If you can't trust a doctor, who can you trust?
It's a fundamental question that now torments Ryan – one of two young males who alleges he was sexually assaulted by a doctor while a patient at Naas General Hospital.
In October 2010, the then-20-year-old went to the hospital suffering with severe anaemia.
Ryan, who asked RTÉ Investigates to use a pseudonym to protect his identity, was so ill that the medics he first met there were surprised he was able to even walk in the door.
"They said that, had I left it any longer, I would have been dead," he said.
For the next several days, Ryan received multiple blood transfusions, leaving him exhausted and confused. He recalls simply wanting to get well again so he could go home.
Ryan was placed under the care of a medical team – one of whom was Dr Pathmadevan Rathnam. From Malaysia, Dr Rathnam graduated in medicine from the National University of Ireland in 2008.
When Dr Rathnam first called to see Ryan during the night when he was asleep, long after the ward's lights had been switched off, the encounter was not what Ryan expected.
"He woke me up and said, 'I need to just do an examination'. And he said, 'I need you to slide down your trousers and underwear, I need to examine you below'. And I thought, 'okay', because I was complaining of stomach pains and pain in my groin, so I thought this was all normal, it is just routine."
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Years later, Ryan still finds the incident difficult to talk about.
But, in a statement he subsequently provided to An Garda Síochána, Ryan managed to detail what he says happened next: "I slid down my pyjama bottoms and underwear and then he placed my testicles in his hand ... and he was fondling me."
Despite professional ethics for doctors in Ireland stipulating otherwise, Ryan told RTÉ Investigates that Dr Rathnam never explained why an intimate examination was necessary, and Ryan was never offered a chaperone.
Instead, he said, the assaults simply increased in frequency, with Ryan saying Dr Rathnam continued to visit him for the following three nights – inappropriately touching him on each occasion.
Such a breach of trust is so serious it eclipses all others, according to Maeve Lewis, CEO of One in Four, a charity that helps survivors overcome childhood sexual abuse trauma.
Unlike other professions, Ms Lewis told RTÉ Investigates, when we go to a doctor, we literally put our lives in their hands. We may have to take our clothes off and we may be nervous something is wrong. As such, it is an extremely delicate situation.
"To think that sexual abuse would happen when we're in that very vulnerable situation – it has a devastating impact on people," Ms Lewis said.
Having received his blood transfusions, Ryan was discharged, without revealing what had happened.
I cried all night and the nurse asked me what was wrong, and I just couldn't tell her
But, four months later, in February 2011, when he was anaemic again and had to return to Naas General Hospital for further treatment, Ryan was terrified to meet Dr Rathnam once again.
This time, the doctor wasn't part of his care team. On some nights, he wasn't even rostered to be on duty – but that didn't prevent Dr Rathnam visiting Ryan's bedside a further two times.
On each occasion, Ryan said Dr Rathnam sexually assaulted him. The assaults increased in severity, he said.
"I was humiliated, and I was frightened. I remember one night in hospital I cried all night and the nurse asked me what was wrong, and I just couldn't tell her," Ryan recalled.
But Ryan did find the courage to tell his mother what had happened, and she persuaded him to report his concerns.
Ryan spoke with one of the nurses on the ward. He recalled her face displaying instant alarm. Ryan and his mother soon met with senior hospital staff.
"They asked me for a description, and I began to give a description and they finished my description – and it shocked me, because they were so accurate and, straight away, me and my mam looked at each other and we were like: this has happened before."
Ryan's suspicions were correct. RTÉ Investigates can confirm that, just three days earlier, staff had received a similar complaint.
The first allegation made against Dr Rathnam had come from another male – this time a minor – who alleged the doctor had also inappropriately touched him in the genital area while at Naas General Hospital.
In a statement to RTÉ Investigates, Naas General Hospital said it received the first complaint on 28 February 2011, at which point the hospital convened a serious incident review meeting and decided to suspend the doctor from duty with immediate effect, pending the outcome of a Trust in Care process, a procedural system for dealing with suspicions or complaints of abuse.
The doctor has not returned to work since his suspension. The hospital added that it also notified the Irish Medical Council, HSE Child Protection Services and An Garda Síochána of the allegations in April 2011.
Therefore, according to hospital records, the formal notification was made more than a month after it received the first complaint.
At that point, Ryan had already reported the incidents to gardaí – but, before they sought to question Dr Rathnam, the doctor left Ireland.
An Garda Síochána told RTÉ Investigates that the case is still an ongoing criminal investigation, and that it is cooperating with Interpol and other policing agencies.
But neither Naas General Hospital nor gardaí told Ryan that Dr Rathnam had left the country and, for a whole year, he said he lived in fear of meeting the doctor again.
In fact, Ryan had no idea how the investigations concerning Dr Rathnam were progressing. From the minute he left hospital, he told RTÉ Investigates that he was left totally in the dark.
In response, Naas General Hospital said the lack of ongoing communication and follow-up was not in line with the standard of practice nowadays and it acknowledges this was not adequate. The hospital added it would like to sincerely apologise to those involved.
The failing Ms Lewis said, was unacceptable.
"If somebody has the courage and the stamina to actually make a complaint in the first place and if then they have no idea of what's happened," she said "they would, quite frankly, ask what the point was."
In June 2015, Ryan was summoned to give evidence at the Irish Medical Council's inquiry, where he once again encountered Dr Rathnam.
The doctor appeared via Skype and had the opportunity to cross-examine Ryan. Ryan described the day as stomach turning and said his experience helps him understand why people would be reluctant to follow through on sexual assault complaints.
"It's a really tough journey," he said. "You'll have many sleepless nights, but I knew, in order for me to heal, I had to see it to the end. That was going to be my vindication."
And, ultimately, Ryan was vindicated. In October 2015, the Irish Medical Council informed him it had cancelled Dr Rathnam's registration, having found him guilty of professional misconduct.
The finding means Dr Rathnam will never be allowed to practice medicine in Ireland again.
However, the decision to remove Dr Rathhnam is not easily found on the Irish Medical Council's online register.
For many, many years I've suffered from extreme depression, anxiety and suicidal thoughts
In fact, when you search for Dr Rathnam, there are no records to be found. Members of the public or prospective employers would never know the doctor had been removed from the register – or indeed that he had even worked in Ireland.
The Irish Medical Council told RTÉ Investigates that, if a doctor is removed from the register, then their names will not appear on the register, as only the names of those doctors who are currently permitted to practise medicine in Ireland are listed.
If Ryan's story raises questions about the ease of access or transparency of the council's processes, then they only serve to add to those already posed by the case of Dr Aamir Zuberi.
As revealed by RTÉ Investigates last year, Dr Zuberi was an anaesthetist at Naas General Hospital who is alleged to have sexually assaulted four unconscious patients in 2016 and 2017.
The suspicions around Dr Zuberi's conduct arose just a year after Dr Rathnam was suspended from duty at Naas General Hospital, when separate concerns also began to arise around his behaviour.
As happened in Dr Rathnam's case, Dr Zuberi also left Ireland before investigations by An Garda Síochána and the Irish Medical Council had concluded.
But, in Dr Zuberi's case, his registration continued to appear to be active on the council's register.
RTÉ Investigates subsequently found Dr Zuberi working in Pakistan. Despite being aware of the serious allegations pending against him, the Irish Medical Council had not informed authorities there.
The council told RTÉ Investigates that it would have alerted all other EU member states, but that the alert system did not extend beyond the EU.
In Ryan's case, Dr Rathnam returned home to Malaysia, where he is provisionally registered with the medical council there and could seek work as a doctor.
The Irish Medical Council did not respond to a question relating to whether it informed authorities in Malaysia that Dr Rathnam had been removed from its register in Ireland.
The issues identified in both cases, Ms Lewis said, are deeply troubling.
"At the very least, we should be able to notify the medical councils in the countries where the person has come from, and where a concern has been raised, or that they've been removed from the register here," she said.
"That would seem to me to be a very basic duty of care to the world's population."
More than 11 years after his assaults by Dr Rathnam, Ryan is still searching for answers.
Having thought he was starting to come to terms with what happened him, he said that learning other patients had also allegedly suffered at the hands of another doctor at Naas General Hospital had brought everything back.
"For many, many years I've suffered from extreme depression, anxiety and suicidal thoughts," Ryan explained.
"But I knew I had to get to the end, because I knew that was the only way I could feel any relief from this. And I did, until it happened again to someone else and now I feel like it is me all over again."
Watch RTÉ Investigates: Abuse of Trust on Prime Time tonight at 9:35pm on RTÉ One and RTÉ Player.
If you have been affected by any of the issues raised in this article, visit rte.ie/helplines.
You can contact Naas General Hospital Patient Services between 9pm and 5pm, Monday to Friday, by phone on 045 849 520.