How to prevent the derailing of doctors? Lessons from the case Jansen Steur
Today, the district court of Overijssel sentenced Ernst Jansen Steur (68) to three years imprisonment. The former doctor was charged for various forms of professional misconduct.
In the period 1997-2004, Jansen Steur was working as a neurologist in the Medisch Spectrum Twente (MST) hospital in Enschede, a city in the vicinity of the Dutch-German border.
For a long time, the concerns about Jansen Steur’s conduct remained concealed or, at best, went unnoticed. Due to problems with his direct colleagues, he was allowed to work in splendid isolation and complaints about him were not handled properly.
In 2004, the Board of Directors of the MST eventually forced Jansen Steur to give up his position at the hospital. It decided not to give any publicity to his case. Instead, Jansen Steur received € 250,000 by way of compensation and he was able to continue his work elsewhere. It was only in 2009, that his alleged professional misconduct came to light and became the object of various investigations. As a direct result of this disciplinary and criminal procedures were started.
Jansen Steur is, in current terminology, a painful example of a doctor not fit to practice. This irrespective of the fact that Jansen Steur was internationally renowned for his groundbreaking research in the field of Alzheimer’s, Parkinson’s and Multiple Sclerosis. Today’s verdict, however, shows that others failed to intervene in an early stage to prevent him from derailing and from posing a risk to others and himself. And these risks can hardly have been underestimated, as is demonstrated in the decision of the court. The Overijssel district court found Jansen Steur guilty of misdiagnosing patients with serious diseases as well as physically and mentally maltreating them, resulting in one patient committing suicide. The district court further held that Jansen Steur had stolen prescription forms, committed forgery and was drug dependent.
The assessment the district court made of Jansen Steur’s fitness to practise is totally in line with the decision of the Zwolle regional disciplinary court of late 2013. This body, consisting of doctors and lawyers, found that it was ‘irresponsible’ to allow Jansen Steur to continue to work as a physician. It struck off his name from the professional register. As a result of the latter, he is no longer entitled to pursue his work as a doctor – not in the Netherlands nor anywhere else in the European Union, since doctors are a so-called registered profession under EU law.
In retrospect, we all know that Jansen Steur was not hindered to continue working as a neurologist after having to leave the MST in 2004. And so he did. He subsequently worked as a neurologist in private clinics in Germany, at least until 2012. There he may have posed other patients at risks as well. This demonstrates the need to intervene, in cases of first symptoms of ‘problem behaviour’, as quickly as possible and to work closely together with health and registration authorities in other countries to prevent the migration of problem doctors.
How can we achieve these goals?
First of all, fitness to practise is not merely an individual responsibility. In case peers get signals that a colleague may encounter problems in performing his or her job safely, they should not hesitate to express their concerns with the person concerned. Such feedback should not be perceived as negative criticism, but reflects the collective responsibility of all health care providers for the quality and safety of health care.
If a doctor encounters, or is found to encounter, functional problems then the doctor concerned should be encouraged to undergo training. The type of training to be followed depends on the type of functional problems at stake, which may range from a lack of medical knowledge or practice, to being unable to properly communicate with problems, not being able to work together with others and mental health problems. Doctors undergoing training, aimed at keeping them on track, should be practically and financially facilitated to maintain the required level of skills, by not having to take vacation or lose their income while undergoing training.
Another important condition to prevent an impairment of the fitness to practise is by organising annual appraisals and regular revalidations. These and more efforts should primarily be aimed at keeping doctors on the right track to prevent them from derailing. Doctors who, partially due to a lack of interventions by colleagues and others, eventually become unfit to practise not only pose great risks to patients, but also undermine the public’s confidence in the health care system.
Last but not least, the Jansen Steur case demonstrates that international collaboration in the field of health care is not a luxury but an urgent need. It is inconceivable that a doctor, forced to leave his own hospital due to functional problems, can without any hindrances continue to practice a few kilometres further in neighbouring countries without anyone being aware of this. In this respect, national health and registration authorities should adequately inform each other about the track record of doctors considering to establish themselves in another country.
The good news is that professional groups as well as national health and registration authorities are aware of their responsibilities to guarantee fitness to practise. During the last few years, various promising and ambitious plans have been made. These now need to be implemented, both nationally and internationally, with an important role to be played by the European Union. Our health is too precious to allow doctors unfit to practise to derail.