by Leandra Esfakis
The Hospital and Health Care Facilities Board was established to address complaints of patients in private health care facilities ( hospitals and clinics) a decade ago. But it has yet to investigate any complaint.
In fact, few people seem to know of the Board’s existence or purpose. However, the Board received in 2004 a complaint of a fatality in one of the private health care facilities that it licenses, but its initial response was that it did not know how to investigate a complaint, and would have to take legal advice.
The response from the Attorney General’s office was also somewhat disturbing: The AG’s staff advised that they did not know how to advise the Board, neither did they understand the purpose of an investigation.
The Act which established the Board gives it three basic functions:
1) to regulate licensees (health care facilities).
2) to investigate complaints concerning the diagnosis, management and treatment of patients.
3) to collect fees.
The Act requires licensees (i.e. private hospitals and clinics) to maintain standards set out in the Act and regulations. The Act also gives the Board power to vary, suspend or revoke a license if the standards are not met. For the public, the critical requirement is the duty to provide appropriate care to the patient.
A complaint of an unexpected fatality may reasonably indicate that appropriate care was not provided. But the Board can only make such a determination following an investigation. It appears the Board is not prepared to undertake any investigation, even though the Minister of Health directed it to do so in the case of the death of Christopher Esfakis.
Are our hospitals and medical professionals above the law and beyond scrutiny? It would appear so. The Medical Council itself, in the last 20 years, has been outstanding for its inactivity. The Medical Council has a duty to review complaints against individual doctors, to discipline or remove from the register any doctors falling short of the standards required by the Medical Council Act.
Are the Board and Council motivated simply to protect their colleagues from accountability? This conduct would compare unfavourably with that of similar statutory boards in other jurisdictions, even third world ones. When dysfunctionalism reaches this level, it has deadly consequences, and the public pays the price.
Let us look , for example, at one other provision of the Hospitals and Health Care Facilities Act, Sec.23(4). This section requires a facility to notify the Chief Medical Officer of the death of any patient in its care. This requirement, it appears, is not followed and, although it is a summary offence to fail to comply, no prosecutions occur.
So the CMO does not receive notifications of deaths, and the Board does not examine these notices of death. Nor, it appears, could the Board maintain any statistics that might indicate an abnormal rate of fatality at a health care facility.
An unusual fatality rate could point to institutional failures which the Board should review. Institutional deficiencies which increase the risk of fatalities may include simply the failure of attending physicians to examine a critically ill patient, the failure of nurses to do the same, the failure of doctors to answer their pagers, and the failure of the institution to have a back up plan when the paging system fails.
These failures can be readily corrected, and lives could be saved. Prompt and full physical examination, prompt and accurate communication of information between medical professionals, and responsiveness to distress are primary to a properly functioning medical institution. When the institution is not able to provide this basic service, patients die. In other jurisdictions, if the duty physicians do not respond, the nurses must call the Chief of Medical Staff.
Hospitals also need a Fatalities Committee, and a Hospital Infections Committee, as self-regulating bodies for problem detection and surveillance of quality control within the hospital itself. If these committees are not in place, the Board should direct the hospital to put them in place. If there is a complaint, then the Board could require the appropriate hospital committee to report to the Board.
On what basis then, and by what criteria, does the Board make its determination that an institution is a fit and proper facility to hold a licence, if there is no examination of causes of deaths, rates of death, or complaints?
Can the Board reasonably determine that a facility is a fit and proper person for the purposes of the Act, without taking into account relevant information on fatalities in the institution? The Board ‘s duty is to protect the public from private hospitals not operating to standards. It would indeed be perverse, if fatalities did not enter into the Board's criteria for evaluation.
It would appear however, that payment of the licensing fee is the operative criteria for obtaining or renewing a licence to operate a clinic or hospital. And speaking of the financial aspect of the Board, the law requires that the Minister of Health submit to Parliament an annual audited account and a report of the Board’s transactions for the previous years of the Board’s existence. It appears this has never happened.
If the Board were submitted to a medical examination, one might diagnose it as catatonic: a state characterized by stupor, rigidity and occasional mental agitation, caused by receiving a complaint, perhaps. But it does not function. It does not respond to the public, to its Minister of Health, nor to Parliament.
Perhaps it is time this Board be allowed to die as quietly as it has lived. No one will notice. No one will complain. No one will investigate.
The Ministry of Health has taken the progressive step of appointing a committee to address complaints of PHA patients. This committee could assume the responsibility for investigating complaints as well from the private hospitals and clinics, because all patients require appropriate care, whether in the public or private hospital system. That is what is being paid for, whether by the public purse, private funds or insurance.
This “complaints committee” could, as regards the private hospitals and clinics, refer the results of their investigations to a Hospitals & Health Care Facilities Board which has the will to carry out its oversight functions.
It is unthinkable, in a modern, democratic society, that any one group of persons or institutions be allowed to function beyond the reach of the law, particularly when it is a matter of life and death. As Lord Woolf, who headed a law reform commission in Britain in 2001 stated:
"It is unwise to place any profession or other body providing services to the public on a pedestal where their actions cannot be subject to close scrutiny. The greater the power the body has, the more important is this need."
my husband died a very terrible way due to a doctor's oversight.
Posted by: Marsha Carroll | August 19, 2008 at 06:18 PM