, Paterson denied that an open breast biopsy and a double mastectomy that he performed on Rosemarie Blake before she died at the age of 56 on July 2 1997 were unnecessary.
The inquest into the death of Mrs Blake is the sixth of 62 being heard at Birmingham and Solihull Coroner’s Court over an eight-month period touching on the deaths of former patients of Paterson.
The court heard on Tuesday that Mrs Blake, from Erdington, died at the Good Hope Hospital in Birmingham after her breast cancer spread to her liver, bone marrow and brain.
Days before she died, she had been admitted to hospital suffering with anaemia, nose bleeds, hypovolemic shock and was vomiting blood.
A multidisciplinary team (MDT) of experts, appointed to assist coroner Richard Foster, concluded that “unnecessary surgical intervention” in March 1996, when Mrs Blake underwent an open breast biopsy, delayed the start of chemotherapy and bisphosphonates and “caused” pulmonary embolic disease.
Paterson said the claims by the MDT were “nonsense” and that their review of Mrs Blake’s notes was “shoddy”.
Asked by counsel to the inquest, Jonathan Jones KC, whether he accepted that the biopsy and the double mastectomy were unnecessary procedures to carry out when previous tests, including a bone scan, suggested her cancer may have already metastasised, Paterson said no.
He said: “We still don’t have a diagnosis, we have a lot of maybes. You need a tissue diagnosis, that’s why she had an open biopsy.”
He added: “Mrs Blake had advanced local disease at diagnosis. She had bilateral cancer which was underestimated clinically and radiologically.
“We weren’t sure about the relevance of her bone scan and it’s clear that I still needed clarity.
“She didn’t have unnecessary surgical intervention, it was for diagnosis. And I still don’t believe the mastectomies were unnecessary.
“This lady had mastectomies on April 6 1996, and had her first dose of chemotherapy 18 days post-op.”
Paterson said he did not believe a delay of 18 days was enough to have made a difference to Mrs Blake’s prognosis.
Asked by Mr Jones if a mastectomy was appropriate treatment for someone whose cancer had already spread, Paterson said: “Yes, in certain circumstances.
“She had bilateral large tumours so local control was a concern. She had secondary thrombotic syndromes which are usually controlled by the removal of the primary cancer load and it allows any subsequent treatment to deal with a lower volume of disease.
“It prevents further metastatic disease because the source is removed and any subsequent treatment, whether that be chemotherapy or tablets, is being asked to deal with a lower amount of disease.
“She had an operable disease which is always an important indication. It would suggest it wasn’t completely out of control but you don’t want to let it get out of control. You want to try and intervene when the situation is still salvageable.”
When asked what could have happened if the breast cancer was not removed by a mastectomy, Paterson said: “You have the patient themselves to consider.
“This lady knew she had a sizeable cancer in both breasts and the first thing a lady wants is to get rid of the cancer and if it is operable and not detrimental, it is an important treatment option for them.
“It’s a horribly mutilating operation from a feminine point of view and the psychological impact is too much for us to debate today, but ladies can rationalise losing a breast if it is full of cancer.”
Paterson said he believed that Mrs Blake died as a result of “spontaneous bleeding” caused by “poorly managed” treatment with blood thinners for pulmonary embolic disease.
He denied that any of the procedures he carried out caused pulmonary embolic disease, saying it was clear Mrs Blake already had this when she first visited her GP complaining of chest pain in February 1996 – before she was diagnosed with cancer.
At the start of the inquest, Mrs Blake’s daughter Katrina described her mother as being “loved by all”.
She said: “She had a zest for life. She was strong and resilient and had a great sense of humour. She was a fighter.
“She had an infectious laugh that could be heard for miles and a uniqueness that shone for all to see.”
The inquest continues.
