PROCESS — A HEALTH CARE NIGHTMARE

THE EDITOR: Why are we seemingly in an abyss with respect to one of our basic rights as citizens — to access and acquire quality health care? We have a complement of extremely qualified professionals and technocrats in all spheres of health care. We have some excellent facilities and allied health personnel. We have amazing dedication, skills, experience, endurance and understanding as a people.

One of the most infuriating reasons for our ailing health sector is the apparent lack of understanding of due process in many aspects of health care delivery. Recently a letter was sent to me signed by certain Heads of Departments of the Hospital indicating quite clearly that no new admissions will be allowed to the wards or even the floors of the institution. This letter was addressed to me and was copied to two other senior administrative staff. What was very interesting though is that letter was copied in large numbers and posted all over the hospital and distributed to nursing and medical staff at the Emergency Department and the original signed document is not even in my possession. On the wards the letter was posted in open display so that patients or relatives could also read this letter addressed to me. It may be humbly suggested, therefore, that senior professionals do not understand policy and due process.

Since this letter was signed by the Heads of Departments of Surgery, Medicine, Obstetrics and Gynaecology, Paeditric Medicine, Orthopaedics, Surgical Subspecialties, ENT and Eyes, I was very worried since patients could not be admitted to the wards or even the floors of the Hospital and that the patients may have died in the Casualty. An emergency meeting was held and immediate contingency plans were instituted. These plans were put in place for the weekend to ensure continuity of quality care at the Hospital. What happened the following day was an amazing display of non-consensus, non-participation in crucial decision making, lack of professionalism and ethics, lack of process and care for our beloved people, lack of direction and co-ordination and lack of respect for colleagues.

On the following day some consultants who were attached to the above-mentioned departments indicated that they were seeing new admissions on the ward. It is thus evident that the heads of departments either left out their consultant team members when they decided to write the letter or the consultants did not adhere to the decision that was made by their team discussion that would have necessarily allowed their respective heads of departments to write me a letter and circulate it to every other health care worker in the hospital. Either way, you would agree, is unacceptable. One of the flaws of this letter was the fact that these Heads of Departments should have written this letter to the Medical Chief of Staff since I do not take directions from other Heads of Department. The Chief of Staff would then discuss it with them and when a decision affecting patient care is made, a memo would be issued to my department instructing me about the policy for implementation. Of course, friendly advice and guidance, sharing information and mutual understanding will always be viewed as a proper and professional way to deal with sensitive matters, especially ones that affect people’s lives.

The net effect of this apparent lack of authority and process is failure to deliver quality care to our fellow citizens. We must ensure a coordinated, professional, ethical, sensible, scientific, educated, non-political, non-racial, non-biased, systematic and respectful approach to health care situations both in “normal” times and in crisis periods. To do this Heads of Departments must reflect a consensus in their decision-making process and must engender the team approach to issues that directly affect the patients that they serve. When written documentation is formulated, signatories MUST ensure that they represent their team and that their members participated in the final decision that would be placed forever on paper as a permanent record. This lack of proper process as reflected in this document and the manner in which it originated and was circulated, would necessarily negatively affect and confuse my already stressed emergency team of hardworking and dedicated persons. Let us recognise Rotary International’s Presidential Theme for this year in all our endeavours. As professionals, let us “sow the seeds of love” in our homes, our communities and in our nation. As health care professionals, let us “sow the seeds of love” in our wards, departments and hospital floors.

STEPHEN RAMROOP, MBBS FRCSEd FRCSGlasg.
UK
Rotarian and Community Worker
Head of Emergency Unit SFGH
Clinical Coordinator Couva District Health Facility
Medical Director South EHSTT