In October 2018, Phil Coleman, a journalist, was sent by his newspaper, the Carlisle-based News & Star to cover the trial of “Dr.” Zholia Alemi, a Consultant Psychiatrist in the NHS who was subsequently found guilty of fraud and imprisoned for five years. Alemi had forged the Will of an 84-year old patient who she had cared for in her Dementia Clinic, in an attempt to inherit her £1.3million estate.

During the trial, Phil realised that this complex scam could not have been the work of an amateur fraudster, and that there was probably a previous history. How right he was.

Alemi, a 56-year old New Zealander had claimed that she had graduated in medicine in Auckland in 1992 but Phil’s enquiries to the Medical Council of New Zealand confirmed that she had never qualified in medicine. After a staggered student career, Alemi had dropped out of medical school during her clinical training. She presented 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 the Professional Linguistics and Assessment Board (PLAB) exam which is designed to test knowledge, skill and competence. As a result, the GMC is urgently reviewing around 3,000 foreign doctors’ qualifications who registered via this loophole.

However, that loophole for Commonwealth citizens, which expired in 2003, is identical to the reciprocal arrangement we now have with the European Union. Graduates from medical schools in other EU countries can register with the GMC without taking PLAB, unlike foreign trained doctors from outside the EU. Are the risks to the NHS not similar?

Phil’s scoop about “Dr.” Alemi is as great an achievement for him as it is an embarrassment both for the GMC and for the Royal College of Psychiatrists. Alemi practised fraudulently within the NHS for more than two decades. 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 so long? 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 practice as a Consultant Psychiatrist. Surely this story casts doubt on the judgement and competence of both organisations.

In every respect, this is a shocking story, but as an experienced Consultant Surgeon, I find all aspects of this story truly incredible. Here are some of my concerns.

To what extent does the GMC investigate the authenticity and qualifications of each individual foreign doctor applying for registration in UK? Last year, and similarly for many previous years, the GMC registered 12,771 doctors, only 7,152 of whom had qualified in British medical schools. The other 5,619 qualified abroad, mostly from countries outside the EU. Pakistan, India and Nigeria top that list. Can the GMC reassure the general public that individual checks were made to confirm that each of these foreign doctors, amounting to 44% of the total registrants for 2017, had an appropriate medical qualification? Are there other spoof doctors practising medicine in this country?

By 2017, and during her 23-year medical career, Alemi had been investigated several times by the GMC’s fitness to practice procedures in response to multiple complaints. Until her arrest and suspension some months later, the worst sanctions she was given were conditions on her practice and a “warning”. Nothing more serious and no mention of suspension or being struck off the medical register.

How did Alemi pass her annual appraisals and 5-yearly revalidation procedures introduced by the GMC following the conviction of Harold Shipman (a general practitioner and prolific serial killer), to confirm that individual doctors were practicing safely?

Dodging the GMC’s registration committee, its appraisal systems and its fitness to practice procedures is one thing, if truly spectacular. Beyond that, and even more worrying, if impressive, is that she managed to train for and pass the specialist examination in Psychiatry (Membership of the Royal College of Psychiatry) in 2003 to reach the GMC’s specialist register in 2012. This enabled her to practice unsupervised as a Consultant Psychiatrist.

We know that Alemi had completed five of six years of medical school training in New Zealand before she was dismissed. By that time, she would have completed her undergraduate module in psychiatry, enabling her to “walk the walk and talk the talk” in that subspeciality. That background appears to have been sufficient for her to start training as a psychiatrist in the UK which involves a minimum of two years of specialist supervised training on a programme approved by the Royal College of Psychiatrists. Inevitably, she would have come into personal contact with many training psychiatrists responsible for her progress and performance. Did no-one suspect that she was not medically qualified especially given the requirements for detailed knowledge in neuroscience and pharmacology, for example.

I have read the daunting process and requirements to pass the pass this exam. Apart from a two-part written examination, there is a patient-centered practical examination witnessed and supervised by experienced psychiatrists. Having taken many demanding postgraduate exams myself, I am amazed by the achievements of this lady and equally baffled by the failure of her peers to detect such fraudulent behaviour. How could she have winged her way through an examination intended to confer entitlement for sole specialist practice?

Moreover, the cost to the taxpayer should be considered. Alemi will have earned significant amounts of money over more than two decades working in the NHS, even though the cost to her patients is incalculable.

What we know so far is probably the tip of the iceberg. Alemi’s clinical career in UK must be thoroughly investigated. How many patients have been harmed or disadvantaged? How can these clinical errors be corrected? Who must take responsibility? How many more skeletons are there in her cupboard and indeed in the GMC’s cupboard? Clearly the performance of the General Medical Council and Royal College of Psychiatrists must be independently scrutinised.

J. Meirion Thomas, FRCP. FRCS

BIOGRAPHY.

J. Meirion Thomas is a recently retired NHS Consultant Cancer Surgeon. He worked at the Royal Marsden Hospital for thirty years, and for the last six years of his career, held a personal Chair in surgical oncology at Imperial College, London.Throughout his career he demonstrated commitment to the NHS and has a track record in service development and clinical research. He currently works in the private sector.

Since 2013, he has been writing in the press on matters relating to the NHS.