Lead Editor–Newsgathering
ryan.bachoo@cnc3.co.tt
On Tuesday, the Medical Board will convene a special general meeting to discuss proposed changes to the Medical Board Act. In recent weeks, doctors, led by Dr Rajiv Seereeram, formed a lobby group called Doctors Ethics and Autonomy Lobby (DEAL). They have been advocating for wider consultation on the proposed amendments to the act while cautioning against some of the changes. Ahead of the special general meeting, the Sunday Guardian sat down with Dr Seereeram to find out more about the group’s concerns with the proposed changes. The group is calling for transparency and accountability from the Medical Council.
Q: What is the membership number for the Doctors Ethics and Autonomy Lobby (DEAL)?
A: It was formed by a quorum of physicians like myself, Dr David Strisiver, and Dr Johnny Siu Chong, and we have some other core members. When we first started to address the issue of the legislative amendments, we got about ten doctors to come on and form the quorum. Thereafter, we set up our network, and people started to join us and pay attention. I think what you may find on the issue of the legislative amendment, particularly in regards to clauses 12A and 12B, which is a new amendment that is proposed, you would find that the majority of physicians are actually aligned with our position on the issue. So, because we are another group, a new group that is newly established, the registration is now coming in, but basically, we have received overwhelming support from the medical fraternity.
What are the proposed amendments to the Medical Board Act that the lobby group is opposing?
I think the public is probably familiar with an article that came out in February highlighting some questions about financial impropriety within the board. There was a meeting in March, and in that meeting, we were presented with three pieces of legislation, or, I should be more accurate, and then two regulations, and then the changes to the act. The board has not asked for input on changes to the act. However, we were asked to comment on regulations that were related to CME (Continuing Medical Education) and unrelated to specialists.
What we realised is that the changes that were in the act were quite significant. For example, if harkening back to the original paper, there was an article in the press that raised questions about financial independence within the board. We realised that there was a new quote, a new clause, and a new section within the act entitled ‘Exemption from Liability’, and this spoke about protections or indemnity specifically for the council. We thought this was somewhat antithetical to what we expected in the amendment. I think the board was looking forward to more transparency in the dealings of the council.
While we understood from the council that they gave a rationale for amendments to these new exemptions from liability, we had an issue with that.
What we did is we looked at it and said, okay, listen, in fact, what we need is fiduciary transparency. We need to be able to define the fiduciary duties of the council. We sat together, and we decided we needed clauses within the act for an annual audit, which has not been done for several years. When you don’t have a proper financial audit for several years, we need to make sure that we have a budget.
Your group contends that some changes threaten the integrity and independence of the medical profession and undermine patient rights and public health. Please elaborate on this.
If you look at what happened during COVID, you will see that there was a different type of governance setting during the pandemic—it was top-down governance. It was, I would say, a bit autocratic. So, we have a lot of bureaucrats internationally governing or making decisions, public health decisions, and dictates that are applied across the globe. Of course, we’re in a pandemic situation. But what happens is that there’s a counterbalance to that and the experiences, the training, and the practical and empirical information and empirical experience that are emanating from the practitioners on the ground. So, the practitioners on the ground who are interacting with patients, who are using the technologies and the drugs, have to be able to meet with each other. They have to have a forum in which they can debate, they can discuss policy where it says clinical policy, public health policy, and then once we meet, as we are doing right now, we have triggered a democratic ... we have triggered a referendum.
DEAL has expressed concern that these amendments were sanctioned by the Medical Council without adequate consultation or approval from the general membership of the Medical Board. What time frame did the consultation take place, and why the general membership of the board hasn’t raised concerns about their inability to provide sufficient input?
The vast majority of the board members were totally unaware of changes in the legislation. In fact, if you speak to most members, the vast, vast majority, the first time they would have ever heard about this is on March 6, when it was announced that the changes to the amendments to the act by the board had already been sent to Parliament or were being sent on their way to Parliament. And I raised that question in the board meeting at that time, and I said, hold on, are you saying that these amendments, you are asking us to vote on other regulations and so on, but the amendments to the act, which include amendments to change our membership status, the registrant, it includes the inclusion of other causes, for example, the indemnity clause, you telling me that we, our input is not sought on these amendments? It’s not needed, and it’s already being sent to Parliament. So, I objected at that time. And that is, when we decided, when we started to look at the column, how can we approve this? The board has not gotten a chance to look at these amendments, and we want to bring them back here before us. We want to democratically have a referendum on them, and we would like to resolve and have some input in the change of our law.
You raised the issue of transparency and accountability. DEAL claims the proposed amendments fail to address transparency in committee appointments and reporting and introduce an indemnity clause for the council, which DEAL argues undermines financial accountability. Please elaborate.
We are asking for an auditor now. We want to make sure we have people on the council who are registered with their statutory bodies and under their regulators to ensure that we have confidence in their professional integrity and the quality of their professional services, and one of those people is an auditor. We would like to make sure that going forward, as the board sets out, hopefully, this has to do with a budget. I think that it’s pretty surprising that, so many times, there’s no budget being provided. We want to make sure that there’s someone on the council who we can depend on and who has their own qualifications and reputation. I’d say, of course, that they will be looking at all of the processes, whether it is whatever expenditures come, if there’s any hiring, if there’s any, for example, tendering, they have to be any tendering if the board is going to embark on, or perhaps construction of our new building.
We’re hearing talk about setting up new systems, online systems, and so on. We want to make sure that those processes are completely transparent. And I think that, in keeping with good corporate governance, it’s only fair that we have an auditor on board. In addition to that, we have just put very explicit clauses within the fiduciary duty section, which we have fleshed out within the app. And you can see one of the goals: for example, we need to have an annual audit. Maybe somebody can challenge us and say, ‘Well, how is it possible that you need to put this into law?’ Unfortunately, it would appear that we need something like this to make sure that our board operates transparently.
Do you anticipate a well-attended session for the special general meeting that’s happening on Tuesday?
Once all notice gets out properly. This has been one of the issues because we believe that the board has a role in facilitating professional communications among its membership, meaning that the secretary has a new board. And the council has a role in relaying communications between the board members. We have great eagerness for a referendum, or, what I’m saying, we must get our notice. We had a preface to the nurses explaining the purpose of the meeting, that the members of the board need to understand what the purpose of the meeting is, and that right now we are reliant on the council to circulate that notice, relying on the concept of circulated notice, and to ensure that the rationale behind the meeting is very clearly presented, including the referendum, so that all of the fraternity understands the gravity of the matter that is being added as beforehand and is being put to vote on at the end.
Now, what is the feedback so far? Well, we have overwhelming support among the networks that we have tapped into, and that includes several hundred doctors, right?