An unprecedented international investigation exposes how doctors who have lost their medical licenses due to serious wrongdoing, including patient harm, can easily relocate and practice in different countries. In Cyprus, a doctor whose medical licenses were revoked in Sweden and Norway, is practicing at a Larnaca clinic. But reporters could only obtain limited data, including in Cyprus, identifying big gaps in information-sharing mechanisms.
The Swedish Medical Responsibility Board finished reviewing Simon Moskofian’s professional conduct at a health center in south-west Sweden in December 2021, and their conclusions were scathing: the general practitioner lacked basic knowledge in key medical areas, conducted medical investigations that were “consistently inadequate,” and intentionally or negligently violated regulations that put patients at risk.
The Swedish documents reviewed by CIReN detail how Moskofian had inappropriately administered medication and failed to document his procedures in 14 patient cases. One of his patients suffered a double lung collapse after Moskofian incorrectly administered cortisone injections for arthritic pain and “exposed the patient to obvious danger of death,” the documents state. Another patient was allowed to determine their own dosage of a potent neurological drug, according to the investigation.
After being notified of Sweden’s revocation, Norway followed with a revocation of his Norwegian licence at the beginning of 2022.
But Moskofian still has an active medical license in Cyprus. CIReN found the doctor registered with the national healthcare system, and practicing at a clinic in Larnaca.
Moskofian told CIReN that he moved back to Cyprus and started working for the General Healthcare System (GeSY) at the end of 2019, on the encouragement of his doctor friends, not because of the Swedish investigation. “My family also were a good reason to return,” he said. He had immigrated from Lebanon to Cyprus in 1972, at 13 years old, and completed his studies and training in Yerevan and Moscow.
Moskofian said that he had been overworked and was burned out during the seven years that he worked in Sweden, adding that if he had been incompetent he would not have been employed there for so long. He claimed that he had a meeting with Swedish licensing authorities before leaving, where they reassured him they wouldn’t take drastic measures like revoking his licence. “But unfortunately, they were not gentleman and correct in their promises,” he said.
While reporters found no evidence of continued wrongdoing by Moskofian, a cross-border investigation found a pattern of doctors who have lost their licenses for serious offenses including patient harm in one country can easily continue to practice in another. Moreover, a doctor’s disciplinary history is rarely publicly available, leaving patients uninformed and potentially vulnerable.
The investigation also found that information-sharing among licensing authorities across borders in Europe was erratic and notifications about bans did not necessarily affect a doctor’s ability to practice elsewhere, or trigger investigations in jurisdictions where they were already licensed.
The European Commission’s Internal Market Information (IMI) system is meant to alert regulators across its 30 member states about disciplinary actions against individuals of some regulated professions.
Reporters obtained anonymised IMI alerts sent on the dates of Moskofian’s revocations in Sweden and Norway through the IMI portal, to which Cyprus as a member state has access – but it’s unclear if the alerts were viewed by Cypriot authorities.
The Cyprus Medical Council did not confirm whether these alerts were received in 2021 and 2022, but in response to a list of questions sent by CIReN in September replied that it “has already started to investigate it and will take all the necessary measures.”
Crossing Borders
The cross-border investigation led by OCCRP, VG in Norway, The Times in the UK, and partners in dozens of countries, including CIReN, confirmed more than 100 doctors who had their medical licenses revoked in one or more jurisdictions for substantial reasons, and are licensed and practicing elsewhere. The majority of the revocations confirmed by reporters involved patient risk or harm.
After revocation, many doctors relocated to a country where, like Moskofian, they held a previous license and resumed practice.
Journalists spent six months digging through public records and petitioning national authorities for information about licensed and banned doctors, and searching the data for cases that could leave patients vulnerable. The information is hard to access in many countries, with authorities often citing data privacy. Detailed information about disciplinary actions was only accessible in the UK, Sweden and Norway.
While Cyprus makes its list of licensed doctors accessible to the public online, there is no way for the public or reporters to find out which doctors have faced disciplinary actions in Cyprus.
In the northern part of Cyprus, despite multiple attempts, the reporters were not able to get information on doctors whose licenses had been suspended or revoked.
According to data obtained from the European Commission, Cyprus only alerted members of the IMI system twice in the past decade. One alert was for a three-month suspension of an ophthalmologist in 2019 for “Substantial reasons concerning the practice of the professional,” which could include misconduct, ongoing disciplinary measures, or a criminal conviction. Another alert was sent out in 2021 regarding a six-month suspension of a plastic surgeon for “other reasons,” which could include administrative reasons, for example, non-payment of professional fees, according to the European Court of Auditors.
The Cyprus Medical Association, which runs the Disciplinary Council, did not respond to questions about doctors suspended or deleted from the license registry.
In June, Cyprus amended its legislation on disciplinary proceedings against doctors, which was published on June 18 in the official gazette of the Republic. The law states that there is no obligation to publish the decisions of the Disciplinary Council. Specifically, the amended legislation stipulates that “the Disciplinary Council shall publish its decisions, or part or summary thereof, on the website of the Cyprus Medical Association at its discretion.” Furthermore, it is left to the discretion of the Disciplinary Council to publish “the name and position of a prosecuted doctor,” for which it invokes the necessity of taking “measures to protect the personal data of those involved in the case.”