CurrentCommentary
TheContinuing Debate on A New Medical Practitioner's Bill
EDITOR'S NOTE: The following letter which was deliveredto Capt. Mabry Kirconnell, and MLAs Mrs. Julianna O'Connor ConnollyMr. Lyndon Martin, has been forwarded to Cayman Net News for publication:
The Hon. Captain Mabry Kirkconnell
P.O. Box 30131 SMB
Georgetown,
Grand Cayman
Subject: Proposed Medical Practitioners'Bill
Dear Mabry:
As I briefly discussed with you, I havevery serious concerns about the proposed Medical Practitioners'Bill. As a Caymanian who is an actively practicing physician inthe Cayman Islands, I feel that I must be bring my concerns toyour attention. Although I do not purport to be an expert on medicineas it is practiced in the UK, in the United States, I was recognizedas an expert on the quality and appropriateness of medical care.I served as a Consultant to the Florida Board of Medicine forten years.
I was also President of the Florida Society of Ophthalmology,Chief of Staff of AMI Memorial Hospital of Tampa, a Member ofthe Ethics Committee of the Hillsborough County Medical Society,Ethics Chairman of the Florida Society of Ophthalmology for threeyears, a member of the Board of Censors of the Hillsborough CountyMedical Society, a member of the Governor's Advisory Committeeon organ, tissue, and blood banking, Clinical Associate Professorof Ophthalmology of the University of Florida, and a consultantto the Florida Peer Review Organization. I also served as legislativechairman, and a registered lobbyist for several medical organizations.If you wish, I could furnish you a copy of my complete CurriculumVitae.
My first observation is that I find it difficult to understandwhy the Cayman Islands needs 56 pages of legislation to regulateless than 100 physicians and dentists when the State of Floridaregulates 25,000 doctors with only five pages of legislation.Of course this legislation does more than regulate physiciansand dentists. Certainly, the Government has a responsibility toassure quality medical care to the Cayman citizens, but this billcannot and will not accomplish that noble ideal.
The first error is on Page three. Osteopathic physicians mustbe included with the doctors and dentists. They treat the samediseases with the same tools and methods as medical practitioners.The training is virtually identical and osteopathic physiciansare accepted into the same training programs as graduates of medicalschools. Indeed, in the United States, medical doctors teach inosteopathic schools and osteopathic physicians teach in medicalschools. It is the common practice for osteopaths and for medicaldoctors to practice together side by side.
On page 4 is a blatant falsehood! Members of the medical and dentalcommunities of the Cayman Islands were not consulted about thisproposed legislation until after it had been prepared as readyfor introduction in the Legislative Assembly. Although other organizationswere privy to the proposed legislation, the medical-dental communitywas not given a draft copy until mid August scarcely a month beforeit was introduced in the Legislative Assembly. In fact, This legislationwas introduced before the members of the medical-dental communityhad time to present their very legitimate concerns! One has toquestion why the medical-dental community was so ignored.
On page 11, the Health Practice Board is proposed. If it is passedwithout amendment, the Cayman Islands will become the only Governmentin the Western Hemisphere in which the medical profession is notself-regulating. In other jurisdictions, the legislative organizationsestablish the health care profession, but leave the actual regulationand determination of the quality of the care to be determinedby a public board, the majority of which are members of the professionregulated.
If this legislation is passed at all, the Health Practice Boardshould have a majority of medical (and perhaps osteopathic physicians)with a board representations of the other allied health professionsand representatives of the general public.
My greatest concern is with the establishment of the "Inspector"selected by the Board and answerable, apparently to no one else.I first question as to whether this should be a function of thissuper-board, or whether it should be the purview of each Council.
There must be a differentiation made between routine supervisionfor quality and appropriateness of care and for investigationof criminal intent. This proposed law would not make such a differentiation!
Certainly, we physicians and dentists have no problem with thelegitimate concerns of the Government that we maintain high standards.I feel that this could be better accomplished by having the appropriateentity, with input from the medical-dental community, preparepublished standards to which we can all abide. On site inspectionsshould be scheduled so that the delivery of health care will notbe compromised.*
The proposed powers of the inspector might be appropriate to criminalinvestigation. But the rights of the accused should be respectedso that the equivalent of a search warrant is included in thelegislation.
Perhaps, a criminal investigation could progress only if approvedby two members of the Council having jurisdiction over the accused,after concurrence with the Chief Medical Officer of the CaymanIslands. Moreover, the details specified in the legislation willso impair the inspectors that they will not be able use theirown (hopefully professional) judgment. This entire section shouldbe discarded and rewritten by someone with greater experiencethan the current author.
Rather than having the Government engage in the Orwellian scenarioproposed by this legislation, efforts should be made that onlyhighly qualified health care practitioners be registered in theCayman Islands. Rather than spending vast sums on inspectors whowould pursue only those health care practitioners in practice,that money would be much more cost effective if spent on extensive,complete background investigations of all health care professionalswho apply for a license to practice in our Islands.
Most countries from which our doctors obtain their training maintainextensive records on the practice of each individual health careprofessional. In the United States this is the Medical PractitionersData Bank, maintained by the Federal Government. The investigationis smoother if the legislation places the onus on the applicantof obtaining information, which the Health Care Practitioners'Board, or the individual Councils, needs to determine the qualificationsof the professional. This careful selection is the mechanism thatwill maintain the quality of health care in the Cayman Islands.
The Government should not be in the business of subsidizing instancecompanies and lawyers! It is totally inappropriate for the Governmentto mandate that health care processionals carry malpractice insurance.There are no other professions or occupations in the Cayman Islandsunder a similar mandate. Certainly, physicians and dentists dohave a responsibility to render care in accordance with acceptedinternational standards and should face retribution if they failto do so.
Perhaps the current legislation, which does offer protection topatients, needs to be strengthened. It should be the decisionof each health care practitioner as to the method for which heis prepared to indemnify the patient for any harm that occursas a result of failure to observe the accepted standards of care.
There is not one iota of evidence that the current malpracticelegislation in the United States has done anything to maintainthe quality of the health care delivered!
It is, however, one of the main reasons why American health careis so expensive.
This legislation imposes inflexible penalties which the Councilsmust render to those found to be in violation of this legislation.
The members of the Council should be given great desecration toaward appropriate penalty. If they are restricted by a legislativeprohibition against merely warnings, or letters of concern, whichin themselves carry neither punishment nor permanent professionalblemishes, minor offences will be allowed to become more seriousso that the proscribed punishment will fit the offence. If theCouncils are prohibited from referring conduct, which the membersof the Council feel is overtly criminal, serious, offences maybe handled inappropriately.
On page 30, the wording of Section 29 (1) (a) should be changedto read "is convicted by any court (whether or not in theislands) of a criminal offence, which would be a crime under theLaws of the Cayman Islands, which, in the opinion of the Council,may render him/her unfit to be registered...."
This legislation will result in an expense to the Government thatI suspect is much less than the Legislative Assembly appreciates.The provisions are so Draconian that any practitioner accusedunder it will have to file legal action to defend himself notonly here in the Cayman Islands, but to protect his rights topractice any where else in the world.
In Florida a category of impaired physicians was created wherebyphysicians with medical or psychiatric or addiction problems wereallowed to be rehabilitated under the supervision of the Boardof Medical Examiners. This has been a highly successful program,which has restored many health care practitioners. But its realvalue is that it provides a venue whereby members of a healthcare profession can report or refer a colleague for help ratherthan punishment.
The result has been that the public has been protected from temporarilyunfit health care professionals who otherwise might have beenallowed to continue their unsafe practices because of reluctanceof colleagues to report a colleague knowing that the result wouldbe banishment rather than help.
Florida law also provides for the Board of Medicine to requirea physician to practice under a proctor, who is a member of thesame specialty as the one disciplined. The proctor supervisesas much or as little of the practice as specified by the directionof the Board of Medicine. This prerogative should be given tothe Council.
This legislation also fails to address the over supply of physiciansand dentists. In the USA, there is an over supply of 70% in orthopedics,anesthesiology, radiology, and ophthalmology. This has resultedin unnecessary treatments and deteriorating quality and a generaldownward spiral of medical standards in the USA.
These underutilized physicians, many facing huge educational debts,have quickly become desperate, often engaging in activities thatthey would never have considered had there been any other avenueopen to them. Some have accepted employment beneath nefariouscharacters whose only interest in health care has been usuriousprofits made at the expense of the patient and the doctor.
Many of these activities would have been illegal a few years ago,but now because of the corrupting influence of these individualson American politicians a situation has emerged in which Americanhealth care is now supervised by businessmen, totally devoid ofa medical background and ethics. The only factor considered inAmerican health care today is bottom line profit!
One only needs to drive through any American city to see the hugeoffice buildings housing these enterprises: edifices and employeeswho contribute nothing to health care, only increasing the costsand siphoning off monies which should be going to care of patients.
This is the last opportunity the Government of the Cayman Islandswill have to prevent these corrupting influences from invadingour islands and displacing those doctors who currently give ourislands the highest quality of health care in the Caribbean. Surelythe adoption of the Medical Practitioners' Bill should be delayeduntil this important issue can be studied and should be addressedby appropriate legislation.
The Ministry of Health and the Cayman Medical-Dental Society havethe expertise to study this issue and to anticipate future personnelneeds of our islands.** This study could be completed within six monthsto a year. The current regulatory system is working well enoughthat there is no need for inadequate unwise legislation, the effectsof which all of us will be affected for many, many years!
As for the constitution of the members of the Councils that willregulate the other health care professions, the legislation shouldmandate that one member of each of the three Councils of the alliedhealth care professionals, shall be a medical doctor licencedto practice in the Cayman Islands.
This would assure greater coordination of all of the health careprofessions and could serve as to a check to any health care professionthat wishes to expand the scope of its practice by legislativefiat rather than by education and training.
In essence, this is a well-intended but poorly drafted and poorlyconceived piece of proposed legislation. I do not purport to bean expert on the medical care of UK. But then, the fact that werefer our tertiary patients to the United States, or to be morespecific, to the Baptist Medical Center of South Florida, requiresthat our standard of practice be congruent with that of the UnitedStates. My only knowledge of the UK medical care has come frommy personal observations at George Town Hospital.
I must say that I find no difference between the accepted standardsof the United States and the care delivered in the Cayman Islands.Certainly the quality of care and the appropriateness of careare identical.
It is my personal opinion that the proposed Health Care Practitioner'sBill is a solution without a problem.
Sincerely,
Waite S. Kirkconnell, M.D.
*Certainly the individual rights we, as Englishmen,enjoy under English Common Law should also be respected.
**Too often does the Government seek outside consultantswho know little or nothing of our islands, failing to uilize locallyavailable expertise that could give assistance to the Governmentthat is more germane, more accurate, and cheaper. this MedicalPractitioners' Bill is a perfect example of these misguided butwell intended intentions.