A Greedy ****

Welcome to Red Herrings!

This week, Joccoaa tells us about a fella who puts the 'con' in 'consultant'.

Hosted by: Brittany Warren & Joccoaa Gray
 
Sound Engineer & Co-host: Christopher Brown
 
Edited by: Joccoaa Gray

If you would like to get in touch, please contact us at redherringspod@gmail.com.

Sources:

The Cost of Trust by Deborah Douglas

http://bbc.co.uk/news/articles/c5yr792r9z2o

https://www.fletcherssolicitors.co.uk/medical-negligence/guides/mr-ian-paterson-breast-surgery-malpractice/

https://www.gmc-uk.org/news/news-archive/comment-on-the-decision-to-strike-off-dr-ian-paterson

https://www.theguardian.com/uk-news/2017/may/31/breast-surgeon-ian-paterson-sentenced-for-carrying-out-needless-operations

https://www.gov.uk/government/news/butchering-breast-surgeon-has-sentence-increased-by-5-years

https://www.gov.uk/government/publications/paterson-inquiry-report

https://www.bmj.com/content/357/bmj.j2678

https://www.theguardian.com/uk-news/2024/oct/31/ian-paterson-inquest-breast-surgeon-mastectomy-didnt-need-to-know

Transcript

SPEAKER_01 0:01

Welcome to Red Herrings. I'm Jacoa, Master's student in Law and Human Rights, host of True Crime Club Newcastle, and creator of True Crime Forum Newcastle.

SPEAKER_00 0:12

Hi, I'm Brittany. I have two degrees in history and 15 years experience in genealogy. We're the red herrings.

SPEAKER_02 0:20

Well, well, well. What do we have here? Two red herrings and the catch of the day. Don't forget about me.

SPEAKER_01 0:26

Hi, Chris! We're the red herrings.

SPEAKER_02 0:29

And Chris.

SPEAKER_01 0:34

So a lot of information from this episode has come from Deborah Douglas. Retired Rolls Royce Aerospace Professional.

SPEAKER_02 0:43

Okay.

SPEAKER_01 0:44

Where are we going with this? It has nothing to do with this. Oh, okay. Oh, okay. That's disappointing. I read Deborah's book that came out, I think, this year, for this episode as my research. It is called The Cost of Trust, and I highly recommend. Deborah was a patient at Little Aston Hospital in the West Midlands near Birmingham between 2003 and 2011 after being diagnosed with breast cancer. In that time, Deborah underwent a mastectomy, breast reconstruction, seven months of chemotherapy, and an operation to remove gallstones. This treatment came from the recommendations of her consultant, Ian Patterson.

SPEAKER_00 1:30

Oh boy. Is this going into like malpractice or is it? Did he make it up?

SPEAKER_02 1:36

Did he not actually have breast cancer? Did he? Oh no.

SPEAKER_00 1:41

No, I'm already. Oh no.

SPEAKER_01 1:44

Ian Patterson was born in Glasgow and moved to Manchester in the 80s to train as a surgeon, eventually choosing to specialise in vascular surgery. He moved to Birmingham in 1991, and by 1994, his career had progressed, and he was offered a role as a consultant vascular surgeon at Good Hope Hospital, an NHS hospital in Birmingham. So throughout this episode, you're going to hear me refer a few times to the Heart of England NHS Foundation Trust. From now on, I will abbreviate it to Heft. Heft is the NHS organisation responsible for hospitals mainly around Birmingham, Solley Hull, Sutton Coalfield, and the West Midlands. I haven't got any maps for you or anything. It's just an area around Birmingham and the geography isn't really relevant. Jill Dallo attended Good Hope Hospital in 1996 for a routine operation. Her surgeon cut into her so aggressively that the scalpel bounced off her spine, severing major blood vessels. Oh no. Jill lost eleven pints of blood and was left fighting for her life in intensive care.

SPEAKER_02 2:55

How many pints of blood does one have?

SPEAKER_01 2:57

I thought it was eight.

SPEAKER_02 2:58

Yeah.

SPEAKER_01 2:59

Yeah. But I read a book for this, and in the book it said eleven, and then a corresponding newspaper article that also said eleven.

SPEAKER_02 3:07

So maybe they topped her back up and then drained her again.

SPEAKER_01 3:10

That's a good point. Yeah, maybe. In 2001, Jill was awarded £40,000 in damages, but has been left with lifetime scars. Is that it? Yep, that's it. She stopped working and she's lost a lot of her community. She said no amount of compensation could repay what she has lost. Jill's surgeon was Ian Patterson. Patterson told Jill the incident was caused by an equipment failure, and she believed this until a colleague of Patterson's blew the whistle on him. Jill said, had he been struck off at that point, instead of getting a slap on the wrist, many people could have been spared the horrific fates that would befall them. At Goodhope Hospital, Patterson had a reputation for being difficult, and he had bad or non-existent relationships with colleagues. Two years after Jill, he moved over to Solihull Hospital, again specializing in vascular surgery. Mark Goldman was the director at the time. Oh, I don't know. I mean, you you might end up asking that a lot.

SPEAKER_02 4:15

Right.

SPEAKER_01 4:15

To be honest.

SPEAKER_02 4:16

Spoilers.

SPEAKER_01 4:18

Um I'm not sure why. Um I think this guy had a way of weasling out of things.

SPEAKER_02 4:24

Right.

SPEAKER_01 4:25

It seems that way.

SPEAKER_02 4:26

Was he related to that guy on the train robbery?

SPEAKER_00 4:28

The weasel.

SPEAKER_01 4:29

Ah, maybe. Once he had secured his place at Hollyhole Hospital, Patterson became a full-on super dick at Good Hope and was asked to leave early before completing his notice period. A super dick? Yeah.

SPEAKER_02 4:43

Did he have a cape?

SPEAKER_01 4:45

That would be such a good comic, wouldn't it? Right?

SPEAKER_02 4:47

Avengers of super dick. I just mean like a giant asshole.

SPEAKER_00 4:52

Oh yes, that was hilarious. It was just said so seamlessly. I'm like, did I just hear that right? I was like, is this like a technical role within the hospital?

SPEAKER_01 5:02

Like what? You would think, as we go on, you would think. I'm just gonna say his notice period again as well, because I said hit notice period before. Was asked to leave early before completing his notice period. So at this time, the hospitals were under Birmingham Heartlands and Sully Hill NHS Trust. That trust later became part of Heft. The senior manager at Good Hope Hospital phoned the director of the Birmingham Heartlands and Solihull Trust to alert him that Patterson had been the subject of the investigation into Jill's inquiry in 1996. We don't know where this information went, but it doesn't seem like it went very far. It has been suggested that the reason for Patterson being taken on, even though he was trouble, was that they were desperate for surgeons. There was a backlog of operations at the hospital, and new government targets had really put the pressure on. Ian Patterson brought the negative attitude with him to Solihull Hospital. He was rude, dismissive, and arrogant. He consistently ignored the opinions of others, took to bullying tactics, and would refuse to attend MMDTs. So these are basically staff and expert meetings named meaningful multidisciplinary team meetings. The point of these MMDT meetings is to discuss practice, patience, patient recommendations, and best forms of treatment for individuals. But Patterson thought that he was above these meetings. He simply wouldn't attend them and he continued to be disrespectful towards colleagues.

SPEAKER_02 6:37

So they fired him, right?

SPEAKER_00 6:38

Case closed.

SPEAKER_01 6:39

Nope. Shortly after a start at Solihull, Patterson quickly moved to breast surgery from Vascular alongside another breast surgeon, John Taylor. Taylor and another breast surgeon left the hospital shortly after Patterson started there. One of them said that their leaving was a direct result of Ian Patterson and the toxic environment he created at the hospital. They said it was almost unbearable to work alongside him.

SPEAKER_00 7:04

That's not good.

SPEAKER_01 7:05

Colleagues described Ian Patterson's behaviour in surgery as nasty, and he would even throw things in the operating theatre. They described his surgeries as a bloodbath and his work extremely messy.

SPEAKER_00 7:17

You do not want that in surgery.

SPEAKER_01 7:21

Patterson liked to boast that he was the fastest surgeon around.

SPEAKER_00 7:25

Why does why is that something you need to boast about?

SPEAKER_01 7:28

Like well, that may become a little bit clear later. Right. But yeah, it's just just just not none of this is cool.

SPEAKER_02 7:36

I mean once you chop, you just can't stop.

SPEAKER_01 7:38

No going back. During his career, Patterson also had practice privileges at two BUPA private hospitals in the Midlands. These were called Parkway and Little Aston. So here is a little lesson on the NHS and private practice. Consultants for the NHS can top up their earnings with sometimes quite lucrative work for for-profit healthcare providers, and this is what we call the private sector. If you need medical treatment and you go to an NHS hospital, you wouldn't have to pay out of pocket for the treatment that you receive at that hospital. Some people though may choose to go private instead, and this costs money. Sometimes the company you work for might offer you a private health insurance, meaning they would cover any treatment costs at a private clinic. Or if you just have the money, you may choose to go private for reasons like shorter wait times, comfier chairs, better coffee, etc. I've never been private, obviously.

SPEAKER_02 8:33

It's just a better class of person, normally.

SPEAKER_01 8:35

So I don't really know what the other perks are, and hashtag save the NHS. And so this is what Patterson did. He would split his time between hospitals, the Solihull NHS Hospital and the two private practice clinics. This was a nice earner for Patterson. The dual income of being salaried from the NHS and then also being paid per treatment at the private clinic, frankly, made him rich. He had a huge grade two listed Georgian house for him and his family, boasting eight bedrooms, four reception rooms, a converted gym and wine cellar.

SPEAKER_00 9:07

What do you do with eight bedrooms? Wine cellar, I get converted gym. Who wants to use that? Eight bedrooms and four reception rooms?

SPEAKER_02 9:14

That's one for each day of the week and then one for like Christmas.

SPEAKER_00 9:17

I guess so. Guests? Guests, I guess. But eight bedrooms. Oh, I know, man. How many kids did he have?

SPEAKER_01 9:24

At least two. Wild. Patterson would frequently spend 500 quid on posh restaurant dinners and he drove an Aston Martin. Whatever that is, says Brittany. A car bike.

SPEAKER_00 9:36

Hey, I do know that.

SPEAKER_02 9:38

Or a bike.

SPEAKER_01 9:38

I mean, I don't know. If you asked me to point to one in a lineup, I wouldn't.

SPEAKER_00 9:41

Oh, I wouldn't know that either, but I am aware it is.

SPEAKER_01 9:44

Automated vehicle. Uh-huh. A now retired breast surgeon, Carl Forth's Mayer, had the operating theatre next to Patterson at Little Aston Boopah Hospital in the early 2000s. He said Patterson's patients would lose a lot more blood because he would rush his surgeries. Another NHS clinician said he lacked empathy or emotion, considering it as a weakness. But Ian Patterson did have a small and oddly loyal team in Little Aston, especially his right-hand woman, consultant breastcare nurse, Beth and Lloyd Owen. She had had a good career and was held in high esteem, specializing in breastcare and breast prosthesis fitting, and she also idolized Patterson. Healthy.

SPEAKER_02 10:28

I'm sure there's no way you get a GOG complex to dock with people falling over you.

SPEAKER_01 10:32

Yeah, no way at all. Back to our little lesson in private practice. Surgeons are not directly salaried employees of the private practice they're working in. Instead, they are a freelancer that rents the facilities from the practice. And that's exactly how Patterson worked within the private practice hospitals. His right-hand woman, Bethan, however, was an employee but reported to Paterson. Despite not being an employee of BUPA private hospitals, he ran the breast clinics, had many patients, and carried out operations. Because of his fast surgeries, he was great at hitting those government targets and had a huge amount of power. That's crazy. So that's why he had his bragging rights about the fast surgeries. Quick side note, don't know if either of you two knew this, it's just a bit interesting. Private hospitals do not have emergency care provision, so the NHS will step in. If something goes wrong during a private operation, an ambulance will be called and the patient will be blue-lighted to the closest NHS hospital. Private hospitals that are run for profit do not compensate the NHS for this, and it costs the NHS around £70 million a year to treat patients that are transferred from private hospitals.

SPEAKER_00 11:47

That's crazy. They like they don't have the capability to help if something goes wrong, then why even do the surgery there? Well, or at least pay the NHS to fix your issue. Yeah. No, I agree. I wonder how many times that's happened where someone's died on the way. Like the NG the NHS has like picked someone up from middle of surgery and they've died on the way on the way to the hospital because they've not been able to like handle it at the first one. Oh god. I God, I don't know. It's immediately where my mind went.

SPEAKER_01 12:18

I would say someone should look into that, but from what you're gonna learn from this episode, do people anything happen? Wow, really? By 2002, private health insurance had become more popular through companies, and it would often be offered as a benefit to employees. And in November 2003, when Deborah Douglas found a small lump in her breast, she took advantage of her private healthcare insurance through her company and went in for a consultation at one of the booper hospitals.

SPEAKER_00 12:49

What is a what are you saying there? A what hospital? Boopa. What is that? Oh, it's um what's boopa cruis?

SPEAKER_01 12:55

I know what it is.

SPEAKER_02 12:56

It's just like a private healthcare conglomerate.

SPEAKER_01 12:59

Yeah, I really think I used to go to a booper dentist through my work. Have you seen like boopa dentists? I've yeah. Okay, no. They do dentistry. Well, yeah. Do they? But you have to pay them. So so yeah, there's like private dentists and then NHS dentists. No one can get an NHS dentist appointment these days. Um, so wherever basically you'll probably go for your dental care, you'll probably pay.

SPEAKER_00 13:24

Yeah.

SPEAKER_01 13:25

Um, one of them might be a BUPA clinic, and that just means like imagine like it's your Tesco versus the food bank. I don't know.

SPEAKER_02 13:35

Thank God. Yeah, so if you use public health care, you're basically like you're going to a food bank.

SPEAKER_01 13:41

I really I just meant like council funded, like it's not paid for by the government. Yeah.

SPEAKER_00 13:47

No, no, you paid them to him.

SPEAKER_01 13:49

You can flip them off. I give you permission. Am I gonna get cancelled for that? It was just I meant like No. Okay, so instead of going to your public library, you go to water stands.

SPEAKER_02 14:01

Yeah, it's just like American healthcare.

SPEAKER_00 14:03

No, see, I still don't really know what you mean by this, so I'm trying to figure it out. Okay. I know you've said it like it you said it's through work.

SPEAKER_02 14:11

Well, it's like sometimes well that happens in America as well. Sometimes you get health insurance through work. It's just like it's just like having health insurance.

SPEAKER_00 14:18

Oh, okay.

SPEAKER_01 14:19

Yeah, but so a company can like offer it. So the company, for example, would pay BUPA or like re-imburse your bill and they offer it as a benefit to work in there.

SPEAKER_00 14:30

I see.

SPEAKER_01 14:30

But you if you don't have that, you can still use a BUPA or a priv private clinic, but you would then need to pay them with your own money. Or you could go to an NHS hospital and get it paid for by the government or your NH your national insurance money that you and tax that you pay. Gotcha.

SPEAKER_02 14:50

But you might have to wait five years.

SPEAKER_01 14:52

Yes, waiting lists are because more people obviously are using the NHS hospitals because l less people have access to private health care. So the waiting lists in the NHS are longer, etc.

SPEAKER_00 15:04

Yeah. Gotcha. Thank you.

SPEAKER_01 15:06

Okay.

SPEAKER_00 15:06

I I because like you said the first time or two, and I was like, I just want to make sure I actually heard like is that what she said? Because it was just like it's like, what what is that word? But yeah, okay. Yeah, makes sense. Thanks.

SPEAKER_01 15:17

Immediately after an ultrasound on her breast, Deborah was told by Patterson that the lump had an uneven and jagged edge and that it is going to have to be removed. He did a biopsy there and then, stabbing her multiple times in the breast with a large needle. In the follow-up appointment the next week, Patterson, yeah, yeah.

SPEAKER_02 15:36

Did he use the word stabbing? Is that a technical term?

SPEAKER_01 15:39

That's what Deborah used in her book. And just for the listeners my laugh was because Britney put her hands on her chest because yeah, it makes your it makes your nipples go out, right? In the follow-up appointment the next week, Patterson would break the news to Deborah that she did indeed have cancer. In fact, her entire left breast and all nine lymph nodes from her underarm would have to be removed. Within the same surgery, Patterson would then perform what is called a trans flap reconstruction. So this takes muscle from the stomach area to reconstruct the breast.

SPEAKER_02 16:12

Interesting.

SPEAKER_01 16:13

Okay.

SPEAKER_02 16:14

It's the fact that you're using the term perform. I mean, I get that's the you know the right term, but it just sounds like he's doing a trick at like a circus or something.

SPEAKER_01 16:22

Yeah, it does, isn't it? Mm-hmm. I actually think I thought that myself when I was writing this because there's a couple of performs that I've taken out and replaced with a different word because it just didn't feel right. So maybe that's why subconsciously I was like, no, he's not on stage. Thought he was, but Patterson tried to reassure Deborah saying, Don't worry, you'll go into the theatre with two boobs and come out with two boobs plus a nice flat stomach, and you'll still be able to wear a bikini.

SPEAKER_00 16:50

I don't know if that's I don't know if I'd be like, say that to me. I'm like, right, well, your job shouldn't be worrying about if I can wear a bikini or not. I agree with you, Brittany.

SPEAKER_02 17:01

Well, I don't know. He's having uh, you know, thought to his patient's psychological uh is is maybe she said bikinis were important to her. She didn't. Are we sure?

SPEAKER_01 17:13

Yes. Deborah describes Bethany and Patterson becoming her rock throughout her ordeal. Yikes. Yikes. Although she did notice some slight personality flaws with Bethon, like having quite a short fuse, especially when challenged. Deborah went in for surgery sometime after 10 a.m. on the 3rd of December. She describes her wedding ring being cut off for the operation.

SPEAKER_00 17:37

Why?

SPEAKER_02 17:38

Because she couldn't take it off normally.

SPEAKER_01 17:40

She couldn't take it off, I guess.

SPEAKER_02 17:42

She had fat knuckles.

SPEAKER_00 17:43

Hmm. Interesting.

SPEAKER_01 17:45

She signed a consent form for the breast removal and trans flap reconstruction despite not having any of the risks communicated with her beforehand. She came to at around 5 PM, feeling hazy and very, very sick. She describes the moment when the pain hit her later that night, saying it felt as though she'd been kicked by a mule. Her every waking minute in the days to come would be absolute agony. Deborah goes on to describe a series of undignified, excruciating and traumatic events during her immediate recovery in the private hospital and then at home. It's absolutely her story to tell, so I won't repeat her words verbatim here, but please go and read her book, The Cost of Trust. It's available everywhere, but if you can, please support your local independent bookshop. Ten days after her operation, Deborah went back for a recovery consultation with Paterson. The tumour and lymph nodes had been sent to the pathology lab for testing. Very helpfully, Deborah describes the three grades to cancer in her book. Grade three is the most serious. The cells grow quickly and have a complicated prognosis. Grade 2 cells look different to healthy cells and grow moderately quickly. And grade 1 is the least serious, looking similar to healthy cells and growing slowly, often responsive to treatment. Deborah was told the results had come back and she had grade 1 with no spread to the lymph nodes, and she was to meet with an oncologist to treat the cancer going forward. Deborah saw a medical oncologist. He said she would have a 6% advantage with chemotherapy, but Deborah really didn't want it. She had flashbacks to how sick chemotherapy had made her ma'am and she didn't want to go through that. But the oncologist pressed that she should have it. On the way home from the appointment, Deborah changed her mind and she started the chemo later that month. As she predicted, it made her very sick, and quite soon her hair started to fall out. Deborah describes the physical toll that the chemotherapy took on her body and how she felt like she looked like an alien. This carried on for months, but she was being reassured that she was getting gold star standard of healthcare, so she trusted the process and focused on healing.

SPEAKER_02 19:57

What does gold star standard of healthcare mean? Is it like a specific thing, or you mean you never hear people say, Oh, we've got a silver star here.

SPEAKER_01 20:03

I thought it was just like a phrase to mean you're getting the best.

SPEAKER_02 20:06

Yeah, well, in which case there's not much for a reassurance, is it? It's like it's really good, honest, you know?

SPEAKER_01 20:12

Mm-hmm. I guess. Yeah, well maybe that's just me. It's because Patterson had this reputation because he'd treat so many people that like he was he's he he did and he did have this God complex. So and then he had like Bethan Lloyd Owen next to him being like, Yeah, no, he really is the bestist. So it's kind of that kind of thing being like, No, you've got the best surgeon ever.

SPEAKER_02 20:33

Fair.

SPEAKER_01 20:34

At this time, Patterson and Bethan were working very closely. She had quit her NHS job at Good Hope Hospital to go and work alongside Patterson in the private sector. In 2001, Bethan set up a local branch of a charity called Breast Friends. This was a successful charity. Yeah, it's good, isn't it? This was a successful charity that offers support to people with breast cancer. Deborah was introduced to it by Bethan after her treatment. She went in apprehensively but remembers her first experience as a positive one, meeting other women who had been treated by Patterson, and it soon became a vital part of her recovery. Andrew Stockdale was an oncologist in the breast care team at the private hospital and had become concerned about Ian Patterson and his practice. Stockdale was seeing cases from the multidisciplinary team or MDT where patients had consented to mastectomies but they were presenting with excessive amounts of breast tissue left over after the procedure. This is an issue because a full mastectomy should remove all of the breast tissue, otherwise you leave in tissue that may be liable to further cancer spread. It all has to go to make sure the chance of cancer recurrence is as low as possible. Stockdale was concerned and decided to audit 100 patients from Ian Patterson. To his horror, he found an unusual number of patients having surgery that was by all. Standards incomplete. He presented his concerns to the trust, or Heft, who took no notice. Of course not. So he went to see the lead cancer clinician Andrew Wake. Andrew Wake took it up to the medical director of surgery, Mark Gannon. Gannon understood the concern and asked Wake to do an investigation. So in January 2004, Andrew Wake submitted his final report from the investigation. This was a month after Deborah's surgery. Wake reported MDT, the multidisciplinary team, was not working effectively or efficiently. He did go on to praise it, but called Ian Patterson dogmatic and dismissive. Also in the report, he said the MDT target performance was remarkable and commended Patterson particularly for target achievements. He said there had been an alarm raised noting concern around the infrequency of pre-treatment MDT discussions for new cases of breast cancer, and that this sometimes led patients to receiving conflicting advice. He also noted that there were concerns around the lack of discussion and input from oncologists regarding women selected for immediate reconstructions. The report goes on to talk about a dysfunctional atmosphere in the multidisciplinary team, and that it was unnecessarily adversarial and insufficiently democratic, with insufficient regard to other people's opinions. And that the MDT took the view that Patterson's surgery is aesthetically pleasing but too conservative, promising the results and negatively impacting relapse rates. Oh, we'll get there. So what was going on here exactly? Patterson was doing what was known as cleavage-sparing mastectomies, and basically was doing it without discussing it with anyone else. He wasn't attending the MTD meetings and certainly wasn't asking for any expert opinions on his practice. But Wake didn't make a big deal about this in his report. He just said there was insufficient information and recommended an audit. Ultimately, this report didn't go anywhere and the audits weren't carried out. Or at least not in any meaningful way. This wouldn't be the last investigation into Ian Patterson that went ignored. In 2007, changes came to the private practice in the West Midlands. Private equity firm Sinvan bought BUPA's 25 hospitals, including Little Aston and Parkway, for one and a half billion quid nearly. And a new company was formed. This was called Spire Healthcare. All of the hospitals were rebranded as Spire, and we are focusing specifically on Spire Little Aston and Spire Parkway. After this rebrand, a standard quality assessment was carried out by the director of the West Midlands Cancer Intelligence Unit, Dr. Jill Lawrence. Lawrence identified concerns around Paterson and his practices. This included high rates of open biopsy, which involves surgically opening the area to remove tissue so it can be tested instead of just using a needle. And he recommended the hospital develop a policy around the safety border of healthy tissue that is left after a mastectomy. She also had concerns about the culture around Patterson and recommended a review around its MDT meetings. Dr. Jill Lawrence's recommendations were not implemented.

SPEAKER_04 25:37

Love it.

SPEAKER_01 25:37

And Patterson carried on as normal. Lawrence would later say that at the time she had frustrations around there being nowhere for her to raise the issue that her recommendations had not been addressed.

SPEAKER_02 25:48

Yeah, it seems weird there's no one further to go to once they've been ignored. You know?

SPEAKER_01 25:52

Yeah.

SPEAKER_02 25:53

Crazy. You'd think they'd be like an independent whistleblowing thing.

SPEAKER_01 25:56

Yeah. I wonder if there is now. If there is, I didn't find it in my research. Dr. Ingall was a surgeon at Little Aston Spire Practice. He had actually been warned off applying for the job by the previous surgeon, but he still applied. Ingall started clocking issues with Patterson almost immediately. He picked up on Patterson's piece of shit attitude for starters.

SPEAKER_02 26:19

Is that what he described it as?

SPEAKER_01 26:20

Word for word. I may have paraphrased. As according to Ingall, he showed no respect from daydot. He refused to even look at him in their first MDT meeting.

SPEAKER_02 26:31

Oh, so at least he went to one.

SPEAKER_01 26:32

One, yeah.

SPEAKER_02 26:33

That's good.

SPEAKER_01 26:34

Despite this though, after a short while of working alongside each other, Patterson went on holiday and asked Ingall to take on one of his mastectomy patients. Ingle did so and was shocked to find after seeing the patient that this person did not need surgery at all. Uh uh. Call it. The histology was completely benign. Why was Patterson asking him to do surgery when there was no cancer?

SPEAKER_00 27:02

Money.

SPEAKER_01 27:03

Mm-hmm.

SPEAKER_02 27:03

Oh.

SPEAKER_01 27:05

So Ingall, startled by what he had witnessed so far, started to write letters of concern to various higher-ups, but nothing happened.

SPEAKER_00 27:14

Has anything happened to this day?

SPEAKER_01 27:16

Yeah.

SPEAKER_00 27:16

Good, good. Just making sure, because you said something earlier that was like, wait, has it? Like, is it is there's still things hap okay.

SPEAKER_01 27:24

Well, I mean, we'll get there, but yes. At some point in the late 2000s, there was another change in the system at the practice. Patients would now see whoever was there on the day instead of the same consultant every time. So Ingle began to treat more of Paterson's patients. And with this, he started to realise that many of the mastectomies were dangerously incomplete, and there was a lot of breast tissue where there shouldn't be. So we've got a few issues happening here. We've got the histology's coming back as benign, so why are they even having surgery? And then we've also got the mastectomies that are taking place are incomplete due to this cleavage saving.

SPEAKER_00 28:07

So, like I'm trying to picture what that even looks like.

SPEAKER_01 28:10

He's just like saving the So what he's doing is because he's doing the immediate reconstructions as well. So he's actually, I imagine it as he's leaving sort of the the cleavage bit, the top part.

SPEAKER_00 28:24

Yeah.

SPEAKER_01 28:25

And then he's doing the reconstructions from the muscle tissue. So it's this keeping this cleavage look.

SPEAKER_00 28:33

Interesting.

SPEAKER_01 28:34

And he's not a plastic surgeon. He's not even a breast surgeon. He's in vascular.

SPEAKER_02 28:39

What do vascular surgeons do?

SPEAKER_01 28:41

Fuck off. That was rude. I have no idea. I assume it's is it a near the spine if Jill's spine was hit?

SPEAKER_02 28:51

It was the blood veins. Is that what it is?

SPEAKER_01 28:53

There you go. He asked and he knew the answer. Typical menphoria. Or a crystal.

SPEAKER_02 28:59

What should not be veins and widgets?

SPEAKER_01 29:02

I did think I could look in look into that, and I thought no one's gonna ask me.

SPEAKER_02 29:06

No. No. If you're a vascular surgeon, get in touch with us at redherringspod at gmail.com.

SPEAKER_01 29:11

That would be good. Or the Instagram. Uh-huh. Red Herringspod on Instagram.

SPEAKER_02 29:17

Yes.com.

SPEAKER_01 29:19

In June 2007, Ingall and his colleague Fernando wrote another letter to the director of surgery, senior manager, and doctor with Heft to complain about Patterson. This guy was Ian Cunliffe. Sorry, I know there's a lot of names in this story. You don't have to keep track of them at all. Just some of them briefly come back up at the end. So I'm just naming them now so that you'll at least recognise vaguely who I'm talking about when I bring them up later. So anyway, Stockdale also joined in raising the alarm with these letters. So he was the whistleblower from 2003 whose complaints resulted in the Wake report. Gotcha. That one had been under Mark Gannon, a different director of surgery who had has now left by this time. Ian Cunliffe actually said that Gannon had briefed him on the allegations against Patterson, but had advised him that the matter was now closed.

SPEAKER_02 30:12

I wish every time someone was upset with me, I could just say the matter's closed.

SPEAKER_01 30:16

Ooh, that's a good one.

SPEAKER_02 30:17

That'd be good. Yeah. No, the matter has been closed.

SPEAKER_01 30:20

No more discussion. When is anyone ever upset with you?

SPEAKER_02 30:23

I'm a lovely person, so I can't even imagine that happening.

SPEAKER_01 30:26

I can't either. I think the next time Britney's mad at you and you say the matter is now closed, you might be a case at True Crime Club thing.

SPEAKER_00 30:33

I was gonna say Mike it even matter.

SPEAKER_01 30:36

In receipt of the letters, Ian Cunliff decided to head an investigation. But he decided to treat the allegations as an HR issue. By making them an HR issue, the investigation would then be confidential, therefore conducted in private and behind closed doors. So he brought in clinical director Rex Paulson. He was to lead the investigation, but you've usually got to find an external advisor as well, so the investigation isn't biased. So they also brought in specialist surgeon called Bishop from somewhere else. Gotcha. Now Patterson, for some reason, and please don't ask me why.

SPEAKER_00 31:14

Why?

SPEAKER_01 31:15

Was consulted on this decision to bring in Bishop, and he immediately rejected it.

SPEAKER_00 31:21

Really?

SPEAKER_01 31:22

Uh-huh.

SPEAKER_00 31:23

Not even surprised.

SPEAKER_01 31:24

Heft took on his opinion and promptly removed Bishop from the investigation and appointed a different guy, Colm Hennessy instead. Hennessy was a consultant general surgeon with a specialist interest in breast surgery based in North Tees and Hartleypool NHS Trust. Paterson approved of this one. We don't know why he disapproved of Bishop but was happy with Hennessy.

SPEAKER_00 31:48

Maybe there are basties behind the scene.

SPEAKER_01 31:50

It may be. So a little hierarchy chart for you here. So at the bottom we have Hennessy who was doing the written report. Then we have Paulson above him, who is the lead. Then Cunliffe, who got the letters and started the process. He's now case manager. And then Heft, who is the NHS trust overseeing everything. But because it's only formally down as an HR issue, it's being overseen in secret by candlelight.

SPEAKER_02 32:15

With no external oh no, with this random external guy, though. Random external guy.

SPEAKER_01 32:20

In total, Hennessy reviewed 61 of Ian Patterson's NHS patient case notes. He interviewed multiple clinicians and staff. Fazel Fatah, consultant plastic surgeon, said that Ian Patterson's mastectomies only took half an hour instead of the standard two hours. He said that the standard of surgery was poor, with too large of a scalpel and quick sweeps.

SPEAKER_02 32:43

Right. I have a silly question. When you chop off the booby.

SPEAKER_01 32:48

Yes. Sorry.

SPEAKER_02 32:50

Um the booby in this. Do you get to keep your nipples?

SPEAKER_01 32:55

Uh yes. So I think they actually do leave the nipples on for the reconstruction. Yes. I it not always. I think it's based on we'll see when we get there, and the nipple may or may not be saved. I think it's the same with like I mean, the only reason I know this is through like watching people on TikTok who've had like gender-affirming care. So like, but I I think it's like the same principle, yeah. But maybe with a reconstruction. No, I'm I'm pretty sure with a reconstruction, you may be able to keep your nipple. But then I also know of people who've gone and had like full-on nipple tattoos because they couldn't. Yes, I've seen that.

SPEAKER_02 33:34

Yes, yeah, that's true. They're so little.

SPEAKER_01 33:41

Did you mean in a jar or did you mean on your body?

SPEAKER_02 33:43

Well, no, I mean like, oh, you could get them reattached somewhere else.

SPEAKER_01 33:45

That's what I meant.

unknown 33:46

Yeah, you can't.

SPEAKER_00 33:48

I thought I meant like you wanted to keep it in a jar, and I was like, Chris, it's just gonna like it's like f it's like tissue.

SPEAKER_01 33:54

And like formaldehyde. No. I mean, technically, I guess you can-like jelly tots. But no, they can literally cut the nipple off, place it on the side, do your reconstruction, or not do your reconstruction, and then like sew it back on. Absolutely, yeah. But I think it might be a case-by-case basis. Hennessy also spoke to Wake, who did the Wake report, and he interviewed Paterson himself. The Poulson report was finished in 2008. The conclusions varied, and they were kind of confusing really. It's like they can't decide where they sit. So it states that all spoken to were concerned about patients' cancer coming back due to the tissue left behind from the incomplete mastectomies. But it said Patterson argued that he was keen to remove all breast tissue, but claims it is perfectly possible to remove the cancer and leave behind fat and not breast tissue. By doing this, he feels he can achieve an improved cosmetic result. Deborah Douglas said in her book that she never would have consented to that risk for the chance of still being able to wear a bikini.

SPEAKER_00 35:00

I was even gonna say that earlier. Like I'd rather never wear a bikini ever again. Right, then same.

SPEAKER_01 35:06

Then to Yeah, no, I I mean, yeah, I and I we are right. That is it. Like that is Yeah, we're right. That is the consensus. This is what everybody agrees with. Like, this guy is completely nuts. And Hennessy has quoted in the report saying Patterson wishes to provide the best possible cosmetic outcome for a mastectomy. Clearly, a tidy scar and some cleavage is popular with patients. Is it? Is it? Have you ever even asked them? It also said that Patterson had improved his relationship with the MDT following earlier criticism and continued to carry out a great volume of work for the unit.

SPEAKER_00 35:45

How do you improve that? By attending one meeting?

SPEAKER_01 35:47

I guess.

SPEAKER_02 35:48

Well, it's an improvement.

SPEAKER_00 35:50

Is it?

SPEAKER_01 35:51

Yeah, I mean his best. No, it's not. It's not his best. It's maybe what he could tolerate when he fucking hates everyone else but himself. Another spanner in Patterson's clinical practice was when he had tried to recommend a male patient an unnecessary mastectomy. Ingle read a letter from Patterson. Men can get breast cancer.

SPEAKER_00 36:12

Yes. It's quite rare, right? Yeah, well, it's rarer than women, I suppose.

SPEAKER_01 36:17

Because they have less tissue there, so. Yeah. This isn't saying that the reason it was unnecessary is because the patient was male, but it was unnecessary unnecessary recommendation. Ingall read a letter from Patterson to the patient's GP where Patterson indicated that the patient needed urgent surgery for his breast. Ingall ended up examining the patient himself and realized that Patterson was advising incorrectly. The correct action should have been a biopsy and certainly not an operation at that stage. Ingall went ahead and did the biopsy himself and it came back as showing no cancer. Again, why was Patterson trying to operate on a patient who blatantly had zero cancer at all? Hennessy had reviewed this case and said that Ingel was correct, but Paulson dismissed it. Given these circumstances, this case was now out of Ingall's hands and it was a matter for Spire, the private company. But if only they'd done an audit of Patterson's records, they would have discovered the truth. Ian Patterson was telling patients that they had cancer to sell them the operation that would cure them when there was in fact no cancer at all. That sucks. And so, as we know, the Pulsum report was regarded as an HR matter and therefore confidential. And so Hennessy and Pulsum were kicked off the board after they finished their report, which even they were surprised with, apparently. Then, basically, nothing happened. Knowledge of the report was limited to a tiny number of senior managers whose main focus was protecting their reputation. The report didn't go on to trigger the kind of system-wide action you would want, ideally. But to be fairly ideally. But to be fair, Heft did make Patterson promise to stop doing his naughty cleavage saving mastectomies.

SPEAKER_02 38:11

Well that's good, so he he promised to stop.

SPEAKER_00 38:14

Nothing.

SPEAKER_01 38:15

Absolutely nothing.

SPEAKER_00 38:16

Nothing.

SPEAKER_01 38:17

Ingle continued to. He sat down and looked at every single patient of Patterson. He said, I was very surprised that the patient would have a very small benign lump in the breast, and without any biopsy, they would go straight to theatre. Paterson was coding them as cancer, and none of them were cancer. Ingle was going crackers by this point and decided actually to leave. No one was listening to him, nor would they help with the situation. Patterson had way too much power, and Ingall realized that there was nothing he could do.

SPEAKER_02 38:51

Why did no one go to the police at this point? Because surely that's like I was just thinking that. Is that not assault? We've done our assault.

SPEAKER_01 38:58

Well, I did mention earlier, and I wondered if you'd clock it that Deborah said in her book she would never have consented to that. Like if she'd known. We do get to that eventually, but yeah, at the minute no one is considering this. Yeah. Hey. No one's considering this as stuff on this podcast.

SPEAKER_02 39:18

Sorry.

SPEAKER_01 39:19

Yeah, yeah, yeah. So so yeah, no one no one's thinking assault, no one's thinking consent, no one's thinking any of it. I mean, they're not thinking anything really. The guy's hitting the targets and raking in the cash.

SPEAKER_00 39:33

I wonder as well, because I was thinking the same line that you were, like going to the police. And that made me think, like, genuinely, what would or could they do besides maybe the same like rats that you've already done? I don't know, like maybe this is me just not knowing anything about this sector.

SPEAKER_01 39:50

At the end of the day, the police are just gonna go to the directors, right? And if the directors are gonna lie about it, what can you do? In 2007, Breast Friends presented a Breast Friends.

SPEAKER_02 40:00

Oh guys, I've got this great idea. It's like they came up with a name and then decided to make the charity.

SPEAKER_01 40:05

I mean, I kind of I have it is it does have a big question mark over it. Like, is that a good name or not? Is it a great name or is it an awful name?

SPEAKER_02 40:14

It's a really good name.

SPEAKER_01 40:15

I don't know about breastfriends.

SPEAKER_00 40:16

I cringe when I hear it.

SPEAKER_01 40:18

Yeah, I cringe when I say it. In 2007, Breast Friends presented a brand new medical device worth 12 grand to Spire Parkway in partnership with a local man who had lost his wife to breast cancer. Deborah noted in her book that no one questioned at the time why a private hospital making millions in profit would let a local cancer charity fund expensive equipment rather than just funding it themselves. Modest as ever, Patterson took all the credit for this fundraising, boasting about it online, and Bethan made sure it was all over the local press releases. Patterson and Bethan were the ultimate heroes of breast cancer treatment.

SPEAKER_02 40:57

Were they romantically involved?

SPEAKER_01 40:59

No. Should I say not that we know of, but the way that people speak about Bethan and her particular relationship to him maybe not reciprocated though, but they say like, well, I I think I used the word idolised at the beginning. I think that's straight out of Deborah's book. Like, she like fawned over this guy.

SPEAKER_02 41:21

Right. Was there an age difference?

SPEAKER_01 41:22

Must have been I've only seen photos, maybe ten years, not a huge one. But then I don't necessarily with a 10-year age gap. For sure. Why are you looking at me like that? Five years.

SPEAKER_00 41:36

I'm fine. You're fine. You were gonna say I'm five.

SPEAKER_02 41:41

Mentally.

SPEAKER_00 41:43

That's so rude. I apologize on behalf of his behaviour this evening. No need.

SPEAKER_01 41:50

But yeah, I I don't necessarily trust the photos online either that I've seen of Bethan. It feels like, no spoilers, but let's just say she keeps a very low profile nowadays, and there isn't that there's like one image that will say it's her online, and I'm like, is it?

SPEAKER_02 42:09

I don't know. Probably don't get the internet good from prison either.

SPEAKER_01 42:15

Do you know this? Have you heard of this? Whilst Patterson was prancing around pretending to be the lord and saviour of the woman of s women of Solihull, of the women of Solihull, professionals around him were openly calling him out. Professor Wishheart, a consultant breast surgeon, commented to a journalist that he had never seen Patterson at a symposium for breast cancer consultants because he didn't keep up with the most recent technology and advances in breast care treatment, but because he thought he knew the best.

SPEAKER_00 42:48

Ridiculous.

SPEAKER_01 42:49

Nor did he have any history of publishing in medical journals. There are strict procedures in place in the NHS for introducing new medical techniques. It must be assessed and peer-reviewed. It should be decided amongst experts that it is an improvement and there must be clinical trials. Even then, the patient must be informed of any risk and offered an alternative if they do not want to be part of that trial. Patterson never applied for any sort of approval to test his technique. One of the pulsing recommendations was that Patterson should be observed doing five mastectomies. In 2008, this actually happened. Woo! And even though Patterson was fully aware that he was being observed, he still did a terrible job.

SPEAKER_02 43:40

Oh my god. Oh what an idiot.

SPEAKER_01 43:42

The observer, Mr. Lee, wrote a report for Ian Cunliffe describing Patterson's surgery as rushed and went on to describe the risks associated with rushing surgeries. With surgery, believe it or not, you must take your time and be meticulous.

SPEAKER_02 44:00

That's crazy.

SPEAKER_01 44:04

In and out. Yeah. Sh what could possibly go wrong? Quite. Rushing can cause further damage, unnecessary trauma, blood loss, and may affect healing. Lee later said that watching Patterson operate was like a whirlwind with constant impatience. What do you think happened after you've reported that? Nothing. Overall, Lee reported that there needed to be more attention paid to hygiene and the removal of all breast tissue and recommended more training and a mentor.

SPEAKER_00 44:33

A training and a mentor.

SPEAKER_01 44:34

That's it.

SPEAKER_00 44:35

About loss of job.

SPEAKER_01 44:38

Certainly no recommendation to let patients know that there were ongoing issues with Patterson and his surgeries. It is unknown if any of his basic recommendations were ever even carried out. According to Deborah in her book, Patterson did agree to visit a senior surgeon for mentoring, but never actually went. And so he was able to carry on with his surgeries as normal.

SPEAKER_02 45:00

Who knew you could just not turn up to things and just say, yeah, I can be bothered.

SPEAKER_00 45:04

Was this not being tracked? Or well no, it must have if he never had a few years ago.

SPEAKER_02 45:10

It's part of the problem that he was a freelancer at the hospital, so he didn't have any like major oversight.

SPEAKER_01 45:16

No, everybody knew what was going on, including the directors, all of the hires up. The problem was firstly he had a lot of power. There was one guy that said the reason apparently, this is he assay, but apparently the reason that they you know that report that went down as HR only. The reason that main guy, whatever his name was, decided to do that was because he thought that if he suspended Patterson without evidence before the report, or like while it was going on or whatever, that Patterson would sue him. And so it was about money, it was about power, and it was also about these targets and them the amount of money that Patterson was bringing in. But then again, it's not just that, it's reputation because it's like how far does it have to go to the point where it's too far, and then you're gonna look a really bad, so then you actually want to bury it more.

SPEAKER_04 46:08

Yeah, do you know what I mean?

SPEAKER_01 46:09

Like it's it's like how far does your lie go be have to before you have to say, Oh, well, actually that bit was lie, and yeah, that bit was a lie. Like, do you know what I mean? Like, you you've got to double down because it's too embarrassing at that point. I think there was a lot of things at play here that just let this carry on, yeah.

SPEAKER_00 46:27

Yeah, so I was gonna say it sounds like it.

SPEAKER_01 46:30

What do you guys think? I mean, that doesn't I might not be right. What do you think was at play here? I don't know.

SPEAKER_02 46:36

It's the just the way you started off by describing as like a freelance like hiring the facilities to do these treatments. It doesn't sound like there was any major oversight people checking his his stuff, or at least any way of holding him to account, even if they did discover these problems.

SPEAKER_01 46:52

They seemed like they were raising concerns and they were just getting brushed under under the Yeah, and I mean they're even though that's the case, the surgeons are still they still have to go through a yearly appraisal, they still have to go through like random audits.

SPEAKER_04 47:05

Right.

SPEAKER_01 47:06

But it just feels like even though those things well, we'll get to the appraisals soon because he he had friends, but even the audits, I mean, people were auditing and then sending the results out and being like, This is an issue, and everyone's like, No, it's not fine. Stay tuned.

SPEAKER_02 47:22

It's probably because the statistics showed that he was like doing half of the breast surgeries in the in the truss or something. Probably more than that. Well, yeah, if we got rid of him, oh my god, we're gonna have a huge backlog. Who's gonna do all the breast surgeries?

SPEAKER_00 47:34

Yes, and did no one ever question why, like, oh, every every patient that he got 100% cancer? Only Ingle?

SPEAKER_02 47:41

See, that's crazy because I would have thought Booper or at least the insurance paying out for all these these breast cancer things.

SPEAKER_00 47:49

It would have raised like some alarms.

SPEAKER_02 47:50

It'd be like, oh my god, this doctor is is costing us millions.

SPEAKER_01 47:55

I mean, I don't know. Do you even when you're processing an insurance document, does it say this was done by Dr. Patterson as well?

SPEAKER_02 48:01

Like, insurance companies were on that because you you know, firstly it's insurance fraud because they didn't need these surgeries, so they were claiming money for stuff that wasn't required. Surely the in I I don't know, they're really good at uh making sure they pay out as little as possible. But yeah.

SPEAKER_01 48:18

Even at the time? Oh yeah. I mean, maybe what contributed it, you know, sometimes just a lot of things have to go in a certain way for it to continue this long, but maybe one of it was the buyout from Spire. I mean, what if the buyout from Synvan, sorry, and the change to Spire? Because maybe if Booper had kept going, maybe someone would have raised the alarm at some point, but they didn't because it was bought out.

SPEAKER_02 48:39

Those are my theories anyway.

SPEAKER_01 48:41

It's safe to say a lot went wrong.

SPEAKER_00 48:43

Yes.

SPEAKER_01 48:44

In April 2008, Spire Parkway received an anonymous letter calling out their lack of balls basically when dealing with Patterson and asking why he had not been suspended. This letter, from what we can tell, was brushed under the carpet. It wasn't shown to anyone and no alarm was raised. In 2006, Marie Pinfield was sent for a mammogram after experiencing pain in her breast and saw Patterson as her consultant. He told her bluntly that she had cancer. Marie was adamant that she wanted the entirety of both breasts removed to reduce her risk of spread to practically zero. Patterson did not want to give Marie a full double mastectomy and insisted on her having a psychological evaluation before he would remove both breasts.

SPEAKER_00 49:32

Oh my god, that's when you get a second opinion.

SPEAKER_01 49:35

Yeah. He was so patronizing with her. According to her sister, who was there the whole time, he told her when push comes to shove, she'll probably want the breast shape to stay.

SPEAKER_02 49:46

Even if you did want the breast shape to stay, could you not decide that after your surgery?

SPEAKER_00 49:51

Yeah, can't you get like reconstructive surgery after?

SPEAKER_02 49:55

Well, like wooden ones, like coconut shells. Well, yeah.

SPEAKER_01 50:00

That's always an option. That's so fair.

SPEAKER_02 50:03

Well, yeah. But yes, of course you can.

SPEAKER_01 50:07

You can certainly, if you change your mind later, for sure. But Marie knew the risks and she knew what she wanted to do with them. When Marie woke up from her surgery, she and her sister Shirley, who had been with her throughout, quickly came to realise that Patterson had in fact only done a partial mastectomy. Marie was so unhappy with the result, she demanded a revision operation. When they requested this, Patterson got visibly angry with them. Like, what even is a steal?

SPEAKER_02 50:38

Right? You'd think you'd be like, oh yeah, sure, we can do it. More money, right?

SPEAKER_01 50:41

More money, unless he has to do it for free because it isn't what she wanted or something. However, she underwent another surgery, and when she came out of that one, he still hadn't done the full mastectomy. She was between a B and a C cup still.

SPEAKER_03 50:54

Oh my god.

SPEAKER_01 50:55

Shirley recalls that Patterson was incredibly arrogant, and she believes that he truly only thought that women should exist in this world if they have a breast-shaped body. After her operation, Marie's breast cancer spread and she died just two years later in 2008 at 49 years old. An independent report later found that Marie could have potentially lived another 10 years if her first operation had been what she had asked for: a full double mastectomy. After Marie's death, Heft finally decided to do a recall on some of Ian Patterson's patients. During this time, Patterson was still operating, which colleagues were frankly furious about. None of his current patients were informed about the recall or the investigation, and they decided to closely involve Patterson in the recall process, which made absolutely no sense because by this point he was flat out denying that he was leaving any breast tissue in his mastectomies. He'd done that promise a little while ago that he wasn't going to do these cleavage-saving mastectomies anymore, and obviously didn't stop. But he's just flat out denying it at this point. Oh my god. Fernando, the oncologist colleague of Ingall and whistleblower, said that every patient, every single patient, needed to be recalled and they needed to see someone independent of Patterson and Spire. But Heft decided they knew better and recalled just twelve patients. They said that they could determine who needed recalled through records. This got a lot of backlash from experts at the time, especially since Patterson kept really shite records.

SPEAKER_00 52:34

I was gonna say you can fake those.

SPEAKER_01 52:36

Well, he just basically didn't write them. But they were incredibly vague. Like they couldn't even figure out what people had actually what treatment they got. That's insane.

SPEAKER_02 52:47

Crazy. But were no one was no one picking up on this at the time, or they were and it just wasn't being taken out.

SPEAKER_01 52:53

The record keeping in particular, I guess out of everything else that he did, it's probably just a lesser thing. But I don't know the process. Who do you go to? Who do you report to and say, oh, the the surgeon keeps shitty notes, I guess. Dr. Jill Lawrence and her staff sent a report after a major audit looking at breast cancer recurrence rates. She reported that Patterson's rates were significantly higher than the national average. To them, this meant there was some genuine difference in the surgeries being performed by him alone. After this, Lawrence's report, in her words, seemed to just disappear. Stockdale said later that it was quite clear the trust was at best naive and at worst totally culpable.

SPEAKER_02 53:39

I mean I think they are culpable because they've they've covered up all these reports. They've been told about it, they've not done anything about it. I agree. At that point, you know, what point would they be culpable if not that?

SPEAKER_01 53:50

Patterson tried to negotiate with Heft to privately see his twelve recalled patients. He said a recall would cause them anxiety, so he should just examine them without informing them.

SPEAKER_00 54:00

I think his surgery caused them anxiety.

SPEAKER_01 54:03

Yeah, just a bit. Thankfully, Heft actually didn't go along with this. But it did then take them six months to actually make contact with the twelve women.

SPEAKER_00 54:12

How did it take six months?

SPEAKER_01 54:13

No sense of urgency. After they had been examined, another forty-eight patients were then also identified for recall, but still the trust wasn't saying a word and continued to keep the whole thing secret for a further year. In the meantime, Patterson was still operating and seeing patients who were undergoing surgery, undertaking chemotherapy and further treatments.

SPEAKER_00 54:36

They should have like put a put him on like I don't know, like they should have suspended him eight years ago. Whatever you want to call it.

SPEAKER_01 54:44

Totally.

SPEAKER_00 54:45

Especially when they're reviewing his patients. Like, don't let him keep I know.

SPEAKER_01 54:50

Even if you're that bothered about him suing you, suspend him with pay. I don't give a fuck.

SPEAKER_02 54:55

He wasn't even salaried. He was freelancing, right? Yeah, you are just letting him do any treatments.

SPEAKER_01 55:03

Well, that would be called taking away practice privileges, which they just weren't prepared to do because he was they had to let anyone who with who was like qualified hire their premises. I don't know how they bring people on board.

SPEAKER_02 55:16

Okay.

SPEAKER_01 55:17

In 2008, a GP complained to Spire Parkway because he discovered that one of his patients was about to have an unnecessary operation. He presented the evidence regarding the bogus operation and was apparently told that Patterson couldn't be suspended because he brought in too much money. That has since been denied. Rumours were going around, though, by this point, and a group of GPs got together to lay out their complaints. So they had another investigation. This time led by a fella called Hendrix. But this guy had overseen Patterson for years during his career and had dished out many positive appraisals to him.

SPEAKER_02 55:58

Oh my god.

SPEAKER_01 55:59

So there's no bias issues in this investigation at all.

SPEAKER_02 56:02

That's good.

SPEAKER_01 56:03

Patterson basically just blamed the nurses when questioned, said they'd misunderstood and got stuff wrong. And Hendrix ate it up. He did, though, order an audit into Paterson, and he knew the best person for the job, Beth and Lloyd Owen. Wow. After all, she worked so closely beside him. She's the best person for the job. Obviously, yeah. What a perfect fit for an audit of the guy who may or may not be butchering innocent people on the theatre table day in, day out. By mid-2010, director Goldman was starting to feel the heat of the press about his decisions. He's the guy from like the way beginning.

SPEAKER_00 56:40

Okay.

SPEAKER_01 56:40

So he retired from the NHS with a £2.5 million pension. Ian Cunliffe also resigned in 2010. So are you ready for a slightly better turn of events? Yes. Well, Conliffe was replaced by a man called Dr. Stephen Smith, and he launched a new investigation into Paterson in 2011. He was surprised by the previous investigation's complete ignorance to the issue of consent concerning the patients of Paterson. He said he appreciated that the patients concerned had not given informed consent to their procedures and was taking it very seriously as everyone else should have before. In April 2011, a full NHS recall of Patterson's patients was announced, two years after the initial limited recall. Patterson was then suspended from the NHS but continued to operate and consult in the Spire private clinics. Then in July 2011, his registration with the General Medical Council was made subject to conditions for 18 months. The conditions were that he was no longer allowed to perform breast surgeries, but he was allowed to continue on with his general practitioning, and his patients in that time were not informed that their treatment was subject to investigation. Spire did finally catch up and restricted his practising privileges whilst they carried out an investigation. They reviewed all of his mastectomy patients from 2007 onwards. A terrifying list of allegations emerged from these investigations, including the continued cleavage-saving mastectomies, as well as performing mastectomies on patients whose results had come back benign, falsifying data, and causing unnecessary anxiety and distress to patients, and the list goes on. In 2012, Deborah got her call saying she was officially being recalled. She went for another review where the consultant didn't have her notes. The issue was that the record keeping had been so shoddy up to this point, the whole thing was just a shambles. Deborah received a letter from Spire that told her she had never had cancer. But when she went in for an appointment with another consultant, it turned out that the notes on Deborah's treatment were so vague that they really had no idea if she had ever had cancer, nor whether she had had a full mastectomy. In 2013, so a year later, Deborah did finally get her answer. She had the grade one cancer and it had not spread. So now she was back to where she began, and her letter saying she had never had cancer had been sent in error.

SPEAKER_02 59:31

That's reassuring.

SPEAKER_01 59:32

She should have been offered a treatment to remove the lump only and then be observed for 12 months. Instead, she had been given an incomplete mastectomy. Also, the chemotherapy was largely unnecessary. There was no evidence that she needed it. She should have had radiotherapy if she needed anything at all, which is a much less intense treatment. In her own words, Deborah had been put through a horrendous regime for profit. In total, 597 patients attended a review, and 414 who had surgery were found to have had unnecessary treatment and follow-ups, chemo, etc., all with poor records and poor patient care. People were coming back for years having all sorts of follow-up treatments for a lump that was completely benign and paying through the eyeballs for it. The Kennedy report, led by healthcare law expert Sir Ian Kennedy, was published in December 2013. Kennedy concluded that concerns about Patterson had repeatedly been missed, minimised, and handled inadequately, allowing him to continue operating despite mounting evidence that aspects of his surgical practice were unsafe. Patterson replied no comment to every question asked when interviewed by police and was formally charged in 2015 with 21 counts of wounding with intent, or commonly known as section 18 grievous bodily harm.

SPEAKER_02 1:01:03

So at least it eventually went tit top for him.

SPEAKER_00 1:01:05

Or did it? I mean it did. I'm sorry. Sorry about that. That was great.

SPEAKER_01 1:01:17

These 21 counts were for 10 patients that the prosecution felt had the strongest cases. So it was like 10 patients that so blatantly never had cancer. In the trial, Patterson gave evidence. He boasted of his sporting prowess.

SPEAKER_02 1:01:32

Oh, that's good.

SPEAKER_01 1:01:34

His long career, his happy marriage. He's now divorced.

SPEAKER_02 1:01:37

Love it.

SPEAKER_01 1:01:38

And denied ever pressuring anyone into surgery. He let himself down though when he muttered lying bitch under his breath when one of his victims was giving her testimony. This hit the headlines and didn't look too good for him in the trial. The jury found Ian Paterson. What do you think? Guilty. Guilty on all counts. He was let out on bail before he was sentenced to less than ten years.

SPEAKER_02 1:02:08

But you can't get it.

SPEAKER_00 1:02:10

I don't know. I just have like every time we like talk about these cases, it's just like ridiculous sentencing.

SPEAKER_02 1:02:14

Go on, 20 minutes.

SPEAKER_00 1:02:15

So I'm like, something has gone wrong where it's like a super silly. I mean you're you are correct.

SPEAKER_02 1:02:21

You Is it under 10 years?

SPEAKER_01 1:02:23

No, it's not under ten years, but it's under you your guess.

SPEAKER_00 1:02:27

What do you say under 10 years? I said 21. 21. So like 11 or something. 15?

SPEAKER_01 1:02:31

15. 15 years in prison. In 2024, the health secretary, Wes Streeting, decided to strip Patterson of his multi-million pound pension. Deborah Douglas became one of the central figures in the fight to expose what had happened under Patterson and to make sure patients were not quietly forgotten once the criminal trial ended, becoming one of the most determined campaigners. She spent years pushing for answers and supporting victims through the trauma of discovering their surgeries may have been unnecessary and incomplete. Many of the women affected by Patterson were dealing not only with physical consequences, but with profound psychological damage. They had trusted a surgeon with life-changing decisions about their bodies. Deborah Douglas became one of the people publicly communicating that betrayal. The Patterson Inquiry was an independent government-commissioned inquiry with its final report published in 2020. The inquiry examined failures across both the NHS and private healthcare systems. Its overall conclusion was that there were multiple institutional failures that repeatedly missed opportunities to intervene and made a total of 15 recommendations. I think 11 of them have been implemented today. Although Beth and Lloyd Owen became a controversial figure because of how closely she worked with Patterson, there is no widely reported public finding equivalent to the criminal convictions or regulatory sanctions brought against Patterson himself. So she just like walked away and yeah, went under the radar. In July 2025, the government announced plans to link NHS pay to waiting lists. Wes Streeting called it carrot and stick reforms to boost productivity and tackle underperformance. Deborah feels that although the NHS is a precious resource that deserves protection and with staff that save lives every single day, she fears that we are in the middle of a perfect storm for another Patterson. That was the tale of a greedy c wow.

SPEAKER_00 1:04:38

That was really good. That was really good. I'd never even heard of that. Like, I mean, obviously, you know, things like that happen all the time, but like I'm not heard of I've not heard of that guy or See, it was the general medical counsel I was thinking of.

SPEAKER_02 1:04:49

Why didn't they why didn't someone who was oh well all these whistleblowers who were saying look he's doing bad shit, why didn't they go to them?

SPEAKER_01 1:04:56

I have no idea. I mean, I guess they did. I don't know how any of these things work. So so I did mention before though, but Deborah goes into loads more detail. She um she talks about other victims, she name drops a shit ton. If you want to go and get all of the details, um her book is The Cost of Trust by Deborah Douglas. My sources are The Cost of Trust by Deborah Douglas, BBC.co.uk, Fletcher's Solicitors, GMCUK.org, the Guardian, Gov.uk, BMJ.com. Tune it in next week for a real good tale.