The jailed former breast surgeon Ian Paterson has refused to give evidence at an inquest into the deaths of 62 of his former patients, in a move labelled “unacceptable” and “atrocious” by families of the deceased. Paterson had been due to speak at the judge-led inquest at Birmingham and Solihull coroner’s court, which is investigating whether 62 of Paterson’s former patients “died an unnatural death as a result of his actions”. It is thought to be one of the largest inquests in British history, with the possibility of more cases being added in the coming months. Paterson, 66, was served a notice in September requiring him to give evidence on Thursday via video link from prison, where he is serving a 20-year sentence for 17 counts of wounding, but lawyers representing him said he had declined to attend. In an application made at 11pm on Wednesday, they cited health reasons, which were not detailed in open court, as well as a “lack of legal representation” and “inadequate facilities to prepare” as the reasons why Paterson could not engage in the inquest process. Judge Foster, leading the inquest, said it would “be greatly enhanced and improved if Paterson participated” and it was the first opportunity, apart from his criminal trial, for him to answer questions about his practice under oath. He would use his “powers to fullest extent to ensure Paterson’s attendance”, he said. Families of the deceased lobbied the judge not to delay the inquest proceedings because of Paterson’s refusal to participate. Stephen Baker, whose wife, Christine, died in 2015, said: “We’ve been put through hell by this individual, and now they’re extending this hell with the constant delays Ian Paterson is creating. I think it’s unacceptable to put [the families of the deceased] through the increased stress of an inquest delay.” Shirley Moroney, whose sister, Marie Pinfield, died in 2008 after being operated on by Paterson, said: “His participation, or lack of it, is just unacceptable. “It’s like water torture, like a dripping tap in your brain, with all these delays. Now, at the 11th hour, he’s putting in another obstacle. It’s atrocious. He’s had plenty of opportunity to prepare. It feels like, why are we even considering these requests?” Earlier this week, Foster dismissed Paterson’s application to be granted legal aid funding, along with his request for the inquest to be adjourned to allow more time for him to read documents. Paterson does now have legal representation, the court heard, but had “no practicable means” to communicate with lawyers from prison, and claimed he had not had complete access to inquest documents since November 2023. They said Paterson “wants to participate in these inquests” and his impending move to an open prison, a move strongly criticised by his victims, might allow him to be able to do so. His legal team have until 16 October to provide further evidence on why Paterson is unable to give evidence. The inquest is not a criminal investigation, but Paterson’s lawyers said any conclusion of unlawful killing could lead to further criminal proceedings being brought against him. Paterson was convicted in 2017 after being found guilty of giving damaging and unnecessary operations to patients. A report published in 2020 found he had subjected more than 1,000 patients to harmful surgery. He was found to have invented or exaggerated the risk of breast cancer to carry out unneeded operations, and in some cases carried out the wrong procedures. Foster said hearings on generic issues would continue as planned, but the first individual patient inquest to be heard in court would now be on 21 October, instead of next week, to give Paterson’s legal team more time to prepare.