Doctors' discipline Editorial
Stabroek News
December 9, 2001

One can understand Health Minister, Dr Leslie Ramsammy's frustration about the quality of service in the nation's public hospitals. Of course he wants to ensure that at least the basics are covered, and in particular, that emergency cases are attended to promptly. However, he could find that his impatient approach in dealing with the problems in this sector is counter-productive in the longer term.

Following the well-publicised case of Mr Shahbodeen Kassim who died at the New Amsterdam hospital after waiting two hours for attention, Dr Ramsammy went back to the institution on Saturday, December 1, where he encountered a second delayed response to a perceived emergency. According to a press release from the Government Information Agency (GINA), Dr Ramsammy had found two patients, one of whom was unconscious, awaiting treatment in the emergency ward with no doctor available to attend to them.

It appeared that they waited more than an hour for the duty doctor to arrive, and that when he did come following the Minister's intervention, he told Dr Ramsammy that he was not at the hospital because he had been on duty since Thursday. He had only left, he was reported as saying, for a short while. The agency quoted the Minister as telling the doctor: "You were called for an emergency more than an hour ago and you did not respond. This is unacceptable."

The statement referred to Dr Ramsammy as indicating that the medical practitioner in question would be disciplined. It was the television newscasts which reported subsequently that the doctor had said that the Minister had told him he would be transferred to Region Seven.

Whatever the justice or otherwise of this particular case, it does raise larger questions about the sector's ability to supply quality health care. If it is true that the doctor in this instance had been on call for 48 hours without relief, then it suggests a systemic problem. At what point do you say when he leaves his post after working unacceptable hours that he is derelict in his duty? We are not in a war zone, or in the middle of a disaster crisis which would demand such commitment; this is an ordinary hospital on an ordinary day. Requiring that medical practitioners work such hours under normal circumstances is not only unreasonable, but it is also not good for the patients; tired professionals will inevitably make mistakes, and those mistakes could even be life-threatening.

The simple truth is that good emergency response requires sufficient medical personnel, and if this cannot be provided, then whatever faults an individual might be guilty of, the system itself will fail to deliver in the way that Dr Ramsammy would like. Prima facie it would appear that the New Amsterdam hospital may fall into this category; it lacks the number of doctors required to make the system run reasonably well even at a basic level.

The UK Government has recently decided to pour millions of pounds sterling into rescuing the failing National Health Service in Britain. While no one is objecting to that, commentators have also acknowledged that money alone will not do the trick; the health authorities will have to recruit thousands of doctors and nurses before there will be a significant improvement in health delivery.

And UK nursing agencies have already been here recruiting our better qualified nursing staff. So even if the Minister has not recognized it yet, he is probably facing a similar problem - whether or not to the same degree - as the Minister of Education, namely, a shortage of trained personnel at all levels.

Given that Dr Ramsammy does not have an abundance of qualified professionals at his disposal, he has to be careful about publicly humiliating any single medical practitioner, lest he undermines the commitment of the others who are still prepared to work in the public sector. Doctors are not primary school children, and whatever their shortcomings, they are best not treated as such. Which does not mean to say that disciplinary measures are not in order when there has been an undisputed breach. However, such measures do have to be seen to be fair, and do have to fall within the rules. It was Dr Luncheon who said at his press briefing last week that a Health Minister did not have the power to transfer a doctor in a public post; there were Public Service procedures in place for effecting transfers.

The problems in the hospitals are of long standing, and no matter how energetic and well-meaning he is, Dr Ramsammy is not going to achieve any instant miracles. If he is determined and imaginative, he will hopefully effect some improvement in some areas, but that is after he has done a careful analysis of what the system is capable of given the resources at his disposal.