Rogue surgeons: how do they get away with it?

Last week, it was announced that a pot of £37m compensation is available to the private patients of breast surgeon Ian Paterson.

By agreeing to pay compensation to Paterson’s private patients, Spire Hospitals and the NHS trust have recognised that they should have done more to protect their patients.

Patients probably take it for granted that the NHS or private hospitals will take action if there are serious concerns about one of its doctors – and pay out when they fail to take that action.

But as the Paterson case shows, sometimes a rogue surgeon can get away with treating patients for many years. Why?

Why are concerns not dealt with sooner?

The first issue is record keeping. Medicine is very complicated and medical practice is constantly evolving. Complications happen sometimes. Mostly, complications are an unfortunate – but not negligent – result of the treatment. Historically, records have not been very well kept – and often the doctors have been left to report (or not) their own complications. Managers or investigators have the best chance of uncovering problems if they have access to complete and accurate data on complications.

Another factor is that consultants often work independently. They are responsible for their own patients.  The junior staff who work most closely with them may not have the confidence or knowledge to report concerns. If junior staff raise concerns, senior colleagues may be reluctant to confront a respected a consultant colleague – and might even go to some lengths to protect them.

Thirdly, information about historical complaints and investigations may not be passed on when managers leave and are replaced. Then, when new concerns are raised, the staff investigating do not have the full picture.  It is difficult to identify the extent of a problem when you only have part of the story.

There is a human factor too: who expects an experienced, confident – perhaps charming – and well-respected surgeon to be harming patients?

Most doctors work very hard, putting the well-being of their patients first. The Ian Patersons are rare. They hit the headlines.

In short, it is not easy to identify a failing doctor.

But sometimes the evidence is there for everyone to see, and still the managers fail to act.

What happens when everything comes to light?

When the problems come to light, the result is costly.

There can be a personal cost for doctors who fail to act. Last year the GMC struck off one of Treliske hospital’s former medical directors for failing to act on an investigation in 2008. That investigation revealed significant and widespread concerns about their consultant gynaecologist, Mr Rob Jones.  Mr Jones was eventually stopped from treating patients  – but not until 2012.

There is a personal and professional cost for those doctors who are left behind to pick up the pieces, perhaps having fought to raise concerns in the first place.

There is a financial cost for the NHS. In the Rob Jones cases, the NHS had to pay compensation to women who were harmed as a result of negligent care by Mr Jones at a time when he should not have been treating patients at all. In other words, this was compensation that would not have been necessary, if action had been taken sooner.

Arguably, the highest price is paid by the patients.  Their lives can be changed by the mistakes and their trust in the medical profession is shaken.

Enable Law represented over 200 of Mr Jones’ patients. Many spoke out in the hope that –  if they told their story –  lessons would be learnt so that no other patients had to go through what they did.

What next?

Following high profile cases like Ian Paterson and Rob Jones, will hospitals react more quickly to concerns in the future? Will they offer compensation more quickly to patients they have failed to protect in the past?

Let’s hope so, because no-one wins when the NHS fails to protect its patients from its doctors.

Laura Scantlebury is an Associate in the Medical Negligence team at Enable Law. She can be reached on 03303 116904, or at laura.scantlebury@enablelaw.com.