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“Fit to fly?” Woman awaiting spinal surgery is fit to be deported, controversial doctor tells UK Home Office

Judges have severely criticised medical assessments by Dr John W. Keen and his company NowMedical, but UK immigration authorities continue to rely on him.

Clare Sambrook
28 November 2019
Typed email

A Leicester woman awaiting spinal surgery fears imminent removal from the UK to Sudan after a medical practitioner has, without examining her, advised that she is fit to fly.

Dr John W. Keen supplies fast-turnaround medical assessments to the Home Office, and to local authorities through his company NowMedical. Some of his assessments have attracted heavy criticism in the courts. Last year, in a case concerning an autistic child’s risk of falling from a council flat balcony, the judge criticised Dr Keen who had advised that a fall was “unlikely to be fatal”.

The Leicester woman under threat of deportation is 55 years old. She fled Sudan fearing persecution for her Bahai faith, and came to the UK seven years ago. Her claim for asylum was refused.

The woman’s family doctor told the Home Office that she has multiple health problems including Type 2 diabetes. She is awaiting spinal surgery, suffers from “spondylolisthesis, sciatica, lumbar spinal stenosis” and takes the prescription drugs co-codomal and pregabalin. Leicester GP Dr Hafiz Mukadam added that his patient “Struggles to sit for prolonged periods as exacerbates back and leg pain.”

The Home Office is preparing to deport her to Sudan, a journey involving flights of 10 to 15 hours’ duration, and obtained advice from Dr John W. Keen, asking him: “Could you assess her fitness to fly, please?”

Typed email

The request was emailed to Dr Keen at lunchtime on Monday 11 November. Before 9 o’clock the following morning, and without examining the patient, Dr Keen emailed back:

“Given her back problem causing difficulty sitting for a prolonged period, I recommend frequent exercise whilst on board any plane by walking around the cabin. I also recommend she take all analgesic medicine with her during the flight. With this, I don’t think her condition precludes travel nor prevents her leaving the UK on a given day.”

Debbie Rea, a volunteer case worker for disabled asylum seekers, who has known the woman for two and a half years, said: “Dr Keen has stated, even though he has never met her, that she can do exercises on the plane and take analgesics to help with pain. How can he ‘prescribe’ this when he’s never seen her? She has a disabled bus pass and Leicester Adult Social Care has provided her with a perching stool, grab bars for the shower, and grab bars outside her house.”

Since March 2000 Dr Keen has advised the Home Office on whether people are medically fit to be deported or “dispersed” within the UK. His company NowMedical sells advice to local authorities and housing associations regarding people who seek priority or specialist housing.

Dr Keen has stated that she can do exercises on the plane and take analgesics to help with pain. How can he ‘prescribe’ this when he’s never seen her?

In November 2017 Dr Keen supplied a report to London’s Haringey Council regarding a family’s request to be moved to safer accommodation. The mother and her two children lived in a first-floor council flat that had two outside balconies. The mother had multiple health issues. Her (then) 5 year old child, known as AM, was severely autistic, had no sense of danger, enjoyed climbing and woke frequently at night. The mother, fearing that her child might access the balconies and fall, wanted the family moved to a safer ground-floor flat.

Without visiting the flat or meeting the mother and her children, Dr Keen reported that, though the property was “less than ideal”, a fall from the first floor was “unlikely to be fatal”.

In the High Court last year Judge Karen Walden-Smith found that Haringey had acted unlawfully and ordered the council to reassess the family for appropriate accommodation. About Dr Keen’s report, the judge was scathing:

“He also does not appear to take into account the real risk to AM of her being able to access the outside balconies, climb up and fall save to dismiss any fall from a first floor balcony as being "unlikely to be fatal".  It is not clear on which medical basis he comes to that conclusion, or indeed what injuries he considers it likely that a 6 year old child might sustain falling from a first floor flat four to five metres above ground level and what level of injuries he considers to be an acceptable risk.”

Barrister Nicholas Nicol has written about Dr Keen’s “unlikely to be fatal” assessment in the case of KS & AM v London Borough of Haringey here.

A homeless woman was denied housing by Lambeth Council who relied upon a desk-top assessment from Dr Keen’s company NowMedical. In 2017 in the Central London County Court, a judge allowed the woman’s appeal, saying it was unfortunate that Lambeth’s reviewing officer “was not given the benefit of a medical opinion which actually addressed the particular circumstances and particular consequences to the Appellant of her condition. It might have helped had someone from Now Medical taken the time to see the Appellant or indeed considered her medical records.” Solicitor Giles Peaker has written about the case, Thomas v Lambeth Borough Council, here.

Regarding a claim for housing by a traumatised Kosovan refugee, Dr Keen advised Birmingham City Council: “there remains nothing to suggest her condition [is] of particular severity”. In 2007 the appeal court judges challenged the council’s description of Dr Keen as “impartial”. They said: “Dr Keen’s is treated as a dependable opinion, albeit he has never examined Mrs Shala or discussed her case with a doctor who has.” (Shala v Birmingham City Council).

In 2006 the then Mr Justice Leveson criticised Dr Keen and the local authority he was advising over the case of a woman suffering post-traumatic stress disorder following rape, torture and imprisonment in Iran. (Ghandali v London Borough of Ealing). Dr Keen had not examined the woman and his assessment of her case was, according to Leveson, “irrational” and “tainted”.

Accounts filed at Companies House, indicate that Now Medical held fixed assets including property of £700,000, and current assets (cash and money owed) of £570,000 in December 2018.


We have alerted Dr Keen to the contents of this article and reached out to him for comment.

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