Bartholomew tells of ‘grossly unethical’ treatment of patient by private doctor

PROFESSOR Courtenay Bartholomew told Sunday Newsday yesterday that since November 1998 he had notified the Minister of Health, the country’s Medical Association, Medical Board and other relevant organisations about private malpractice in the treatment of HIV/AIDS patients in Trinidad and Tobago. Prof Bartholomew, Director of the Medical Research Foundation, was replying to Dr Steve Smith, president of the Medical Board, who called on him on Thursday to provide evidence with respect to revelations made in his address at Tuesday’s launching of the Health Ministry’s HIV/AIDS Health Sector Plan.

Dr Smith, according to one report, said the Board had written to Prof Bartholomew requesting the evidence so that a tribunal could be set up to investigate the allegations. Prof Bartholomew told Sunday Newsday yesterday that he had received no communication from the Board.
The malpractice letter from the MRF was signed by Prof Bartholomew together with Dr Noreen Jack, Senior Research Fellow and Dr Jeffrey Edwards, Research Fellow. The letter was addressed to a private practitioner and copied to Dr Hamza Rafeeq, then Minister of Health; Dr Rawle Edwards, acting Chief Medical Officer; Dr Deo Singh, President Elect, TTMA; Dr Frank Ramlackansingh; president, Northern Branch, TTMA; Dr Mitra Sinanan, president, Medical Board of Trinidad and Tobago; Dr James Hospedales, Director, CAREC; Dr Robert Lee, Registrar, TPHL; Dr Sankar Moonan, Chairman, Ethics Committee, TTMA.

Excerpts from the Foundation’s letter addressed to a medical practitioner:
In April this year you were called to see a patient in a private nursing home to confirm a diagnosis of AIDS made by a consultant there. The patient, who was subsequently referred to us by CAREC, complained, among several other dissatisfactions, that this diagnosis by the consultant was voiced in the presence of two nurses after a rapid test was said to be positive for HIV. This diagnosis was made without the scientifically and legally required confirmation by a second test.

Moreover, she was not informed that an HIV test was being done on her, nor was any counselling given. This was grossly unethical and unprofessional. It appears, however, that a second blood sample was sent the following day to TPHL/CAREC. We are told that upon arrival at the nursing home you immediately confirmed that she had AIDS without awaiting the result of the confirmatory test from TPHL/CAREC, apparently on the basis of what was allegedly observed as “thrush” in her throat. No culture was done! This was also unethical and unprofessional. The patient’s faithful husband was also informed by you of the HIV positivity of his faithful wife and that you felt that he may also be HIV positive because of the advanced stage of his wife’s disease, a fifth ethical and professional misconduct.

The stress and distress of this middle class couple with a small private business enterprise, as a result of this diagnosis, was of such a serious nature that it caused unbearable domestic and work problems of untold dimension, including suicidal thoughts and marital separation. In July 1998, we first saw the patient and confirmed that she was never truly HIV positive. Her repeat ELISA (Cambridge Biotech) was negative. A Western Blot was also negative, as was a PCR quantitative viral load test assayed at the Molecular Diagnostic Laboratory of the Institute of Human Virology in Baltimore, USA. In fact, when she returned to the nursing home at our request on August 7 to obtain a written report of the rapid HIV test, she was then given a second report from TPHL/CAREC, dated May 15, 1998, which clearly stated that the test performed there was HIV negative.

In short, she was never told of this second negative report until August 7, three months later, and only because she went to the nursing home to obtain her report on our advice. This sixth breach is not only unethical and unprofessional but also criminally negligent. But there was yet a seventh breach of HIV doctor/patient protocol and ethics in that the full name of the patient was written on the request form from the private nursing home to the TPHL/CAREC laboratories. This history must indeed be the world’s worst case scenario as it breaks all the ethical rules of HIV disease and the doctor/patient relationship. In fact, it is so appallingly serious that the patient and her husband had consulted a lawyer without our knowledge. This is not the first time that we have encountered such improper pronouncements to patients of their alleged HIV status and which have eventually turned out to be wrong.

If someone of your status does not know the rules, then, obviously, this is very serious matter which necessitates informing all doctors in the island of the established rules about HIV diagnosis to patients, including obtaining informed consent for testing for the virus, particularly in certain people. This is now the urgent responsibility of the Ministry of Health and of the Medical Association. We regret that we have had to be associated with this unfortunate affair in light of our mutual history, but this is too serious a matter to shelve.

We are requesting those who have been copied to observe strict confidentiality on this matter and to treat this with discretion within the limited professionals. The copy to the Medical Board is not a request for disciplinary action. It is more important than that. It is a request to inform the nation’s doctors in a circular (without quoting the reason) of what the rules and ethics of HIV investigation and diagnosis should be, lest there are more recurrences.

Yours sincerely
Prof C Bartholomew
Director
Dr Noreen Jack
Snr Research Fellow
Dr Jeffrey Edwards
Research Fellow