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Can a clinician who has been struck off in one country still practice in another? Recent cases suggest the answer can be yes. At the core of the problem is weak cross-border communication, especially limited access to the European Union’s Internal Market Information System (IMI), which is designed to share disciplinary actions among member states.

The most recent example involves Abdel Nacer Alem, a cardiologist struck off the French Medical Council, who was convicted in 2024 by the Judicial Court of Aix-en-Provence in France for sexually assaulting 14 patients in Salon-de-Provence, a town in the Provence region of southern France. He continues to practice in Belgium today, as reported by the daily La Provence and Le Monde.

In fact, in March 2024, Alem appeared in court as a free man. Fourteen women, aged between 47 and 75 years, had filed civil suits. Between 2017 and 2018, Alem had sexually assaulted complainants in his office, where he practiced 3 days a week in Salon-en-Provence.

“All had been referred by their primary care physicians, who recommended the good practices of this cardiologist, now 62 years old, who had no prior record. All reported ‘inappropriate palpations’ of their breasts, on the buttocks, and on the genitals,” reported the daily La Provence.

Alem had made a habit of carrying out these sexual assaults between noon and 2 PM while his secretary was away on her lunch break. 

‘Trajectory of the Arteries’

The cardiologist, to palpate his patients’ erogenous zones, would claim to be following the “trajectory of the arteries” or would speak in medical jargon during his assaults. The investigation began on March 28, 2018, with an initial complaint, followed by many others, all of which described similar incidents: searching for arteries, groping, caressing, ‘forceful, insistent’ gestures on their private parts and breasts, even going so far as to mention possible ejaculations while they had their backs turned, reported La Provence. The disciplinary board of the French Medical Association had decided to strike Alem from the medical register on November 29, 2020. During his trial, Alem, who admitted to the acts, justified them by citing a complicated personal situation. 

He and his wife had, in fact, had to go and retrieve their son, who had left to join the jihad in Syria. They had spent 3 months in the country searching for him, working under extreme conditions. They finally found him, seriously injured, and brought him back to France before he was sentenced in 2015 in Paris to 7 years’ imprisonment for glorifying terrorism, reported La Provence.

Four Years in Prison

The prosecutor had requested a 4-year prison sentence, including 3 years of probation, mandatory treatment, a ban on contacting the victims, and a permanent ban on practicing medicine.

Alem was sentenced to 4 years in prison, including 18 months to be served under electronic monitoring, and a ban on practicing medicine.

Alem nevertheless circumvented this ban by moving to Brussels, the capital of Belgium and a multilingual EU hub. He continued to practice in Belgium every day of the week at two locations. He explained to Le Monde that he had worked only a few days in Belgium, a country for which he had applied for a license to practice just before his conviction, thereby allowing him to provide a criminal record that was still clean. The Iris Sud hospitals, the cardiologist’s public employers, terminated his contract for serious misconduct. The matter was referred to the Belgian Medical Association. The hospital had no indication or legal basis to suspect this situation, said a spokesperson.

Without direct access to the IMI or to ‘checks other than those provided for by law,’ the institution had no grounds to block the hiring, explained Le Monde.

Other Cases

Alem is not the only doctor to have used this subterfuge. Among them is Dr B. This specialist in visceral and digestive surgery was suspended indefinitely for serious misconduct by decision of the French Medical Association — for multiple self-prescriptions of morphine, according to the decision to strike him from the register issued by the Disciplinary Chamber of First Instance of Brittany. However, the French IMI alert from June 2022 went unheeded on the Belgian side. It was never opened, and in January 2024, Dr B was granted a license to practice in Belgium. He revealed nothing about his ban on practicing medicine, Le Monde detailed. Nor did he mention his 3-year suspended prison sentence for involuntary manslaughter in 2015 during a surgical procedure. Alerted by Le Monde, his employer in Belgium — the Belgian social security system, for which he served as a medical evaluator — suspended him pending the conclusions of an investigation by the Federal Public Health Service (the national authority responsible for public health oversight).

A French gynecologist, suspended in France until July 2027 following the death of a newborn for which the Dunkirk (a city in northern France, near the Belgian border) court held him partially responsible, is now based in Wallonia, the French-speaking southern region of Belgium.

France, for its part, also welcomes Belgian doctors who have been disbarred or suspended in their home country, such as Dr O, anesthesiologist and intensive care specialist, who was disbarred in Belgium for serious reasons and now practices in Lille, a city in northern France close to the Belgian border.

The French Ministry of Health noted that only the National Council of the Order of Physicians (which is responsible for the profession’s guiding principles of clinical practice) is authorized to grant or deny permission to practice medicine.

This story was translated from Medscape’s French edition.