Matthew Brafman, 33, from New York state, was jailed for a total of three and a half years at the Old Bailey. His English-born wife, Alison, 30, was put on probation for two years after admitting aiding and abetting him in forging documents.
The Recorder of London, Lawrence Verney QC, expressed concern that Brafman managed to get appointed as senior house officer at St George's Hospital in Hornchurch, Essex in September 1991 by submitting false certificates and references to the General Medical Council, the doctors' regulatory body.
'That you did obtain that employment is a matter of some concern, but that is for others to investigate,' he said.
The GMC said last night that it had approved a number of changes to its screening procedures for foreign doctors as a result of the case. These included a requirement that American medical graduates should take its medical and linguistic ability test before being granted limited registration. At present, American and EC graduates are exempted from the test, which three-quarters of applicants fail first time.
Ann Curnow QC, for the defence, said that Brafman, who worked at the geriatric hospital for two months without arousing suspicion, was believed by a psychiatrist to be suffering from an underlying personality disorder - 'a Walter Mitty syndrome'.
Brafman had worked at military hospitals during 12 years in the US Army but had no formal qualifications. His level of expertise was said to be lower than that of a registered nurse.
He admitted to obtaining pecuniary advantage by deception, using false instruments and filling in a death certificate for the elderly woman, Jessie Harris, while unqualified to do so. Mrs Harris, 78, died within 12 hours of being admitted to St George's.
The judge directed the jury to return a not guilty verdict on the manslaughter charge, which Brafman had denied, after the court heard conflicting views on the cause of Mrs Harris's death.
Sentencing him on the other charges, he told Brafman: 'It is difficult to assess how much damage might have been done by what you carried out. Very fortunately, the damage actually done does not appear to have been established as great. 'But it may be on your conscience that you undertook this position of trust when you were wholly incompetent to do so.'
Brian Barker QC, for the prosecution, told the court that the GMC had accepted at face value the documents submitted by Brafman when he applied for a foreign doctor's certificate of registration. These included forged certificates from two non-existent medical institutions in Alabama.
Brafman - described by a supervising doctor at St George's as by no means the worst senior house officer he had come across - transferred to the casualty department of Oldchurch Hospital in Romford, Essex in November.
There, unlike at St George's, he was required to make initial clinical judgements and within 24 hours a consultant surgeon expressed concerns. 'It was his view after a short time that he had about as much knowledge as an ambulanceman or a field orderly,' Mr Barker said.
After further checks, Brafman was arrested. Interviewed by police, he said he was amazed that his deception had succeeded and that one phone call would have exposed him.
Ms Curnow said that Brafman had never given a satisfactory explanation of his motives. 'He says that every day on the ward was nerve-wracking, but there were days when he convinced himself that he could do the job properly.'
His employer, Barking, Havering and Brentwood Health Authority, said yesterday that it taken all proper steps when appointing Brafman. When doubts were raised it had made persistent inquiries to the GMC before receiving confirmation that he was not a qualified doctor, it said.
Linda Percival, service development director, said that the authority had introduced 'probing technical questions' into interviews with aspiring junior doctors as a direct result of the case.
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