Pres­sure to pro­vide cover on ros­ters leaves our hospi­tals vul­ner­a­ble to hir­ing rogue doc­tors

Irish Independent - - News | Health - Eil­ish O’Re­gan

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 ofec lamps ia and thought that a pul­monary em bo­lus 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.

Warn­ing: Judge Peter Kelly

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