Doctors Hospital is seeking a judicial review to challenge the practice in the Cayman Islands of allowing ‘institutionally registered’ medical professionals to practise without having to adhere to the same criteria as healthcare workers in other facilities.

The applicant, under the name CTMH Holdings, is asking the Cayman Islands government, the respondent, to formulate criteria for designating an institution as a place at which ‘institutionally registered’ practitioners may be employed, to review such designation, and publish a “transparent document” of the criteria.

This is the second judicial review filed by Doctors Hospital in relation to the government’s treatment of other medical institutions. Earlier this year, it submitted, and was granted, an application for leave for a judicial review over what it described as “vast and unilateral” financial concessions, such as the waiver of customs duty, work-permit fees and stamp duty, offered to both Health City Cayman Islands and Aster Medcity, a new $350 million hospital planned for West Bay.

Doctors Hospital, previously known as Chrissie Tomlinson Memorial Hospital, notes in the application that the Health Practice Act (2021 Revision) permits “institutionally registered” medical practitioners to practise in the Cayman Islands, “notwithstanding that they may be less qualified and less experienced than fully registered medical practitioners”.

The relevant legislation, which originally came into effect in 2011, was one of a handful of laws passed by the then government to help pave the way for the opening of Dr. Devi Shetty’s Health City Cayman Islands. That legislation, which was opposed by the Cayman Islands Medical and Dental Society, included a section that recognised medical qualifications from countries, including India, not accepted in Cayman.

A designation, which at that time was called ‘special registration’, has since been changed to ‘institutional registration’. Currently, there are three medical institutions listed under that designation – Health City, the Cayman Islands Health Services Authority and Total Health.

Aster Caribbean Holdings Ltd., which plans to open Aster Medcity, is also seeking to secure an institutional designation.

Under the Health Practice Act, medical practitioners seeking to be registered on what is known as the ‘principal list’ are required to show specific qualifications or accreditation from one of seven countries – Australia, Canada, Jamaica, New Zealand, South Africa, the UK and the US – or regional councils, and demonstrate that they have worked a minimum number of years in their field.

To apply for inclusion on the ‘institutional list’, according to the Health Practice Regulations, applicants can be registered as a health practitioner in any country other than those seven, and have “obtained qualifications from an institution approved by a relevant Council in accordance with guidelines approved by the Cabinet and published by the Council in the Gazette; or (ii) passed an equivalency examination approved by a relevant Council”.

In its submission to the court, Doctors Hospital said, as far as it was aware, “no equivalency examination has yet been approved by the Medical and Dental Council for medical practitioners” for the purposes of the regulations.

CTMH Holdings lawyers sent a pre-action protocol letter to the government, asking it to identify whether any criteria exists for granting and reviewing designations under Section 24 of the Health Practice Act, and if not, to confirm that “CIG commit to publishing criteria within a specified timeframe”.

According to the judicial review application document, the Attorney General’s Office replied on 18 May 2021, stating that there were no criteria, published or otherwise, for granting and reviewing designations, and the “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”.

In its application, Doctors Hospital states, “For the avoidance of doubt, the Plaintiff does not seek the quashing of the designations already granted to Health City, the Health Services Authority and Total Health Ltd. However… the Plaintiff seeks to ensure inter alia that such designations are henceforth subject to review pursuant to transparent criteria which give effect to the statutory purpose and that any future applications for designation are determined pursuant to such transparent criteria.”

CTMH Holdings is also requesting that if the court grants permission for it to go ahead with this judicial review, that it can link to the judicial review relating to the financial concessions.

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