Colleagues of disgraced surgeon Ian Paterson raised his concerns twenty years ago, the inquest has heard

A colleague of disgraced surgeon Ian Paterson raised concerns that he had performed “incomplete” breast cancer operations 20 years ago, an inquest has heard.

A judge-led inquest into the deaths of 62 former Paterson patients began at Birmingham and Solihull coroners’ courts on Tuesday and is set to become one of the largest inquests in British history.

A review will be conducted to determine whether each of the patients “died an unnatural death as a result of Paterson’s actions” and is expected to take a year, with more patients possibly added in the coming weeks.

Later stages of the investigation will look at whether there were any systemic failures by hospital management in responding to the concerns raised about Paterson.

Paterson, who is serving a 20-year prison sentence for 20 injuries after being found guilty of performing unnecessary and harmful breast cancer surgery in 2017, will testify on Thursday.

Dr. Andrew Stockdale, an oncologist who worked with Paterson in the 1990s and 2000s, said he raised the alarm that patients are still left with large amounts of breast tissue after a mastectomy, putting them at greater risk of the cancer returning.

He reviewed 100 consecutive cases referred to him in 2003 and found a worrying number of cases where breast tissue had been left behind by Paterson, or where patients required further surgery, and raised this with his superiors.

He noted that of the 41 patients who had mastectomy, 34% of them required further surgery, which “should have been impossible,” Stockdale said. “Those are terrible numbers,” he said.

These operations were later referred to by Paterson as ‘cleavage-sparing mastectomies’ and were against national guidelines. “I thought they were incomplete,” Stockdale said. He also said team meetings, led by Paterson, to discuss the treatment of cancer patients had an “adversarial, challenging and non-professional atmosphere”.

Stockdale said Paterson was an “outspoken person,” that he had “firm opinions,” and that the meetings were not “an environment for balanced discussion.” He also complained that Paterson made decisions about patients without discussing treatment options with colleagues, presenting their cases as “fait accompli.”

“The first we heard from a patient was when an operation was completed,” Stockdale told the inquest.

On Monday, Judge Richard Foster rejected Paterson’s application to grant him legal aid, along with his request to postpone the inquest to allow him more time to read the relevant documents.

Paterson claimed he had been unable to read the inquest documents because he only had supervised access to a laptop, and his requests to do so had been denied due to low staffing levels at the prison.

Foster said it was beyond his power to provide the funding, and that the investigation team had gone “to great lengths” to provide him with copies of all relevant material.

A total of 562 patient deaths treated by Paterson, who worked in the NHS and private hospitals in the West Midlands between 1997 and 2011, were reviewed as part of the investigation process.

An independent report published in 2020 found that he had subjected more than a thousand patients to harmful surgeries over fourteen years before being stopped.

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