Doctor told medical student in Fife hospital his next patient ‘sounded like they worked for Al Qaeda’

A locum ear, nose and throat doctor told a medical student at a Fife hospital that the next patient on his clinical list “sounded like they worked for Al Qaeda” – in one of several remarks he made which amounted to serious misconduct.

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Dr Nikolay Tsakov also told the student that he showed a photograph of himself holding an air gun to patients and laughed about doing so, and attempted to make reference to a joke about oral sex made by British comic character Ali G.

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The incidents, which happened at Kirkcaldy’s Victoria Hospital in November 2016, were admitted and found proved at a Medical Practitioners Tribunal Service (MPTS) hearing which concluded his fitness to practice was impaired by reason of misconduct.

The remarks were made at Kirkcaldy's Victoria Hospital in November 2016. Pic: Jamie Callaghan.

In assessing his behaviour in relation to the oral sex remark, the tribunal accepted Dr Tsakov may have been trying to explain how diseases like candida – which causes thrush – can be transmitted through the mouth but added: “The tribunal accepted his evidence that he was embarrassed to use the term oral sex and attempted to “crack a joke”, referencing a joke from the comedian Ali G. Nonetheless, the tribunal considered Dr Tsakov’s remark to be sexualised and vulgar.”

The tribunal also noted there was a “significant power imbalance” between the doctor and the young medical student and said such remarks are capable of creating the impression he “disrepspects and overly sexualises women.”

The report added: “The tribunal therefore determined that Dr Tsakov’s actions with regard to this comment amounted to misconduct that was serious.”

In relation to the Al Qaeda comment, the tribunal found it would give patients and the public an impression that people from particular backgrounds are not respected in a clinical context.

The tribunal made no finding that the doctor holds any racial prejudices or was motivated by malicious intention - but decided the remark fell “far below the conduct expected of a doctor” and deemed it to be serious misconduct.

The doctor also told the medical student he had been in trouble for making inappropriate comments previously and had completed a course to be “more PC.” The tribunal found this remark to be “foolish” but did not view it as misconduct.

Other incidents

The report also detailed a number of other allegations admitted by Dr Tsakov and proved while he worked in other areas of the UK.

While working as a locum at North West Anglia NHS Foundation Trust in October 2017, Dr Tsakov admitted saying to a pregnant colleague: “Is that what happens when you sleep with no knickers on?”

The following month at the same health trust, he admitted showing two colleagues a picture on a computer showing several naked women on top of each other with their legs open and genitals visible.

And in his time working at Northern Health and Social Care Trust in Northern Ireland in December 2017, he admitted showing two colleagues a picture of a toy rabbit with an erect penis on his mobile phone.

It was also found proved he used clinic time to make personal travel arrangements, causing delays to patients.

While working at the Rotherham NHS Foundation Trust in 2018, he was also found to have told a healthcare assistant that she reminded him of “a German Nazi with blonde hair and green eyes.”

He also admitted ignoring requests from a colleague not to use a syringe because it was not sterile for use.

And on one occasion he admitted attempting to remove grommets - a small medical tube - from a patient’s ear by shaking their head “vigorously from side to side.”

But the tribunal found that a conditions of practice order was a “sufficiently restrictive sanction” to protect the public, in particular his colleagues, from any repetition of his misconduct.

The tribunal accepted he had apologised for his behaviour which he himself described in evidence as “disgraceful” and “outrageous.”

Dr Tsakov, whose primary medical qualification is listed from 1999 as a physician at Medical Academy Sofia in Bulgaria, properly resumed work in January this year under close supervision with chaperoning, having not worked for a large period of time since February 2019. The report said he now works as a locum registrar in Princess Alexandra Hospital, Harlow.

Supporting evidence was also received by the tribunal from other colleagues and patients. Documents were also submitted demonstrating his remediation, including certificates of courses he had completed including one focused on maintaining professional boundaries.

Dr Tsakov had a previously unblemished professional record with no prior fitness to practise findings against him.

The MPTS also noted he has been adhering to conditions since the start of the year and found his misconduct not malicious but more the “result of clumsiness and insensitivity.”

The tribunal determined Dr Tsakov’s fitness to practise is impaired and imposed conditions on his registration for a period of 12 months. It also directed a review hearing should take place.

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