by Larry Smith
The debate over medical lawsuits in the United States contrasts dramatically with the situation in the Bahamas.
American doctors face soaring costs for malpractice insurance and want to cap huge legal claims. The Bush administration accuses lawyers of filing frivolous suits that make treatment more costly while forcing doctors to curtail vital care.
This threat of potentially bankrupting litigation causes American doctors to engage in defensive medicine, analysts say, which wastes billions of dollars a year by directing money to unnecessary drugs and tests.
But in the Bahamas, the position is almost exactly the reverse. Patients have little recourse in cases of medical negligence; regulatory supervision is almost nonexistent; and doctors are free to ignore complaints about the care they provide.
To make matters worse, we have no publicly available statistics on issues of safety, timeliness and competence in the Bahamian healthcare industry...data that is urgently needed to drive quality and efficiency among service providers.
As crazy as it seems, doctors are the third leading cause of death in the US (after heart disease and cancer). They kill nearly a quarter million people a year, according to the Journal of the American Medical Association. And this estimate does not include the negative effects associated with disability or discomfort. Evidence from other studies indicates that as many as 30 per cent of patients receive inappropriate care in the US.
If that is what happens in the world’s most advanced and litigious healthcare industry, what risks do we face in the Bahamas? The short answer is - no-one knows.
Critics say that when it comes to safety, the healthcare sector should borrow a page from the airline industry. When aviation accidents occur, the industry can analyze important data to help prevent future errors. In healthcare, no such universal information system exists.
According to Leandra Esfakis, an attorney whose late father was a well-known Nassau GP: “We have the benefit of some very good medical practitioners here. But many of us also have grave reservations (no pun intended) about local healthcare facilities, which may have problems that are never brought to light, and never addressed.”
Parliament set up the Hospital & Health Care Facilities Board in 1998 to inspect and license the private healthcare sector in the Bahamas. One of its chief responsibilities is to investigate complaints from the public.
However, it has no record of ever doing so. In 2004, for instance, a complaint was made to the board over the death of a patient at a private hospital and it has yet to respond. Two more complaints have since been submitted concerning inadequate care at the same hospital. In all three cases, the patients died.
At first, the board said it had no idea how to undertake an investigation. So it asked the Attorney General’s office for advice, but it still won’t say when or if an inquiry will be launched. The board’s chairman, Dr Kirkland Culmer, did not respond to faxed questions on this subject.
One has to ask why, seven years after it was set up and six months after a complaint was made, this statutory body is either unable to hold an inquiry, or refuses to do so. From the public’s point of view, the only leverage available is the possibility that a complaint will affect the bottom line of the facilities involved. At the very least this would mean suspending licenses until improvements are made.
There is no point in setting up a statutory body to inspect hospitals and clinics without the capability to ensure that proper standards are met and legitimate complaints addressed. After all, these are matters of life and death. If the health standards legislation is not implemented, it leaves the survival of patients at risk.
And why create meaningless statutes in the first place? We are currently being inundated with so-called “consumer protection” legislation by the Ministry of Trade & Industry. Will these regulations have any more impact than the laws currently in force to govern the medical profession?
Why aren’t death records from private hospitals collected and analyzed...for comparison with similar rates in similar-sized hospitals elsewhere? If this were done, perhaps it might move those responsible to address the root causes of deficiencies, instead of running for cover.
In Britain a special commission undertakes independent investigations into complaints about both the National Health Service and the private healthcare sector. These investigations are normally completed within six months - and information is published on a Web site.
The UK commission says it aims to be “an authoritative and trusted source of information” and wants to ensure that this information is used to drive improvement in the industry. Complainants who are unhappy with the outcome of a review by the commission can take the matter further, to an independent health ombudsman.
In the Bahamas, the Hospital Board is supposed to protect the public from sub-standard healthcare. But the big question is whether the law works well enough in a small, incestuous, accountablity-free society like ours to allow safeguards to be enforced.
The automatic licensing of private hospitals, whether or not they meet proper standards, can be construed as putting lives at risk. And the position is very similar for the elite Bahamian medical fraternity.
A medical council was established by statute in 1975 to license physicians in the country. There are currently over 600 doctors here, about half working full-time in government service. Under the Act, they can theoretically be disciplined for negligence or incompetence, for disclosing confidential patient information, or for serious professional misconduct.
Written complaints are supposed to be evaluated by the council, which may then appoint a disciplinary committee that includes a judge. Penalties can include a one-year suspension of license, a fine of $1000 and payment towards the cost of the proceedings,
The council consists of seven members, including the chief medical officer, who acts as registrar. Members are appointed by the minister of health in conjunction with the Bahamas Medical Association.
Their chief responsibility is “to ensure that proper standards of professional conduct in the practice of medicine and proper standards of general fitness to practice medicine are maintained.”
However, since the council was created, only one Bahamian doctor has ever been suspended - and that was for drug abuse - although formal complaints have been lodged over the years (one as recently as last December). It seems there is no accountability on the part of healthcare providers in the Bahamas.
But as the late Indian sage Krishnamurti once said: “It is no measure of health to be well-adjusted to a profoundly sick society.”
•Larry Smith is a weekly columnist for the Tribune, the leading daily newspaper in the Bahamas.This article was originally published in January, 2005 and is reprinted here by permission. You can read more of Smith's columns at www.bahamapundit.com.
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