The Irish Medical Council turned down an offer of advice from the former president of the Royal College of Surgeons Ireland Medical University Bahrain, Professor Tom Collins, just weeks before the council's controversial decision to grant full accreditation to the training college's medical courses, according to new documents seen by RTÉ's This Week.
Prof Collins had previously expressed serious concerns over the freedom of medics and academics in the country from state and military influence, which had led to his decision to quit his post.
Documents obtained under Freedom of Information by the Global Legal Action Network (GLAN), a group of lawyers and human rights activists, and shown to RTÉ, reveal that Prof Collins offered to provide a briefing to the Medical Council directly, or to the members of an accreditation team which it sent out to inspect the facility's medical courses in October 2014, but that offer was rejected.
The IMC later voted 10-7 to grant accreditation to the RCSI-Bahrain, with one member, Dr Ruairi Hanley, who repeatedly opposed the granting of accreditation to the RCSI Bahrain, raising concerns in official minutes that the move could give "legitimacy" to the Bahraini monarchy, who violently suppressed protests in March 2011, and which has been accused of the violent mistreatment and subsequent imprisonment of some doctors who provided care to protesters.
Speaking on RTÉ's This Week, Prof Collins confirmed he had made the offer, and said he was "surprised, and continue to be surprised" at the IMC's decision not to hear from him.
He said he had major concerns over medical freedoms in Bahrain, where he said the military and security apparatus of the regime had a direct input into the public hospitals which RCSI Bahrain was working alongside, in the delivery of clinical and academic training.
Asked whether he was reassured by the fact that the Medical Council met with students and medics in confidential meetings as part of its field trip to Bahrain, he said "no, not at all".
He said the freedom to speak out in Bahrain was in doubt.
He said there were questions over the level of influence which the military and security forces in Bahrain had over public hospitals and healthcare delivery, which raised major ethical dilemmas for medics.
In 2011, a report by an independent Bahraini inquiry team, called the BICI report, heard widespread accounts of protesters and medics being mistreated at some public hospitals, and in some cases protesters from the majority Shia community either tortured or denied care on the instruction of security forces loyal to the Sunni monarchy.
Numerous doctors have been imprisoned in Bahrain, including Dublin-trained Dr Al Ekri, who was jailed after giving an interview to Al Jazeera which was critical of the regime. Another doctor who was also given a lengthy sentence for criticising the system was Dr Nada Dhaif.
She travelled to Dublin in 2012 to speak to NGOs and outlined her experience, in which she said she was detained for two months, tortured by electrocution, beaten, and threatened with rape if she did not sign confessions.
Dr Gearóid Ó Cuinn, of the University of Lancaster Law School and director of GLAN, said the IMC's interpretation of its statutory guidelines mean that the issues it considered were too narrow and did not take sufficient account of major human rights issues.
Dr Ó Cuinn said just weeks before the IMC's visit to Bahrain, a patient at one of the hospitals was arrested and charged with defamation for a tweet which criticised one of the facilities.
In response to a series of questions from RTÉ, the Irish Medical Council said its role was "determined by statute, and we must operate in line with a strict legal framework. The Medical Council has raised concerns through political channels about allegations of human rights abuses in Bahrain, which is our only means to do so".
With respect to the issued it considered as part of its assessment of the RCSI Bahrain, the IMC said: "our role in education and training is to accredit medical education and training programmes and the bodies that deliver them.
"It would be outside of our legal remit both within Ireland and overseas for those decisions to be influenced by factors unrelated to the specific medical school or programme seeking accreditation."
The IMC added that the accreditation of the RCSI medical school in Bahrain was a process which was "conducted in line with international best practice and in accordance with the strict parameters of the Medical Council's role in this area.
"A strict and transparent procedure was adhered to throughout the accreditation process and it is not, nor has it ever been the practice to interview former heads of schools as part of this process. Pertinent submissions from external parties were considered by the accreditation team and the Council, including a report from Ceartas on human rights in the country".
"In looking at the factors affecting medical education and training, the accreditation team found the internationally accepted criteria for accreditation were met. Before the accreditation team's recommendation was endorsed by the Council, in line with the legal process, the Minister for Education and Skills was consulted.
"The report was published on the Council's website in December 2014 to clarify the reasons for the decision and to ensure transparency for the public and interested parties. In addition, the report was sent to the Joint Oireachtas Committee on Education and Social Protection for its perusal," the IMC statement said.