A DOCTOR was “financially motivated” when he referred eight patients to a new treatment for prostate cancer, a medical tribunal has heard.

Consultant urologist Paul Miller, 63, was said to be an “early advocate” of high intensity focused ultrasound (Hifu), which emerged in the mid-2000s, with trials taking place in the UK, the United States and France.

The General Medical Council (GMC) said his “personal enthusiasm” led to him training on how to use a Hifu machine and to form a private company, Mobile Hifu Limited, in October 2005, of which he was a director and a shareholder.

The company purchased a Hifu machine for £500,000 and subsequently rented it out to privately-run Spire Gatwick Park Hospital in Surrey for Mr Miller to use to treat patients with prostate problems.

Opening the case for the GMC, Catherine Cundy said: “It is part of the GMC’s case that he had had a financial interest in the provision of Hifu to Spire Gatwick Park patients.

“He did not disclose that financial interest to those patients, and in consequence that provided a financial motivation with selection of Hifu as a treatment modality.

“There existed a financial conflict of interest and the referral of the eight patients was financially motivated.”

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Five of those patients were initially treated within the NHS at East Surrey Hospital in Redhill – where Mr Miller also worked – before they were treated privately at Spire Gatwick Park, the Medical Practitioners Tribunal hearing in Manchester was told.

Ms Cundy said Hifu was not considered at the time, or today, as a standard mainstream treatment for prostate cancer.

She said relationships between Mr Miller and a number of colleagues at East Surrey Hospital deteriorated as time went on and “part of the focus of the tensions was Mr Miller’s championing of Hifu”.

She said that, by September 2008, the management at Sussex and Surrey NHS Trust made it clear to Mr Miller that if a multi-disciplinary team made up of clinicians recommended Hifu then they should be referred to possible inclusion in a trial at Basingstoke Hospital.

However, Ms Cundy said, Mr Miller continued to recommend Hifu to his prostate patients “despite its relative infancy and lack of established data to its long-term efficacy compared to more standard treatments”.

She said it is the GMC’s case on the evidence of its two expert witnesses that Hifu was not appropriate for the eight patients as alternative standard treatment “offered them better or more certain prospects”.

She added that there was a “total absence” of any indication on the patient consent forms about the risks attached to the treatment.

Mr Miller is also alleged to have failed to provide adequate care to five other patients and additionally is said to have provided false evidence to a coroner.

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The tribunal heard Mr Miller was excluded by the NHS trust in late 2013 for an investigation into his treatment but phoned the wife of one patient, a bladder cancer sufferer, to say her husband “was the reason for his suspension and he would be used as a whip to beat him”.

When the man’s wife told Mr Miller the cancer had since spread to the prostate and two lymph nodes, the consultant is alleged to have told her “people can live with that”.

Ms Cundy said it was the GMC’s case this was an attempt to interfere with a trust investigation.

Mr Miller is also accused of falsely claiming at that patient’s inquest in October 2018 that he had sent or arranged a letter to be sent to him in May 2012.

Ms Cundy said a GMC assessment of Mr Miller’s capability at the end of 2017 concluded it was unacceptable in maintaining professional performance, assessment, clinical management and record keeping, while his working with colleagues was cause for concern.

In October 2019, senior coroner Penelope Schofield criticised Dr Miller and Sussex and Surrey NHS Trust at inquests into the deaths of 10 of his cancer patients who died of natural causes but she found three had been contributed to by neglect, and “missed opportunities” were noted in three others.

Dr Miller denies misconduct on various dates between 2004 and 2018.