Queries over second medic in Ian Paterson patient case
The death of a patient of disgraced surgeon Ian Paterson was contributed to by "substandard" care provided by another doctor who treated her prior to Paterson, an expert has told an inquest.Winifred Worrall, from Shirley in Solihull, had grade three cancer in her left breast when she died on 30 July 2001 aged 85.In a report on Ms Worrall's death submitted to the inquest, Dr Richard Linforth, a consultant breast surgeon, said a delayed diagnosis of two years, despite a "red flag", was a contributory factor.He alleged this was due to her doctor in 1998, Dr John Taylor, not giving her an ultrasound after her mammogram came back clear. The inquest heard that Dr Taylor is now deceased.
Surgeon Paterson was jailed for 15 years, later extended to 20 years, in 2017, after being convicted of wounding patients by way of botched and unnecessary operations. The former employee of Heart of England NHS Trust, who also worked at Spire Little Aston, is eligible for release in 2027.Ms Worrall was one of 63 breast cancer patients treated by Paterson, and whose deaths are now being investigated.While Dr Linforth claimed that Paterson's surgical treatment did not "materially impact" Ms Worrall's survival, he did say Paterson's treatment was "inadequate" and "poor", suggesting "a surgical incompetence in managing breast cancer".Dr Linforth alleged this was due to Paterson's failure to clear the margins of Ms Worrall's cancer and his inability to remove any of her lymph nodes during her surgery.He also said a more probing history of her symptoms would have led to her having a CT scan to stage her cancer, meaning she could have avoided the mastectomy and "its discomfort". Dr Linforth maintained she could have had palliative endocrine therapy and radiotherapy instead.
'Failure of care'
Ms Worrall had presented to Dr Taylor in 1998 at the age of 83, with an inverted nipple and nipple discharge, the proceedings heard.Dr Linforth told the inquest on Thursday: "I do believe for anyone with a nipple discharge and inversion, an ultrasound is mandated. Failure to request an ultrasound was a failure of care."If I got a letter about a woman of that age with nipple inversion, it's a red flag. To me, this is a cancer unless proven otherwise."Speaking at the inquest on Wednesday, Paterson also said that given her age and "new worrying symptom", he claimed he would have performed an ultrasound at the time if she had been his patient in 1998.
The inquest heard that a cancerous mass in a dense breast might not be picked up on a mammogram, meaning Ms Worrall's mammogram may have missed the tumour she was later diagnosed with in 2000.Four months after her diagnosis of breast cancer, Ms Worrall was diagnosed with metastatic bone cancer.Dr Linforth said he believed that diagnosis and treatment in 1998 would have prevented the cancer from metastasising to her bones.
Disputed cause of death
Ms Worrall's recorded cause of death in 2001 was carcinomatosis and breast carcinoma.However, at the inquest on Wednesday, Paterson said he was "very concerned" that the wrong cause of death for Ms Worrall had been given on her death certificate, as two letters addressed to her GP by consultants in the weeks before she died made no reference to her being terminally ill.Paterson expressed his belief that Ms Worrall's "long history of heart disease" was a factor and said he was concerned it was not on her death certificate. However, Ms Worrall's granddaughter emailed the coroner on Wednesday night, expressing her upset over Paterson's claims over the cause of death.In an email read out by the coroner, she said her father distinctly remembered Ms Worrall crying out when she was told her condition was terminal."I remember speaking to my nan and her being deeply upset about her prognosis and that she wouldn't survive," she said.
Dr Simon Russell, a clinical oncologist acting as an expert to the inquest on Thursday, said he was also sceptical of the death certificate."The majority of ladies with bone-only metastatic breast cancer will live for some years," he said."I think Winnie died of the breast cancer spreading to the back and causing significant pain, immobility, and psychological distress – on top of pre-existing cardiac disease."Pain, immobility and shock were too much for her underlying issues to take."The proceedings continue.
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