Saturday 21 April 2018

Are we doing enough to vet our doctors?

Allegations that a medic raped a patient in a Kerry hospital have sent shock waves through the health industry. Are sufficient safety measures are in place?

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John Meagher

John Meagher

The shock has yet to subside among staff at the Bon Secours private hospital in Tralee, Co Kerry, but few want to put their heads above the parapet and say what they think. The news is still too raw and shrouded in conjecture.

It is alleged that a medic working at the MRI and CT diagnostic department raped a female patient in his care there. The overseas national, employed by a third party - an international company that handles diagnostic scans in several Irish hospitals - is said to have attacked the woman after she was changing back into her clothes following a procedure.

The incident happened on September 10, and was revealed in the Sunday World last weekend when it emerged that the man did not turn up to a follow-up meeting arranged with gardaí. It is believed that he fled the country. In earlier contact with police officers, the married father-of-one claimed that he and the patient had had consensual sex. It's a claim strongly denied by the woman, who's in her early 60s, and a file has been sent to the DPP.

Management at Bon Secours - which was named private hospital of the year in 2014 - have been tight-lipped this week with its PR consultant, John Drummey, insisting that "it has no comment to make at this time".

The news has sent shock waves through the Irish health system and, according to Stephen McMahon, director of the Irish Patients' Association, the allegations make for sobering reading for those who place their trust in the medical profession. "Obviously, a crime like the one alleged can be perpetrated from any walk of life," he says, "but it's particularly alarming when it's carried out by someone from within the medical profession. These are people that we trust with our health, and hospitals are environments where we need to be taken of care in, so for an alleged rape to happen in that environment is especially disturbing."

The third party, which is conducting an internal enquiry, says the worker in question passed two vetting checks in the past three years, but McMahon says an independent enquiry is essential. "I would call on (Health) Minister (Simon) Harris to open an enquiry into this case to alleviate public fear. As patients, we have to believe that no stone is left unturned when it comes to the recruitment of doctors, nurses and any other medical personnel."

The Health and Safety Executive (HSE) is the largest employer in the state, responsible for over 100,000 staff. It says it employs stringent rules when it comes to the recruitment of medical staff, although as Bon Secours Tralee is a private hospital, the HSE has no jurisdiction over it.

"The HSE requires hospitals to ensure that contractual provisions requiring employees to declare whether they are, or have been, the subject of any investigation by a medical registration or licensing body or authority in any jurisdiction with regard to their medical practice or conduct as a practitioner are fully enforced," says HSE communications director Paul Bailey. "Hospitals are also required to ensure that there are appropriate sanctions applied in cases where references are not obtained or checked prior to the doctor commencing employment."

Non-consultant medical doctors (NCMDs) must be employed under NCHD Contract 2010 which stipulates that they sign a declaration prior to employment where the opening clause reads: "I declare I am not the subject of any investigation by a medical registration or licensing body or authority in any jurisdiction with regard to my medical practice or conduct as a practitioner. I have not been suspended from registration nor had my registration or licence cancelled or revoked by any medical registration or licensing body or authority in any jurisdiction in the last 10 years, nor am I the subject of any current suspension or any restrictions on practise.

"In addition, I confirm that I am not aware that I am the subject of any criminal investigation by the police in any jurisdiction."

Bailey says the HSE's National Recruitment Service applies "the same suite of checks - reference checks, occupational health clearance, garda clearance and other validation of medical registration and related documentation - as they do for NCHDs."

The Irish Medical Council says it conducts extensive background checks before it allows doctors to be registered to practice in Ireland. It requires a passport as evidence of identity, a detailed career history, verified qualifications with all documents "notarised by a notary public or attested by a justice of the peace/commissioner for oaths/member of An Garda Síochána". It stipulates that documents signed by a police officer from another state are not acceptable.

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The council also requires a Certificate of Current Professional Status, to prove that applicants are "in good standing with no ongoing proceedings, conditions or findings against you and should be sent directly to the Medical Council from your previous regulatory authority".

Qualifications from non EU-EEA member states are validated on behalf of the Medical Council by the Educational Commission on Foreign Medical Graduates. "The Medical Council also uses the European Union's Internal Market Information system - a secure database - and can directly exchange information on an ongoing basis with other European regulators concerning qualifications, disciplinary histories and sanctions of individual medical practitioners," according to spokesperson Ailbhe Enright.

"Doctors who graduate from Non-European Union countries or Switzerland may be required to sit one of the Medical Council's examinations known as the Pre-Registration Examination System (PRES)," she adds. "The exam is an Open Structured Clinical Exam-format which requires the active participation of the medical practitioner in a simulated medical environment."

And yet, despite such measures employed by both the HSE and the Irish Medical Council, malpractice continues to happens in Irish hospitals. "You need only think back to the doctor who wasn't able to take a pulse to see that some people fall through the cracks," Stephen McMahon says. "She was hung out to dry to an extent, but what about those who employed her? What sort of process had taken place to ensure that that doctor had the competence to do the job?"

The Romanian doctor in question, Asia Ndaga, had been employed by Letterkenny Hospital in 2011 but a subsequent enquiry revealed that she had virtually no experience in caring for patients.

Her medical education was largely based on book-learning and university training rather than on any practical trainee work in hospitals. The Romanian doctors' register had no record of her name.

A senior doctor who works in one of the big Dublin hospitals says the malpractice cases that are covered in the media make for sobering reading, but he says in all his years of hospital work, he has rarely come across medics who have given him cause for concern.

"The language gap can be a problem," he says, "the communication skills can sometimes leave a lot to be desired - and you do hear of the frustrations of patients in that regard - but that's an issue that's not always confined to non-English speakers unfortunately.

"Any fears I would have had about new recruits would be based around exhaustion - the long working hours juniors often have to do - rather than incompetence.

"I read about the guy who confused an ankle and elbow and thought I'd never encountered any doctor who would have made such a ­fundamental mistake. I'd hate for the public to think that sort of thing happened a lot because, in my experience, it doesn't."

The case the doctor refers to is that of Omar Hassan, who was found to have been responsible for 28 cases of professional misconduct, including misidentifying an X-ray of an ankle as an elbow.

Hassan had managed to move between three Irish hospitals before his mistakes were uncovered. The same doctor had claimed to have passed the Irish Medical Council exams with "high marks".

According to a leading recruitment consultant, stringent application measures and exhaustive background checks can only do so much. "Of course these steps will weed out the 'bad eggs' and raise red flags to any past questionable behaviour, but they can't predict future intent," he says. "What I'm saying is, someone could have an impeccable record but go on to do something highly inappropriate and illegal in the course of their employment."

Meanwhile, the challenges faced by recruiters in the health industry are echoed in other professions, too, according to author and recruitment specialist Rowan Manahan.

"It's getting harder in the private sector," he says, "because they are using multiple-stage selection processes with different interviewers coming at it from different perspectives. We've also seen a rise in platform tests and psychometric profiling.

"But the public services lag behind on all of this. Not always, of course - I'm directly aware of a number of instances of multi-stage recruitment processes being used there.

"But all too often it's a single-hit, 45-minute interview, for quite senior roles.

"Time and again I have recommended conducting long-term audits or just simple follow-ups after a selection process; but I'm not aware of any being done."

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