The president of the High Court has expressed concern about how a doctor who mistook an ankle for an elbow in an X-ray could have been employed in three Irish hospitals.

Mr Justice Peter Kelly made the remark when dismissing an appeal by Dr Omar Hassan Khalafalla Mohamed (30) against being struck off the medical register for professional misconduct and poor professional performance.

Describing Dr Hassan as having “sub-standard medical knowledge”, the judge said he could not understand how the doctor found himself on the medical register in the first place, apart from the fact he obtained appointments in three different hospitals.

The judge noted the Irish Medical Council (IMC), which had recommended the erasure of Dr Hassan’s name from the register, had expressed similar concern in its report.

The IMC made the recommendation after a Fitness to Practise Committee earlier this year found Dr Hassan guilty on multiple grounds related to his conduct and performance.

After the judge confirmed the striking off order, Dr Hassan, who qualified in Sudan, said: “For me it is meaningless.”

When the judge ordered him to pay the costs of the legal action, Dr Hassan said he did “not believe in the integrity of the procedure”. He also said he did not believe it was a fair decision.

In his appeal to the court, Dr Hassan argued, among other claims, he should not be struck off because the evidence against him did not meet the required standard.

He also said the complaints against him should never have been referred to the Fitness to Practise Committee because they were not of a serious and grave nature.

Mr Justice Kelly said the Committee had made its findings after hearing 30 witnesses over 11 days. It had met the criminal standard of proof – beyond a reasonable doubt – in making its findings, he said.

It would be difficult to consider the complaints were anything other than of a grave nature, he said.

Burn injury

Among incidents which happened in the Midland Regional Hospital Portlaoise, Mayo General, and Galway University Hospital between 2012 to 2014, Dr Hussain, while performing a gall bladder-related procedure, stood on the pedal of an electrosurgical machine, which was not in use, and caused a burn injury to a patient, the judge said.

In another, he attempted to insert a needle into a patient’s arm on a number of occasions, causing her pain, even though the procedure was not necessary.

While senior house officer in Mayo General, Dr Hassan had, on one occasion, failed to provide assistance to an intern who was dealing with a patient experiencing an upper gastrointestinal haemorrhage

In an incident in the Galway hospital, he failed to attend in a timely manner, or at all, to review a patient, who had presented in significant pain with an ankle fracture.

Some time around February 17th, 2014, during a trauma meeting/teaching session in Galway, he misidentified an X-ray image of an ankle as being one of an elbow.

He was also found by colleagues to act in a bizarre way and to be aggressive and confrontational both to colleagues and patients.

The court previously heard Dr Hassan had complained about his treatment at the public inquiry and threatened in correspondence it “will be fully paid for at an extremely bloody price for the people involved worldwide”.

He also wrote there would be “a grave response from me and my family side to these events outside court and not necessarily in Ireland”.

On that occasion, Mr Justice Kelly said he was glad to know the IMC had informed gardaí of the threats.