Nigerian 'Doctor' lacking basic medical knowledge employed in busy maternity hospital

A doctor with no clinical experience and lacking basic medical knowledge was employed as a senior house officer at a busy maternity hospital, a fitness to practice hearing has heard.

Dr Francis Megwa’s lack of basic medical knowledge so alarmed the retired chief clinical director of University Maternity Hospital Limerick (UMHL), Dr Gerard Burke, admitted he feared Dr Megwa had never attended medical school.

Dr Megwa, who is originally from Nigeria but attended medical school in Romania, is facing multiple allegations of poor professional performance relating to his term of employment at UMHL in 2018.

It is alleged that Dr Megwa, while practising as a senior house officer (SHO) in obstetrics and gynaecology at UMHL, between July 9 and August 14, 2018, failed to demonstrate sufficient skill or knowledge expected from an SHO.

Dr Megwa faces allegations he failed to demonstrate basic competency concerning taking and analysing medical histories and showed a lack of understanding around the diagnostic significance of patterns of symptoms.

He is also accused of failing to demonstrate competency in prescribing medication commonly used in obstetrics and gynaecology and setting intravenous cannulation.

In respect of a patient with a previous history of a caesarean section who presented with placenta previa and a substantial haemorrhage, Dr Megwa is accused of being unable to give a clear history of the patient and failed to quantify her blood loss.

Concerning the same patient, he is accused of failing to identify or demonstrate an understanding of a differential diagnosis. He is also accused of failing to develop an appropriate management plan for the patient.

Counsel for the CEO of the Medical Council, Neasa Bird BL, told the committee Dr Megwa obtained his qualification from a Romanian university in 2015.

He spent four months as an intern or observer in a private hospital in Romania, followed by a two-month volunteer position in an emergency hospital in Bucharest.

Following a gap of over a year, he carried out a four-month observer post at an NHS hospital in Scotland. He never worked in paid employment as a qualified doctor.

The fitness to practice committee heard Dr Megwa is not registered in either Romania or Nigeria, but was entered into the general register in Ireland in October 2017.

Dr Gerard Burke, a consultant obstetrician and gynaecologist, told the committee that following an assessment he carried out on Dr Megwa’s competency, he complained to the Medical Council on August 10, 2018.

He told the inquiry a colleague had reported her concerns at the end of the first week of Dr Megwa’s employment. Dr Burke then met with Dr Megwa on July 20, 2018.

“He didn’t have a lot of the basic skills that we normally see in our SHOs who hitherto would have always completed an intern year - he hadn’t done that.

“The following week, another colleague, Dr Mustafa, mentioned to me he was very worried about him.

“I went down to the emergency unit at the maternity unit; this was where Dr Megwa was assigned to work. I arranged to meet him to discuss the concerns and look into them further.

“I met with him and explored the situation with him.

“I was sufficiently concerned to give him an oral warning and place him on conditions of an observer role - like a medical student.

“He wasn’t to prescribe drugs; he wasn’t to do any procedures without direct supervision by one of the other doctors.”

Dr Burke told the committee he used the meeting as an opportunity to explore Dr Megwa’s medical knowledge.

He said: “I formed the impression he had very little medical knowledge - almost none,” adding he found this “extremely surprising for somebody who had been through medical school for five or six years in any country”.

“His knowledge was so poor I had never come across the like of it before,” he said.

Ms Bird asked Dr Burke if he could ascertain the nature of Dr Megwa’s previous experience and training. Dr Burke said several aspects of Dr Megwa’s past surprised him.

“He had graduated from a medical school in Romania, but he was not registered in Romania, nor was he registered as a doctor in Nigeria where he was a citizen.

“He had been turned down for registration in the UK, which was still part of the EU at the time. So I was surprised he was only registered in Ireland.”

Dr Burke said that very often, in the field of obstetrics and gynaecology, junior doctors don’t have the full range of the practical skills required, and they have to learn these gradually over the first six months.

“You expect that anybody who has been through a medical school and is registered to take blood and insert an IV cannula – he wasn’t able to do any of these things.

“Moreover, I was told he wasn’t able to take a history competently.

“And he didn’t seem to know how to prescribe drugs, and he didn’t seem to know very much about drugs.

“I encountered a person who seemed to have an extreme lack of medical knowledge that any doctor would have. He didn’t seem to have any at all.”

Following his oral warning to Dr Megwa, Dr Burke and a colleague carried out an assessment to determine his medical knowledge using questions used in a final med pass/fail candidate.

Dr Burke said the questions asked of Dr Megwa were at the extreme of somebody’s “really, really basic” medical knowledge.

“He was asked things like what are the causes of a postpartum haemorrhage, that’s at the lowest level of a pass/ fail question.

“He could only give one cause of breathlessness. He didn’t know the basic management of eclampsia.

“He seemed to be extremely poor on the causes of anaemia he only seemed to know of one, iron deficiency.

“Anybody who is a qualified doctor could trot this knowledge out. It is drummed into you in medical school.

“We were suspicious that he knew near nothing, so the questions were pitched at that level.

“I had some doubts that he had ever been to medical school. It went through my head."

Following a question by committee member Dr Maire Milner about the interview process which saw Dr Megwa offered the position of SHO, Dr Burke said: “Clearly an error was made in that regard.”

“There is no doubt the interview process was flawed,” he added.

The hearing continues.

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