Doctors Hospital has taken legal action against the Government for failing to produce guidelines against which healthcare facilities are assessed before being designated as a facility that can employ 'institutionally registered' medical practitioners.
In particular, Doctors Hospital say Government has not created transparent criteria for designating and supervising such facilities so the public could be assured there was adequate supervision of the less qualified and less experienced practitioners they employed. Because of this, Doctors Hospital say Cabinet’s power to designate a facility is liable to be exercised arbitrarily and in a way that failed to promote the purpose of institutionally registered practitioners only being permitted to work at certain facilities.
Before the legal action was taken, Doctors Hospital formally asked Government on 23 April 2021, to “identify whether there are any criteria for granting and reviewing designations under s.24A(2)” of the Health Practice Act (2021 Revision). The letter also asked to “confirm CIG commit to publishing criteria within a specified timeframe”. The Attorney General’s Office replied on 18 May 2021, admitting that there were no such criteria, that Government did not know why the only facilities designated to date (Health City, the Health Services Authority and Total Health Ltd) were granted designations, and that there were no arrangements for supervising the ongoing suitability of those facilities as places institutionally registered practitioners may practice. Doctors Hospital said they gave Government one last chance to respond in June but did not get a reply, so took the legal action.
Doctors Hospital said it accepted that Government could introduce a tier of registration, whereby less qualified and less experienced practitioners were permitted to practice in the Cayman Islands. However, in creating a system where these practitioners could only work at facilities designated by Cabinet, the Legislature must have intended that these facilities would adequately supervise those practitioners, they said.
The legal action also included a reference to the lack of any regulation setting the requirements to be met for institutionally registered practitioners to be registered as specialists in a particular field (such as oncologists or obstetricians).
“This lack of regulation risks patients being treated by insufficiently trained and inexperienced doctors without their knowledge, further risking potential harm to patients and the rising costs of health care via increased insurance premiums,” Doctors Hospital said.
Dr Yaron Rado, Board Chairman and Chief Radiologist of Doctors Hospital furthered: “As stated before, we believe in fair and competitive marketplaces. Further, we need this system to be transparent and safe for people engaging in healthcare in Cayman. We understand individuals are being granted institutional list registration for positions without completed residency programmes. This is alarming to us and should be alarming to everyone.”
Dr Rado said that to be registered as a specialist on the principal list, a physician needed at least four years post-medical degree specialist training and to successfully sit a board exam to be licensed in Cayman.
“None of this is overseen on the institutional list. So, we will continue to challenge the Government about this. Ultimately, what is at stake is the health and well-being of the people of Cayman and the standard of healthcare that the Islands deliver. To maintain high standards, Doctors Hospital has chosen only to employ fully registered practitioners who are on the principal list,” he confirmed.
Practitioners registered on the principal list, deemed the most qualified and experienced, can practice without supervision, while practitioners registered on the provisional list, deemed to be adequately qualified but lacking experience, must practice under the supervision of a practitioner on the principal list. Practitioners registered on the institutional list merely need to have qualified at a medical school listed in the World Directory of Medical Schools. These practitioners may be employed only by a health care facility Cabinet has designated as permitted.