Inquests have been opened into the deaths of four women treated by rogue breast surgeon Ian Paterson, who was jailed in 2017 for wounding patients.

Senior coroner Louise Hunt said preliminary investigations gave her reason to believe the deaths “may have been caused or contributed to by acts or omissions in the treatment provided by Mr Paterson, and potentially by other clinicians involved in the care”.

The Scottish surgeon was employed by Heart of England NHS Foundation Trust (HEFT) but had practising privileges in the independent sector at Spire Parkway and Spire Little Aston in Birmingham.

In 2017, he was jailed after being found guilty of 17 counts of wounding patients with intent, against 10 victims.

Paterson was found to have carried out unnecessary operations in NHS and private hospitals, exaggerating or inventing cancer risks and claiming payments for more expensive procedures.

He was handed a 15-year prison term, but Court of Appeal judges later increased his tariff to 20 years.

In September 2017, more than 750 patients treated by Paterson received compensation payouts from a £37 million fund.

The independent Paterson Inquiry into the issues raised, published in February, found many of Glasgow-born Paterson’s patients were “lied to, deceived or exploited”, though the consultant maintains his innocence.

The inquiry, chaired by retired Bishop of Norwich the Rt Rev Graham James, said the surgeon was able to go on performing unnecessary operations for years amid a “dysfunctional” healthcare system that failed patients.

He added there were “missed opportunities” to stop Paterson, describing the failure to suspend him in 2003, when an NHS colleague first raised concerns, as “inexplicable”.

The inquiry was presented with NHS figures showing that of Paterson’s 1,206 mastectomy patients, 675 had died by 2017.

The senior coroner for Birmingham and Solihull Ms Hunt and her colleague Emma Brown, area coroner, formally opened the inquests in a hearing at Birmingham Coroner’s Court which took place remotely.

However, Ms Hunt said it was “likely” further inquests would be opened into the deaths of other former patients of Paterson.

The coroner is still investigating those cases, after being asked by West Midlands Police in January to examine a sample of 23 deaths of former Paterson patients.

Inquests were opened on Monday into the deaths of Deborah Hynes, 51, of Beacon Road, Sutton Coldfield, West Midlands, as well as Marie Pinfield, 50, Yvonne Cordon, 39, and Shionagh Gough, 76.

Mrs Hynes died at the Priory Hospital in Birmingham in October 2013, and cause of death at the time was given as metastatic breast cancer.

Opening the inquest, Ms Hunt apologised to Mrs Hynes’s husband, John Hynes – who dialled in to the hearing – for any additional distress caused, adding the process was likely to take “many months”.

The court heard Mrs Cordon, a cleaner, originally born in Co Antrim, Northern Ireland, but latterly from Birmingham, died at a hospice in November 2000.

Mrs Gough, a former purser, who was born in Scotland but lived in Hampton-in-Arden, near Solihull, died at a nursing home in June 2006.

Ms Pinfield, of Warwick Road, Olton, Solihull, was a police officer, who died in October 2008.

Ms Hunt said the inquests’ scope was yet to be determined but would “likely” be an Article 2 hearing which looks at the broader context surrounding each death.

The coroner indicated the hearings were also likely to look at “care provided by Mr Paterson and other clinicians”, his supervision by managers and employers, and whether there were “systemic failings” by his bosses “responding to concerns about Mr Paterson”.

The inquests could also look at “any inaction or failure” by healthcare and professional body regulators, “any failings in the culture of the hospital where Mr Paterson worked”, and in patient recalls.

Ms Hunt said: “I am sure that list will change over time and will probably become much longer.”

The coroner said investigations into whether other inquests were needed would be continuing, some of which may need permission from the chief coroner if the deceased had been cremated.

She added a pre-inquest review hearing would be fixed in due course once the total number was known, because of the likelihood of issues “common to all cases”.