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March 24, 2009
The Doctor’s World
A Quandary in Sweden: Criminals in Med School
By LAWRENCE K. ALTMAN, M.D.
A year ago, Sweden’s most prestigious medical school found itself in an international uproar after it unknowingly admitted a student who was a Nazi sympathizer and a convicted murderer, then scrambled to find a way to expel him.
It is hard to imagine how the case could get any more bizarre. But it has.
The 33-year-old student, Karl Helge Hampus Svensson, having been banished from the medical school of the Karolinska Institute in Stockholm on the ground that he falsified his high school records, has now been admitted to a second well-known medical school—Uppsala, Sweden’s oldest university.
New twists in his and another case highlight the difficulties that three of the country’s six medical schools have had in admitting and dismissing students with serious criminal offenses in just the past two years. The cases resonate far beyond Sweden, raising fundamental questions about who is fit to become a doctor.
The circumstances of Mr. Svensson’s admission to Uppsala’s first-year class—reported in January by Swedish news organizations—are unknown, because none of the officials involved will publicly discuss his case. He apparently uses an assumed name—a customary practice for Swedes seeking to remain anonymous because of a personal threat. Last week, Uppsala officials, responding to concerns about Mr. Svensson’s admission, said he had not participated in class work, but did not say why.
In another embarrassing twist, a Swedish newspaper reported last month that much of the verdict and court files regarding Bjorn Soderberg, Mr. Svensson’s murder victim, had been cut out or replaced with blank pages. The police said they had been unable to find a culprit.
And in still another case, a 24-year-old medical student at Lund University was convicted last April of raping a 14-year-old boy while he slept. A district court sentenced the student to two years in prison, but a higher court reduced the sentence to two years’ probation and medical therapy.
When the dean at Lund sought to expel the student, a national board that reviews expulsions blocked the action, saying that although the man had committed a serious crime, he was not considered a threat to people or property. The decision was then reversed by an administrative court, which upheld the expulsion; the student did not appeal.
In contrast with the United States, Swedish laws and customs are sympathetic to released offenders, saying that once they have served their time they should be treated like ordinary citizens. But the cases raise questions about protecting the rights of patients and fellow medical students and health care workers.
Entry to Swedish medical schools is highly competitive. At Uppsala, for example, a spokeswoman said there were 2,603 applicants for the spring semester and just 100 admissions. They include Mr. Svensson, who is taking up a taxpayer-financed slot that could have gone to another student.
Indeed, the Uppsala County Council, which runs all government health facilities in the area, says it will not allow Mr. Svensson to do any clinical work, which is a critical and mandatory part of medical school training. That raises questions about how he will complete a degree even if he does attend classes.
Mr. Svensson, who has not responded to numerous attempts to reach him over the last year, was convicted in the 1999 hate murder of a trade union worker and was paroled after serving 6 ½ years of an 11-year sentence—a typical penalty for murder in Sweden. He entered Karolinska in fall 2007 while still on probation; he had earned credits for medical school while in prison.
The disclosures about his past proved deeply embarrassing to the institute. Among other things, two senior faculty members on the admissions committee that interviewed him failed to ask for an explanation of the six-and-a-half-year gap in his résumé, the period he was in prison.
Swedish universities are legally prohibited from conducting background checks on applicants. To complicate matters, Mr. Svensson legally changed his surname from Hellekant after his conviction.
In the United States, the chances of a convicted criminal’s being admitted to medical school were reduced in 2002, when the Association of American Medical Colleges’ standard application form began requiring answers to questions about felony convictions. In 2008, questions were also added about military discharge history and misdemeanor convictions.
Since Mr. Svensson had done nothing wrong in medical school, Karolinska officials said they were powerless to expel him until they discovered his falsified records, blaming the Swedish agency responsible for checking the validity of educational records.
The Swedish medical licensing agency said that it would not allow Mr. Svensson to practice even if he earned his medical degree. But because the agency’s jurisdiction excludes universities, questions arose about whether and how medical school officials should inform patients examined by Mr. Svensson about his criminal past, and what the patients’ responses would be.
Now Uppsala has declined to say whether its admission committee interviewed him or knew of his criminal past. Nor is there a public explanation of how he earned any high school credits he may have been lacking in the relatively short period since his expulsion from the Karolinska.
Last year, Karolinska officials, acting in part on a committee’s recommendation, exhorted the Swedish parliament to enact legislation to allow medical schools a freer hand in admitting and dismissing students in cases where they would have patient contact.
But little has happened.
Sweden’s medical student association is divided about whether a convicted murderer should ever be allowed to become a doctor.
The president of the student group, Yosef Tyson, said his colleagues have been annoyed about the very limited journalistic coverage of the cases and the complexities of the issues in training doctors.
“The problem is not that he’s been accepted again; the problem is that nothing was done about this a year ago,” Mr. Tyson said in an interview. “Everyone is in limbo.”
Mr. Svensson’s case has raised the question of whether Swedish universities should now be allowed to require criminal records as part of a background check of applicants. While such requirements are rare in Sweden, they do exist for prospective teachers of young children and for applicants to private companies where personal security is important, like taxi services.
Another concern is the threat he might pose to patients who are immigrants, or their families—long a target of neo-Nazi vilification. Even as a student, he will have access to electronic medical records, which could potentially be misused.
In a group interview, five upper-level Uppsala medical students criticized the university for not holding an open dialogue about Mr. Svensson’s case, and they worried that the affair was harming their school’s reputation—and, by extension, theirs.
“Not talking to us, telling us, creates a lot of talk and rumors, when we should be focusing on school,” said one of the students, Jessica Svefors, 25.
Pontus Andren, 23, said the issue was one of trust. “If a rapist or a murderer with neo-Nazi motives can study to become a doctor, that causes a crisis that affects the entire medical profession,” he said. “When you arrive at a hospital or an emergency room, you might not be alert or even conscious as a patient, and that puts you in a really vulnerable position.”
But another Uppsala student, Karl-Wilhelm Olsson, 23, said that “the important factor is whether a person is a risk to another human being, and it’s hard to draw a line.”
He added that while there is no law requiring a university to bar prospective students because of a criminal past, “a student should be expelled if he or she is viewed as unfit.”
But Gustav Stalhammar, 25, said Mr. Svensson should be allowed to become a doctor. “Who is to say that he might not become a great doctor, even if it in some ways would feel wrong or awkward to have a murderer for a colleague?” he asked. “It is not fair to have preconceptions about his character.”
Still, the five students said they were upset because they had not had a chance to meet Mr. Svensson and judge his motivations. And they are concerned that he has not publicly expressed regret for his crime.
“A convicted murderer is a risky candidate for the job, especially if you haven’t been able to ask him why he wants to become a doctor,” Mr. Andren said.
Ms. Svefors said the issue went well beyond the Svensson case. “I am upset that nobody’s done anything with this issue, that no one has shown civil courage to expel him, that those who have power to do something are just trying to hand off the problem to someone else,” she said. “This is hurting our reputation as future doctors.”
Majsan Boström contributed reporting from Uppsala, Sweden.