Dear Editor,
In 1964 Bookers Sugar Estates Ltd introduced the first Contributory Hospitalisation and Maternity Insurance Scheme (CHMIS) into British Guiana. The insurers were none other than the American Life Insurance Co out of the USA. After some years of successful management the expanded scheme became self-financed and included every employee who was paid regularly, that is down to a weekly basis.
In 1969 the government of the day led its Caribbean counterparts in establishing the National Insurance Scheme, which few would realise also catered for unemployment benefits – a provision which was never enacted.
Following in 1972 was the promulgation of the Private Hospital Act – at a time when there were few such agencies – Medical Arts, St. Joseph’s Mercy, Prashad’s, Davis Memorial Hospitals come more readily to mind. Of course there were the hospitals in the sugar industry, spanning from Skeldon to Uitvlugt Estates along the coast; and that of the Bauxite Company up the Demerara River in what is now Linden.
It is uncertain how many, if at all, of the current players in the Health Sector (public or private) are aware of the relatively comprehensive piece of legislation, that is, hopefully, apart from the licensing requirements which applicants were required to fulfill. For example the applicant had to specify whether it was:
“(a) medical or surgical hospital
(b) a medical, surgical and maternity hospital
(c) maternity hospital
(d) a home for the care and accommodation of convalescent or chronically ill persons
(e) a hospital for the care of any specified class of patients suffering from any specified disease, disorder or illness.”
Further: “Every licensee shall state the maximum number of patients who may be accommodated in the hospital at any time and may be limited to any particular class or classes of patients.”
Licences are intended to be issued annually by the relevant Minister. But who knows this?
Of interest are the following two clauses of the Act:
“12 (1) Every private hospital shall have at all times two persons designated by the licensee as the superintendent and deputy superintendent thereof, respectively, and the superintendent shall be resident thereat.
(2) A superintendent and a deputy superintendent shall possess such qualifications as may be presented, and the licensee of a private hospital may, if so qualified, be designated the superintendent or deputy superintendent thereof.”
The above is subject to the approval of the Minister.
What is more interesting is the requirement to maintain a register of patients:
“13 (1)
a) the name, age, sex and usual place of abode of each patient, and the date of his admission to the hospital;
b) each patient’s diagnosis and surgical operation, if any;
c) the name of the medical practitioner attending each patient;
d) the date on which each patient left the hospital and , if transferred to another hospital, the name of the other hospital or, in the event of death of a patient in hospital, the date of his death; and
e) such other particulars as may be prescribed.”
What may be most critical is the provision instituted for the inspection of private hospitals.
The following extracts may therefore be of interest to delinquent parties:
“15 (4) The Minister may designate teams consisting of a medical practitioner and a midwife and such other persons as the Minister may consider necessary which shall be authorised to make an inspection and examination of any private hospital or hospitals or any aspects of the administration, operation of management thereof as may be specified, and which shall make a report thereon to the Minister.”
And while the parties are contemplating their responsibilities, it would probably be of greater concern to discover that the Act provides for Regulations with regard to the following, amongst others:
“19 (f) prescribing or restricting the type and amount of surgery, gynaecology or obstetrics that may be performed in any class of private hospitals and the facilities and equipment that shall be provided for such purposes;
(g) the admission, treatment, care and discharge of patients and for the control of the admission of any class of patients;
(h) the records, books, reports, returns and other documents to be made and kept in respect of private hospitals and the production to, and inspection by, the Minister or any person authorised by him of such records, books, reports, returns and documents;
(i) the establishment and operation of periodic medical audits of the work performed in private hospitals;
(j) the reports and returns to be submitted to the Minister by private hospitals; or
(k) prescribing anything authorised or required to be prescribed by this Act.”
There is of course reference to penalties.
What the Act did not specifically foresee and which now appears to be an issue in a highly commercialised health environment, is the possibility of complaints by patients about inflated costs of medical treatment, some of which they regard as unnecessary anyhow.
This development, in the context of the above, may well be seen as having substantive legal implications.
Yours faithfully,
E.B. John
