Colleague of Ian Paterson tells inquest butcher surgeon's operations were 'not adequate'

A colleague of disgraced breast surgeon Ian Paterson had raised concerns the mastectomies he was carrying out on cancer patients were "not adequate" but did not report him to the General Medical Council, an inquest has heard.

Consultant plastic surgeon Fazel Fatah, who carried out breast reconstructions after Paterson performed mastectomies on patients at the City Hospital in Birmingham, said he requested not to work with him anymore after becoming suspicious of his technique.

He said that Paterson would often leave whole "chunks" of tissue behind and exit quickly after surgery.

Mr Fatah gave evidence on Thursday at an inquest into the death of former patient Melanie Chalklen, who had residual breast tissue left behind after one of Paterson's mastectomies.

Ms Chalklen's inquest is only the eight in a series of 62 set to be held at Birmingham and Solihull Coroners Court regarding the deaths of former patients of Ian Paterson which may have been unnatural.

Paterson, who is currently serving a 20-year sentence, was due to give evidence remotely from prison but this has been rescheduled to Monday.

Mr Fatah said two of the four patients he operated on with Paterson, including Ms Chalklen, had residual breast tissue left and both showed signs of cancer.

He said this led him to believe that Paterson's technique of using a large knife to quickly "shell" the breast out instead of "meticulously" dissecting and separating the gland from the skin was inadequate for cancer patients.

He said Paterson would give a "quick sweep of the knife" rather than a "careful inspection" that was required.

He had originally given Paterson the "benefit of the doubt" after he had found "chunks" of breast tissue left behind by Paterson.

Mr Fatah then told the lead breast surgeon at City Hospital, Martin Lee, about his concerns and Paterson was stopped from carrying out surgeries there. He also said he never saw or heard from Paterson again.

He also spoke to another colleague John Taylor regarding Paterson, suggesting that they should investigate the results of Paterson's mastectomies to see if there was a pattern.

The inquest was told that Mr Taylor, who has since died, said that it would not be possible because of Paterson's "aggressive nature" and the support that he had from the trust.

According to Mr Fatah, "those were his exact words", and they trusted Paterson because he was "more productive as a surgeon operating on a larger number of patients in the given time".

After suggesting an audit of all of his histology results Mr Fatah said Mr Taylor "looked at him and smiled".

When asked why he didn't report Paterson to the General Medical Council, Mr Fatah said: "I didn't really feel it was my role to report him to the GMC based on my limited experience".

"I thought that was definitely the responsibility of management and colleagues that he worked with more at his trust, and that is why I spoke to Mr John Taylor".

He also told the inquest he did not tell Ms Chalklen he had identified breast tissue left behind because he "didn’t want to cause her distress". He said it felt "wrong" to tell her that she would "require further treatment" and that it was really for Paterson to explain.

The consultant, who stopped working for the NHS in 2013 but now works part-time in the private sector, said that Paterson would usually leave quickly after carrying out the mastectomy, leaving Mr Fatah to carry out the reconstruction.

He said Paterson would leave very quickly, not taking clinical notes, or leaving a handover. "He would pack the whole cavity with large swabs and then leave".

The inquest is continuing.

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