The fact that doctors about whom serious concerns have been raised can move to different hospitals and clinics and continue to treat patients in Ireland is a breach of patient trust, argues Liz Farsaci
SERIOUS complaints about doctors, those who have promised to “do no harm”, are concerning for everyone involved — the patients, the doctors, colleagues, and the medical profession in general, as well as friends and family members.
Apart from the harm that may have been caused, or the severe lack of knowledge that could lead to harm, there is always the issue of broken trust.
We trust doctors with our lives; we trust them with our health; we trust them to be knowledgeable in their field, because we need to make choices about our healthcare based on the information they give us.
The Medical Council of Ireland, which is based in Dublin 2, between Stephen’s Green and Merrion Square, takes all complaints against doctors very seriously.
Once a complaint is made to the regulator, a committee — known as the Preliminary Proceedings Committee (PPC) — investigates it further. If they believe the complaint to be serious enough, they then refer the case to the Fitness to Practise Committee, which holds an inquiry.
“The PPC, in conducting any investigation, is bound by fair procedures and the principles of natural justice, and must fairly evaluate and gather relevant information in relation to any matter being considered,” said a spokeswoman for the Medical Council.
“Equally, the CEO, in presenting allegations of poor professional performance or professional misconduct at a fitness to practise inquiry, must adduce evidence in support of any such allegations, usually to the criminal standard of proof.
“This is important, as the criminal standard of proof is a higher standard of proof than that in a civil case, and therefore requires that any complaint must be investigated in a robust manner,” the spokeswoman added.
Thus, while not all allegations made against doctors are proven at these inquiries, the complaints have been deemed serious enough to warrant the disciplinary hearings that are the fitness to practise inquiries.
If the allegations are proven, and doctors are found guilty of professional misconduct or of poor professional performance, sanctions will be imposed on them. These can include paying a fine, providing a written apology, or being struck off the register.
All these factors mean it is very worrying when a complaint is made against a doctor and they come before an inquiry — and it is even more worrying when doctors continue to treat patients even after red flags are raised about their professional practice.
Perhaps more worrying still is when a doctor is able to move to another hospital or clinic, different to the one where the incident that gave rise to the complaint took place, even after initial concerns have been raised.
When this happens, serious questions about our health care system and the hiring policies within it are raised.
These issues were highlighted in January this year, when Dr Omar Hassan — who became known to many as ‘the ankle and elbow doctor’ — was the subject of a disciplinary hearing, which ran for over two weeks.
Dr Hassan, who was 30 at the time of the inquiry, worked as a junior doctor at the Midlands Regional Hospital in Portlaoise from July 2012 to January 2013; Mayo General Hospital in December 2013; and at University Hospital Galway in January and February 2014. In all three positions, Dr Hassan was placed off-call shortly after he began took up the posts.
Colleagues at the Portlaoise hospital raised concerns about Dr Hassan after he had worked two night shifts — on July 20 and 23 — covering the emergency department. On foot of those concerns, a decision was made to take him off the night shifts in which he covered the emergency department.
In October, the hospital decided to relieve Dr Hassan of all his clinical duties.
In January this year, Eadaoin Cooke, who works in the HR department in Portlaoise, told the inquiry that a number of colleagues raised concerns regarding Dr Hassan shortly after he took up his post.
“In this case, the issues arose out of clinical shortfalls with Dr Hassan in performance of his duties,” Ms Cooke said. “It seemed to be initially clinical but as time went on there seemed to be some personal misunderstandings as well.”
Several nurses from the hospital told the inquiry that Dr Hassan had acted aggressively towards them, and displayed bizarre behaviour.
Dr Hassan then moved on to Mayo General Hospital, where he was hired for a six- week period from November 2013 until January 2014.
However, Dr Hassan was removed from his on-call duties at the start of December after concerns were raised regarding his lack of assistance in the resuscitation of an elderly patient.
In Galway, Dr Hassan was employed as an orthopaedic senior house officer from January 13, 2014, for six months. However, he was placed on administrative leave on February 21, 2014, following colleagues’ concerns over patient safety.
After Dr Hassan’s first night on call, two colleagues were so concerned about his apparent lack of clinical abilities that they checked on the Irish medical register to confirm whether he was actually a registered doctor.
Consultant orthopaedic and trauma surgeon John McCabe, Dr Hassan’s senior colleague at Galway, told the inquiry in January that he “would have absolute, serious concerns” about Dr Hassan working in another hospital.
“I would never knowingly have Dr Hassan ever work alongside me,” he said.
Also during the inquiry, consultant orthopaedic surgeon Aiden Devitt, who also works at Galway, said to Dr Hassan during cross-examination: “I don’t think you know what it means to be a doctor. If you pulled someone off the street they would make a better fist of it than you did.”
Orthopaedic consultant Mutaz Jadaan told Dr Hassan at the inquiry the following day: “I’ve never, ever had a concern about a doctor in the way I had concerns about you.”
Perhaps the most memorable day of the 11-day hearing was when Dr Hassan’s former colleague at Galway, consultant Odhran Murray, told the inquiry of an instance in which Dr Hassan mistook an x-ray of an ankle for an image of an elbow during a training session with colleagues.
Doctors were discussing cases, Mr Murray said, and an image of an ankle was put up. Dr Hassan said it was an image of an elbow and proceeded to tell everyone about the ‘elbow’ fracture.
“There was an audible gasp in the room,” Mr Murray told the inquiry.
In 2014, GUH made a complaint about Dr Hassan to the Medical Council.
Following this, his medical registration was suspended by the High Court, following an application by the Medical Council in March 2015. This meant he was not able to practice medicine, pending the outcome of the inquiry.
On January 26, Dr Hassan was found guilty of professional misconduct and poor professional performance, on multiple grounds.
The Medical Council then decided to request that his registration remain suspended. Dr Hassan is currently appealing this, and is due to appear before the High Court again in October.
Dr Hassan has strongly rejected the findings of the fitness to practise committee, and subsequently wrote to the Medical Council: “What have taken place will be fully paid for at an extremely bloody price for the people involved worldwide.
“As it seems that following regulations and putting forward reasonable explanations did not work and do not work, so me and my family will take things into our own hands in the future, as our local culture of fair revenge may extend down generations.”
On foot of the findings in relation to Dr Hassan in January, then-health minister Leo Varadkar called on the HSE to review its recruitment procedures.
The review identified a number of systemic issues, including a lack of centralised recruitment processes for doctors in service posts; an absence of single HR systems across HSE hospitals; and a lack of measures in place to assess a doctor’s competency to practise medicine, prior to the decision of the Medical Council to grant the doctor registration here in Ireland.
The HSE is rolling out a new policy in order to address these concerns and in a bid to prevent similar situations arising again.
Although few cases are as dramatic as that of Dr Hassan, a number of other hearings held within the past year have involved doctors who have continued to work after concerns were raised about them, to the Medical Council or within their employment setting. Some of these doctors have worked within the private sector.
A lengthy inquiry into consultant gynaecologist Dr Peter Van Geene took place between July and October 2015, although it concerned patients he had treated while working at Aut Even hospital in Kilkenny between 2009 and 2011.
The inquiry examined the care he provided to four women — Patients A, B, and C, as well as patient Helen Cruise, who was the only person in this case to waive her right to anonymity.
Dr Van Geene was found guilty of poor professional performance on only two out of the 15 counts he faced.
The two allegations that were found to amount to poor professional performance were in relation to Ms Cruise. These related to the manner in which consent was obtained from Ms Cruise for her operation, and the way in which Dr Van Geene communicated with her during a post-operative conversation — specifically, the allegations that Dr Van Geene failed to adequately explain the procedures due to be carried out, as well as the risks involved, amounting to poor professional performance.
The committee also found that Dr Van Geene communicated with Ms Cruise in an incorrect or inappropriate manner during a post-operative conversation with her at St Luke’s Hospital, where she was transferred.
During the inquiry, Ms Cruise said Dr Van Geene told her, after he had performed a hysterectomy on her, that he had thrown her womb into a bucket on the floor. Dr Van Geene has always denied he said this.
At the conclusion of the inquiry, Ms Cruise was too upset to make a statement, and her daughter, Aneke Cruise, burst into tears and ran out of the inquiry room.
Dr Van Geene continued to practice after the events at Aut Even hospital took place, working at the Whitfield Clinic in Waterford for a period of time.
A statement from the clinic confirmed: “Mr Van Geene worked at Whitfield Clinic on part-time basis, as his main clinical practice was based in counties Kilkenny and Kildare.
“He ceased his clinical practice at Whitfield Clinic in October 2013.”
Although the inquiry into Dr Van Geene concluded a year ago, sanctions have yet to be imposed on him.
In an unprecedented move, Medical Protection Society has pulled its medical insurance cover for Dr Van Geene, as well as for Aut Even hospital, the High Court heard last month.
At the time, Dr Van Geene’s legal representatives, from Matheson solicitors, announced they were applying to “come off record”, which means they would no longer represent the consultant.
This application is due to be heard in October, when it is understood that five civil actions against Dr Van Geene will also come before the court.
In June this year, an inquiry began into Dr Emmanuel Gbadebo Alabi, who is based in Cork. The inquiry concerned his time at Mayo General Hospital in Castlebar, where he worked as a senior house officer from January to February 2009. This was his first clinical position in Ireland.
Dr Alabi went on to work in Our Lady of Lourdes Hospital in Drogheda in July 2010, and Letterkenny Hospital in Donegal in August-September 2010.
It was alleged that Dr Alabi failed to bring an x-ray report to the attention of his superiors at Mayo General Hospital in 2009, in the case of a patient who later died of cancer.
Last month, Dr Alabi was cleared of the allegations in relation to this case.
However, this was not the only complaint made about Dr Alabi, nor the first time he had been before a fitness to practise inquiry at the Medical Council.
In August 2012, Dr Alabi was found guilty of professional misconduct at a Medical Council inquiry in relation to his time at Letterkenny Hospital.
In August 2010, Dr Alabi was offered a one-month contract at Letterkenny, which was later extended.
He was dismissed at the end of September, when it came to light that he was the subject of a Garda investigation in relation to a laptop.
In August 2008, he had convinced a staff member at Argos in Blackpool, Cork, to repay him €599 for the return of the laptop, which was not the one that had originally been purchased. In September 2010, he received a four-month suspended sentence at Cork District Cork in relation to the matter.
In 2011, Dr Alabi was found guilty of poor professional performance at yet another fitness to practise inquiry in relation to his time at Our Lady of Lourdes Hospital in Drogheda in July 2010. It was found that he failed to carry out basic duties, including scrubbing up in preparation for a caesarean section, inserting intravenous lines, and recording a patient’s history.
During this inquiry, a consultant obstetrician at Our Lady’s admitted she had not contacted Dr Alabi’s previous employer for a reference because the hospital was in such desperate need of junior doctors.
This issue has arisen numerous times during fitness to practice inquiries into junior doctors.
While many such doctors remain in Ireland, many others have moved on to work in other countries by the time they come before the fitness to practice committee. This means that even if they are found guilty of professional misconduct or poor professional performance, it is of little consequence to them.
Dr Saqib Ahmed worked as a junior registrar in oncology at University Hospital Limerick between July and November 2012.
He was not the subject of a fitness to practise inquiry until the summer of 2015, by which time he was had taken up a position in America.
In July 2015, Dr Ahmed was cleared of professional misconduct and poor professional performance, despite the fact that many of the allegations against him were found to be factually true.
Dr Ahmed faced a total of eight allegations of professional misconduct and/or poor professional performance.
While a number of the allegations were proven to be factually true, only a sub-section of one of the claims was proven to amount to poor professional performance. This was in relation to the allegation that Dr Ahmed failed to request basic medical tests for a patient whom he saw on November 6, 2012.
Perhaps the most memorable allegation faced by Dr Ahmed was that he used his thumbnail to mark a patient’s skin for surgery.
The Medical Council says that while patient safety is paramount, it has a duty as the regulatory body for the professional to ensure that any complaints are investigated properly and that all doctors receive fair and judicial treatment, and are presumed innocent.
“The role of the regulator is to act in the public interest, and they must ensure that procedures followed are fair and reasonable to all parties concerned,” a Medical Council spokeswoman said.
“Any regulator is afforded the power and remit to discipline or sanction a member, and so it must ensure it acts responsibly and fairly to all parties concerned in any investigation or inquiry.
“Investigations vary in scope and timing depending on the circumstances of each complaint.” Although Medical Council staff take measures to ensure the process is efficient, a number of factors contribute to delays in holding an inquiry, according to the spokeswoman. These include difficulties in accessing information, accessing expert opinions, and the fact that inquiries often last longer than expected because a number of doctors choose to legally represent themselves.
Additionally, the Medical Practitioners Act 2007 restricts the council’s ability to streamline processes and timelines, although it is in discussions with the Department of Health in the hope of adding amendments to the act which will address these issues.
This, however, might be of little comfort to the patients and doctors who wait years for traumatic, stressful events to come to some kind of resolution.
During his inquiry last autumn, Dr Dawar Siddiqi, who worked as a consultant radiologist at Bantry General Hospital in 2013, pleaded with the hearing’s committee to consider the effect the process had had on his own life.
“Does anyone know what I’m going through by not getting a job?” he asked. “Does anybody know how it affects the person?
“Who is going to think of the doctor? Look at the human side of the doctor.”
Perhaps patient and mother-of-seven Helen Cruise put things even more succinctly when she described the effect her surgery and experiences with Dr Van Geene had on her: “Mentally, I’m destroyed. My whole life has been turned upside down.”
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