Doctors Hospital is celebrating what it regards as a victory in the judicial review it brought to court challenging tax concessions for Health City and the designation of medical facilities in Cayman.
Dr. Yaron Rado, chairman of the board of Doctors Hospital, in a statement following the judgment, claimed that until it brought the judicial review, Cabinet had been “arbitrarily” granting institutional facility designations to medical centres like Health City – and more recently to Total Health and the Health Services Authority – “without reference to any particular policy or criteria and with no review mechanism in place”.
He said when Doctors Hospital announced its intention to challenge the government over the lack of criteria for a centre to be designated as an institutional facility, “Remarkably, the initial response from CIG was that Doctors Hospital should apply to be designated. In other words, rather than address the absence of regulatory oversight of institutional doctors, CIG’s response was to invite Doctors Hospital to apply to ‘join the club’.”
During the hearing, the court heard arguments relating to ‘Institutional’ facilities, a designation created initially to enable Health City to bring in staff from its sister institutions in India, who had received qualifications from outside the seven countries on what is known as the ‘Principal List’. Once a healthcare premises is designated as an ‘institutional facility’, it can hire staff from outside the countries on the Principal List.
Doctors Hospital had asked the court to declare that government must formulate criteria for designating an institution as a place at which institutionally-registered practitioners may be employed, and establish criteria for reviewing those designations.
A few days before the hearing was scheduled to begin in April this year, the government produced written ‘Guidelines for Designation as an Institutionally Registered facility to employ practitioners on the Institutional Registration List’. Then, during the hearing, Tom Hickman, QC, representing the government, said designated institutions would be reviewed at regular intervals to ensure they met the required criteria.
These undertakings by government meant that the court did not need to rule on those points in the judicial review.
However, with regard to ambiguity in the Health Practice Regulations over the levels of experience and education required by practitioners on the Institutional and Principal Lists, Justice Richard Williams, in his 19 Aug. ruling on the case, said there would be “great merit” in legislators considering the wording of the regulations associated with the Health Practice Act “to remove any potential uncertainty in this important area of patient safety”.
Agreement on qualifications
Williams said that both parties in the case had agreed to interpret the Health Practice Act and regulations as stating that the educational qualifications required for medical staff on the ‘Institutional List’ be the same as those on the ‘Principal List’.
Nellie Pouchie, chief officer in the Ministry of Health and Wellness, at a media briefing on healthcare issues on Wednesday, was asked by the Compass about the impact of the judicial review ruling.
“We just received the judgment recently,” she said. “We have not gone through all of the details of what other proactive actions might be needed, moving forward, on the issues that were identified, that were contested.”
However, she said, the ministry was looking at the institutional registration regulations “to ensure that we have a balanced playing field” for all providers. She said the ministry had received comments that the system was not balanced.
She also noted that the ministry had to make sure that healthcare providers are aware of what is required when it comes to the various types of registration, and “anything that needs to be strengthened in that regard, we have to look at that”.
Pouchie added that the ministry had received recommendations from the Health Practice Commission “with respect to various instances of registration that we are currently considering as well”.
The ministry was not yet in a position to give more information on what the review of the regulations would entail, she said.
Rado, in his statement, said, “As a direct result of Doctors Hospital’s legal challenge, all doctors practicing medicine in Cayman must now meet the same, high standards before they may be approved to practice in the Cayman Islands and before they may hold themselves out as specialists in a particular field. This outcome is not just a win for the medical community and Doctors Hospital, but it is a victory for the people of the Cayman Islands who may now have greater confidence in their healthcare system.”
Health City, however, has stated that its staff, while being on the Institutional List have always met the same educational and experience criteria as those on the Principal List, as required by the Health Practice Commission and the Medical and Dental Council.
Justice Williams, in his ruling, stated that neither party had been “fully successful in this matter”, and did not make any ruling on costs in the case.
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