RHA misinforming public

THE EDITOR: I ask to be allowed to respond to your editorial (27.06.05) concerning the current impasse between senior doctors in the public sector and the present political administration. I write today as a consultant and senior doctor at the San Fernando General Hospital and as a private citizen. Incidentally, the first record of this type of action by senior doctors was circa 1917 at the Port-of-Spain General Hospital. I have worked as a consultant at this hospital for very nearly 21 years and am the most senior of the consultants in the Department of Medicine at that institution. As an employee of the Ministry of Health, I do not have an individual contract. I am “governed” by a common industrial agreement arrived at as a result of the collective bargaining effort of the PSA who at the time were the titular representatives for doctors in matters as wage arrangements etc.

That collective agreement which is a legal collective contract, affords me the option of either choosing to work or not to do so during my “off” time. My choice of one or the other option which is written into the agreement must be informed by other relevant issues, not the least of which is first, my responsibility to the patients under my care, who under no circumstance must I abandon. The second relevant consideration has to be my perception of the value which my employer, the Ministry of Health, attaches to the work I do. That value is reflected in such things as the conditions of work which he provides, and the remuneration package I am afforded. As it presently stands, when I work on the weekends I get an official half-day compensatory leave the following week which cannot be translated into cash in lieu of the leave.

Of course with perennial staff shortages and the paperwork involved in arranging the compensatory time off, and the pervading perception that doctors who are not on the wards must be in their offices, the compensatory time off is not usually taken and the half days accumulate. Let us say that cumulatively, such leave amounted as is presently the case with me, to one year. I am then told (a) it must be taken or I would lose it; (b) I cannot be paid for the work it represents because this simply is not done; and (c) I cannot take it all at once because of the staffing situation, but must take it say in two week periods.

If I do not take the leave and it is withdrawn, then I would have worked as a consultant at that hospital for an entire year without pay, since I cannot be compensated financially for my time. If I take it in two week periods then because of the structure of my salary, I lose half my total allowances each month, and in the case of one or two of these allowances, I lose all of it. I also lose half my basic salary each month. Hence, by taking a year compensatory leave in two week blocs, would mean that for the two years and roughly two months that such a state exists I would have been receiving a salary of roughly one-third or possibly a quarter of its paper value. Mind you, if I opt to take the entire year off I get only my basic salary minus tax — or less than a quarter of my paper salary. Our MoH must be singularly unique in the way it perceives “reward” for extra work!

Hence, I decide that such an arrangement is clearly against my best interest. I wish to exercise therefore, the other option my employer has written into my wage arrangement which informs me that I can simply opt to stay home during those off days. Of course, I afford my employer written notice of my decision two months prior to exercising that legitimate choice. I ask you: have I breached my ethical responsibility to my employer or to my patients in effecting my alternative choice?

I am certain that I have not. Having offered me that legitimate option, would I be wrong in assuming that should the majority of doctors like myself decide that we are no longer comfortable with the idea of pro bono work for a year at a time, and we all took a decision to take the time off as a stress relief measure, then surely our employer must have alternative arrangements in place. And indeed, I can assure you that he has, since the 1994 RHA Act is explicit in this regard in according the RHA the administrative responsibility, along with the necessary administrative power, to house any patient who for one or other reason, cannot be housed in one of the hospitals it owns and operates.

The Act does not discriminate between “private” or “public” health facility in the exercise of this discretionary power of the RHA. It is therefore in my opinion not only open deceit, but it is deceit steeped in malice and an expression of a collective willingness on the part of an RHA to collide with the Ministry of Health in informing the public of this country that “Doctors are making poor people suffer.” If one can read what I have written above and arrive at that conclusion then I can offer no further comment. I end though, with a verbatim quote from a report prepared by David Kelly and Associates on behalf of RMC Resources Manage-ment Consultants, and presented to this incumbent administration in May 2002.

Having studied the working of our ministry, having examined and analysed existing problems for the umpteenth time, their report concluded: “The MoH, in conjunction with the RHAs, should establish a Healthcare Improvement Plan (HCIP) for the fiscal year 2002/03. This plan should be consistent with the HSRP, and should identify the priority areas for funding increases in the next fiscal year. These should include:

•A substantial improvement in physician (and nurse) compensation
•An improvement in working capital for the RHAs to assist them in managing their funds in a more effective manner.
•An improvement in supplies and equipment available in hospitals and health centres.
•Enabling the EWMSC to perform the role for which it was planned and built.
•Improved availability of outpatient pharmaceuticals in hospitals and health centres.”

It is time that the political administration in charge of this country recognise the absolute need for “political accountability” with the same vigour that it demands managerial and professional accountability in the public sector.

DR STEVE SMITH
Consultant