Regulation loopholes

The government bodies that regulate the medical, nursing and pharmacy professions in Jamaica do not require routine disclosures from members on whether they are the subjects of lawsuits or complaints, a Sunday Gleaner review has found.

The review also shows that Jamaica lags behind CARICOM countries such as Trinidad and Tobago and Guyana where certain declarations are required by regulatory bodies before licences can be granted.

This is concerning because the Jamaican authorities are established to protect the public, and that means they must be aware of all relevant information before granting licences, argued Dr Morais Guy, the opposition spokesman on health.

A fourth local regulator, the Dental Council of Jamaica, has started reviewing its systems to implement a new requirement for dental practitioners to make declarations.

That decision to reform came after it learnt from Sunday Gleaner reports that one of its registered dentists, Dr Michelle Charles, is the subject of an administrative complaint filed by the Florida Department of Health in the United States. She was involved in several disciplinary cases in the past.

Charles, who is the Jamaica Labour Party member of parliament for St Thomas Eastern, has rejected the latest allegations contained in the November 2021 administrative complaint.

A similar situation of ignorance could have confronted the Nursing Council of Jamaica (NCJ), the Medical Council of Jamaica (MAJ) and the Pharmacy Council of Jamaica (PCJ), an evaluation of their systems suggests. The councils do have complaints mechanisms.

The typical requirements for renewal and registration are payment of prescribed fees, proof of continuing education completion and basic biographical information.

Letters of good standing or of good character are required in some instances, but those are typically done once and only at the point of registration. Most licence-renewal processes do not require one.

Two key functions of the nursing council are to register nurses and to grant them licences.

Persons have to pass a qualifying exam to become registered. They then apply for their licences which they have to renew every two years.

Applicants for renewal are not required to make any declaration on whether they were the subject of any complaint, disciplinary action or litigation, whether locally or overseas.

WORKING ON FIX

That flaw has now been recognised by the council and will be fixed, said its registrar, Sheila Daley-Jones.

“The board is currently working to amend the document as soon as possible,” she said last Tuesday.

For the Medical Council of Jamaica, doctors and other professionals policed by that body are required to apply for a practising certificate annually. There’s also no requirement to declare complaints or actions taken against them outside of the council.

Overseas-based doctors seeking to practise here are required to submit a certificate of good standing from the body with which they were previously registered. Local doctors must submit a similar document.

However, Registrar Professor Howard Spencer said that certificate is not routinely required after its first submission.

He said while he understands the merits of disclosure, it could be an administrative headache to accommodate that new system, given the limited resources of the council.

“Everybody who said ‘no’, you’d have to have a method of investigating whether there had been any problem. We have 3,000 doctors registering every year ... . For you to investigate all 3,000 to see whether they are telling the truth is a problem,” he said.

Dr Brian James, president of the Medical Association of Jamaica, an advocacy group for medical doctors, said the issue requires more thought.

“Medicine and social situations change so rapidly, so fast, nowadays, that we should be continuously in the process of reviewing our ethical standards and the rules governing the practice of medicine,” Dr James said.

Like the previous two regulators, the Pharmacy Council of Jamaica does not require certain declarations and only asks practitioners annually to submit the required fees, continuing education activities and a set of biographical information.

IMPORTANT REFORMS

Guy, the People’s National Party’s spokesman on health, said the reforms to require key declarations are important, noting that the burden would be on the practitioner to ensure the information is correct.

“It not only gives more credibility to the annual certificate of practice but it also demonstrates to the people of the country that the respective councils are ensuring that persons who provide service to people in the health-related area are people of unquestionable character,” he said.

A look at regional regulatory bodies shows some authorities requiring practitioners to make some of the declarations that are now not required in Jamaica.

In Trinidad and Tobago, applicants to that country’s medical board are asked to indicate whether, arising from a complaint, their conduct, competence, capacity or fitness to practise had been reviewed in another jurisdiction.

If the applicants ticked ‘yes’, then they have to provide additional details, including an explanation of the review.

The Dental Council of Trinidad and Tobago currently requires persons to declare whether they have faced any disciplinary action in any country.

In Guyana, similar declarations are required by that country’s medical council. For example, an applicant for medical licence must indicate whether they have been penalised by any licensing authority or were the subject of any inquiry.

The registration and renewal process for several other CARICOM countries were not readily discernible but they generally have similar requirements as Jamaica.

Barbados law requires annual registration of medical practitioners who must provide, among other things, proof of being fit and proper, a certificate of good standing and any other information that the council may require.

editorial@gleanerjm.com