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A doctor received sums totalling about €12,650 from a seriously ill patient aged in his seventies in circumstances suggesting a breach of the Medical Council’s ethical guidelines, the president of the High Court has said.

Mr Justice Peter Kelly said that and other matters warranted making orders preventing Dr Zsolt Siklosi practising medicine here and suspending his registration on the council’s general practitioner specialist register.

Those orders, under Section 60 of the Medical Practitioners Act, apply pending further order.

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In the interests of public protection, the judge said his ruling, made following an in camera hearing of the Medical Council’s application for the suspension order, should be made public.

A citizen of Hungary and the UK with an address in Co Roscommon, Dr Siklosi was registered on the medical register here in 2011.

He was in court on Tuesday and sought an adjournment of the council’s application to allow him get legal representation and opposed the ruling being made public.

Refusing the adjournment, Mr Justice Kelly noted the council gave the doctor notice last week of the intended application.

Having made the order, he allowed Dr Siklosi a month to instruct lawyers and returned the matter to early May.

That followed a referral from the council’s preliminary proceedings committee (PPC) due to concerns about alleged breach of conditions previously imposed on the doctor’s registration, serious allegations he had received monies from a patient and a perceived lack of probity in his dealings with the council.

Dr Siklosi was previously found guilty by a FTP committee in 2016 of professional misconduct and poor professional performance.

The misconduct included failing to disclose he had been arrested on foot of a European Arrest Warrant in June 2013 and that his surrender to Hungary was sought in respect of certain offences, the judge noted.

Those findings led to the High Court making orders in March 2017 censuring him with conditions attached to his registration, including that he not prescribe psychoactive medication.

In an affidavit, council president Dr Rita Doyle said the conditions should have been very clear to Dr Siklosi but it seemed he had breached them “within a matter of days”.

She said the complaint that led to the council seeking the suspension was made in November 2017 by a health care practise, GP World Health Care, Bracken Road, Sandyford, Dublin, which said it had recently offered work to Dr Siklosi but after they sought certain documents showing he was allowed practice here, he had “disappeared”.

That complaint alleged, before he left the practice, he took money from a named patient and that other elderly sick patients who desperately need help from doctors might be at risk of losing money by giving it to him.

Investigations by the PPP to date have revealed Dr Siklosi has received a total €12,650 by way of “unsolicited interest free loans” on the basis of “friendship” from an elderly sick patient between October-December 2017 when the doctor first treated that patient on a walk-in basis in September 2017, Dr Doyle said.

The €12,650 included sums allegedly provided to help Dr Siklosi set up a new practice and €150 to fix a car clutch.

The judge noted another complaint being investigated was made in June 2017 after a woman who attended Dr Siklosi at the Net Dr Now surgery in Swords alleged he signed a prescription using two different pens in the woman’s presence.

It was alleged the name of the “medical practitioner” on the prescription turned out to be a secretary at the clinic and not a GP.

The matter was reported to the council and Dr Siklosi acknowledged the seriousness of the breaches and said he did not understand the importance of the relevant condition on his registration but, on advice, did so now.

That matter was to be subject of an inquiry.

The judge said there is at least prima facie evidence the doctor has been in receipt of a substantial sum from a seriously ill patient in circumstances that would suggest breach of the council’s ethical guidelines.

There was also a prima facie case over failure to provide full and frank disclosure including about where Dr Siklosi is working which is “highly suggestive” of a lack of probity in dealings with the council, he added.

Source: Irish Examiner
By: Ann O’Loughlin

Hospital doctors are still not being paid for all the long hours they work – which contributes to the reason they are emigrating in growing numbers, a doctors’ leader has said.

Dr Paddy Hillery said a growing number of young doctors are becoming demoralised and frustrated with their jobs.

Doctors are choosing to leave the Irish hospital system as they feel their efforts are not being rewarded or appreciated, said Dr Hillery, who is chairman of the non-consultant hospital doctors (NCHD) committee of the Irish Medical Organisation.

“Doctors in training see the reality of working in the healthcare system in Ireland,” he said.

“More frequently, they are coming to the conclusion that the sacrifices they will have to make to stay in Ireland, personally, professionally and in their own health, are not worth the benefits,” he said.

“Ongoing chronic lack of strategic investment in the health service is making the job itself demoralising and frustrating.

“NCHD contracts are continually breached and there are significant problems in getting paid for all hours worked, and this has undermined the relationship and view that NCHDs have of their employer and the health services,” he said.

Ireland produces the highest number of medical graduates per 100,000 population in the 36 countries which are members of the Organisation for Economic Co-operation and Development (OECD) but more than half of those doctors have indicated they are planning to practise medicine outside of Ireland.

“Many consultant posts, which were once so sought- after, are now not receiving a single applicant, resulting in 500 vacant consultant posts in the country,” said Dr Hillery.

“This is a direct consequence of the pay discrimination for any consultant appointed since 2012.

“Patients are suffering due to this recruitment and retention crisis.

“Some 7,000 operations were cancelled last year and 2018 saw record levels of overcrowding in our hospitals,” he said.

“Our doctors are increasingly leaving Ireland’s shores and taking up positions in other English-speaking countries, where they are valued and treated with respect.

“And this will continue until the Irish Government values doctors,” he said.

A study released in 2017 revealed one in three hospital doctors in Ireland has experienced burnout.

The National Study of Wellbeing of Hospital Doctors in Ireland found up to 10pc of doctors reported severe to extremely severe levels of depression, anxiety and stress.

Alan O’Keeffe
The Irish Independent

A new test for prostate cancer could help save lives by facilitating earlier diagnosis, according to new research from UCD scientists supported by the the Irish Cancer Society .

Published ahead of Daffodil Day – the society’s annual fundraiser which gets underway on Friday – the research shows a simple urine test could help save some of the 3,500 men diagnosed with prostate cancer in Ireland every year.

Cancer researchers at UCD led the development of the new test which has so far shown to be 70 per cent more specific for prostate cancer, when compared to blood tests currently used by doctors.

If the new “epiCaPture” test is further validated it could help to more accurately identify which men do or don’t need invasive tests. This means that many men could be spared harsh treatments that often have long-term side effects.

The test could also help to identify aggressive prostate cancer early, so that more patients can be potentially cured of their cancer.

The research was part of an international collaboration led by Dr Antoinette Perry, assistant professor of cell biology and genetics at the UCD School of Biology and Environmental Science and the UCD Conway Institute.

Dr Perry and her team including PhD students Eve O’Reilly and Irish Cancer Society funded researcher Alexandra Tuzova said, while early detection was vital, current tests to detect prostate cancer were not entirely accurate.

She said “over the last four years our research team at University College Dublin has worked with doctors, nurses, patients and other scientists from around Ireland, the UK, USA and Canada to study urine from almost 500 men. We showed that almost 90 percent of men with aggressive prostate cancer have changes in their DNA that we could find in their urine.

“These changes were absent in healthy men and men with non-aggressive disease. If we can replicate these findings, our research could contribute to a new, more accurate test to help catch aggressive prostate cancer and save lives from this disease.”

Dr Robert O’Connor, head of cancer research at the Irish Cancer Society, said: the new findings highlighted “the vital work, world-class cancer researchers are doing in UCD and across Ireland to identify new ways to improve the diagnosis of cancer”.

But he said more work was needed before the potential benefits reach cancer patients.

The Irish Cancer Society currently funds more than 100 researchers across Ireland and are on track to invest €30 million into research in the decade up to 2020.

“But we could fund even more research if we had the funds. That’s why Daffodil Day this Friday needs to be the biggest one yet, ” said Dr O’Connor.

Author: Tim O’Brien
Source: The Irish Times

Half of Irish hospital doctors say they are emotionally exhausted and overwhelmed by work, while one-third are experiencing burnout, according to new research.

Just one in five say their work situation leaves them enough time for family or personal life, the study of more than 1,700 doctors shows.

Work stress is reported by over 80 per cent of those who participated in the study while almost 30 per cent of doctors say they are insufficiently able to cope physically and mentally with the demands of work.

The extent to which Irish doctors are experiencing exhaustion is higher than in the UK, Australia or the US, prompting the study authors to call for a critical review of the their working conditions.

The study, published in BMJ Open, surveyed 1, 749 doctors and is the first national survey conducted on a group of hospital doctors working within the same health system in Ireland.

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Lead author Blánaid Hayes, former dean of the faculty of occupational medicine at the Royal College of Physicians of Ireland (RCPI) says the results give “great cause for concern”.

“Surprisingly, in a milieu where evidence is the key driver of patient treatment, the evidence on the relationship between workplace psychosocial environment and employee health is paid little attention by those who fund and manage healthcare organisations. It is buried under the constant refrain of ‘putting the patient first’ with little regard for those who are instrumental in providing care.

“When work poses excessive demands with little control and support, its impact on both physical and mental health can be negative, leading to stress-related disorders, depression and other common mental health issues.”

The data was collected in 2014, following a period of cutbacks in the health service.

Low levels of work-life balance and high levels of stress were apparent among doctors of all grades. However, burnout was highest among male doctors, younger staff and doctors who were less able to cope, had a greater over-commitment or had a lower desire to practise.

Just over 70 per cent said they had a strong or very strong desire to practise medicine.

A failure to deal with these problems will lead to doctors retiring early or developing health problems, the authors warn. This will cost the State money and contribute to “intolerable” vacancy rates for consultants, they warn.

RCPI president Prof Mary Horgan said the college was pursuing “innovative approaches” to support doctors’ health and to raise awareness of the importance of caring for them.

Source: The Irish Times
By: Paul Cullen

A consultant in emergency medicine at Sligo University Hospital has told an inquest he did not order a brain scan on a 19-year-old student in the early hours of the morning after her admission, because he did not think an emergency scan was needed at that time.

Lisa Niland was admitted to the hospital at 9.30pm on the evening of 17 January 2017 after collapsing and vomiting with a sudden severe headache while in a fast-food restaurant.

She died three days later in Beaumont hospital.

The coroner’s court has heard the cause of her death was a catastrophic bleed to her brain.

Dr Fergal Hickey told Dublin City Coroner’s court, that the decisions he made were made in good faith, in the situation he found himself in and within the confines in which they were working.

Dr Hickey said he received a phone call from the senior doctor on duty in the emergency department at 2.15am in the morning on 18 January.

He said the doctor – Katherine Langtree – raised the issue of whether or not Ms Niland needed a CT scan.

He said he agreed that one was required but his decision was that an emergency scan was not needed at that time.

He said Dr Langtree told him there were no neurological signs present at the time of her phone call, and there was no indication an emergency ct scan was needed.

Dr Hickey said he agreed that the most likely diagnosis at the time was a bleed to the brain, but he said he did not think there was anything to be gained by requesting the scan in the middle of the night.

He said in his 25 years of experience, Beaumont hospital would not admit someone in the middle of the night, even with a brain bleed, if there were no other neurological signs present.

The scan did not take place until just after 10am when the haemorrhage was identified.

However, Ms Niland had three cardiac arrests before she could be transferred to Beaumont by helicopter.

Surgery was carried out but her life support machines were turned off on 20 January.

Mr Hickey said he worked in a very imperfect system and the constraints were not determined by him.

The coroner’s court has heard that in Sligo hospital and other similar hospitals around the country, a CT scan could only be ordered by a consultant.

Mr Hickey said it was a factor in his decision making that if he had called in a radiographer in the middle of the night, that radiographer would not have been available to the hospital the following day.

Mr Hickey said on the basis of the information he had at 2.15am, and the absence of neurological signs, time was not as much of the essence as was being portrayed.

However, he said if he had been told of clinical signs which were evident more than an hour later, he would have requested such a scan.

Earlier, Ms Niland’s father, Gerry Niland, told the court his daughter was suffering from excruciating pain, had no balance and was screaming in agony during her time in the hospital.

He said he was asked by nursing staff if she had been drinking and was asked twice if she had taken drugs even though he was crystal clear that she had not.

Mr Niland said the surgeon in Beaumont told him he “couldn’t believe what had happened at Sligo”.

The first nurse who assessed Ms Niland at Sligo said she had asked her to be reviewed by a doctor within 15 minutes of her admission, to see if she needed a brain scan as she was concerned about a possible bleed.

Nurse Erin Lyons said Ms Niland had complained of a sudden onset of a headache and that had caused her to prioritise her as a “category 2” patient, the second most serious category for patients in the department.

Ms Lyons said that she discovered later that she had written “category 3” on Ms Niland’s chart but at all times treated her as a category 2 patient.

Ms Lyons said she also wrote on Ms Niland’s chart that she had had a few drinks the previous night.

But she said she did not believe that was a cause of her symptoms.

Dr Katherine Langtree said she had discussed the possibility of an emergency CT scan with Dr Hickey in the early hours of the morning.

But he said there was no indication such a scan was needed and Ms Niland should be admitted for one first thing in the morning.

Ms Niland was assessed again by the medical team more than an hour later where she was reported as being drowsy and having clumsy coordination.

Dr Langtree said she had seen no neurological signs during her assessment, and her concern was based on the sudden onset of Ms Niland’s headache and her pain.

The coroner, Dr Myra Cullinane said she intended to record a narrative verdict which sets out a summary of the facts.

However, this was strongly opposed by the family’s solicitor Damien Tansey who said the correct verdict should be one of medical misadventure.

Dr Cullinane said she would agree to adjourn the inquest until July to hear evidence from a witness from Beaumont Hospital before reaching a final decision.

Source:RTE
Orla O’Donnell

AN ENGLISH CONSULTANT working in two Dublin children’s hospitals has been before a fitness to practise hearing in the UK after he was found to have had inappropriate contact with the mother of a patient while working in Manchester.

Dr Malcolm Lewis has been employed as a paediatric consultant nephrologist in both Temple Street Children’s Hospital and Our Lady’s Children’s Hospital Crumlin since August 2016.

A spokesperson for Temple Street said that Lewis ceased employment in Royal Manchester Children’s Hospital in the same month he began working in Temple Street and Crumlin. On his retirement from the hospital in Manchester, parents took to the hospital’s Facebook page to describe the positive experiences their children had under his care.

A complaint was made against him in the UK a number of months after he began working in Dublin, and Lewis informed his Irish employers of this.

Lewis provided Temple Street and Crumlin with the details of the complaint as provided to the UK’s General Medical Council and a decision was taken that he remain employed at the Irish hospitals pending the outcome of the tribunal.

Fitness to practise

A UK medical tribunal was heard between 18 February – 1 March and is due to resume on 17 September.

The tribunal heard details of allegations against Lewis and made findings of fact in relation to them.

Among the allegations were that Lewis used his professional position in the hospital to pursue an inappropriate relationship with the mother of a patient.

The teenager in question had undergone a failed kidney transplant in which the mother had been the donor.

The tribunal found that it was proven that Lewis had inappropriate contact with the mother by meeting her outside hospital grounds to discuss her child’s treatment, and that he had also accessed the child’s blood test results and conveyed them to the woman.

During this period, Lewis was not the child’s treating consultant and it was also found by the tribunal that he had sent a gift to the patient’s address.

Lewis gave evidence in person during the tribunal and was found to be a “credible witness”.

The tribunal said that he “accepted elements of the charges but remained consistent that his actions were not inappropriate”.

“The Tribunal found that he gave careful and considered responses to the questions put to him,” the tribunal stated in its determination of the facts.

However, the Tribunal found Dr Lewis less convincing in his responses to Tribunal questions. In particular, he did not provide satisfactory explanations as to the appropriateness of maintaining a friendship with a parent of a patient.
The tribunal noted testimonial evidence on behalf of Lewis suggesting that he “routinely provided patients with his personal details at the outset to the parents of seriously ill patients”.

The tribunal also determined that it was “more likely than not” that the interactions between Lewis and the mother began when they “bumped into one another” in the hospital.

In a response to TheJournal.ie, a spokesperson for Temple Street said Lewis had provided the hospital with documentation regarding the findings from the completed stage of the hearing.

“Dr Lewis has been found to have continued to communicate with the family in question after ceasing to be their treating consultant,” the statement said.

The tribunal will reconvene between 17- 19 September to consider whether the doctor’s fitness to practise is impaired.

Author: Rónán Duffy
Source: The Journal.ie

A doctor who admitted working under the influence of opioids cannot be named although the hearing of sanctions to be imposed on him can be heard in public, the president of the High Court ruled.

The doctor admitted taking medication from practice stocks and using “leftovers” from opioid vials which he had only part administered to patients to feed his own opioid addiction.

Today, Mr Justice Peter Kelly ruled the Medical Council would have to hold in public a hearing at which it will censure him for misconduct along with a series of conditions on his registration.

He has taken steps to recover from his addiction and other mental health problems and has spent a substantial period not practising medicine.

The judge said however that his name cannot be published and can only be referred to by initials.

The Medical Council had sought a ruling on whether the sanction hearing should be in public and whether and the report of its Fitness to Practice Committee (FtPC) should be published.

It followed a FtPC hearing into an investigation arising out of complaints that, over a five year period, the doctor was using opioids which arose after he had been prescribed pain relief for injuries he suffered some years earlier.

He admitted a number of allegations including administering opioids to 36 named patients where he knew it was not clinically warranted or was inappropriate.

He also admitted prescribing opioids to six patients in excessive strengths and/or quantities.

Anything left over in the vials of medication, he admitted using on himself.

He admitted that on one or more occasions during a three-year period, he took Tramadol samples from one or more pharmaceutical company representatives for himself.

He also obtained Tramadol and/or Cyclimorph and well as Pethidine and/or morphine sulphate from practice stock supplies or by using stock practice prescriptions.

He admitted prescribing 10 vials of Cyclimorph for an identified patient and presenting that prescription to a pharmacy in circumstances where the doctor knew or ought to have known this was inappropriate.

Generic and unrelated image of doctor
He admitted he was under the influence of opioids while engaged in practice and that this may impair his ability to do so.

The FtPC recommended censure although the Medical Council CEO said his registration should be cancelled because his conduct was “at the most serious end of the spectrum”.

The full Medical Council agreed with the FtPC censure sanction given the admissions he made and his rehabilitation.

The Council then asked the High Court to consider the appropriateness of having the sanctions hearing in private and of anonymising the names of patients, or other appropriate measures.

Its view was disclosure of such material would potentially be detrimental to the doctor and named patients.

Mr Justice Kelly said the hearing in public in which all names are anonymised would accommodate the constitutional rights of all involved.

The Council also recommended that the patients involved be provided with the FtPC report so they can be made aware of how they have been treated.

However, it said it was not in the public interest to publish a transcript of the FtPC inquiry and did not believe the public at large should be informed of the conditions to be imposed on the doctor’s registration.

Mr Justice Kelly agreed the patients involved should be advised.

He said the Medical Practitioners Act 2007 clearly gives discretion in relation to advising the public.

While the term “public” was not defined in the Act, it appeared to him the Council was entitled to advise “a limited constituency of the public”.

It was a matter for the Council to exercise its discretion in this regard.

“Needless to say, the advice will have to be given in a sensitive way since I am sure that it will come as a great shock to the patients”, he said.

Source: The Irish Examiner

Ann O’Loughlin

The Minister for Health has said the need for access zones outside health centres providing abortion care is a priority after it was revealed that American anti-abortion groups are planning operations in Ireland.

An undercover report for The Times Ireland Edition found an American anti-abortion group was training protesters to approach women seeking terminations, as well as urging activists to phone doctors pretending to seek an abortion to find out which health centres were performing the procedures.

The Times Ireland report revealed Sidewalk Advocates For Life will target women including rape victims and couples who have gone through fatal foetal abnormalities.

Leo Varadkar
@campaignforleo
We as a people voted overwhelmingly to provide safe & legal abortion in Ireland. Abortion is deeply private & personal and no woman chooses to end her pregnancy lightly. No one should be coerced, intimidated or harassed when accessing or providing these services #repealedthe8th

Speaking on RTE Radio 1 on Monday, Minister for Health Simon Harris said action must be taken to protect women.

“The idea that anybody, but particularly outside groups would be trying to undermine our democratic decision and effectively, in my view, harass and intimidate Irishwomen is something that is quite despicable and shows why we need to get on doing what I intend to do regarding safe access zones, that piece of legislation is a priority for me,” he said.

Likewise, the Taoiseach Leo Varadkar wrote on social media that women did not deserve to be intimidated for accessing medical care.

“We as a people voted overwhelmingly to provide safe and legal abortion in Ireland,” Mr Varadkar wrote.

“Abortion is deeply private and personal and no woman chooses to end her pregnancy lightly.

“No one should be coerced, intimidated or harassed when accessing or providing these services.”

Louise O’Reilly TD
@loreillysf
Great chat with @ciarakellydoc & @_Katie__ONeill on @LunchtimeLiveNT just now about an American group who are organising to come here to target women availing of their legal right to abortion care We need legislation to prevent this ASAP #repealedThe8th

The article, published on Monday, has caused widespread concern and was discussed by members of the Seanad.

Labour Senator Ivana Bacik said: “Given the reporting today on plans by US-based anti-choice groups, who have very intimidating means of targeting women, and who now plan to bring their activities to Ireland, this issue has become even more pertinent.

”Exclusion Zones were not included in the legislation for abortion passed in December and many of us raised this issue during the debates at the time, and warned about the risk of protests outside clinics.

“The Minister for Health should not allow the practice of intimidation of women outside GP offices and health clinics to take hold before he acts.

“He should seek to amend current legislation or bring in new law if necessary, as soon as possible.”

In a statement to the Times Ireland, Sidewalk Advocates For Life said they are a “law abiding organisation that teaches others to lovingly and peacefully reach out to women at abortion centres, offering them non-violent solutions to their crisis situation”.

Figures show that 274 GPs and 10 hospitals have so far signed up to provide abortion services in Ireland.

The Yes side won the referendum on whether to repeal the Eighth Amendment, which prohibited abortion, by 66.4% to 33.6% in May 2018.

Press Association
Source: The Irish Independent

A jury has failed to reach a verdict in the trial of a doctor accused of sexually assaulting a teenage patient over 20 years ago.

Kevin Mulcahy (61) of Creggane, Lombardstown, Mallow, Co Cork had pleaded not guilty at Dublin Circuit Criminal Court to sexual assaulting a woman in his surgery in Mallow, Co Cork on a date in February 1995.

He also denied a second count of sexual assault at the same location on a date between May 8, 1996 and December 31, 1996.

The jury had heard that in early 1995 the complainant’s brother took her to Dr Mulcahy and that he allegedly touched her breasts and “it didn’t feel right”.

The woman alleged that in the summer of 1996 she went back to Dr Mulcahy and he exposed himself.

The jury failed to reach a verdict after deliberating for over five hours. Judge Pauline Codd thanked the jurors for their care and attention during the trial. She adjourned the case for mention on February 26, next.

During the trial Maddie Grant BL, prosecuting, told the jurors that the State’s case was that the woman was an honest and truthful witness who had never resiled from her allegations since first making them in 2005 to doctors treating her for a psychiatric condition.

She said the woman was very forthcoming about her bipolar disorder and her efforts to manage it. Ms Grant told the jurors they heard expert evidence that the complainant’s illness did not contribute to her allegations.

In his closing speech Blaise O’Carroll SC, defending, said there was no evidence to corroborate the allegations. He said after attending Dr Mulcahy the woman made no disclosure to her older brother.

He said within a year she began seeing another GP, a woman, but never told this woman about her allegations. He said it was bizarre that the woman subsequently went back to Dr Mulcahy for treatment when he allegedly sexually assaulted her a second time.

He said that this evidence “doesn’t have the ring of truth”. In a statement to gardaí Dr Mulcahy said he didn’t recall carrying out any physical examination of the complainant.

Mr O’Carroll said that the allegations emerged out of a state of acute psychotic disorder where the complainant at one point believed she was pregnant by immaculate conception with the baby Jesus.

“That would be a red flag that would make somebody extraordinarily cautious,” he said.

Online Editors
The Independant