Eilish O'Regan: 'Pressure to provide cover on rosters leaves our hospitals vulnerable to hiring rogue doctors'
When the country's medical watchdog admits it is worried about how some rogue doctors are ending up on our hospital wards, how concerned should patients be?
The latest case of an EU-trained junior doctor who was hired in a busy maternity hospital, despite having no experience treating patients, highlights again how substandard medics can slip through the system.
The doctor was fourth on a panel of doctors for the senior house office job after a three-person interview. Monitoring him in his first days on the job revealed the extent of his inadequacy.
A senior doctor wrote to him saying "concern was raised with me today by two consultants about your performance".
He was lacking in the basic competencies required of a doctor in the hospital - history taking, blood tests, insertion of IV cannulas, how to prescribe drugs and knowledge of and familiarity with the drugs.
It continued: "I directed that you are to work only under supervision: you are not to take blood or insert IV cannulas or perform any other medical procedures without supervision, you are not to prescribe drugs, you are not to perform internal examinations without supervision."
Yet the same doctor scored an indulgent 55 out of 100 marks for clinical medical and diagnostic skills at the interview. It's one of a number of serious cases to come before an exasperated Judge Peter Kelly, who heard the High Court application for an order for the doctor's suspension.
He warned of the potential impact of this on "unwitting patients".
"If this interview process was worth its salt it would have demonstrated his lack of basic medical knowledge," he said.
"It would also have demonstrated that a candidate for appointment as a senior house office in an obstetrics and gynaecological department did not know any cause of anaemia other than iron deficiency, did not know about the basic management of eclampsia and thought that a pulmonary embolus should be treated with aspirin."
The latest case is among a series of rogue doctors hired to work in hospitals, including a Sudanese medic who practiced in public and private facilities around Ireland.
He mistook an X-ray image of an ankle for an elbow at University Hospital Galway. It was among more than 30 alleged examples of professional misconduct and lack of professional knowledge bordering on the "disgraceful and dishonourable", according to his fitness to practice hearing.
Another case involved a doctor who worked as a psychiatrist but wrote incorrect medicine dosages on letters for patients' GPs and did not know how to perform CPR.
It's no accident several of cases happened in the smaller regional hospitals outside Dublin which find it particularly difficult to attract doctors in specialties like surgery, obstetrics, anaesthesia and orthopaedics.
The EU working time directive, which limits the hours a junior doctor works, means these hospitals face pressure to fill rosters.
They are all overseas doctors, frequently natives of an African country but educated in an eastern European university which has different training requirements to Ireland.
Some are supplied by a doctor's locum agency - which has medics on its books who are sent to work in hospitals on a short-term basis.
They are also not training posts so they are not building up any credits on the road to being a consultant.
At the same time many expensively Irish-educated doctors are taking the plane to Australia. There is a clear need to tighten up the vetting of overseas junior doctors - but the underlying problems behind the pressures to provide medical cover in smaller hospitals may be more difficult to resolve.
Making these jobs more attractive such as offering long-term contracts would be one step in safeguarding patient safety.