Khalafalla misconduct case flags wider issues in health service

The lengthy inquiry into Dr Omar Hassan Khalafalla, who was found guilty this week of 28 counts of poor professional performance and professional misconduct, has caused widespread and understandable concern.

Dr Hassan worked in the Midland Regional Hospital at Portlaoise, Mayo General Hospital and University Hospital Galway and, despite colleagues flagging concerns, was able to move from one facility to the next without any obvious difficulty.

Dr Hassan misdiagnosed an X-ray, put on protective gear incorrectly and re-contaminated his hands by touching a non-sterile area while scrubbing up, according to just a few of the incidents described at the fitness-to-practise inquiry at the Medical Council.

Other medical staff in the hospitals quickly spotted the issues relating to his work, so the time he spent in each place was short. It is clear, however, that the pre-employment checks one would expect to see carried out were not done as thoroughly as needed. The inquiry heard evidence that hospitals failed to contact previous employers before appointing him, and failed to investigate his references, which in some cases were negative.

The Health Service Executive requires hospitals to ensure employees declare if they are under investigation before taking up a post. The employees have to sign a declaration and can be fired if found to have lied. It isn’t clear what background checks are carried out.

Minister for Health Leo Varadkar has responded by telling the HSE to review employment procedures for staff who move between hospitals and facilities.

As HSE director general Tony O’Brien pointed out yesterday, the two hospitals to which Dr Hassan moved are in the same group.

The background to this case is a dire shortage of staff, particularly those prepared to work in smaller hospitals, and a heavy dependence on overseas doctors on short- term contracts.

Inevitably, these doctors start off being unfamiliar with their working environment and culture, and it may take time before problems become apparent. And, by the time this two-way familiarity may be established, they move on again.

It’s a crazy situation, but not one amenable to a simple solution. In recent years, efforts have focused on ensuring English-language competency, but it is clear clinical competence must come into greater focus too.