“57. Inevitably, the effect of carrying out the unnecessary procedures upon these individuals, has varied from one to another. However, it is clear both from listening to their accounts during the trial, and subsequently having considered their victim impact statements, that the physical, and particularly psychological effect upon each of them, has been profound. 58. All of them have suffered the pain and discomfort associated with surgery, whilst some have suffered the debilitating longer-term effects of complications arising from the unnecessary procedures; especially those who have undergone mastectomies with immediate subcutaneous reconstruction. 59. All of them have been left feeling violated and vulnerable, whilst some have suffered prolonged psychological conditions, including post-traumatic stress disorder, anxiety and depression, which has required professional intervention and treatment. 60. All of them have been left with physical scarring to their bodies, and those who underwent mastectomies have had their breast tissues removed. The one man who was affected by this type of procedure has spoken eloquently of the effect that this procedure has had upon him, and it is probably difficult to overstate its psychological effect upon the women to whom it took place, which is best encapsulated by one of the victims, who puts it in these terms, “Now and probably for the rest of my life, when I look in the mirror I see a victim of Paterson, who took away part of being a woman.” 61. In addition to economic losses caused to some of these individuals, either from the cost of the operations themselves, or the psychological impact on their employability, the other effect which is common to all these individuals has been their loss of trust in others, including the medical profession, and the reputational harm of your conduct may well extend beyond those immediately affected.” “Now and probably for the rest of my life, when I look in the mirror I see a victim of Paterson, who took away part of being a woman.” 9. As Hallett LJ observed in the course of delivering the judgment of the CACD: “The jury’s verdicts mean that they were satisfied that over a period of 14 years, in respect of ten patients (nine women and one man) the offender deliberately misrepresented the contents of pathology, exaggerated the risk of cancer and advised and carried out unnecessary surgery including mastectomies.”
“The total amount payable by the Company in respect of all damages costs and expenses arising out of all claims during any Period of Insurance consequent on or attributable to one source or original cause irrespective of the number of Persons Entitled to Indemnity having a claim under this Policy consequent on or attributable to that one source or original cause shall not exceed the Limit of Indemnity stated in the Schedule”
“The word event, occurrence or claim describes what has happened; the word “cause” describes why something has happened. The words “one source or original cause” are, as Hobhouse LJ said, “wide”
“A culpable mis-appreciation in an individual which leads him to commit a number of negligent acts can arguably be said to constitute the single event or originating cause responsible for all the negligent acts and their consequences. The same is not true when a number of individuals each act under an individual mis-appreciation, even if the nature of that mis-appreciation is the same. Each of the Gooda Walker underwriters formed his own policy, insofar as he had one, and took his own underwriting decisions for his Names, independently and from his own viewpoint. While their actions suffered from similar shortcomings, the individual approaches which resulted in these short-comings were by no means identical. In my judgment, if one applies the approach of Mr. Justice Clarke in Caudle v. Sharpe, the result is that the approach to underwriting of each underwriter was a separate originating cause, resulting in the losses suffered by the Names on whose behalf that under-writer was writing business.”
“To construe “original cause” so widely as to encompass any claims arising from bad design on a particular project by the insured architect would give too vague a meaning to those words”
“Mr Paterson performed surgery or diagnostic treatment on LF on25 October 2000 ,24 April 2002 ,7 January 2004 ,2 February 2005 ,12 July 2006 and2 May 2007 that was unnecessary and carried out without informed consent. Had LF been advised, as she should have been, that the procedures were unnecessary she clearly would not have consented to them. b. Mr Paterson failed to carry out a standard triple assessment to diagnose LF’s condition in April 2002, December 2003, January 2005, July 2006 and April 2007. Had he done so, he would and should have ascertained that surgery was unnecessary. c. On 5 occasions Mr Paterson performed a lumpectomy that was unnecessary. This was an invasive procedure carried out under general anaesthetic that had no benefit for LF and which caused her the anxiety of believing she had needed treatment for breast cancer when with competent care it ought to have been ascertained that she never had breast cancer.”
“On12 November 2008 , [Mr Paterson] performed a "cleavage sparing mastectomy" whereby a mastectomy was purportedly performed upon the Claimant but a significant proportion of the tissue in her left breast was left behind. This was not a procedure recognised by a responsible body of surgeons and the Claimant did not give informed consent for it. As a result of this negligently performed procedure the Claimant was exposed to an unnecessary risk of recurrence of her breast cancer. The residual tissue was not discovered until 2012, when it was discovered as part of the [Spire’s] review of [Mr Paterson’s] private patients. As a result of the discovery, the Claimant was required to undergo two further operations to remove residual breast tissue in February 2012 and January 2013.”
“In order to gain a proper understanding of this case, it is important to appreciate that the offences of which you have been convicted by the jury are not ones involving either negligence or even recklessness, where someone causes harm either by oversight, or knowingly or otherwise is working beyond their capabilities. On the contrary, as the jury found, these offences represent the intentional application of permanent harm by you upon patients who were in your care, for your own selfish purposes, rather than because they were necessary to maintain their health. In these circumstances, they represent the antithesis of the Hippocratic oath.”
“Did the quantum of the damages and interest paid to the Patients, the Patient’s costs, and the Claimant’s defence costs arising out of the second distinct group of Claims exceed£10 million ? If not, what was the quantum of the damages, interest, costs and defence costs of Claims arising out of Mr Paterson’s deliberate conduct?”
“… to audit and analyse the underlying claims, to establish whether a claim falls into the second group and, where it does, to identify the quantum (damages, the Patients’ individual costs, and the appropriate share of Patients’ common costs) of such a claim. We request that in your analysis you break down the quantum figures so that it is clear how much is attributed individually to damages, the Patients’ individual costs, and the appropriate share of Patients’ common costs. It is only necessary to continue this task up to and until it is established that the quantum of the second group of claims exceeds£10 million . After that value is reached, it is unnecessary to continue the task.”
“Accordingly, from my involvement in these claims and my work on the audit, whilst I am unable to disclose the total figure for reasons of confidentiality, I can be (and have always been) confident that the value of the Category 2 claims, including damages, VAT and costs (including disbursements), is well in excess of£10 million .”
“23) In terms of Slater and Gordon’s cases, these have all now been assessed to see whether they fell into category 1 or category 2. The claims which fell within into each category were then entered onto an Excel Spreadsheet. That Spreadsheet is privileged and confidential. I do not waive any privilege or confidentiality by referring to it. My clients are not willing to waive privilege or provide that Spreadsheet. The damages received by each client and costs were added in separate columns and totalised. 24) The audit shows that out of 115 cases, 84 fall within the Second Group. These claims are consequent on, or attributable to, Mr Paterson deliberately or dishonestly performing surgery … 28) The audit and analysis confirmed that the amount of damages and costs awarded to the 84 Claimants in the Second Group came to a total of£2,267.693 .00. For the avoidance of doubt, that total necessarily does not include the amount of any defence costs incurred for and on behalf of Spire and which may be allocated to the Second Group. 29) I have spoken with Thompsons and understand they have undertaken a similar audit and the amount of damages and costs awarded to their Group 2 cases is in itself over£10 million ”
“Quite remarkably, my learned friend asked no question whatsoever about the way in which the audit had been carried out, nor did he check how it had been added up, nor did he check the margin with which they are able to be confident that these claims exceed 10 million. In short, everything points to the fact that the group 2 claim exceeds 10 million.”