GEORGE TOWN — Doctors Hospital has applied to the Grand Court in Cayman for leave for judicial review of the ongoing failure by the Government of the Cayman Islands to formulate and publish criteria against which healthcare facilities are assessed before being designated as a facility that may employ ‘institutionally registered’ medical practitioners.
Doctors Hospital’s central complaint is that the CIG has failed to formulate, publish and apply a transparent criteria for designating and supervising these facilities so the public can be assured there is adequate supervision of the less qualified and less experienced practitioners they employ.
In the absence of such criteria, Doctors Hospital claims, Cabinet’s power to designate a facility is liable to be exercised arbitrarily and in a way that fails to promote the purpose of institutionally registered practitioners only, being permitted to work at certain facilities.
A pre-action protocol letter was sent to the CIG on 23 April 2021, which asked it 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:
(1) there are no criteria, published or otherwise, for granting and reviewing designations,
(2) CIG is unaware of the reasons why the only facilities designated to date (Health City, the Health Services Authority and Total Health Ltd) were granted designations, and
(3) there are no arrangements for supervising the ongoing suitability of those facilities as places institutionally registered practitioners may practise.
By letter dated 18 June 2021, Doctors Hospital offered the CIG a final opportunity to commit to publishing criteria for granting and reviewing authorisations, failing which it would commence legal proceedings. No reply to that letter has been received.
Doctors Hospital accepts that the Legislature was entitled to introduce a tier of registration, whereby less qualified and less experienced practitioners are permitted to practice in the Cayman Islands. However, in creating a system where these practitioners may only work at facilities designated by Cabinet, the Legislature must have intended that these facilities will adequately supervise those practitioners.
Cayman Islands’ lack of regulation of doctors claiming to be “Specialists”
Doctors Hospital’s application also refers 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.
“As stated before, we believe in fair and competitive marketplaces,” says Dr Yaron Rado, Board Chairman and Chief Radiologist of Doctors Hospital. He added, “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. To be registered as a specialist on the principal list, you need at least four years post-medical degree specialist training; to successfully sit a Board exam and then have completed three years post specialty experience 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.”