Nothing to fear
Last week, I received a call from a distressed parent who had taken her son to the casualty department of San Fernando General Hospital.
The child was bleeding from the ear after a nasty fall. The mother was concerned that she had been waiting to see a doctor for more than two hours. That was around 6 pm.
I called several friends, in an effort to get medical attention for the child, but no one could assist. (To my amazement, the child (Steven Deo from Reform Village) was made to wait an incredible six hours (from 4:30 pm to 10:30 pm) before a doctor attended to him.
Coming on the heels of baby Luke’s case, where a misdiagnosis about a build-up of ear wax probably led to the death of the child, it is amazing the healthcare system has not changed its procedures to ensure children receive special treatment.
I publish the name of this child in the hope that Health Minister Jerry Narace, or someone from the South-West Regional Health Authority, can explain why this happened.
Something is terribly wrong at San Fernando General Hospital, because this patient’s story is certainly not an aberration.
The casualty department is notorious for its long wait for medical attention. And if it’s not that, it’s the perennial problem of insufficient beds and the pictures of people having to sleep on benches.
In recent times, I have filed quite a few new medical negligence cases. I have many friends who work in the healthcare sector, and many have expressed concern about this development.
Truth be told, I am extremely sensitive about the cases I chose to file, because the law of medical negligence gives wide latitude to doctors and nurses, so that most mistakes do not necessarily amount to negligence in law.
In the stressful hustle and bustle of professional life, mistakes can and do happen. Not every misdiagnosis is evidence of negligence, and there is an appreciation about the need for doctors to act and make judgment calls in situations where time is, literally, of the essence.
Healthcare professionals have nothing to fear by this medico-legal development.
The cases I have filed are extreme and ridiculous (operating on the wrong knee, patient falling off an elevated machine and injuring her hip because they didn’t strap her on and close the bars by the feet, overdose, baby being burnt with a hot water bottle, improper monitoring leading to baby deaths, failure to do an ultra sound to confirm a live and viable foetus that led to inappropriate and wrong treatment, falsification of medical notes by a doctor to hide his own mistake that led to the death of the patient, etc.)
In some countries, medical negligence litigation has helped improve the system. In others, healthcare professionals panicked and adopted a “hands off” attitude, expressing fear of litigation.
Instead of being decisive and efficient, the system slowed down even further, and patients suffered while lawyers prospered. Professionals became reluctant and adopted a “textbook wait and see” attitude towards patient management and care, preferring to err on the side of extreme caution.
The idea was to let the faceless system take the blame, rather than risk their personal reputation.
Good sense must prevail and the balance be struck. Better self-regulation of the profession will assist in striking the right balance, and to this end, I wish to propose establishment of an independent medical complaints panel for doctors, comprising foreign and local professionals.
The objective of such a panel would be to receive and evaluate complaints from disgruntled patients. A written report can be prepared explaining conclusion, and this can be subsequently used as evidence of negligence in appropriate cases.
This would solve the problem of the unavailability of professionals to testify in court, and weed out frivolous cases. It will also assist the judge who will have the benefit of an independent expert report to guide him.
(This is helpful in medical negligence cases where judges and lawyers know little about the intricacies of medical procedures and treatment).
We are fortunate to be blessed with a large body of competent and hard-working doctors and nurses, and these cases are not meant to be a witch-hunt.
They are meant to fill a void that existed in the dispensation of justice in the area of professional negligence, in keeping with developments in other developed and developing nations.
By Anand Ramlogan 2008-04-20
As Anand will know the law is not there to jump on every human failing. In negligence law on the whole the law is careful to distinguish that which is pardonable human failure from mistakes which are 'reckless', callous and contemptible. Chopping off the wrong knee or putting the wrong injection into the spine, are examples of the latter group.
"Good sense must prevail and the balance be struck. Better self-regulation of the profession will assist in striking the right balance, and to this end, I wish to propose establishment of an independent medical complaints panel for doctors, comprising foreign and local professionals."
That sounds like the kind of thing a judge sitting high up might think. From the experience here in the UK, with all it's fancy legal checks and balances, self-regulation has not been seen to facilitate striking the right balance. This is so apparent that UK medical regulation is moving away from 'self-regulation' with some speed.
Independent complaints panel? Eh heh? I have to say mockingly. Very fanciful, but pie in dee sky! Independent? Anand yuh still livin' in Trickidad or yuh emigrate tuh Englan'? Trickidad eh know 'B' from bullfoot about the meaning of 'independence'. This is not to say that your idea is not a good one - if it could be properly set up and allowed to work 'independently'.
Mixing foreign - presumably first world professionals - with locals? Yuh looking for big infighting ,name calling, racial abuse etc etc. Immediately you looking at a clash of cultures and personalities within such a panel. I'm not saying it is impossible to create such a panel and for it to work. The immense problems will be in setting it up, preventing dog or cat fights, giving it lawful powers, and keeping the fingers of politicians out of it. Independent is like the Judicial Appointments Commission here in the UK. Yuh cyah get dat dong dey! Ah cyah see it, boy.
I don't expect such a panel will ever be successfully set up. It is unlikely to serve existing political motives in T&T, which appear intent on starving the population of healthcare in order to maintain political control. Think laterally. Poor health faciliities delay the likelihood any large scale protests. The resemblances of T&T to Zimbabwe in earlier days, are actully more apparent with each passing day. Look at the whole picture - the whole puzzle. The dilapidated fourth world conditions of healthcare in T&T are not by accident or neglect, they are by design. So Anand, your suggested solution seems oblivious, to that which is apparent to many sitting outside of T&T- who in fact have a clearer perspective about what is going on.
T&T has enough 'law' in its stash to fight for better health care. The issue for example of children waiting hours and hours in very poor conditions need not be thought of from a 'negligence' perspective at all. It could well be actioned from a Constitutional perspective. To my knowledge S5(2)b of the Constitution has never been the foundation of action against any healthcare facility or emanations of the government in healthcare facilities. You might have thought that at least in a dungeon of despair as is St. Ann's Hospital, that some action would have come from that area of law. But no..nothing.
The Constitution is powerful law and it needs to be used to protect the rights of the people. The legal 'fight' from whatever appropriate angles needs to happen soon, before the Privy Council is removed as the highest court for T&T. The institutions of government need to rocked into its senses by the force of law. Timing is everything. And when they have been shaken, and are willing to listen up. Then feed them your very good first world ideas.
I think Anands idea is a good one Walker.Not easy to implement but by no means impossible.
However, you are right with respect to the issues that you have pointed out such as cultural clashes between foreigners and locals and politicians keeping ther finger out of such comissions in order for them to qualify as being independent.
Yes, the constitution does protect citizens against such mismanagement in healthcare in theory , you are right.However , the mere existence of a law is no guarantee of enforcement and having a comission will serve to deal with the issue of enforcement and move the stress of fighting a battle against an institution off of the individual so the battle is between two parties of equal stature. The average man in the street does not understand the ins and outs of the constitution and does not have access to sufficient funds to hire an appropriately qualified lawyer to fight his case.
I am a trini living in the UK and what I would say that your statement on moving away from self regulation here in the UK is not accurate.
Mr Anonymous, yuh know yuh could sign up at the site? It real easy. Whuh yuh 'fraid or what? Okay, personal reasons - cool.
Thanks for supporting my case on the lack of enforcement of Constitutional rights. The average man in the street does not have to understand the ins and outs of the Constitution to know his rights. If dee average man in T&T cyah read den dee average man could find somebody who could read dee Constitiution to him. All dee average man have to do is to open he mouth and arks a question. Funds to hire a lawyer? Come nah man. There are lawyers in T&T who will take on pro bono work or do cases at a reduced fee.
There are open and shut cases of breaches of Constitutional rights in health institutions just waiting to be championed. Perhaps the fault is not wid dee average man but with lazy ass lawyers who eh know nuthin' 'bout dee Constitution. Or maybe dey 'fraid to take on dee Govament, lest they or dey relatives be visited by murderous gunmen, kidnappers, rapists, or police officers with erections. I does talk plain.
Self-regulation of medicine in the UK is almost dead. If you read anything of what is going on the GMC is being emasculated as we speak. The government has operated with stealth on the GMC by introducing various super-regulatory bodies such as the CRHE. Yes I know what the role of the CRHE is because I've had personal dealings with them. And I've had two cases I took before the GMC myself. Much has changed since the Shipman Inquiry. One thing you will know is that Shipman is a similar instrument to Bristol. When the UK government wants to drive change they will spend big money on public inquiries.
'Stealth'? Yes, stealth. The politicians have been very careful to work in a way not to rile up doctors. They are have been closing the vice very carefully. Doctors in the UK are largely blind to slow-burn political process in my opinion (based on my observations). But watch this: Doctors expected to lose right to self-regulation and Doctors lose the right to police themselves. The Guardian and the Times are reputable newspapers in the UK. But look at the direction of the wind coming from 2005 with Dame Janet Smith here: The GMC: Expedience before principle. See also Doctors attack Gordon Brown's plans to regulate doctors.
The GMC has been under so much pressure and has changed so much since 1997 (at least) that it's role and function has changed significantly. They have been beaten about the head from left right and centre. The so-called regulator has actually been regulated. So at one level doctors in the UK are given a dressed up notion that they are self-regulated but at another level the heavy hand of government has been, in the background, reshaping the regulator and regulating at a distance. But all that is likely to change rather soon. The trajectory of changes from the late 90's and the proposals made by Dame Janet Smith will bite. So my friend if the regulator is a 'puppet on a string' can you really say that those regulated have been self-regulated? I don't think so. But if you want to believe otherwise that's cool. It will all be decided within the next few months. But you will see and feel what I'm talking about if you work in the medical profession.
It's interesting that the Roger England report was used back in the 90's in T&T to railroad in Health Authorities in T&T. At the same time the UK was moving away from RHA's to recentralised super-authorities. So this talk about self-regulation of doctors in T&T is crumbs that fell off the European table, just like the RHA scene. But as I always say Banana Islanders feel dey know it better than those like me who actually rub elbows with medical regulation in the UK. Man, eef Pastor Patos say is so is so, yes! Who is me, tuh say anyt'ing. So yuh right boy. Me eh know wha' a talkin' bout.
Here is the full story FYI Captain Walker....The consultation continues.The changes proposed are not likely to be a 360 degree turnaround as you are implying.
http://www.bma.org.uk/ap.nsf/Content/RegulationmedicalprofessionSc?OpenD...
The public awaits the passing of new laws.
On hiring a lawyer for a reduced fee.Like you ent listening to teh news back home? Ppl don't have money to buy food , u think they will have money 4 a lawyer?Especially the ppl who have no choice but to use public health i.e. the grassroots. Get real.
Lol...I,m not registering on this site. last time i tried it took to long and froze up my computer.
Furthermore Captain....like yuh never went to d health office back home or teh general hospital?Yuh could dead in casualty ....I nearly died my self. Trust me the UK system is far from perfect but it ain't nowhere near the circus that we have back home that is called a Healthcare system. You don't find that lack of enforcement and absence of developed laws to protect citizens in the UK.Yes malpractice does occurr but there is more enforcement of laws here to protect the public and there are more effective channels through which complaints could be directed.Back home when you complain is liek water fallin on duck back...No system could be worse than teh existing one.
You is a real Trini boy! You spend more time writing two anonymous responses than registering with dee site. Daize about 200 wo'ds. Tuh register is jes less dan 10 wo'ds. So what crap yuh talking. Yuh paranoid no ass.
And further more yuh shortsighted as hell. Boy, if you really in dee UK you would know dat the game all happens behind closed doors. Dee BMA eh know what dee ass go hit dem. You quoting t'ing from las' year. Man I giving you what eh even in the media. Buh like ah true Trickidadian, yuh behind in dee race as usual. Dey go carpet yuh ass jes now.
You provin' only one t'ing. Dat you i's a old talker and excuse maker. You represent the pathology of all Trini's i.e. paranoia, time-wasting, self-serving circularity.
You song (aka 'sound') very much like a fella we had out here who call he self 'scholar'. Doh come here wid yuh monkey tricks. We doh have time tuh was'e wid you. And stop was'ing odda people time. Eef yuh like Trindad so much w'at dee ass yuh doing living in dee UK.
In light of this exchange, we are presenly reviewing our policy for the third time on anonymous postings.
At this time we have re-instated a block on all anonymous postings.
Site Admin
2008-04-21 18:02 GMT - Site Admin Rated a *****FIVE STAR***** contribution.
I lived in Trinidad for 35 years before migrating. I did not think to leave the land of my birth, but a situation arising that needed me elsewhere (England) took me away from the land of my birth. Okay, it's still a place I call home, even if unconciously so.
Like many Trinidadians, I was contented in Trinidad; I grew up wthin the system and lived with it and accepting it as others did, after all, it is the way it is. Change? You may grumble, occasionally cuss and want to put a hand on some idiot who making things a little more difficult than normal, but in the end, you accept. That's it, you accept.
Moving away to England opened my eyes considerably. Not in the sense that I was enlightened that I DO NOT HAVE to accept, but more in the way things could be. Asking myself why it is this way and not like Trinidad and Tobago (indeed some more Caribbean islands as well), I concluded the answer lay in discipline.
I have said it before, and I say it again. You look at a Trinidadian or Tobagonian going abroad, and 'suddenly' becoming successful, and first words out of your mouth - 's/he lucky!'. Luck? Luck had nothing to do with it. I can attest personally to studying till 3 in the morning, catching a few hours sleep, starting work at 7 AM, and doing a part-time job after work for additional finance to fund my studies. Luck? Nothing lucky about that. It's the discipline to see a goal, want it so bad you can taste it, and then finding the means to discipline yourself to getting it.
Now that I am 'lucky' to be an a job where I sit at a desk all day with limited actual work (more responsibility though) I ask myself, would I have been doing this if I did not discipline myself in the past? Or would I be continuing my education if I did not have discipline to see something better in the horizon and want it?
I can look at Trinidad and Tobago from outside, and see that the main cause of the problems is not the parliamentarians, the lawyers, the quasi-governmental organsiations, the leaders... more and more I am realising it is the people. The people who lack the discipline to root themselves out of ignorance and into self-awareness. Schoolgirls selling sex for a box of chicken and chips, schoolboys hustling for 'brands and bling', young professionals seeking the better pay package, the employers seeking higher profits... everyone lacks the foresight to see something better in the horizon where EVERYONE can gain. Nope, at the moment the lack of vision and discipline is causing selfish needs to gain root.
Sometimes I ask myself 'Are they too blind to see?'. How could they not see that if all these years of voting UNC and PNM their lives have not progressed beyond the ghetto (this despite the massive buildings etc), how could they not see that they should try something new?
How could they not see that they are being used to fill the pockets of the selfish few, the parasitic oligarchy as one man claimed?
To want what is better, be it in health care, education, security whatever, Trinidadians and Tobagonians need to dicipline themselves first. They can never have self-regulation because they are not disciplined enough. That is why we always need 'massa' to crack the whip for us. Why we are never to work on time, never meeting appointments on time, never meeting deadlines on time... simple lack of discipline to do what is right and necessary to keep the cogs turning smoothly.
I don't know who chose the watchwords of the nation: DISCIPLINE, TOLERANCE, PRODUCTION, but it is obvious that person had much foresight. Too late we realise that there are lessons to be learnt from them, as all I am seeing today is a reflection of the truth - we forgot them and never lived to the true potential from them that we were suppose to .
And to add to Jumbie's excellent comment, I must ask what about 'Integrity'? Anand himself knows of the Integrity Commission first hand. He lost a case here in London, against their dam nonsense, here at the Privy Council concerning a certain matter.
I was fortunate to be there in the Privy Council and witnessed the tremendous fight that Anand and Sir Fenton Ramsahoye put up. I was confident they would win. The five law lords 'tapped up' State counsel all round. But no - for the absence of a form - yeah a mere form - amongst other technicalities, Anand and Sir Fenton did not see victory. It was a very sad day.
But hold on. Why is integrity important? Well if you don't have integrity, self-regulation of any kind is a virtual impossibility. And I argue that if the Integrity Commission, supposedly meant to be the shining beacon of integrity in T&T, is so lacking in integrity in the eyes of the average man, can we expect to find it elsewhere in any meaningful quantities? I don't think so. Integrity Commission? Are you thinking Maha Sabha? Think it now: Newsday 2008-03-27.
So Anand, draw on your experience. Your people in high places lack integrity. Can you really expect integrity to come from the womb of corruption and bobol? I don't think so - very unlikely. I argue that 'self-regulation' of anything in T&T is likely to remain wishful thinking for quite a long time. Dey might call it self-regulation, but it eh go be dee real t'ing!
...As I read Anand's article, I don't know anyone who leaves home to go to work on a given day and expects to come back home facing a "lawsuit"...so for me the real issues are not so much that the Medical & Health Care Professionals should be afraid in carrying out their duties and responsibilities, but doing so in a reasonably efficient and effective manner, while exercising the required due care and diligence and good judgement associated with their respective professional responsibilities...nothing to fear...!
...but this is obviously not whats happening, at least in San Fernando General Hospital anyway, it is currently operating as a "system in distress" , a system that is sick and dying, if not completely dead, while the staff , both doctors and nurses, are working as hard as they could but operating under duress and frustration...in the face of severe shortages of all kinds, beds, pillows, medicine, staffing, diagnostic tools and machines, you name it and they don't have it...! No one should have to work under those type of "primitive conditions" today...! Lets face it, thats where the real problem lie...not in the people...in the system...in the Government of the day..!
...on one hand, the Government will tell us repeatedly and would have us believe that they are providing "free medical care" to the people...well nothing is "free" if it is paid for by taxes collected from its citizens, so there is nothing free about our health care.....it belongs to us and it is a right of its citizens....!
.....as Anand said, mistakes will and do happen in healthcare, but those should be few and far between, exceptions if you will, not routinely and regurlarly as is the case here...!
...having said that, I fully agree with Captain Walker that TnT is not ready for self-regulation for the reasons he cited, they are still quite far away from being able to implement such a mechanism to deal with sub-standard health care or mishaps arising from some of these incidents...! I also agree that for such a system to work, the integrity of the panel must be above board and without question, something that I find sadly lacking at this time...!
....I also concur with Jumbie's citation of "discipline" or lack thereof, as an epidemic that have afflicted most of our citizens today, and hence this too presents a barrier towards putting such a plan in place or having it work as it should towards achieving any successes...!
...that being said, absent of any real effort by the Minister of Health to stop blaming everybody for their abject failure to implement and maintain a first class health care system for its people, amidst all the "windfall" oil and gas revenues they are getting beyond their wildest dreams...but wasting it on non-essentials such that the people, to whom the monies rightfully belongs,will never derive any benefit ..of anykind.....!
...in the meantime, the lawsuits will have to do just fine, if thats the only recourse and remedy available to the people.....and hopefully, the many hard working and diligent health care practitioners don't get caught in the frenzy....if it can be helped, as Anand said, by being carefully selective...!
....somehow I feel the Minister of Health along with the Southwest Regional Health Authority should bear the brunt of these lawsuits along with end consequences too...but that maybe only wishful thinking....if only there was a way to hold them personally responsible...but that too is wishful thinking in TnT...!
...so in the meantime, if you have to go to the Hospital, sad as it may sound, call your lawyer first, or for that matter take your lawyer with you...?...only in sweet Trinidad & Tobago...you say eh!
...goodluck..Trini.t.o.o
...
"Healthcare professionals have nothing to fear by this medico-legal development."
Eh heh? I say mockingly. Well somt'ing funny dey boy. Well not really 'funny' but more like phoney.
Watch dis: Newsday 2008-04-22. So doctors leaving according to MPATT. But it is not a false story - it has been happening for quite some time. I know of three doctor friends who are in New Zealand, Australia and Canada. The first (from NZ) took a trip back to T&T sometime last year. Well, basically the trip made the decision for him, not to return. What was the pull back to Monkey Island? Famaly (Family). What was the push - a totally barking mad system of healthcare relative to other parts of the world - and a sense of futility.
The haemorrhage of medical manpower has been well known about by those in high government. Well eef dey don't know, dey mus' be drunk or asleep at the helm. And their solution is to pay a few high-flyers big money and bring een a bunch ah predominantly Spanish-speaking doctors - and tell the population that Spanish is dee second language. Well today my real name is Elton John - right?
But dig dis: TT Express 2008-04-25 - Oma Panday recovers from heart surgery in Englan'. Ahm...excuse meh dey tah. Like why so many politicians and dey famaly flyin' out for major healthcare - like operations and higher risk procedures?
Allyuh get it yet? Okay ah go tell yuh. On dee one hand yuh have doctors flying out 'fraid fuh dey own ass tuh work in local hospitals - and on dee odda hand yuh have politicians and dey relatives flyin' out frightened fuh dey own ass in dee Nation's hospitals. Ah cyah make it plainer dan dat boy.
So whilst Anand's reassurance is largely to good doctors who are diligent, doctors in T&T cannot say hand on heart that a sick and deficient system will not try to make them into fall guys. So in many ways Anand's reassurance is not likely to hit the spot.
My advice eef yuh going into any T&T Hospital as a patient? Take out a big fat insurance policy, legal insurance, write yuh will - and take food, water and linen along wid yuh. If yuh more sophisticated, take covert surveilance equipment.
My advice to T&T doctors? Leave now. Leh meh say dat again - LEAVE NOW!!
We inform our supporters of a new 'sister' site:
The Medical Justice Board
go www.mjb.cc
This site will provide support internationally to those who are victims of medical mishaps.
For FREE!!
Professionals who wish to volunteer their time and skill may apply to join the MJB.
[The site is currently assisting a complainant with a case of psychological abuse of patients by a psychiatrist, who came to the attention of a Coroner's court recently. That's all we can say of the anonymised details. These matters remain highly confidential.]