News - An Armenian doctor whose license was revoked in Sweden continues to work in Cyprus.

Due to serious violations, doctors who have been stripped of their medical licenses can easily move to other countries and continue treating patients, both in Europe and beyond its borders. This is possible because of inadequate warning systems, the indifference of state authorities, and a lack of accountability. OCCRP (Organized Crime and Corruption Reporting Project) and a number of partners, including Hetq, for months studied public registries and sent official inquiries to national authorities to obtain data about licensed and license-suspended doctors. More than 100 doctors who have been stripped of their licenses but are working in another country were found. In Armenia we did not find such stories, because individual medical licensure does not yet exist, and there is also not enough public data on which a study could be based. Therefore we began to search for Armenian doctors in available foreign databases. Credentials are not a license: how is the quality of medical care monitored in Armenia? The Swedish Health and Social Care Inspectorate (IVO) in December 2021 completed an investigation into the professional activity of Simon Moskofyan at a health care center in southwestern Sweden. Their conclusions were stark: the physician lacks fundamental knowledge in several important areas of medicine, has not carried out adequate medical examinations, and has acted, deliberately or negligently, in violation of rules essential to patient safety. Hetq and the Cyprus Investigative Reporting Network (CIReN) studied Moskofyan's Swedish documents, which describe in detail how he made improper prescriptions during the treatment of 14 patients, and carried out actions, whether deliberately or negligently, that caused complications, including in one case death. From the 14 patient cases, we singled out three: 2018년 September, a 72-year-old patient visited a private clinic to receive a steroid injection for shoulder pain. A few hours after the injection, the patient developed respiratory distress and called for an ambulance. In the hospital, a bilateral pneumothorax was detected, and chest drains were placed. The Swedish Health and Social Care Inspectorate (IVO) writes: 'The medical record lacked information about the injection site, the drug, and the dosage.' IVO concluded that the doctor did not provide the necessary level of safety during treatment. On August 2, 2018, Dr. Moskofyan visited the home of a patient born in 1930 with a nurse. The medical record noted that the patient had prostate cancer and COPD, breathing was shallow, the rate was 48–50, and the patient did not respond to communication. The record states that antibiotics were prescribed via intramuscular injection. The same document also attached a death certificate, but the epicrisis does not indicate that the patient died on the day of the visit. IVO wrote: 'The record does not show that there was a discussion about changing treatment goals or palliative care planning.' IVO concluded that the treatment and the documentation did not meet the requirements. On June 26, 2018, Simon Moskofyan, with a nurse, visited a patient born in 1954 at home. The entry notes a diagnosis of Alzheimer's disease, but there is neither anamnesis nor an objective examination. Medication decisions were made after a telephone consultation with the on-call psychiatrist. In July and August, Moskofyan, without performing any examination or assessment, wrote referrals to the psychiatric department. In September a new referral to the hospital's emergency department was recorded with the note: 'intestinal bleeding. blood transfusion.' The note contains no data about the patient's condition, blood tests, or hemoglobin. IVO noted: 'It is not possible to understand what happened to the patient.' The conclusion states that the patient's treatment and the documentation did not meet professional standards. Based on the review of 14 cases, Sweden's inspectorate concluded that Simon Moskofyan did not meet professional standards and revoked his medical license. After the license revocation in Sweden, Norway also canceled Moskofyan's medical license at the beginning of 2022, but he still has an active medical license in Cyprus and is registered in the Cypriot national health system (GeSY), working at one of the clinics in Larnaca. The Cyprus-based investigative journalism network CIReN reported that Moskofyan said he had returned to Cyprus and started working there in late 2019, 'encouraged by his physician friends,' and not because of the Sweden-based investigation against him. Another reason given for the return was his family: he had lived in Cyprus since he was 13 (since 1972), after moving there from Lebanon, and had received medical training at Yerevan's Mkhitar Heratsi Medical University. He told our Cypriot partner that he had studied in Moscow as well. The doctor asserts that, although he spent seven years in Sweden being 'extremely burdened and tired,' he would not have worked there so long if he could not. He says that before leaving Sweden he met with licensing authorities who 'assured him that the license would not be cancelled.' Moskofyan says the licensing authorities subsequently 'have acted dishonorably and have not kept their promises.' We also tried to determine from Yerevan State Medical University named after Mkhitar Heratsi what specialization Moskofyan had obtained, but the university declined to provide information, citing the Personal Data Protection Act. We also tried to determine whether he has patients in Armenia, but could not confirm any facts. Thus, the investigation reveals systemic problems in doctors' licensing systems: - Many doctors who have been stripped of their licenses for serious violations or for harming patients continue to practice in another country with ease. - Doctors' disciplinary histories are rarely made public, creating an atmosphere of ignorance and vulnerability. - Information sharing among European licensing authorities is irregular; a license cancellation in one country does not always affect whether a doctor continues to work in other countries. The European Commission's Internal Market Information System (IMI) is designed to inform the 30 member states about disciplinary actions. Hetq and CIReN have obtained anonymous notices sent at the time of Moskofyan's license revocation in Sweden and Norway. Since Cyprus is also a member country, it should have access to these notices. However, the Cypriot Medical Council has not confirmed whether it received the 2021-2022 notices, but in response to CIReN's inquiry it said that 'an investigation has already begun and will take all necessary measures.' As of the publication of the article, it is still possible to book a consultation with Dr. Moskofyan.