News
Dr. Gerald Smith has beenappointed new Chief Medical Officer
Following discussions between the HealthServices Authority, the Ministry of Health Services and the GovernmentLegal Department, it was decided that in order to avoid any suggestionof conflict of interest, it was undesirable for one person tosimultaneously hold the posts of medical director of the HealthServices Authority and chief medical officer (CMO) of the CaymanIslands Government.
Dr. Bryan Heap, who was the CMO of the HealthServices Department, became medical director when the changeoverfrom a department to a Health Services Authority took place on1st July, 2002, says Permanent Secretary in the Ministry of HealthServices, Miss Andrea Bryan.
Following upon this changeover, Dr. GeraldSmith has been appointed by His Excellency the Governor, Mr. BruceDinwiddy, as CMO with effect from 16 September until further notice."Dr. Smith has sprung into action and is already dealingwith matters such as patient referrals to private practitionersand registration of health practitioners," notes Miss Bryan,adding that Dr. Smith had previously served as CMO.
She explains that once Health Services ceasedto exist as a government department and became a private authority,its employees also ceased to be civil servants. Their employmentstatus was automatically transferred to the authority, and somepositions were modified to be more in line with those of a privatehealth facility. Instead of a CMO, therefore, the authority hasthe position of medical director (MD) in charge of physician services.
Dr. Smith in his role as CMO will now performthose duties required by General Orders and various laws , mostnotably the Health Practitioners Law, explains Miss Bryan. Inaddition, under General Orders, only the CMO can refer civil servantsto local private practitioners or overseas medical specialists;there are also specific duties for the CMO under the Misuse ofDrugs Law, as well as the Mental Health Law. The medical directorof the authority is not authorised to fulfil these functions.
Furthermore, Miss Bryan acknowledges thatkeeping the posts separate avoids conflicts of interest. The CMOpostholder is the chair of the Health Practitioners Board, whichissues rulings on cases involving both private- and public-sectorpractitioners. Meanwhile, the medical director is, by law, a memberof the Health Services Authority's board.
"As supervisor of the authority's physicians,the medical director would most likely be involved in any matterscoming before the board that would involve one of them,"she explains. "To have one person in the dual posts of CMOand medical director would therefore potentially pose a threefoldproblem.
"First, the person would chair theHealth Practitioners Board proceedings as CMO; second, he wouldbe a member of the Health Services Authority board as medicaldirector; and third, the person may be involved as supervisorof the health practitioner whose case is being heard. This wouldpresent a blatant case of conflict of interest," she asserts.Following consultation with the Legal Department, it is consideredthat given the statutory functions of each post, it is questionablewhether one individual could properly discharge one function withoutcompromising duties in the other.
Saying that he "very much welcomes"the new arrangements, Dr. Heap notes that they remove any potentialconflict of interest on his part. "As medical director ofthe Health Services Authority I have a role in establishing andmonitoring clinical standards, and reporting to the Health PractitionersBoard should serious concerns with regard to professional misconductarise," he remarks. "It is therefore not at all appropriatethat I should chair a board which has to consider and judge anysuch concerns."
Comments Dr. Smith, "Having acted aschief medical officer in the past, I am pleased to assist in resolvingthe conflicts that were present in the former roles of the CMO.I look forward to assisting the Ministry of Health in undertakingthe roles of the CMO as set out in our various laws."