A colleague of rogue breast surgeon Ian Paterson raised concerns that the mastectomies he was carrying out on cancer patients were “not adequate” but did not report him to the General Medical Council, an inquest has heard.
Consultant plastic surgeon Fazel Fatah, who carried out breast reconstructions after Paterson performed mastectomies on patients at the City Hospital in Birmingham on four occasions, said he requested not to work with him any more after becoming suspicious of the disgraced surgeon’s technique.
He gave evidence on Thursday at an inquest into the death of former patient Melanie Chalklen, who died aged 61 in November 2017 after being diagnosed with ductal carcinoma in situ in her left breast in 1998.
Mr Fatah said two of the four patients he operated on with Paterson – including Ms Chalklen – had residual breast tissue left behind after a mastectomy had been carried out and both showed residual tumour.
I didn’t really feel it was my role to report him to the GMC based on my limited experience and the views I had formed of him
He said this led him to believe Paterson’s technique of using a large knife to quickly “shell” the breast out, something which took him around half an hour, instead of “meticulously” dissecting and separating the gland from the skin, which would take other surgeons up to two hours, was inadequate for those with cancer.
He said: “It is normally a time-consuming and meticulous operation. The way Paterson did the surgery, he used quite a large scalpel, so instead of actually defining the tissue layer between the skin and breast tissue, he just created a layer with the knife, which meant there was no separation of the two entities to make sure the breast tissue had been removed.
“It was a quick sweep of the knife round the top and bottom of the breast and lifting it off the muscle.
“It is more likely to leave breast tissue behind using a large knife because you are not getting into that defined tissue plain, it is not a careful inspection of the tissue.”
Mr Fatah told the lead breast surgeon at City Hospital, Martin Lee, about his concerns and Paterson was stopped from carrying out surgeries there and he never saw or spoke to him again, the inquest heard.
He also spoke face to face with John Taylor, Paterson’s senior breast surgeon colleague at the trust where he worked, to share his thoughts and suggested they should carry out an audit of the histology results of mastectomy specimens to see if there was a pattern with breast tissue being left behind.
The inquest was told Mr Taylor, who has since died, said that would not be possible because of Paterson’s “aggressive nature” and the support he received from trust management.
Mr Fatah said: “Those were his exact words. I took it that from a quantity point of view, he was more productive as a surgeon operating on a larger number of patients in the given time.
“I took it that that is what he meant, that they supported him because he was an active surgeon who did a lot of procedures.”
After suggesting an audit of all surgeons’ histology results so as not to single Paterson out, Mr Taylor “just looked at me and smiled”, Mr Fatah said.
Asked by counsel to the inquest Jonathan Jones KC why he did not report his concerns about Paterson’s practice to the General Medical Council, Mr Fatah said: “I didn’t really feel it was my role to report him to the GMC based on my limited experience and the views I had formed of him.
“I thought that was definitely the responsibility of management and colleagues that he worked with more at his trust, and that is why I spoke to Mr John Taylor.
“If they felt he should be reported, it was their responsibility not mine.”
I didn’t expect any surgeon to stay until I finished the operation but I would expect them to hang around for a little while
He also told the inquest he did not tell Ms Chalklen that he had identified breast tissue left behind because he “didn’t want to cause her distress”.
He said: “I felt it was wrong to tell her that and cause her that disappointment. I thought that was really for Paterson to explain to her because he would have had to explain she would require further treatment.”
Mr Fatah said that after first noticing “chunks” of breast tissue had left behind by Paterson after he had carried out a mastectomy, he initially thought he had made a mistake and “gave him the benefit of the doubt” until he saw it again in his fourth patient, Ms Chalklen.
The consultant, who stopped working for the NHS in 2013 but works part-time in the private sector, said Paterson would usually leave quickly after carrying out the mastectomy, leaving Mr Fatah to carry out the reconstruction.
He said: “I didn’t expect any surgeon to stay until I finished the operation but I would expect them to hang around for a little while until at least I have had a look at the cavity that is left behind, and for them to write their own clinical notes about the procedure.
“Paterson would leave as soon as he finished. I would expect at least a handover, saying this is the cavity, what do you think, have a look. He would pack the whole cavity with large swabs and then leave.”
Paterson, who is currently serving a 20-year sentence for wounding 10 of his former patients after being convicted in 2017, was due to give evidence remotely from prison on Thursday but it was rescheduled until Monday.
Ms Chalklen’s inquest is the eighth in a series of 62 to be held at Birmingham and Solihull Coroners Court touching upon the deaths of former Paterson patients which may have been unnatural.
The inquest continues.
