Friday 9 December 2016

Dodgy doctors... our poor record in catching bogus practitioners

Ireland's poor record on detecting health fraud and catching bogus doctors comes as little surprise to Maurice Gueret

Published 08/08/2016 | 02:30

Console House in Francis Street.
Console House in Francis Street.
Dr Maurice Gueret

The story of how the founder of the Console suicide charity masqueraded as a doctor in a Dublin casualty department back in 1983 caught everyone's imagination this summer. Those of us who trained at the Royal City of Dublin Hospital on Baggot Street in the 1980s were familiar with the story, though few would have believed that the bogus medic would go on to claim millions of euro from the HSE for his services to mental health.

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The incident was a major embarrassment for a small hospital where just about everyone knew everyone. There were other candidates for the casualty job. Kelly was fortunate to be a local lad, and nobody rumbled his lack of a medical qualification before he started work. There was a lot going on at the time. The hospital celebrated its 150th anniversary the previous year only to find out that its long-term future was in doubt. A thrusting young Trinity Senator named Shane Ross had just been appointed to the board. 1983 saw both the retirement of the Matron after a decade in charge, and the appointment of the hospital's first ever full-time chaplain. With hindsight, the junior doctors at the time did recollect that their new casualty officer wasn't all that sociable. He tended to avoid the daily camaraderie at the doctors' residence. It was noticed that Kelly preferred the company of medical students to qualified personnel. The benefit of hindsight suggests he was trying to pick up some diagnostic tips and acumen from students, rather than imparting his own more limited clinical knowledge to them.

Ireland doesn't have a particularly proud record when it comes to detecting health fraud. In recent years we have seen cases of bogus surgeons performing home circumcisions, sometimes with lethal consequences. There was a gentleman in south Dublin who masqueraded as a family doctor for a number of years without question. He wrote prescriptions, referred patients for tests and admissions at the local hospital, and even invited a local TD to perform constituency political clinics at his surgery. He was reported to both medical authorities and the police, but it would appear that no case was ever taken against him. I don't believe anyone ever even bothered to check the care of his former 'patients'.

The mass misuse of money at Console isn't the first such scandal at an Irish charity, and it won't be the last. The bigger issue is that those who fund these organisations with millions of euro of your money need to be given a role in rationalising the whole sector. The best way to ensure good management in the voluntary sector is to insist that duplicate organisations become one. There are too many home-grown charities in our voluntary sector - foreign aid, homelessness and drugs are distinctly overpopulated fields that come to mind. But the number of 'mental health' charities really takes the biscuit. Huge amounts of money are siphoned off down the suicide-prevention sideline instead of properly funding and better organising the State mental-health services that already exist. GPs need access to a responsive psychiatric service for public as well as private patients. When I was training, there weren't enough psychiatrists to go around, but the ones we had tended to stay in their jobs for life. Access wasn't great, but continuity of care was excellent. Today the turnover of consultant psychiatrists is such that very often local GPs don't even know the name of the person they are supposed to refer to. Earlier this year I wrote to one mental-health service in Dublin and they were unable to provide me with a list of their psychiatrists available for referral. As a nation, we could spend a lot less on helplines, and more on real help when it's needed.

Theresa May's new regime across the water is determined to ensure that family doctors don't receive a penny more than the pound of flesh they are due. NHS England has hired an outsourcing company to review the patient lists of 8,000 GP surgeries across England. What they are looking for are 'ghost patients' who have not been getting sick often enough. Anyone who has not visited the doctor in the previous five years will be written to and delisted if they don't reply within six months. Some GPs are up in arms at what they call 'list-cleaning.' They claim that low-visiting groups such as older children and young men may miss out on future care. NHS England plan on saving more than £100 a year for each 'cleaned' patient. All the more to invest in outsourced management.

University Challenge is back on the box and all is well again. My hand shot up the other evening when Jeremy Paxman asked which country celebrates Respect for the Aged Day. I knew that one. It's Japan's public holiday that was originally called Old Folk's Day until the PC police got their hands on it. I was born in 1963, the year Japan started handing out silver sake cups to every citizen who reached 100. There were 153 recipients then. Last year, Japan counted almost 62,000 centenarians. Silver is on the up, and politicians are getting worried about the ever-increasing cost of the cups. They considered a proposal to make them out of a cheaper metal, or even wood. Another bright spark said that they could be replaced by a congratulatory letter instead. In the end, they took a leaf from chocolate manufacturers and decided to reduce the size of the cup. A Respect for Politicians Day could be some time off.

Dr Maurice Gueret is editor of the 'Irish Medical Directory'

drmauricegueret.com

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