Medical Council to introduce new training for foreign doctors

THE Medical Council intends to introduce cultural and clinical training for foreign doctors in a response to the large number of non-Irish medics appearing before its disciplinary bodies.

The council, which regulates the more than 18,000 doctors at all levels of the profession practising in Ireland, has indicated that tackling the issue will be one of its priorities for 2014.

In 2012 foreign doctors made up 60% of those brought before the council’s fitness-to-practise inquiry, leading to concerns about the training and qualifications of non-Irish doctors in the system.

Medical Council CEO Caroline Spillane expects foreign doctors to account for a similar number of those appearing before disciplinary inquiries once the statistics for 2013 are complied. But she cautions against drawing simple conclusions from the figures.

“All we have is data, we don’t have information underneath that and that’s why we need to do more research,” she said.

In the coming months the council will be commissioning a qualitative analysis of cases to look into why certain groups of doctors have a higher number of complaints made against them.

But Ms Spillane does agree that even the raw data shows that a certain type of doctor is more likely to end up before the fitness-to-practise committee.

“Doctors who are male, doctors who have qualified outside of Ireland, and doctors who are on the general division of the register are probably more likely to go on to a fitness-to-practise inquiry.”

Currently medics who move to Ireland from another EU-EEA country have automatic recognition of their qualifications. Other doctors may have to complete a pre-registration exam, depending on their country of origin. All doctors have to go through a Medical Council level one assessment where their previous work experience, their training and education and their record with a foreign regulatory authority is examined.

But despite these safeguards, doctors with poor skills and discipline are still turning up in hospitals around the country and eventually finding themselves the subject of disciplinary measures.

Ms Spillane believes some of the responsibility for this lies with the HSE and individual hospitals.

“The piece that we have no jurisdiction over is the identification of doctors for roles in the healthcare system. That’s the employer’s role and it is up to the employer to assess a candidate’s suitability for the role. We can assist the HSE in the development of a comprehensive induction and orientation process that could be helpful to doctors, particularly who are coming in from outside of the country, newly into a health system. That’s probably one of the areas which I think should be a focus for us in 2014.”

Overall the Medical Council is satisfied with the progress of its fitness-to-practise inquiries since they started being held in public in Mar 2009. In 2012, the most recent year for which statistics are available, 470 doctors had complaints made against them by a patient or a fellow professional. These complaints are first investigated in private by a preliminary proceedings committee and if it decides there is a case to answer, the matter is referred on to the fitness-to-practise inquiry.

Last year this happened in 57 cases.

At this stage the identity of the doctor becomes publicly known. The case against the doctor is prosecuted by a solicitor representing the CEO of the Medical Council, while most doctors will hire a solicitor or barrister to defend them, although this is not always the case.

Although the decisions reached by the fitness-to-practise committee on allegations against a doctor are made public immediately, their recommendation as to punishment must first be sent on to the board of the Medical Council for approval and this can be appealed by the doctor. The board’s decision on sanction, in turn, has to be confirmed by the High Court at a later date.

In general, there has been a marked increase in the number of complaints made against doctors in recent years but Ms Spillane does not agree that the reporting of proceedings in public has led to this rise.

Instead she believes that patients now have higher expectations of the care they should receive from their doctor. There has also been a rebalancing of the doctor-patient relationship, where they now work more collaboratively and patients are provided with information so that they can make the best decision for themselves.

“Also we are generally seeing in society as a whole that people are more likely to raise concerns if there’s a shortfall,” she says.

“It’s traumatic for doctors to have to go through that process and of course very traumatic for patients, especially those who are witnesses, to go through that process.”

SAMPLE CASES

- Dr Colm Quigley, a consultant in general medicine and a former president of the Irish Hospital Consultants’ Association, had five allegations of poor professional performance proven against him before a fitness-to-practise inquiry in April.

They related to his handling of a patient, referred to him with what his GP feared was a “serious underlying condition”.

Despite two appointments with the man over a 15-month period, and a series of enquiries from the man and his wife, Dr Quigley failed to ensure a series of medical tests were carried out.

The man, identified only as Patient X, went on to die from lung cancer.

However, it was not alleged that any error on Dr Quigley’s part caused the deterioration in the patient’s health or his death.

Among the allegations proven against Dr Quigley was that he failed to recognise in Nov 2010 that tests he had planned in Aug 2009 had not been carried out.

The committee also found that Dr Quigley had failed to ensure that he had an adequate system in place for tracking patient tests.

He was also found guilty of poor professional performance for failing to respond to three letters from Patient X’s widow.

- Dr Patrick Rafferty, of Mount Carmel private hospital, Dublin 14, was found guilty of five separate allegations of professional misconduct in relation to his treatment of two women.

One of the women had to be rushed to hospital for emergency surgery to remove her fallopian tube.

She made her complaint “so the same thing never happens to another woman”.

The other patient told of how she permanently lost the use of one of her kidneys following a hysterectomy carried out by Dr Rafferty.

Dr Rafferty had denied all but one of the allegations against him but in delivering its ruling, the fitness-to-practise committee stated that it found Dr Rafferty’s evidence to be “inconsistent and lacking in credibility in significant respects”.

It also raised concerns about surgeries carried out by Dr Rafferty at Mount Carmel without the aid of another surgeon or a surgical nurse.

During the three-day hearing, Michelle Howe told of how less than 24 hours after she was assured by Dr Rafferty that her pregnancy was “non-continuing” but not ectopic, her husband had to rush her to hospital where she underwent an emergency salpingectomy to remove a section of her fallopian tube.

Ms Howe told the inquiry that the following day, Dr Rafferty “came in and sat down” and said, ‘so it was an ectopic pregnancy’.”

According to Ms Howe, he then told her that “the outcome would have been the same”.

“I told him I wouldn’t have had to have emergency surgery and a blood transfusion. I accepted that I had to have the tube removed but my life had been put at risk and a lot of stuff was avoidable,” she told the hearing.

The inquiry committee found that one allegation in relation to Dr Rafferty’s other patient, Ms Cathy Coyle, was proven as fact and constituted professional misconduct.

This was that he failed to refer her to a urologist following tests which showed her kidney was not functioning properly.

- Dr Derek Graham was found guilty of professional misconduct in April after admitting to incorrectly vaccinating dozens of young children and babies between 2008 and 2011.

His practices sparked a HSE investigation that led to it re-immunising more than 335 children who had been his patients over almost two decades.

Dr Graham, who worked in Newcastle, Co Dublin, admitted to a series of allegations against him in relation to the mis-vaccination of approximately 50 children between 2008 and 2011.

He was found guilty of professional misconduct in respect to one of these allegations, that he mixed vaccines that were meant to be administered in separate injections.

The GP was also found guilty of the lesser charge of poor professional performance in connection with three allegations.

These were that he inaccurately recorded injections as being given in different limbs to the limbs they were actually administered to; that he used the PCV7 instead of the more up-to-date PCV13 injection on babies born after Oct 2010 when he knew or ought to have known this was inappropriate; and that he failed to maintain accurate patient records.

The medicines in the case include the six-in-one vaccine, which immunises against diphtheria, tetanus, whooping cough, hib, polio and hepatitis B; the MMR against measles, mumps and rubella; and the PCV (pneumococcal conjugate) vaccine.

- Adam Jacobus Smith was found guilty of more than 50 counts of professional misconduct and/or poor professional performance in May.

The Waterford-based consultant dermatologist prescribed a drug with a known risk of stunting growth to an 11-year-old boy and gave the drug Stellara to a patient, in a period before it had been licensed for use in Ireland.

Dr Smith faced more than 100 allegations relating to 12 separate patients who were under his care in the Whitfield Clinic, Waterford, Aut Even Hospital, Kilkenny, and Barringtons Hospital in Limerick.

The case, which ran over 31 days of hearings since Apr 2012 was one of the longest in recent times.

- Dr Iman Ekky was found guilty of poor professional performance in November after misdiagnosing a woman with herpes, despite the woman’s protests that she was in a loving and monogamous relationship.

Following the hearing, the woman and her husband said they hoped no other couple would ever have to go through the stress, devastation, and utter embarrassment they suffered.

In total, Dr Ekky, who worked at the Drumcondra Clinic in Dublin, had eight allegations of poor professional performance proven against her.

These included that she diagnosed Patient A with herpes in circumstances where there was no evidence for the diagnosis and that she failed to take into account that Patient A was in a monogamous relationship.

During the inquiry, the 36-year-old woman, said she felt “stupid” and that she was being told that if she was not “playing-away” then her husband was.

The couple — who met when they were teenagers and had been married for 12 of their 18 years together — spoke after the inquiry of the stress and anxiety Dr Ekky’s misdiagnosis caused them. Patient A’s husband said another couple might not have withstood the pressure of the original diagnosis.

“We hope and pray that nobody has to go through this stress, devastation, and utter embarrassment as well, in many respects for my wife and family, in regards to such a treatment and such a diagnosis,” he said.

- Dr Lech Kielpinskie was found guilty of professional misconduct in November for failing to give a woman’s solicitors access to her medical records.

He was forced to amputate the woman’s toe because he allegedly forgot to remove a tourniquet months earlier.

The woman, who was identified only as Patient A, visited Dr Kielpinskie in Feb 2012 following an accident at home where a heavy cast iron cooker fell on the large toe of her left foot.

Ciaran Quinn, a solicitor who was working with McHale Muldoon solicitors at the time, told the inquiry that the woman completed a clinical negligence questionnaire outlining how Dr Kielpinskie carried out treatment on her toe under anaesthetic but afterwards failed to remove a tourniquet, which prevents blood flow, from the toe.

Mr Quinn said that when Dr Kielpinskie realised what had happened, he put the woman on various medications but on Apr 17, 2012, her toe had to be amputated.

Following this, the woman gave instructions to McHale Muldoon solicitors to sue Dr Kielpinskie but because the firm has been unable to get the woman’s medical records, it could not proceed.

The inquiry heard evidence from a number of Medical Council employees that it believed Dr Kielpinskie was living in Poland.

Despite this, efforts to contact him had been unsuccessful.

-Dr Bolarinwa Oluwole was found guilty of professional misconduct for lying about his past when applying to work in Ireland.

Dr Bolarinwa Oluwole had intercourse with two women who came to him for psychiatric help and made sexual advances to a third while working in the Canadian province of Nova Scotia.

He also kept a stash of prescription medication, pornography, and condoms in his office desk.

Dr Oluwole was struck off the Nova Scotian register in 2012 but just months later turned up looking for work in Ireland.

However, he lasted just one day as a locum psychiatrist in the Cavan-Monaghan area before a tip-off lead to his past being uncovered.

During the hearing, the whereabouts of the Nigerian-born doctor were not known, and he did not turn up for the inquiry that found him guilty of three allegations of professional misconduct.

- Dr Vincent Osunkwo was found guilty of professional misconduct and poor professional performance in Dec 2013 for trying to read an X-ray upside down and using a scalpel in an attempt to insert a tube into a patient.

During a three-day inquiry into his practices, Dr Vincent Osunkwo was described as “a threat to patient safety” and “lacking in basic medical knowledge that could be expected of a medical student”.

He worked in the Midland Regional Hospital, Portlaoise, between Mar 9 and Apr 12, 2009, and had previously worked in Crumlin Children’s Hospital.

He was employed as a senior house officer in Portlaoise after emerging as the sole applicant for the job.

The inquiry heard from a nurse who worked with Dr Osunkwo of how she had to snatch a scalpel from his hand moments before he was about to cut into an elderly patient’s vein in order to take a blood sample.

The nurse told how she cried “Jesus, what are you doing?” to Dr Osunkwo. She said that she honestly did not believe he was a proper doctor,

Another nurse said she saw Dr Osunkwo trying to insert a canula into a young man with a total of six puncture wounds in his arms.

“I noticed there was blood running down the patient’s arm. I pulled the curtains and asked the doctor what he was doing,” she said.

The nurse said the patient was “quite alarmed” and looked relieved when she came in.

Among the allegations found to have been proven against Dr Osunkwo were that he told members of his medical team that a patient was “fine” when that patient was in fact receiving oxygen in intensive care, that he told a consultant that a scan performed on a patient’s kidney was “fine” when it in fact showed multiple abnormal masses, and that he asked a nurse if a patients pulse rate of 165 beats per minute was high.

Dr Osunkwo is understood to have returned to Nigeria and did not attend the inquiry in to his practices.

He applied for an Irish visa in May 2013 but was refused entry. His subsequent appeal was also refused.