Disturbing interference at the Medical Council
Two communications on Facebook posted by a nominated member – one of 5 nominees designated by the Minister of Health and Quality of Life in accordance with the provisions of the Medical Council Act – of the Medical Council of Mauritius (MCM) dated June 2nd and 7th respectively have brought into the public domain certain irregularities which have been taking place at the MCM.
I have been able to independently verify some of the facts presented, but even this much is enough to be a matter of grave concern not only to the medical profession at large, but also to the country as a whole. That is because good governance has been the major plank on which the December general elections were fought – and won by its loudest protagonists constituted by the members of the present government; the idea even materialized in the form of a Ministry of Good Governance.
The objective: ensuring the proper functioning of all the institutions of the country with regard to their functional autonomy according to the legislations and norms pertaining to each.
It is no secret that good governance is a key criterion in the global assessment of a country’s performance, and all genuine democratic countries – large or small – are very vigilant as regards preserving, and consolidating further, the strength of their institutions. On this rests the image of a country. Unwarranted interference in the functioning of an institution is viewed very severely, to the extent that those responsible have even had to resign from their positions when they were exposed. The most notorious case of course is the Watergate scandal because of which American President Richard Nixon had to resign, and currently President Donald Trump is facing a barrage of public criticisms and questionings daily because of his perceived attempts at interfering in institutions such as the judiciary, the FBI, etc.
The Facebook posts highlight irregularities at the level of an Investigating Committee (IC) of MCM examining a case of alleged medical negligence on the part of a private medical practitioner, who is said to be related to a high cadre in the Ministry of Health (MOH). A member of the MCM who does not form part of the IC was present during a meeting of the IC, allegedly at the behest of the high cadre.
Further, prior to a Special Board Meeting of the MCM, the five nominees had learnt through the press about their ‘revocation’ – apparently on the order of the Minister MOH –, to prevent them from intervening on the report of the IC. They had already addressed a letter contesting the ‘revocation’ to the Senior Chief Executive, MOH. Four of them were there (the fifth one was taken up elsewhere and could not attend) and insisted on being present at the meeting, where they reiterated their objection to being ‘revoked’, asserting that they were still members of the MCM in accordance with the provisions of the Medical Council Act 1999 as amended (inclusive of Section 6 of the Act which relates to the Vacation of Office of member). The meeting was therefore adjourned.
A third point is about the post of registrar of MCM. The last incumbent’s term came to an end on May 31st, and apparently instruction was received from the Ministry for the substantive appointment of Dr A Foondun, who had done actingships before. The nominees objected to this also, on the grounds that Dr Foondun is considered, based on a previous judgement of Judge Domah, to be a public officer and therefore is not eligible. In any case, it is not the Ministry but the MCM which is empowered to appoint a registrar. In fact, a panel consisting of a sitting judge, the Chairman of the MCM and the SCE MOH was constituted, and a call for candidates was made. On the day of the scheduled interview, the SCE was apparently prevented from being present.
A final point is that the nominee who posted on Facebook has filed a statement at ICAC, denouncing the irregularities.
As an ex-member of the first MCM and former Director General Health Services, I find these happenings very troubling, to say the least. I would therefore like to make a few points for the guidance of those who have the responsibility of running the MCM.
1. There is no question of anybody else except the members of the IC being present during its sittings. To start with, the IC should have suspended hearing when the member of MCM not forming part of the IC came to attend. Further, the Board of MCM should seek legal advice as to whether any sanction should be taken against that member.
2. A technical representative of MOH, who is one of the Directors of Health Services, sits on the MCM Board. It is unethical for a technical cadre above this level, that is the DGHS – even if in an acting capacity – to be on the MCM Board. This would amount to conflict of interest.
3. The panel to select a registrar need not have any cadre from MOH. Along with the sitting judge and the chairman MCM, a suitably experienced senior medical practitioner can form part.
As a matter of self-respect and dignity, any member of the medical profession who finds herself/himself in conflict with the provisions of the Medical Council Act or with the ethical norms of the medical profession, irrespective of the position s/he occupies, should forthwith withdraw by own accord from participation in its meetings.
And further, the MCM is a regulatory body and is duty-bound not only to function autonomously but demonstrate concretely that this is the case. When a past chairman of MCM made a declaration to the effect that MCM would cooperate with MOH, I publicly – in an article in this paper – reminded him that it was not the mandate of MCM as a regulatory body to cooperate with MOH. The MCM’s brief was to regulate the conduct of medical practitioners and set professional standards of practice in the paramount interest of patients. If anything, it was for MOH to support MCM in its decisions, especially where the national interest was concerned. But MCM could be open to suggestions from MOH and directives from the Minister MOH in specific circumstances as defined in the Medical Council Act, certainly not in its routine functioning and especially in individual cases.
Historically, the Medical Council Bill was first passed by Parliament in August 1967. But it was only in 1989 that it was enacted. Why? That’s because in its original form, the chairman of the Medical Council was to be the Permanent Secretary of MOH. In the early 1970s the GMDOA, of which I was a member, led the move to undo this gross anomaly so that it would be the medical profession that would regulate itself. Now that this has been acquired, what a shame it is to find political-cum-administrative interference making a comeback, negating all these years of struggle.
I make a sincere appeal to the Minister of Health and Quality of Life, Dr A Husnoo, for having trained in the UK and therefore being fully aware of what professional ethics is about, and respected as a paediatrician, not to let the medical profession – and the patients – down. It will be the greatest service he would render to the profession, the patients, the MCM as an institution, and the country’s larger interest – especially at these times when our image is not the brightest. Thank you in advance Dr Husnoo.
These irregularities are all the more intolerable when I reflect on how smoothly the first MCM was run and functioned, and practically all decisions were taken unanimously, without any hint let alone attempt at partisanship or clique formation, as the Facebook post also points out. If that is the case, it is indeed very very shameful and unbecoming of professionals in whom the patients and the public have put their trust. If they do not feel that they can return this trust in full measure, then they should resign and let others who are more professionally and ethically minded do the job. And save their reputation.
* * *
AH1N1: History need not repeat!
I was in the centre of the storm (as DGHS) when the AH1N1 pandemic broke out in April/May 2009. At the World Assembly in Geneva, I had met Dr Palacio from Mexico, an epidemiologist who had been in the forefront of the detection of AH1N1, and putting in place the protocol to tackle it in her country.
In Mauritius the AH1N1 issue became a politically hyper-driven combat that some parts of the media logged on to by storm and turned into a panic that the country and the people did not deserve. Everybody went berserk. The politics of it was such that, predictably, there was a backlash on the part of the same media that was being overfed with the proper information daily in face-to-face meetings, and sometimes twice daily. MOH was accused of hiding numbers of people affected and of deaths that had taken place.
The reason? Because some nutty professor in Reunion had published a rubbishy paper in the Journal de l’Ile or whatever that the number of expected deaths here would be around 600. And that piece of unfounded extrapolation on purely theoretical grounds was being dangled as gospel-truth, and no amount of reassurance could dispel that concocted figure from the biased minds. As it is, the number of deaths was under 30.
Fortunately there is no comparable hysteria this time round. I know the Public Health professionals who are handling the matter at MOH, and everybody must rest assured that they are thoroughgoing, highly competent experts who have set in place the protocols required for detection and management of the affected patients. Our hospitals are fully equipped to deal with the cases requiring in-patient treatment, including ICU support.
We should thank the Ministry of Health and its dedicated staff for doing a great job of containing AH1N1 without any hullaballoo.