Doctor who? | 27 June 2019

Last October, Phil Coleman, a journalist on the Carlisle-based News & Star, went to cover the trial of Zholia Alemi, a 56-year-old consultant psychiatrist who was accused of forging the will of an 84-year-old dementia patient in an attempt to inherit her £1.3 million estate. During the trial, Phil realised this complex scam could not have been the work of an amateur fraudster, and suspected previous mischief. How right he was. It turned out that Alemi had been practising in the NHS for 23 years without a medical qualification.

Originally from Iran, Alemi moved as a young woman to New Zealand where she claimed she had graduated in medicine from the University of Auckland in 1992. Yet Phil’s enquiries to the Medical Council of New Zealand confirmed that she had never qualified. After a staggered student career, Alemi had dropped out of medical school during her clinical training. Nevertheless, she went on to present forged papers to the General Medical Council (GMC) to obtain UK registration. At the time, there was a loophole which allowed certain graduates from Commonwealth countries to register with the GMC without taking our certifying Professional Linguistics and Assessment Board exam, which is designed to test knowledge, skill and competence.

Alemi was found guilty of fraud, and imprisoned for five years. But the matter must not be allowed to rest there. The GMC and the Royal College of Psychiatrists must be held to account for their part in the scandal. How could these two prestigious bodies, who are responsible for safeguarding medical standards in the UK on behalf of the general public, possibly have allowed a spoof doctor with forged documents to have deceived them for more than two decades? Not only did they register her as a medical practitioner in UK but they also let her train and take the key postgraduate examination, which allowed her to practise as a consultant psychiatrist.

Nor is the case of Zholia Alemi the only such embarrassment. In 2015 the Georgian national Levon Mkhitarian was jailed for six years for fraud after practising as an NHS doctor, treating more than 3,000 patients in seven different hospitals. The 40-year-old had qualified as a doctor but, after being banned by the GMC, stole the identity of another doctor and forged papers to gain employment. He was only caught when he tried to get hold of a staff pass for a hospital in Kent. Also that year, Oluwadamilola Opemuyi, from Maidstone, was jailed for faking qualifications to get a job as a GP — only after treating 91 patients and even signing a death certificate. The 43-year-old tricked a locum agency into believing she was Oluwadamilola Adeyo – a GMC-registered GP – by handing over documents saying she was fully qualified.

Following the Alemi case the GMC acknowledged that it had made inadequate efforts to check doctors’ qualifications in the 1990s and, earlier this month, published the results of a review into more than 3,000 foreign doctors who had gained the right to practise in Britain at that time. It found none had used fraudulent documents to gain registration with the GMC. Yet the more recent cases show there is still something wrong with the hiring process in some hospitals and surgeries for doctors who have gained qualifications abroad — or claim to have.

The problem is exacerbated by the huge reliance on foreign-trained doctors. Last year, the GMC registered 15,301 new doctors, 8,115 of whom had qualified abroad, mostly from countries outside the European Union, with Pakistan, India and Nigeria topping that list. As these figures show, we imported more doctors than we trained. Can the GMC reassure the general public that individual checks were made to confirm that each of these foreign doctors, amounting to 53 per cent of the total registrants for last year, had a verified medical qualification? Or are there other spoof doctors practising medicine in this country?

The GMC seems unable to pick up on doctors without proper qualifications even when there are serious concerns about their performance. By 2017, and during her 23-year medical career, Alemi had been investigated several times by the GMC’s fitness to practise procedures in response to multiple complaints. At worst, she was given a ‘warning’ — nothing more serious. How did Alemi pass her annual appraisals and five-yearly revalidation, procedures introduced by the GMC following the conviction of Harold Shipman, a general practitioner and prolific serial killer?

Dodging the GMC’s registration process, its appraisal/revalidation systems and its fitness to practise procedures is one thing, but even more worrying is that Alemi managed to train for and pass the specialist examination in psychiatry in 2003 to reach the GMC’s specialist register in 2012. This enabled her to practise independently as a consultant psychiatrist. We know that she had completed five of six years in medical school in New Zealand before she was dismissed. By that time, she would have completed her undergraduate module in psychiatry and been able to bluff convincingly enough to begin specialist training in the UK. During her training, she would have come into personal contact with dozens of consultant psychiatrists who would have acted as her mentors, supervisors and ultimately her examiners to confer a specialist qualification. How could she have winged her way through all those hurdles? Did no one suspect that she was not medically qualified, especially given the requirements for detailed knowledge in neuroscience and pharmacology?

What we know so far may be the tip of the iceberg. How many more skeletons are there in Alemi’s cupboard and indeed in the GMC’s? Her clinical career in UK must be thoroughly investigated. How many patients have been harmed or disadvantaged? How can these clinical errors be corrected? Somebody needs to be taking more responsibility.

For his work on the Alemi case, Phil Coleman was deservedly shortlisted for this year’s Private Eye Paul Foot Award for investigative and campaigning journalism. He has done his job. But it is deeply worrying that it has taken a regional news-paper reporter to do the work which should have been done by the GMC and Royal College of Psychiatrists.