The new Coroner’s Court law: Investigating and Preventing Deaths in The Bahamas

The government’s draft Coroner’s Bill makes welcome changes to the archaic 1909 Coroners Act that currently applies in the Bahamas.

The intent of the proposed law is to help prevent “reportable” deaths and promote justice. A primary purpose of the Bill is to reduce “the occurrence of other deaths in circumstances similar to those in which a death occurred.” 

It gives the Coroner (a specialist magistrate) the power to report preventable deaths to investigating authorities:  “if satisfied that the public interest would be served.” This process has the potential to make changes in the public interest that will promote a safer society. But other institutions will have to perform if that potential is to be achieved.

For example, we will need a Hospitals Board and a Medical Council able and willing to investigate any Coroner’s report on a preventable death in healthcare services. In other words, we can no longer avoid making healthcare facilities accountable for the patients who are in their care.

This concern is not a matter of mere speculation. The following case history illustrates the Hospitals Board’s apparent inability to address the accountability issue:

In April, 2002 a 42-year-old patient died unexpectedly in a licensed hospital in Nassau. Medical evidence at his inquest states that his chances of surviving his injuries were 95-97 per cent.

In August 2004 the patient’s widow filed a complaint with the Hospitals and Healthcare Facilities Board regarding her husband’s diagnosis, treatment and care, and asked for an investigation.

The following month then Minister of Health, Dr. Marcus Bethel advised that the Board had been directed to investigate the widow’s complaint. But the Board refused, saying it had no jurisdiction to investigate “medical malpractice.”

In 2006 a newly appointed Board agreed to appoint Pan American Health Organization officials to a special panel to investigate the widow’s complaint. But the panel was never formed.

In 2007, the 2005 Board chairman was reinstated, and other members of the 2006 Board were replaced.

In June 2007, at a “Meet the Ministers Conference”, Minister of Health Dr. Hubert Minnis assured the audience that the widow’s complaint would be investigated “according to the due process of law.”  No investigation has taken place.

In May 2008 the Hospitals Board chairman was reported in the Tribune to have said (in a Rotary Club speech) that the Board did not want to investigate any complaint because it did not want to be involved “in that detailed level of work.”

In July 2008 Bahamas Patient Advocacy, a public interest group, launched a petition on its website directed at the prime minister and the minister of health. The petition now has over 500 signatures, calling for accountability in both private and public healthcare facilities.

In December 2008, the Hospitals Board’s “annual” report for 2007 was tabled in Parliament. This was only the second such publication in its 11-year history, although it is required by law to report annually. The report stated that the Board did not want to be pressured to investigate the widow’s  complaint [which it did not do].

The report also noted that the hospital in question had conducted its own investigation into the patient’s 2002 death. That hospital had identified “significant opportunities” in the process of care provided to the patient that [if they were addressed] would mitigate against such an incident (ie, death) occurring again.”

The report added that the Board’s legal committee had recommended an investigation to determine whether remedial action had, in fact, been taken by the hospital. There is no indication that this investigation ever took place.    

As of July 2007, there were 10 Hospitals Board members, six of whom were doctors or representatives of the medical, dental or nursing professions. As of April, 2008, the Medical Council had seven members, all of whom were doctors. Under the circumstances it may be fair to ask whether these bodies have the public interest as their primary concern.  

Medical tourism is now being touted as a potential income earner for the Bahamas. But it’s success will depend not only on the services being offered, but the quality assurance behind those services.

This may be an opportunity for the Bahamas. But only if regulatory bodies like the Hospitals Board and the Medical Council can improve their oversight track records, to provide quality assurance in Bahamian healthcare.  

Bahamas Patient Advocacy and its petitioners urge the government to put in place effective investigative bodies to act in the public interest. The legal structure to support accountability in health care services must be appropriate, and functional.

Then, and only then, can the declared purpose of the Coroners Bill  - to help prevent reportable deaths and promote justice - be achieved.