Joel Le Scouarnec, 74, is already in jail after a court in 2020 found him guilty of abusing four children, including two of his nieces.
In a separate four-month trial to start on February 24, he faces allegations that he also assaulted or raped 299 patients, most while they were under general anesthetic at a dozen hospitals between 1989 and 2014.
In total, 256 of the 299 victims were under 15, with the youngest aged one and the oldest aged 70.
The surgeon was never investigated during his career despite a 2005 sentence for owning sexually abusive images of children.
Investigators only uncovered his alleged crimes after he retired in 2017, when a six-year-old girl accused him of rape and police found countless accounts of abuse in his diaries.
Victims and child rights advocates say the case highlights systemic failures that allowed Le Scouarnec to repeatedly commit sexual crimes.
"How many people knew he was a pedophile and let him practice medicine in contact with children?" one of the victims told AFP, on condition of anonymity.
"They knew and they did nothing."
- 'Asked him to resign' -
Le Scouarnec was practicing in the western town of Lorient in 2004 when the FBI alerted French authorities that he was among hundreds in France who had been consulting sex abuse images of children online.
A court in nearby Vannes the following year handed him a suspended four-month jail sentence.
But by that time the doctor had already moved on to work in Quimperle, another town in the same region of Brittany.
The Quimperle hospital was struggling to recruit new staff and its maternity ward and surgery department were threatened with closure, the town's current mayor Michael Quernez said.
"The arrival of the new surgeon must have been a relief," he said.
Le Scouarnec did not tell managers about his conviction but a fellow practitioner, psychiatrist Thierry Bonvalot, heard about it from another colleague.
Bonvalot told AFP the colleague "made it sound like it wasn't anything".
"He said he was an alcoholic who was lonely, whose wife no longer wanted him, and didn't provide any proof of the conviction," Bonvalot said.
"But then very quickly other things started to draw my attention."
First, Le Scouarnec defended a radiologist at the hospital who had been accused of raping female patients, Bonvalot said.
The man, Mohamed Frehat, would later be sentenced to 18 years in jail for raping and assaulting 32 female patients, including eight minors.
On another occasion, Bonvalot, who also served as head of the hospital board, needed to ask Le Scouarnec about an operation he had performed on a young boy.
"He summed up the operation with so many sexual metaphors that I was shocked. He confessed he had been sentenced for child pornography," the psychiatrist said.
"I realized he was dangerous and asked him to resign. He refused."
- Doctors vote -
On June 14, 2006, in a letter seen by AFP, Bonvalot wrote to the hospital director questioning his colleague's ability "to remain completely calm when treating young children" in view of his "legal past".
On July 19, he sent a copy of the letter to the Order of Physicians of the Finistere department of Brittany. AFP saw the stamp indicating the body had received and read it.
Bonvalot told AFP he also approached the town mayor of the time, Daniel Le Bras, who was also an anesthetist at the same hospital.
"Le Bras told me, 'I'll take personal care of this,'" Bonvalot said.
Le Bras did not respond to an AFP request for comment.
Despite Bonvalot's efforts, on August 1 that same year, Le Scouarnec became head of surgery at the hospital.
As is routine in such promotions, hospital management requested a copy of his criminal record and received a response stating it was blank, according to documents from local and regional health agencies.
After receiving the July letter, the Order of Physicians asked the Vannes court for a copy of the 2005 court ruling against Le Scouarnec for owning abusive images.
The court only sent it over on November 9, after repeated reminders, according to an email chain seen by AFP.
The Order of Physicians then alerted the Finistere Health and Social Directorate, a local state authority.
The directorate received a letter from the hospital's director on November 23 defending its chief surgeon as a "serious and competent" doctor with "excellent relations both with patients and their families, as well as with staff".
His arrival "has enabled us to stabilize our surgery activities in a satisfactory manner", wrote the director, who has since died.
At a meeting at the Finistere Order of Physicians on December 14, 18 out of 19 doctors decided not to sanction Le Scouarnec.
They decided to let the local health authority deal with the matter instead.
- Patient's death -
At the same time, Yvon Guillerm, head of Brittany's regional hospital agency ARH, started investigating the hospital after an unspecified "complaint to the prosecutor's office", according to a letter dated March 13, 2007 that he sent to Bernard Cheneviere, a high-ranking health ministry official.
Guillerm would tell investigators 10 years later that a female patient had died on Le Scouarnec's operating table and that the death, combined with the doctor's past conviction, was "concerning", according to a judicial document.
On March 14, 2007, Guillerm followed up by sending a report to Cheneviere that stressed it believed Le Scouarnec to be morally unfit to practice.
It suggested the health minister should intervene directly and file a complaint with the National Order of Physicians.
But 12 days later, the health minister was replaced in a cabinet reshuffle and no complaint ever seems to have been made to the medical body.
- 'Collective failure' -
It is unclear what the ARH investigation found, but it led to the closure of the obstetric and surgery wards in Quimperle in June 2007.
A decade later, allegations would emerge that Le Scouarnec raped or sexually assaulted more than 30 children at that hospital, including four in the single month of May before the closure.
The surgeon left Quimperle, briefly working in another town in Brittany called Pontivy.
But then someone called the hospital to inform it about Le Scouarnec's past and its director fired him, according to investigators.
In June 2008, Le Scouarnec moved to southwestern France and began work at a hospital in the town of Jonzac. He told the director he was being investigated, but she disregarded this.
He would work there for almost a decade until his retirement in 2017.
Frederic Benoist, a lawyer for French advocacy group La Voix de l'Enfant (The Child's Voice), said the fact Le Scouarnec was never barred from practicing was the result of "collective failure".
The charity has filed a legal complaint over these failings "putting others in danger", he said.
The prosecutor's office in Lorient has said a preliminary investigation has begun.
© Agence France-Presse
