Thursday 21 May 2015

What we can learn from the case of Victorino Chua

Hi guys, I don't know if you guys have all read about this story of a Filipino nurse Victorino Chua in the UK who has been found guilty of murdering two patients and poisoning another 20.  It was a case that stunned the nation as Chua had no real motive to kill his victims - they were just innocent patients who happened to have been in the ward where Chua worked. Chua has just been sentenced to a minimum of 35 years in jail for these murders. Investigations into the case has uncovered a thriving industry of fake documents in the Philippines whereby anyone could purchase a fake diploma or degree for a small fee. This of course, will sound way too familiar to my Singaporean readers who have been complaining about the way there are many foreigners with fake degrees working in Singapore. What lessons can we learn from the case of Victorino Chua then? What can we do to prevent something like this from happening again?
1. Gatekeepers need to take far more responsibility

As a former gatekeeper, I did take my job very seriously but I have never ever asked to see someone's degree - be it a photocopy or an original. Quite simply, I know that I can interrogate someone during an interview to uncover just how much s/he knows and that is a far safer way for me to test the person's knowledge. Given the very high quality of some of these forged degrees, it would be very difficult and time consuming for me to try to check if that certificate presented to me was authentic or not - but at least I can test to see if the person does have the necessary knowledge and skills to do the job by subjecting him/her to intensive questioning and tests. Given the intense competition for jobs these days, I have to reject quite a high number of applicants who probably all have genuine, authentic qualifications.

Might there have been a possibility that I had once allowed someone with a fake degree past me as a gatekeeper? Yes, that is entirely possible - but that then reminds me of the case of American forger and conman Frank Abagnale (you might have seen the film of his life Catch Me If You Can). I say, if you can get past me, convince me that you have the right skills without actually having completed the degree you claim you have, then I concede that you deserve the job because there have been so many people who are armed to the teeth with genuine qualifications who have failed to convince me that they are good enough for the job. Now, you may question my stance on this issue - but I simply have to assume that the degree could well be a forgery so I will always test the candidates very thoroughly.
Can you spot a forged degree?

In the case of Chua, I wonder if the NHS (his employers in Manchester) actually tested his skills as a nurse, if there was any doubt about whether he was genuinely trained as a nurse. The investigations did uncover evidence that Chua did attend a nursing college (which has since closed down) in the Philippines at some stage, but it was clear that his degree was forged. If it was indeed the case that Chua was no more than a nursing college dropout rather than a qualified nurse, why didn't his employers pick that up either in the interview process or when he was working as a nurse? Didn't any of his supervisors spot the gaps in his knowledge or was he not sufficiently supervised by his line manager? How was Chua managed as an employee in the hospital? It seems appalling that Chua was simply able to slip through the net because he was able to present a very well forged document - his line managers at the NHS have not been doing their job properly. (And if Chua did not have any gaps in his nursing knowledge despite not having passed the necessary exams, well, then the forged degree was not relevant to his murderous intentions.)

2. Mental health issues are neglected by employers

I refer you to the recent case where Germanwings co-pilot Andreas Lubitz deliberately crashed a plane into the French Alps, killing all 150 on board. Lubitz was a German citizen who was born and bred in Germany, he flew for a German airlines - so it was never an issue of Germanwings hiring foreigners with fake qualifications: all of Lubitz's qualifications was 100% authentic and he was properly trained to do his job. It just so happens that he had serious mental health issues and was clinically depressed and suicidal. His employers failed to notice just how badly Lubitz's state of mental health has deteriorated and allowed him to keep working when really, he should have been put on sick leave because of his depression. But no, Lubitz's employers didn't pay attention and the consequences were disastrous and tragic.
The NHS has a pretty poor reputation for the way their workers are treated - hospital staff have very long hours and are subject to a lot of stress. It is for this very reason that we have a chronic shortage of nurses in the UK and are forced to recruit nurses from countries like the Philippines to meet the demand. Many locally trained British nurses and doctors end up working either in the private sector or in places like Middle East or Australia, where working conditions are better and they get paid more. Chua had been working with the NHS since 2003 - he was only arrested in 2014, so there were plenty of opportunities for his employers to spot the tell tale signs of Chua becoming a killer. In a confession, Chua wrote, "They thought I’m a nice person but there a devil in me. Inside of me I can feel the anger that any time it will explode.” Chua wasn't a killer when he first arrived in the UK in 2003, he was just a Pinoy looking for a better life in a richer country; but something happened along the way which turned him into a killer by 2011 and as in the case of Lubitz, none of his employers noticed. We need to recognize the role of mental health in these cases.

3. Murderous intent vs sheer incompetence

Please note that Chua's victims didn't die as a result of Chua's inability to care for them as a nurse. Rather, they died because they were deliberately, maliciously murdered by Chua in cold blood. This is very similar to the Germanwings case, whereby the plane didn't crash as a result of Lubitz's inability to fly that plane, rather, it crashed because Lubitz deliberately brought it down with the intention of killing everyone on board. Hence, the fact that Chua may have forged his documents is actually unrelated to the murders that he has committed. The fact that Chua had committed a crime of forgery is totally unrelated to the fact that he killed two people and tried to poison others. Compare this to the case of Marie Ratcliffe, the British midwife who was so terribly incompetent that she had caused the death of up to 11 babies - now unlike Chua, Ratcliffe had no intent to kill or harm anyone, she was just utterly incompetent at her job.
4.Let's not give in to xenophobia

The British health system (NHS) would not be sustainable without the very large number of foreign nurses, doctors and other medical professionals employed in the system. The problem here is not so much the fact that foreigners are employed, but rather, it is the regulation of the system: ensuring that there are proper checks and balances. All records of qualifications and work experiences should be properly verified and even after that, the new member of staff should be subjected to further tests if necessary. And when these new workers start work in our hospitals, they need to be carefully monitored by their line managers to ensure that they are definitely able to do the job. The solution is to improve the system - not to chuck the baby out with the bath water by banning all foreigners from working in our system just because of one case like Victorino Chua. If a Filipino (or Indian etc) national does have the right qualifications to find a job abroad, then s/he should not be subject to discrimination and each case should be judged on the basis of merit. Racism or xenophobia certainly will not solve the problem.

5. What needs to happen next? 

Singaporeans have talked about rejecting graduates from unaccredited universities (aka 'degree mills) or even those from universities ranked at the wrong end of the local league tables. That will not solve this problem per se: those Filipinos who are determined to seek work abroad will simply forge a degree from a better Filipino university or a foreign university. Given how good the forgers in Manila are, they can even forge you a very authentic looking degree from Oxford or Cambridge or any other prestigious university in the world. An online degree from a degree mill is no better than a forged degree: having said that, it only takes a moment to check the status of degree mill university on google whilst it can take a lot more time and effort to verify a very authentic looking forged degree from a respectable looking university. I can see why some Filipino would forge a degree just to get a work permit to escape the poverty in the Philippines - as to why anyone would be dumb enough to get a degree from a degree mill, that's beyond me!
It is not hard to spot a degree from a degree mill...

This is why you need good gatekeepers who will be able to test each candidate's subject-specific knowledge to check if the candidate is indeed as qualified as s/he claims he is. This is why the interview process is so incredibly important particularly in these cross-border recruitment schemes: if the NHS wants to continue recruiting nurses from places like the Philippines, Romania or India, they must spend sufficient time interviewing and testing these nurses thoroughly before even allowing them to get on a plane to London. Even if you were to ban all foreign nurses and doctors, it still does not eliminate the risk of such cases happening again: English nurse Beverly Allitt is currently behind cars serving a 30 year jail sentence for having murdered four children and the attempted murder of another three. English doctor Harold Shipman was a notorious serial killer who murdered 15 of his patients - he killed himself whilst in jail in 2004. Please note that both Allitt and Shipman are both as English and local as they come: Allitt is from Lincolnshire and Shipman was from Nottinghamshire - both in the East Midlands in England. Oh there are plenty of notorious killers and murderers in the UK - let's not pretend that the only criminals and murderers here are foreigners. The problem is not foreigners working in the NHS, the problem lies with the way staff are recruited and managed in the NHS.

That's it from me on this issue. Let me know your thoughts on the issue, leave a comment below. Thanks for reading!

13 comments:

  1. Well getting a diploma/degree online from a degree mill, to me, is certainly better than forging a certificate. The consequences that one have to face once they are found out is tremendous.

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    1. Well Dakota, the difference is that buying an online degree from a degree mill isn't illegal at all. You and I can buy a few today just for fun and we wouldn't be breaking any laws at all. And if you managed to get a job based on those online degrees, then that's the fault of the gatekeeper giving you the job - you've done absolutely nothing wrong. Forging a degree however, is completely illegal - it is fraud: you are attempting to convince the employer that you are a graduate of a university when you have never ever passed the exams of that university

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    2. Hi Alex, I believe Dakota was suggesting just that. In Singapore, buying an online degree from a degree mill will not result in legal actions. The employer can simply just choose to ignore it or fire you but you will not face legal action. If it is a forged degree, then it becomes a legal case and the one who got charged and declared guilty by the court for using forged documents will be banned from getting employment in Singapore, finito. Either way, the gatekeeper and interviewer certainly need to have a very good working knowledge in knowing the skills that are required in the candidate they intend to hire.

      Interesting that you mentioned that the fake nursing training for Victorino Chua actually bore no relation to the fact that he killed his patients. It certainly was not that he was incompetent but that he simply had gone over the cliff mentally. Excellent take on that.

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    3. Certainly, there have been huge failings on the part of the NHS is not having managed Chua properly. If it is indeed true that he didn't complete his nursing training, then woah, he managed to learn very quickly along the way to convince everyone that he was at least able to do his job.

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    4. LIFT: Or he could be a professional trickster like this guy:
      http://www.nbcnews.com/id/40630166/ns/health-health_care/t/fake-doctor-duped-hospitals-universities-ama/#.U2EzuvldWLg

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  2. I wonder, is it really possible for gatekeepers and employers to efficiently evaluate the mental condition of job applicants and employees? Even picking up warning signs from colleagues we meet every workday might prove difficult. After all, the more highly intelligent a person is, the more likely they are to be able to smile and talk their way around things and even convince themselves that everything is alright even though their subconscious is screaming otherwise. Maybe the possibility of running into insane people with evil intent is something we just have to live with in modern society where by and large most services are provided by complete strangers.

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    1. Hi XM, good question. I think there is a difference between the responsibilities of gatekeepers and line managers: for a gatekeeper, the amount of time you spend with a candidate is rather limited and most of your effort is spent on the testing process. Does the candidate possess the right skills to be able to do the job? One does not really have enough time to test the candidates' mental health and we barely have enough time to evaluate their skills.

      Line managers, however, are a different matter. I have worked with people who are clearly mentally unstable - they are either mentally fragile, or volatile (this crazy woman would burst out screaming or crying for no good reason and everyone was scared of even talking to her just in case they end up in the line of fire) and the line managers in this case have a lot to answer for: I remember once that crazy woman starting screaming and crying at work for no good reason and a group of us were like, oh shit what do we do? And even the line manager just said, "leave her alone, let her calm down" and I was like, yeah but we have work to do .... In the case of Lubitz or Chua, maybe the warning signs were less obvious but even when warning signs are very obvious, some lousy line managers often just look the other way and say, "I can't handle this - if I close my eyes, I can pretend I didn't see that." This is why I think we need legislation to force employers to take more responsibility over such issues - because the consequences can be very tragic if someone like Lubitz or Chua slips through the net.

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  3. I think that your entry makes a defense clearly for the case that a person's qualifications (or lack thereof) are not necessarily related to his or her committing of a crime, especially when it comes to something in the moralor ethical department such as poisoning someone. Ouyang Xiangyu is an example that comes to mind, because she simply did a few rather unthinkable things against other girls, especially those of the same national origins as her, although she was clearly in the know that these were objectionable acts that could be persecuted legally and were potentially dangerous. Her education in university (in Imperial College, London, and in Singapore during JC days) certainly did not teach her morals or ethics, and were more of programs teaching her how to process knowledge and facts at the most.

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    1. Well in the case of Ouyang, she was still a student - she wasn't working: but she still had the equivalent of some kinda supervisor at her university who really ought to have monitored her behaviour/progress/well-being?

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    2. Yes, from an academic perspective, her supervisor ought to have played a role in terms of coming in between any potential conflicts between her and other team mates or lab mates, to defuse the tensions, and also, to advise her accordingly in situations when she could not handle the stress and was about to reach the point of "flipping the switch" (I am using that term from "The Vampire Diaries" when vampires turn off their humanity and then go on some blood-sucking rampage as they will without a conscience). The fact that her supervisor did not do so points to a few things potentially: 1) her supervisor was not guiding her properly and giving her way too much leeway; 2) she was not enjoying a relationship of open sharing with her supervisor in giving feedback about her stress and relationships with others in the laboratory. I used to have an adviser and she played many roles in advising me throughout my PhD, especially during my candidacy examinations and my thesis writing and defense, and her role extended beyond that of a teacher or instructor. Of course, her role was also supplemented by other (2 to 3) professors in a complementary capacity as part of the supervisory committee. That is at least the setup within the Canadian and North American (including the USA) systems, and I assume that Stanford U would not have been any different.

      If Ouyang Xiangyu is not giving any feedback about her stress and her inability to cope at the lab, there are various possible reasons which I will not speculate about, one of it being the Chinese tendency to stick around in one's own enclave and refuse to mix around with people from other cultures. It is largely a "one man/woman for himself/herself" mindset, and might be the main reason why nobody was perfectly aware of the tensions boiling over into this series of situations of attempted poisoning and sabotage. The North American educational system (in the US and Canada) has always prided itself on transparency of process with regards to the review of students' potential performance in graduate school (with extensive reviews and reports during stages such as the candidacy exams, and I was able to gain access to what professors--internal and external--thought of me and my work throughout without fail). At that stage of graduate school in North America (the PhD), you are regarded almost no differently from someone in academia such as say, a post-doctoral or junior colleague who has already obtained his or her PhD years ago, and the expectation is simply that you are already entering the profession (but are merely entering a protracted "grooming process" via collaboration with peers and guidance by your adviser)--GRADUATE SCHOOL IS NOT STUDYING BUT WORK, so to say, in that setting. I was in fact quite surprised that she just turned to doing those things and with the silly sustained attempts at poisoning, I mused that maybe there were more deep-seated personal reasons such as animosity between her and her female lab peers over their personal and social lives.

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  4. Isn't it rubbish? I have to pay close to $60k and spend 3 years to get a qualifying healthcare certification while those from certain developing countries (who i shall not name since we all know where) can pay a token sum to degree mills to get a paper certification and start work immediately.

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    1. Choaniki - they've improved the system whereby qualifications are subject to a lot more scrutiny before they are recognized and a job permit is issued. Chua came to the UK way back in 2003, when a photocopy would do, yeah that's right, a PHOTOCOPY. Geez.

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  5. mental health systems all over the world....have a lot to improve on.....
    1. UK-acute shortage of beds, long average waiting time
    2. US-mentally ill people get into trouble with the police, some of them have to stay in jail
    3. China-people are afraid to seek help
    4. Serbia-mentally ill people are ill-treated and locked up
    The mental health system in Singapore is no better either. It is best not to be in a position where one needs mental health help. People act like the mental health system in Singapore is good, but it stinks like shit too.

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