Up Against the Men in White Coats

In the blockbuster film Men in Black, a powerful but shadowy organisation was able, through its control of information, to silently wield power over an unwitting population.

Here in Trinidad and Tobago, our Men in White Coats in the medical profession appear to be represented by organisations that operate in a similar manner.

This week, I was going to get into a draft Patients Bill of Rights as promised. But the deeper I waded into the quagmire of the two bodies that represent the medical profession, the more complex it got, with many false trails and political and financial agendas, with a cadre of doctors of the old guard who are terrified of change and who prefer to deal with the issues raised in this column with personal and sexist attacks at the columnist, rather than with serious discussion that would propel their profession forward.

But this obfuscation only redoubled my determination to find the answers to my questions: “Who will take responsibility for the medical profession, and who will bring about change?”

I am aware there are hundreds of highly-qualified, dynamic doctors in this country who live the code of ethics and follow the patient’s charter as a matter of course; that every day, doctors see and bring relief and hope to hundreds of sick people and their families; that there is compassion, and lives are saved; that the excellent doctors among us have either practised abroad with systems like the patient’s charter and code of ethics or continually upgrade their skills.

But I am also aware of the Men in White Coats. They are the ones who are in it for the money, power, social standing; who close ranks, protect their turf and can’t be bothered to upgrade their skills. Neither group will deny what I am calling for is systems.

Even if one patient dies under the care of a doctor, it is too many. Even if one doctor regularly breaches the code of ethics, it is too many. Absolute power for a few is terrible for the profession and inevitably can corrupt absolutely and tarnish the entire profession.

In my quest for answers, I sent out letters early this week requesting basic information and comments from Dr Omar Ali, secretary of the Medical Association and Dr K Mungrue, secretary of the Medical Board; these were copied to the Minister of Health, Dr Hamza Rafeeq and Lennox Grant, Editor-in-Chief of the Trinidad Guardian.

The following is an extract of the letter:

Please find enclosed four columns, an editorial and a viewpoint by Professor Syam Roopnarinesingh regarding the perceived need for checks and balances in the medical fraternity. Included in one of the columns is a patient’s testimony of perceived malpractice.

I would be grateful if you commented specifically on the following questions raised in the columns. If you are unable to give me a comprehensive response by Friday, a brief initial comment and an idea of when the full response will be delivered will be appreciated for this Sunday’s column.

“Could you give me a list of the names and contact numbers of the members of the Board of Medical Association/Medical Board?”

“How often does the Association/Medical Board meet? Are the Association’s Board/Medical Board’s minutes available for public perusal?”

“We understand that a code of ethics for doctors is in place. Is it possible to get a copy?”

“What is the complaints procedure if there is a perceived breach of the code of ethics?”

“Does the Medical Association/Medical Board deal with malpractice issues? If the answer is yes, what is the formal procedure through which the Association handles claims of malpractice?”

“For the years 1997, 1998 and 1999, how many complaints have been received and what were the findings, and what were the disciplinary procedures if any?”

“What are the functions of the Medical Association and how do they differ from those of the Medical Board?”

“Is there a patient’s charter of rights in place? If not, why not? If so, why doesn’t anyone know about it?”

I also requested comments on my suggested Code of Conduct, Malpractice Board, a Medical Ombudsman, and Data Bank on doctors.

The official response from the Medical Board three days later was:

“Dear Ms Mathur,

I acknowledge receipt of your letter dated 22nd August 2000 and will refer your request to the Council of the Medical Board of Trinidad and Tobago.

Sincerely, K Mungrue, Secretary MBTT.”

The official response from the Medical Association two days later came in the form of a phone call from the secretary, Dr Omar Ali.

He said: “Last night the matter was discussed at our council meeting and is under consideration.”

“That’s it?”

“That’s it.”

But, I protested, could he not give me answers to the basic questions like how often they meet? I was prepared to wait for a substantive response to my suggestions outlined in the columns.

“I am guided by council,” he responded.

Even when I suggested the Medical Association was acting like a secret Lodge, and wondered how if I, as a journalist, am having so much trouble with getting information, how would a patient get through to them?

The answer came, doggedly, solidly blocking all entry: “I am guided by council.”

However, I was able to contact Dr Fuad Khan, vice president of the Medical Board, who openly spoke out against his own organisation, referring to it as a “toothless bulldog” and added the “Medical Association is practically useless because it has no legal powers.”

The following is a summary of his comments:

The Medical Association of T&T is not a statutory body and therefore has no legal powers, and its Code of Ethics (also not a legal document) is at least 30 years old and has not kept up with the needs of patients.

The Act under which the Medical Board operates dates back to the 1960s and provides no protection for the Board when they have to deal with disciplinary issues; the doctors who they are trying to investigate slap them with an injunction. Currently, the Medical Board faces expensive lawsuits from doctors.

The Board has no power to investigate or comment on malpractice complaints. So patients have no recourse but litigation. The Board is therefore limited to writing warning letters to doctors or holding back registration.

The proposed Medical Board Act that deals with patients’ rights issues raised in these columns, has been tossed to and from the Ministry of Health for the last four years, but nothing has come of it.

The Board is aware of cases of persons parading as specialists who do not hold the necessary qualifications.

I also spoke to two council members of the Medical Association who agreed it has no legal clout or inclination to discipline doctors, or educate patients.

It operates more like a union in the interests of the doctors (by closing ranks when complaints came in) than an independent body interested in upholding standards of the profession.

The patients of this country wait with bated breath for a response from the Medical Association, the Medical Board and the Ministry of Health.

We can’t afford to exhale just yet.