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2017年5月2日，英国医学会（BMA）官方期刊《英国医学杂志》发表新闻报道：英国乳腺外科医生被指控二十项非法伤害和蓄意伤害罪名！ 乳腺外科流氓医生：伊恩·帕特森，对1000多位女性进行了失误或不必要的手术，被宣判犯有17项蓄意严重人身伤害和3项非法伤害罪名。 帕特森，59岁，主要在西米德兰兹（英格兰中西部）索利赫尔医院工作，被诺丁汉刑事法庭宣布有罪，并将于5月底判决，蓄意伤害的最高刑期为终身监禁。 上述指控仅涉及他的10位私人患者，其中包括1位男性。起诉人称：公道的外科医生认为所涉乳房手术均不合理。帕特森向患者们和全科医生们对活检结果进行误导，对家族史危言耸听，并声称乳房切除术对防止癌症进展至关重要。 不过，尽管上述刑事案件主要是对健康者进行不必要的手术，但是针对他的几百例民事诉讼大多数都涉及他对真正癌症的乳房切除术不充分。 帕特森擅长“保留乳沟”的乳房手术（与彻底的乳房切除术相比，复发率较高）并于2007年英格兰中心医保基金根据调查告知其停止该手术后仍继续进行。结果，超过1100位患者被召回进行复查和治疗。 为此，医保基金已经支付将近1800万英镑（折合2100万欧元或2300万美元）以解决帕特森造成的256笔公立医院患者医保索赔。他工作过的斯派尔医疗（英国第二大私立医院集团）面临着数百笔索赔，但是赔偿尚不确定，因为他并未被斯派尔雇用，而且医疗维权联盟（英国最大的医生维权组织）在他的商业保险范围超出后拒绝承担他的赔偿责任。 起诉人朱利安·克里斯多夫御用大律师（又称资深大律师，直译女王顾问、皇室或王室法律顾问）表示：帕特森的动机亦是“不可理喻”，无论“保持他忙碌、成功、炙手可热、事业如日中天的外科医生形象”，还是“通过额外的手术和随访咨询……赚取额外的费用”，或者因为帕特森先生“以帮助别人为快乐之本”。 患者称他有完美的床边功夫（为患者提供服务的态度）和感染能力（感动并说服患者的能力）。2013年，其中一位患者接受英国医疗卫生委员会前主任委员伊恩·肯尼迪为撰写调查报告而进行的面谈时称：“尽管他是一位顾问（英国医生高级职称），但他总是站在你的立场说话”。 但是，十多年来，同事们一直对帕特森存在很大质疑，直至2012年，英国医学总会终于注销了他的行医资格。此前，他是4次调查和通报的对象。 2008年，受医保基金之命调查帕特森的外科医生马丁·李将其技术堪比“旋风”，其手术如同轻松进入剧院……而且只想尽快完成手术。 其他工作人员称帕特森“傲慢自大”、“咄咄逼人”、“独断专行”、“横行霸道”。一位外科医生告诉肯尼迪：这意味着帕特森经常孤立工作，正符合他的目的。 肯尼迪总结道，帕特森之所以能够长期如此，是因为英格兰中心医保基金奉行“保密和包容”，而非把患者放在首位，并且由于其他临床医生没有及时引起英国医学总会的重视。 西米德兰兹（英格兰中西部）总警司马克·佩恩对此评论道：帕特森是一个有恃无恐的流氓恶霸，扮演着上帝，玩弄着人命，因此而过着奢华的生活。 BMJ. 2017 May 2;357:j2134. Breast surgeon is convicted of 20 counts of unlawful wounding and wounding with intent. Dyer C. The BMJ. The rogue breast surgeon Ian Paterson, believed to have carried out negligent or unnecessary surgery on more than 1000 women, has been convicted of 17 counts of wounding with intent to cause grievous bodily harm and three counts of unlawful wounding. Paterson, 59, who worked mainly at Solihull Hospital in the West Midlands, sobbed quietly as the verdicts were announced at Nottingham Crown Court and faces sentencing at the end of May. The maximum sentence for wounding with intent is life imprisonment. The charges related to just 10 of his private patients, including one man. All underwent breast surgery that, prosecutors said, "no reasonable surgeon at the time would have considered justified." Paterson misrepresented biopsy results to patients and GPs, played on fears raised by family histories, and claimed that mastectomies were essential to prevent the development of cancer. But though the criminal case focused on unnecessary surgeries performed on healthy patients, most of the hundreds of civil claims against him involve insufficiently thorough mastectomies for real cancer. Paterson specialised in "cleavage sparing" breast surgery, associated with a much higher recurrence rate than full mastectomies, and continued to practise this technique after he was told to stop, following an investigation at Heart of England NHS Trust in 2007. Eventually over 1100 of his patients would be called back for further tests and treatment. The trust has since paid out nearly £18m (€21m; $23m) in damages and costs to settle 256 claims involving Paterson's NHS work. Spire Healthcare, which owns the private hospitals where he worked, faces hundreds of claims, but compensation is uncertain because he was not employed by Spire and because the Medical Defence Union has refused to cover him for claims lodged after his commercial insurance coverage lapsed.[1] Paterson's motives remain "obscure," said prosecutor Julian Christopher QC at his trial, "whether to maintain his image as a busy successful surgeon in great demand and at the top of his game, whether to earn extra by doing extra operations and follow-up consultations ... or because Mr Paterson enjoyed the responsibility that came with helping people." Patients said that he had the perfect bedside manner and radiated competence. "Even though he was a consultant, he spoke on your level," said one, interviewed for a 2013 report compiled by Ian Kennedy, former chair of the Healthcare Commission. But colleagues had been raising grave doubts about Paterson for more than 10 years when the General Medical Council finally suspended him in 2012. By then he had been the subject of four investigations and reports. Martin Lee, a surgeon asked by the trust to observe Paterson during surgery in 2008, compared his technique to a "whirlwind." Lee added, "He would breeze into the theatre ... and just try to get on as quickly as possible." Other staff described Paterson as "arrogant," "aggressive," "autocratic," and "a bully." This had meant that he often worked in isolation, which suited his purposes, one surgeon told Kennedy. Paterson was able to keep working, Kennedy concluded, because the Heart of England Trust focused on "secrecy and containment," rather than putting patients first, and because fellow clinicians failed to bring their concerns to the GMC.[2] Chief Superintendent Mark Payne called Paterson a "controlling bully, who played God with people's lives so he could live a luxurious lifestyle." References
PMID: 28465329 DOI: 10.1136/bmj.j2134 |
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