Disgraced breast surgeon Ian Paterson made a “very wrong decision” to perform a mastectomy on an 82-year-old cancer patient who died of post-operative complications, a coroner has been told.
Gladys Currall suffered a perforated duodenal ulcer and cardiac arrest five days after undergoing a mastectomy performed by Paterson, who is serving a 20-year prison sentence for wounding patients after he was convicted in 2017.
Mrs Currall, from Solihull, West Midlands, was diagnosed with breast cancer after a “huge” 7cm carcinoma was found in her left breast on February 6 1998 and the cancer had spread to her lungs and bone.
An inquest into Mrs Currall’s death – the fourth of 62 expected to be heard at Birmingham Coroner’s Court in an eight-month period – was told on Wednesday the mastectomy should not have been carried out in the first place as her cancer had already spread and would be of no benefit, and that she likely developed the ulcer that led to her death post-surgery.
It was a bad decision, but it went from a seven then to a nine. He hadn’t considered the intervening two weeks. I don’t think she was reassessed by him
A multi-disciplinary team of experts who reviewed Mrs Currall’s medical records to assist coroner Richard Foster with the inquest concluded that she should have been offered alternatives such as endocrine therapy instead of a mastectomy, saying in their report: “It seems highly probable that her life was shortened by inappropriate surgery.”
The court was told on Tuesday that the day before the mastectomy was carried out, on March 19 1998, Mrs Currall had deteriorated since Paterson saw her on March 5 and was described as being dehydrated, frail and in “impending renal failure”.
Giving evidence, one of the experts, consultant surgeon Professor Mike Dixon, said: “I think on the balance of probabilities, it is 51 per cent likely the ulcer perforating was because she went through the extra stress of surgery on top of other co-morbidities, like kidney failure.
“It’s a combination and the straw that broke the donkey’s back was that surgery. That pushed it over and played a direct role in the ulcer perforating.
“Mortality from a mastectomy is very low. I think had she not developed an unfortunate complication she would have probably survived the operation.”
Asked by counsel to the inquest, Jonathan Jones KC, if the ulcer could have been present before the mastectomy, Professor Dixon said: “There were no symptoms of abdominal pain and ulcers are very painful, so all I would say is there is no evidence it was there before the surgery.
“They can come on very quickly. On the balance of probabilities it wasn’t there before given she had no symptoms.”
Paterson should have decided against carrying out the mastectomy the day before when it was clear Mrs Currall was frailer than when he had made the decision to operate at the beginning of March, he said.
Professor Dixon said: “There are times when you need to decide not to operate and this was one of those times. It was a very bad decision to operate on someone who was very clearly unwell.
“Whatever perceived benefit there may have been, there were other options and therefore there was no reason to go ahead with the operation. It shouldn’t have happened.”
Dr Simon Russell, oncologist, added: “She was pretty frail, she had lost weight, taking her to theatre was the wrong thing to do.”
Asked by Mr Jones if Paterson’s decision to perform the mastectomy gave rise to an “obvious and serious risk of death”, Dr Russell responded: “Yes it did.”
Professor Dixon added: “It certainly significantly increased her chance of death in the post-operative period because he operated on her in poor condition.
“Did it affect her chance of survival? Absolutely. Would she have died when she did if she hadn’t been operated on? Probably not. It was a very poor clinical decision.”
Coroner Mr Foster asked the pair to rate how bad Paterson’s decision to operate was, on a scale of 1-10 with 10 the worst.
Professor Dixon responded: “It was at least a nine. Because the op had little advantage to Gladys and given her poor condition, it put her at risk of post-op complications, which she did develop.
“It was big risk for little advantage. The decision to proceed in light of her deteriorating clinical condition was a very poor decision. If 10 is the worst decision you’ve ever made, nine is pretty bad.”
Dr Russell added: “It was a bad decision (on March 5), but it went from a seven then to a nine. He hadn’t considered the intervening two weeks. I don’t think she was reassessed by him (before surgery).”
Paterson, originally from Glasgow, is serving a 20-year sentence for wounding imposed after a trial at Nottingham Crown Court in 2017.
The surgeon, who was living in Altrincham in Greater Manchester when he was convicted, was employed by the Heart of England NHS Foundation Trust and practised in the private sector at Spire Parkway and Spire Little Aston.
He was appointed as a consultant at Solihull Hospital in 1998 and practised there until May 2011.
The fifth inquest, into the death of kitchen assistant Christine Gould, 56, who died at a care home in Edgbaston on May 24 2003, is expected to start on Thursday.
