A new investigation has exposed a deep and dangerous flaw at the heart of Europe’s system for regulating doctors: national health authorities across the continent are routinely ignoring official warnings about physicians who have been banned elsewhere. The result is a fragmented oversight regime that allows doctors disciplined for serious misconduct – including actions that directly harm patients – to quietly cross borders and continue practicing.

At the center of the problem is the European Union’s Internal Market Information System (IMI), a digital platform designed to facilitate cooperation between authorities in the EU’s single market, as well as associated countries like Norway and Iceland. Under EU rules, when a doctor loses their license for “substantial reasons” – such as misconduct, criminal convictions, or serious breaches of patient safety – the relevant authority must issue an alert through IMI so counterparts in other countries are informed. In theory, this system should prevent banned doctors from simply relocating and resuming work under a different regulator.

In practice, newly obtained data suggests the system is failing on a systemic level.

An analysis of more than 500 IMI alerts issued about doctors in 2024 and 2025 reveals a striking pattern: only about one-third of the jurisdictions that receive these warnings actually open them. Even fewer go a step further and access the personal data attached to the alert – including the identity of the disciplined physician. In many cases, the warnings are effectively ignored, rendering the entire mechanism little more than a bureaucratic formality.

One case illustrates the stakes. Swedish health authorities revoked a doctor’s license in 2021 after investigating more than a dozen incidents involving inappropriate administration of medication. One patient suffered a double lung collapse. Citing inadequate medical knowledge and serious risks to patient safety, Sweden immediately filed an IMI alert to notify the other 29 jurisdictions in the European single market. Norway followed with its own alert months later after revoking the same doctor’s license.

By that time, however, the doctor was already practicing in Cyprus.

Despite receiving two alerts flagging a physician whose actions had caused severe harm, Cypriot authorities failed to open either warning. According to access logs obtained by journalists, Cyprus did not review the alerts until October of this year – and then only the day after an international investigation, Bad Practice, published by OCCRP and its media partners, publicly exposed how banned doctors are able to move freely between European countries.

Cyprus is far from an outlier. Data shows that half of the states participating in the IMI system did not open a single alert issued last year for “substantial reasons.” These include Bulgaria, Croatia, Cyprus, Czechia, France, Greece, Hungary, Iceland, Latvia, Lithuania, Liechtenstein, Luxembourg, Portugal, Slovakia, and Slovenia. Another three countries – Austria, Estonia, and Finland – opened fewer than five such alerts.

By contrast, a smaller group of countries appears to use the system more consistently. Authorities in Sweden, Spain, Norway, the Netherlands, Malta, Poland, Ireland, Italy, and Denmark accessed all or nearly all alerts issued for serious disciplinary reasons. But even among these more diligent users, confidence in the system remains low.

Norway provides a telling example. Its authorities recorded a 100 percent alert access rate in 2024, in part because the country deployed an automated bot to open every IMI warning. Yet despite this technological workaround, Norwegian media partner VG still identified multiple doctors practicing in Norway who had been banned elsewhere for grave offenses, including sexual assault. In response, Norwegian regulators launched dozens of investigations and suspended or revoked at least seven medical licenses.

“This is not satisfactory, and it challenges patient safety throughout Europe,” said Jan Christian Vestre, Norway’s Minister of Health and Care Services. He emphasized that in a shared labor market for healthcare professionals, effective cross-border information exchange is essential – something he believes the current IMI system does not adequately provide.

Regulators themselves acknowledge many of the system’s shortcomings. One recurring complaint is that the emailed alerts authorities receive are heavily redacted due to data protection rules. Names of doctors are often omitted, meaning recipients must log into the IMI platform and take additional steps to determine whether an alert is relevant to their country.

Cyprus’ national IMI coordinator told journalists that this redaction makes alerts difficult to assess without further investigation. Belgian authorities echoed similar frustrations, telling media partner De Tijd that they do not proactively open alerts about healthcare providers because the notifications lack identifying details and are not synchronized with national medical databases.

“The only way to process all those alerts would therefore be through manual control, case by case, which is labor-intensive, inefficient and difficult to achieve,” said Annelies Wynant, a spokesperson for Belgium’s Federal Public Service Public Health.

Lithuania’s healthcare accreditation authority has made comparable complaints. Its head, Eglė Savulienė, said that from the electronic notifications alone, “it is not possible to identify which doctor is being referred to.” She added that authorities are expected to cross-check identification numbers for each alert, a task made unrealistic by limited staffing and resources.

These explanations highlight a deeper contradiction. The IMI alert system costs roughly 2 million euros per year to operate and covers multiple regulated professions, not just doctors. Yet despite this investment, the platform relies on voluntary engagement by national authorities, who are not legally required to consult the alerts they receive.

The European Commission, which oversees the system, acknowledges the challenges but frames them as issues of cooperation and implementation rather than structural design. In an emailed response, the Commission said it is “continuously working on improvements,” including new functionalities to make IMI easier to use. At the same time, it stressed that the system’s effectiveness depends on member states’ compliance with alert obligations and the adequacy of national regulatory frameworks.

That response is unlikely to reassure patients or healthcare advocates. The data shows that in many countries, alerts about doctors accused of misconduct, facing disciplinary action, or convicted of crimes are never opened at all. In such cases, the system does not merely function imperfectly – it fails entirely.

Sjur Lehmann, director of the Norwegian Board of Health Supervision, was blunt in his assessment. “It is clear that the countries that have not yet used the available functionality in IMI need to change both their attitudes and actions in order to contribute to increased patient safety in Europe,” he said. At the same time, he argued that the platform itself must be improved to reduce friction and make critical information harder to ignore.

The broader implications are troubling. Europe prides itself on free movement, including for highly skilled professionals such as doctors. But free movement without effective oversight creates loopholes that can be exploited by those who pose real risks. When alerts about dangerous practitioners sit unread in inboxes, patient safety becomes collateral damage of bureaucratic inertia.

The Bad Practice investigation has already prompted action in some countries, but the underlying problem remains unresolved. As long as opening alerts is optional, identification is obscured, and national authorities lack the resources or incentives to act, banned doctors will continue to slip through the cracks.

The data now makes one thing clear: the failure is not due to a lack of warnings, but a lack of attention. And in a healthcare system, that indifference can carry life-altering – and sometimes fatal – consequences.

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