THE president of the High Court has expressed concern at how a doctor with "such sub-standard medical knowledge" - including mistaking an ankle for an elbow in an x-ray - could have been employed in three different hospitals.
Mr Justice Peter Kelly made the remark when he rejected an appeal by Dr Omar Hassan Khalafalla Mohamed (30) against his striking off the medical register for professional misconduct and poor professional performance.
The judge said he could not understand how he found himself on the medical register in the first place, apart from the fact that he obtained appointments in three different hospitals.
The judge acknowledged the Irish Medical Council (IMC), which had recommended the erasure of Dr Hassan's name from the register, had also expressed similar concern in its report.
The IMC made the recommendation after a Fitness to Practice Committee found him guilty on multiple grounds related to his conduct and performance earlier this year.
After the judge confirmed his striking off, Dr Hassan, who qualified in Sudan, said "for me it is meaningless".
When the judge ordered he pay the costs of the legal action, Dr Hassan said he did "not believe in the integrity of the procedure."
He also said he did not believe it was a fair decision.
In his appeal to the court, Dr Hassan argued, among other things, he should not be struck off because the evidence against him did not meet the required standard.
He also said the complaints against him should never have been referred to the Fitness to Practice Committee because they were not of a serious and grave nature.
Mr Justice Kelly said the Committee had made its findings after hearing 30 witnesses over 11 days. It had met the criminal standard of proof - beyond a reasonable doubt - in making its findings, he said.
It would be difficult to consider the complaints against him were anything other than of a grave nature, he said.
Among those incidents, which happened in the Midland Regional Hospital Portlaoise, Mayo General, and Galway University Hospital between 2012 to 2014, was while performing a gall bladder related procedure he stood on the pedal of an electrosurgical machine, which was not in use, and caused a burn injury to a patient.
On another, he attempted to insert a needle into a patient's arm on a number of occasions, causing her pain, even though the procedure was not necessary.
While senior house officer in Mayo General, on one occasion, he failed to provide assistance to an intern who was dealing with a patient experiencing an upper gastrointestinal haemorrhage
In an incident in the Galway hospital, he failed to attend in a timely manner, or at all, to review a patient, who had presented in significant pain with an ankle fracture.
Around February 17, 2014, during a trauma meeting/teaching session in Galway, he misidentified an x-ray image of an ankle as being one of an elbow.
He was also found by colleagues to act in a bizarre way and to be aggressive and confrontational both to colleagues and patients.
The court previously heard Dr Hassan had complained about his treatment at the public inquiry and threatened in correspondence it "will be fully paid for at an extremely bloody price for the people involved worldwide".
He also wrote there would be "a grave response from me an my family side to these events outside court and not necessarily in Ireland".
Mr Justice Kelly, on that occasion, said he was glad to know the IMC had informed gardai of the threats.