by Leandra Esfakis
The Ministry of Health is working on a bold new programme of providing universal access to health care, but what is it doing to regulate health care presently?
The issue was recently brought into focus by an official complaint to the Hospital and Health Care Facilities Board about the death of a patient in a local hospital in 2002. The complaint alleges serious institutional failings in that hospital caused or contributed to fatal injuries and death.
The Board is supposed to act in the public interest. Regulations require the Board to make an investigation where there is a complaint about the “management, diagnosis or treatment” of a patient. However, last year the Board refused to accept it’s responsibility and declined to order any investigation.
How can a regulatory body, year after year, re-license medical facilities, apparently in a pro-forma fashion, without making any investigation when there are serious allegations of institutional deficiencies resulting in death?
Not so long ago, the Board published a list of doctors who had not paid fees to license their clinics. That was no reflection on the quality of care they provided. It was a question of money, and the Board went after those who hadn’t paid.
Is the Government only interested in collecting its fees from hospitals and clinics? Or will the Board address the risk of bad management which risks lives?
An appeal was made to the Minister of Health, by lawyers for the deceased patient, on the grounds that: “Having regard to its regulatory function as prescribed by statute, the allegations in the Complaint, and the evidence that was and is available to the Board but for its default, no reasonable Board could have reached the determination made by the Board, and by reason of that determination, the Board has abdicated its function and is in dereliction of its duty.”
Many months later, the only answer from the Ministry of Health is that “the matter is receiving attention.” And this answer is not in writing. It is a verbal response.
But it is not a response to the appeal that was made. It is an answer that can mean anything, and therefore means nothing. There is no indication, what is being done, if anything, or when. There is no transparency. It is an answer which sentences the Complaint to a bureaucratic limbo and protects the Minister from accountability
In other words, the buck stops nowhere. But must we take the low road?
The Ministry of Health is accountable to all patients of any clinic or hospital. It is responsible for the Hospital and Health Care Facilities Board. The Board is responsible for the "health care providers" it licences. Health care providers are responsible for decisions of life and death. If there is a complaint, the Board must investigate it.
The minister was asked to consider the reasons for the appeal, and made a decision: that is, vary or reverse the decision of the Board, and make an order to the Board, based on his decision. If the appeal is being refused, the minister needs to give reasons why the appeal is refused. It is a straightforward matter.
This would be the response of a society governed by the rule of law. However, this assumes that the democracy has reached a political maturity, and ministers say what their Ministry is going to do, and when. It appears that the Bahamian Government leaders have not reached that stage. But it is time to grow in that direction if we intend to mature and progress.
The recent announcement of a change in the membership of the Hospital and Health Care Facility Board, is encouraging. The new chairman, Jerome Gomez, is an accountant, not a doctor. The composition of the new Board at least, gives hope it will function objectively and in the public interest.
The Ministry is now proposing a social health insurance scheme. The people will pay for this by payroll deduction, and the government will administer the programme. To date this kind of set up has not proved a successful formula for providing the public any consistent quality of service in any field.
The question, however, is not just whether we can afford health care, but also can we afford health care that effectively is not regulated? That is what we have so far. Will the Ministry of Health continue to allow its constituents, Bahamian patients, to be exposed to that risk? Or will the new Minister, Dr. Bernard Nottage, and the new Board, order an enquiry and implement existing laws to promote quality health care?
Over two thousand years ago, Hippocrates, the father of Western medicine, gave some useful advice: “Do no harm, allow no injustice.” We have had some time to consider this advice. If we intend to build a healthy society, we would follow it.
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