The tail of two scandals: Common causes, different aftermaths

COMMENT – Important similarities lie at the root of the scandals involving ‘rogue’ UK surgeon Ian Paterson and that of the Poly Implant Prothèse (PIP) breast implants. The stark contrast in their handling, however, underline the ongoing failure to properly address the harm and risks posed by PIP.

Mr Paterson performed, over many years, a variety of unauthorised and/or inappropriate procedures on upwards of 750 breast cancer patients — from unnecessary radical mastectomies to ‘cleavage-saving’ mastectomies which increased the risk of a return of the cancer.

Questions hang over his recruitment in the first place, and it is also alleged that he had been allowed to continue operating for years after colleagues had raised concerns about him. The latter fact is arguably the most meaningful failure in the scandal. In the case of PIP, the fraud involving the use of an filler unapproved for human implantation was similarly missed due to surveillance failures (see News story) over several years.

Indeed, the common denominator of the regular trickle of major UK incidents of public harm involving procedural and/or regulatory shortcomings is a failure to act on grounds for suspicion or concerns, as a result of prejudice, distrust or what is euphemistically described as a “lack of professional curiosity”, often followed by a lack of accountability or readiness to correct the situation.

The Paterson case has moved forward rapidly since then and, as recently as April 2017, he was found guilty of various degrees of wilful injury and is serving a 20-year prison sentence.

Today, Spire Healthcare, the private health provider which employed Mr Paterson, disclosed to its shareholders and the stock market that it has set aside £27.2m to compensate around 750 patients. A significant number of those cases were for NHS patients, for whom an additional £10m has been set aside by the NHS and Mr Paterson’s insurers. A total of £37.2m for around 750 patients. Additionally, potential victims will have until October 2018 to file a claim.

It is fair to assume that for PIP victims, particularly the around 45,000 women affected in the UK, today’s developments will be galling, even distressing, given the speed and clarity with which the Paterson scandal is being addressed and his patients’ needs recognised; the length of the prison sentence; and the meaningfulness of the award for damages.

In the case of PIP and the vast majority of the around half a million women affected worldwide, their plight has not been recognised with anything like the same sense of responsibility and sensitivity, let alone the same attention to their welfare (and that of their children, especially in the case of pregnant or breastfeeding mothers who still have PIPs).

Irrespective of the history of the Paterson case and the full detail and context of today’s announcement, something clearly does not add up, raising two fundamental questions:

First, is the Paterson scandal simply a case of fraud, about a ‘rogue surgeon’, or is it not, fundamentally, another huge case of a string of gross failures to protect the patient, the public and the common good? (Spire and the NHS have acknowledged responsibility for failures in clinical governance. But ‘clinical governance’ is an oversimplification of the problem, given the apparently demonstrable layers of failure.)

Second, what real difference is there between the harm caused by a fraudulent, negligent doctor who the provider or NHS has contracted, and the harm caused by a fraudulent product which the provider or NHS has bought (ie ‘contracted’) and implanted?

At the core of the PIP and Paterson scandals lie very similar failures and shortcomings. However, the handling of the two situations has been radically different. Many PIP victims would argue that the aftermath of the scandal has been at least as harmful as the fraud itself.