Doctors Industrial Action

Dear Minister Imbert,

 Not withstanding the low expectations and cynicism with which the population regards politicians (with ample cause) I must congratulate you on your firm handling thus far of the current industrial action taken by public service doctors.

The people of this country have watched with dismay, the casualties of this action by the Medical Practitioners Association (MPATT): Dead infants being carted off to mortuaries, pregnant mothers living with dead fetuses inside them, waiting rooms overflowing with people ailing from renal failure to high blood pressure and everything in between being forced to turn home hours later, untreated, having to resort to borrowing or begging to save their lives in private medical institutions for extortionate fees.

Doctors represented by MPATT are refusing to sign contracts until you renegotiate with them, heads of medical departments are resigning, and hospitals are eerily empty, devoid of care.

They want you to renegotiate for higher salaries, better conditions before they start doing their rounds of the wards again. They are taking out full page advertisements simply begging you to talk to them.

The action of members of MPATT, a yet unrecognized medical arm of the Public Services Association (PSA) representing doctors, has been denounced as “illegal” by the PSA’s President Jennifer Baptiste Primus who nevertheless hasn’t let you off the hook claiming that your health ministry must accept responsibility for creating “chaos” by sending out letters advising doctors to go on leave after their contracts had expired.

In MPATTs defense Dr Phillip Ayoung-Chee, a urological surgeon, pointed out in a Guardian column last Thursday that doctors in the public service are underpaid, which is why we fail to attract foreign doctors or even locals studying or working abroad.

You have remained resolute in what amounts to a calamitous crisis in health care, refusing to negotiate with this yet unrecognized body, correct in your position that negotiations will contravene the Industrial Relations Act.

Clearly the impasse must end. No doubt you have plan B in operation because although you are correct not to be held hostage by MPATT on behalf of this nation, as Health Minister you cannot allow more people to die of neglect in our hospitals.

By the time this is published the impasse may have been resolved but the underlying rot in the practice of medicine in this country will continue unabated as it has for decades.

There is some poetic justice in your refusal to meet with MPATT since the medical fraternity represented by the Medical Board and the Medical Association of Trinidad and Tobago has also remained unanswerable to the public for decades. I have personal experience of this. For some three years now I have publicly presented to them case upon case recounted to me by distraught relatives of a teenager, a cancer patient, a baby, an elderly woman (the stories never stop) who died of negligence and misdiagnosis. Each time the medical fraternity has been accountable. Curt one-line replies have been issued from the Medical Board and Medical Association promising a comprehensive response. Three years have passed and the deafening silence grows louder. No investigations have been made.

Mr Minister if you are firm in your resolve that the nation should not be held hostage by doctors I suggest that you consider the following proposals which I have put together with the help of several medical doctors who are interested in creating systems that will enforce high standards and accountability, yield better informed patients, and protect both patients and doctors.

1. The Medical Association of T&T needs to revise its 30-year-old Code of Ethics and Bill of Patients’ Rights. Both documents must be displayed prominently in all public and private institutions.

2. The Medical Board currently has no power to investigate malpractice complaints. The proposed Medical Board Act dealing with patients’ rights issues has been tossed between the Board and the Ministry of Health for the past six years. The previous Health Minister said he had been waiting for a response from the Board for three years and under the circumstances the Medical Board is not answerable to him or anyone else. I hope you are not that patient.

3. Two years ago the Ministry of Health was drafting a Health Services Act that would give the Health Minister the power to license all health institutions, impose standards, create a disciplinary body, educate the patient population, and hold all health professionals accountable. What happened to that?

4. Private and public care should not co-exist since it encourages a system that exploits patients, so that a patient who might die waiting for an operation from a particular doctor in a public medical institution might live if he pays the same doctor a hefty fee in his private practice across the road. Then there’s that question of all that access to drugs. If the system has to co-exist it needs to be monitored closely.

5. Although some of our doctors rank among the best in the world, many GPs are sub-standard because there is no system of continuing compulsory medical education for them. They are not kept up to date with the latest drugs and medical information. In the US the doctors have 50 hours of continuing medical education every year, and have to be board certified every seven years or else they can’t get their license renewed. It’s vital you institute that sir.

4.Create the following systems:

An independent Medical Malpractice Board to examine complaints over medical treatment. This Board should put forward decisions that can allow legal action to take place in a reasonable time.

A medical Ombudsman.

A published National Data bank which would list doctors, their area of expertise, including ongoing training, a record of complaints of both breaches of codes of conduct, and record of malpractice complaints.

Currently, neither your Ministry not the Medical Board has the power to successfully investigate charges of malpractice, enforce standards, or continuing education. Our citizens have for decades been held hostage by the medical fraternity since doctors rarely testify against one another in this closed fraternity.

Mr. Health Minister, if you are serious about ending this hostage situation use the resolve you have impressively demonstrated to cut through ridiculous red tape, pay doctors what they deserve but also create systems that ensure accountability, transparency and recourse to patients. If you succeed it will be the noblest achievement of your lifetime and your Government.