Story taken from Stabroek News online newspaper www.stabroeknews.com
The Medical Council of Guyana is to meet on Wednesday to consider the case against a Berbice doctor whose patient died several days after a part of his intestine was allegedly improperly sewn up.

The man died while undergoing follow-up medical care at the Georgetown Hospital. The doctor, John Austin was to have been invited yesterday to the hearing. Up to last evening, Dr Austin said he had received no communication from the council and declined to say anything on the matter.

Roopchand Hansrajiea, age 57, from Number 73 Village, Berbice, died on November 4, while doctors at the Georgetown Hospital tried to correct complications which had resulted from an operation the man underwent at Dr Austin's office in New Amsterdam. The man had gone into the clinic over a hernia.

Stabroek News learnt that the man died from shock resulting from an infection caused by a build-up of faeces from the allegedly incorrect surgical procedure. The surgery, Stabroek News understands, caused a part of the man's intestines to be sewn up resulting in the faecal accumulation.

Chairman of the Council Dr MY Bacchus confirmed the hearing yesterday. He said that the Council had met on Wednesday during which it considered a letter of complaint sent by the Georgetown Hospital. "We are sending it to the Attorney-General's Chambers which will then forward it to the High Court to facilitate an injunction [against the doctor]," he said.

He said that the Council has not received any correspondence from the man's family.

According to a source in Berbice, the man's family may be approaching the Medical Council for action to be taken against the doctor.

The man, who has three children and operated a sluice in his village, went to the doctor for surgery after it had been diagnosed that he had a wound in his intestine that was infected.

The man's children told Stabroek News that Hansrajiea returned from the doctor and told them that he had awakened during the surgery and was given an injection.

He was said to be "feeling alright" after he returned but began complaining of pains the next day. This was on November 1.

On November 3, the man went back to the doctor to have the wound dressed and the doctor gave him a paper that, according to the family, said he had a weak heart beat and that he should go the New Amsterdam Hospital.

At the New Amsterdam Hospital, the doctor who looked at him told him that he needed another surgery because he was infected, and yet another doctor recommended that the man go to the Georgetown Hospital because he was in a critical state.

On November 4, he went to the Georgetown Hospital for the next surgery and when the doctors cut him open to clean out his insides he died from septic shock.

Questions were then raised about the earlier operation he had had.

Dr Austin had been debarred from surgical procedures following a previous death at his surgery although he was still allowed to practise other forms of medicine.

Dr Bacchus told Stabroek News that the council summoned the doctor after that procedure and questioned him, in the presence of an Ear, Nose and Throat (ENT) specialist and an anaesthesiologist and with the input of the two, the council concluded that the doctor had been negligent.

The Council then stopped him from practising general and specialist surgery.

Dr Austin then moved to the High Court and was granted a Writ of Certiorari and a Writ of Prohibition resulting in his being able to operate again.

According to Dr Bacchus, the council was denied a hearing in that matter.

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Letter to the editors of Kaieteur News & Stabroek News by Bryan Mackintosh

Dear Editor, I’m still reeling from shock and extreme anger after reading about the death of Berbician Roopchand Hansrajiea due to the total incompetence of one Dr. John Austin. This is not the first time that the unskilled and uncertified work of this doctor has resulted in the death of someone, it sadly has happened before. The medical council of Guyana had in no uncertain terms made it quite clear to this medical practitioner that he must never practice surgery again. The medical council had come to that decision after they had investigated the death of one of his patients. This doctor however went to the Courts of Guyana and got a Judge to grant him an injunction restraining the medical council from enforcing their decision. The result is that someone has died because of this Judge’s decision.

Why do we even bother to have a medical Council when all a doctor has to do is get a Judge to override any decision that the medical council makes against him or her. A few years ago, one medical practitioner actually got a Judge to grant an injunction preventing the medical council from hearing a complaint against him, to the best of my knowledge that case was never heard by the medical council and as such the person who made that complaint was never given justice or even a change to have his grievance heard. The Medical Council of Guyana indeed seems to be a toothless poodle and it is us the ordinary people who will continue to suffer if this perception does not change. I am sure that if this series of events had occurred in any other country that the politicians there would have hurriedly put laws in place to ensure that it never happened again to ensure that patient’s rights were properly protected. What has happened to the late Mr. Roopchand Hansrajiea can happen to any of us and I truly hope that this horrible incident is not swept under the carpet like so many others before. The family and friends of Mr. Roopchand Hansrajiea deserves justice and I pray that they find the strength to seek it. Come on Guyana, raise your voices loudly, let the doctors and their protectors know that have had enough of their nonsense. Enough is enough. 

Yours faithfully, Bryan Mackintosh. Health Advocate

Unprofessional journalism
Tuesday, November 16th 2004. Story taken from www.stabroeknews.com
Dear Editor, I knew the late Patrick Denny. He was a decent, down to earth individual. I also know Dr Santosh, not personally but professionally. He is a surgeon attached to both the Georgetown and Prashad hospitals. He operated on Mr Denny. I do not know anything about the nature of Mr Denny's illness or the clinical condition or the operative findings and procedure. What I do know is that Adam Harris is totally out of order (KN14/11/04) in suggesting that Patrick Denny's death was due to "Surgery gone wrong" by Dr Santosh. Harris has become judge and jury without knowing all the technical facts - and he does this because he has access to writing articles in a newspaper. Jumping for Dr Santosh's jugular because Mr Denny was his personal friend is totally unprofessional.
What Mr Harris should do is argue in his newspaper for the Medical Council to get more teeth - so that when a case has been tried by a doctor's peers - and a decision arrived at - some smart aleck lawyer won't take that case to some judge and get an injunction against the council's decision without that judge even listening to the medical council's side - as happened recently when the council took a decision to prevent a doctor from doing surgery. The doctor took a lawyer who got a judge to grant an injunction against the council without listening to a word from the council. You know what? That doctor operated again. The patient died in Georgetown Hospital ten days ago. I do hope the court is well satisfied. Now Mr Harris - I want you to take up that story.
Yours faithfully,
Dr M.Y. Bacchus
Stabroek News Editor's note: We are sending a copy of this letter to Mr Adam Harris for any comments he may wish to make.

Medical Council gets formal complaint against NA doctor over patient death
Tuesday, December 14th 2004 as published in Stabroek News
The Medical Council of Guyana has received a formal complaint from the family of Roopchand Haransrajiea, who died last month while undergoing corrective surgery after an operation in New Amsterdam.

Haransrajiea, age 57, from Number 73 Village, Berbice, died from septic shock on November 4, while doctors at the Georgetown Hospital were attempting to correct complications resulting from a hernial operation the man underwent at a doctor's office in New Amsterdam four days earlier.

Septic shock is said to have resulted from an infection caused by a build-up of faeces from the surgical procedure as a result of part of the man's intestines being sewn up.

As the family has formally approached the Council, that body could now take the necessary action against the doctor. It would have been hard-pressed to do so without the family's formal approach, Stabroek News understands.

According to Chairman of the Council, Dr MY Bacchus, the family tendered the letter recently and this as well as the letter from a doctor at the Georgetown Hospital were forwarded to the Berbice-based doctor who had on November 1 operated on Haransrajiea. Bacchus said the Council is now waiting on a response from the doctor who will be subsequently called before the Council on this matter.

That same doctor and the Council are before the High Court on another matter, involving an injunction the Council had obtained against his performing surgeries following an earlier patient death on his operating table. A judge had granted a stay of this injunction, resulting in the doctor being able to operate again.

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Death of hernia patient as reported in http://www.kaieteurnewsgy.com/headlines.htm

Patient reportedly awoke from surgery with one testicle missing - family gives statement to Medical Council

Hansraj Roopchand, the patient who died last month shortly after a hernia operation at a private Berbice clinic, reportedly awoke from the operation with his left testicle missing. This is the claim that is being made by Roopchand's relatives, who have finally given a statement on his death to the Guyana Medical Council. In the statement, the relatives said that when they went to collect Roopchand from the private clinic, the surgeon told them that Roopchand only had one testicle.

But according to the statement, Roopchand subsequently told his relatives that he always had two testicles. Roopchand had visited the surgeon to have surgery to his left hernia. A medical source said that one of the pitfalls that surgeons have to avoid during hernia operations is mistakenly severing the artery which supplies blood and oxygen to the testicles.

The Council has since given the accused surgeon a copy of the family's statement, along with a statement from a Georgetown Hospital physician who had attempted to save Roopchand's life. According to a source, the physician under scrutiny will be given a chance to respond to the allegations. The Council was unable to investigate the case until receiving a formal complaint from the patient's family.

Hansraj Roopchand, of Number 73 Village, Corentyne, was rushed to the Georgetown hospital in a critical condition on November 3, a day after undergoing surgery at the physician's clinic. A statement from a Georgetown hospital physician said Roopchand's stomach was filled with faeces when he was rushed to the hospital by ambulance.

This, the statement said, was due to the fact that the surgeon had mistakenly stitched up Roopchand's bowel after the surgery. According to the statement, the patient's pulse was rapid, his blood pressure was low and he had difficulty breathing. It added that physicians at the Georgetown Hospital performed corrective surgery, but Roopchand succumbed shortly after.

The Council had attempted to bar the physician from performing surgeries at his clinic after finding him culpable in the death of a 12-year-old boy. However, the surgeon has filed an injunction in the High Court to continue operating at his clinic. That hearing is scheduled to continue this week. The 12-year-old from Lancaster Village , Corentyne, died at the clinic while being prepared for surgery for tonsillitis.

He reportedly lapsed into a coma from which he never awoke after being given an anesthetic. A few years ago, the same physician was implicated in the deaths of two patients while practicing at the New Amsterdam Hospital. After an investigation, officials from the Ministry of Health suggested that the surgeon be transferred to the Georgetown Hospital , where he would work under supervision.

The verdict is out finally: Berbice doctor disbarred
Tuesday, April 19th 2005
The Guyana Medical Council has disbarred the doctor involved in the post-operation death of a Berbice patient. The council found at an April 5 meeting that Dr John Austin was guilty of professional malpractice and ruled that his name be erased from the medical practitioners' register.

Speaking with Stabroek News yesterday, Chairman of the Guyana Medical Council Dr MY Bacchus said that the decision was based on the testimony of the family of Roopchand Hansrajiea, of Number 73 Village, Corentyne Berbice. Hansrajiea died following an operation done by Doctor John Austin of New Amsterdam.

Dr Bacchus revealed that the post mortem showed that the man's bowel had been sutured to his abdomen and he had a large hole in his intestine. This caused an infection. He had gone to Dr Austin's office for a hernia procedure, four days before he died on November 4, 2004.

According to Dr Bacchus, when the doctors at the New Amsterdam Hospital realized that there was nothing that they could do they referred him to the Georgetown Hospital. The patient died before anything substantial could be done for him, the doctor at that hospital is reported to have said.

Dr Bacchus said on the date fixed for the hearing, which began earlier this year, Dr Austin showed up without his legal counsel; and this had been the case on at least one prior occasion.

According to Dr Bacchus, Dr Austin remained silent when questioned by the members of the council at the April 5 hearing. Dr Bacchus said that the case against Dr Austin was made on the basis of the statement that he had made and his response at the hearing, in addition to the family's testimony. He said the testimony of the doctor at the Georgetown Hospital, who treated the patient, was also crucial to the decision.

But speaking to Stabroek News, Austin stated that he has not been informed by way of letter that his name has been erased from the register of medical practitioners in Guyana. He is adamant that the Medical Council was not justified in its actions since it had no grounds. According to the disbarred doctor, the council is "trying to fool the public."

The Medical Council had previously sought to bar Dr Austin from performing surgical procedures after it found that another patient had died under his care, but Dr Austin was able to get an injunction against the council which allowed him to continue with surgeries, leading up to the fatal one in November.

Disbarred doctor still practising
says council pursuing vendetta by Daniel Da Costa www.stabroeknews.com
Wednesday, April 20th 2005
Former Medical Superinten-dent of the New Amsterdam Hospital, Dr John Austin who now runs a private clinic is continuing to practise even though the Guyana Medical Council has disbarred him.

Dr Austin told Stabroek News yesterday that he continues to work because he has not received any official correspondence from the council stating that he has been disbarred, and only learnt about its decision through articles in the newspapers.

According to Chairman of the Council, Dr MY Bacchus, the council found Dr Austin guilty of professional malpractice at a meeting on April 5 and ruled that his name be erased from the medical practitioners' register.

Bacchus said the decision was based on the testimony of the family of Roopchand Hansrajiea of Number 73 Village, Corentyne, who died following a hernia procedure conducted at Austin's clinic in New Amsterdam in Novem-ber 2004. According to Dr Bacchus the decision was also based on the statement made by Dr Austin, his response at the hearing, and the testimony of the doctor at the Georgetown Hospital who treated the patient. Hansrajiea died at the Georgetown Hospital four days after the procedure was conducted on November 4, 2004. Bacchus further noted that on the date fixed for the hearing which began earlier this year, Dr Austin showed up without his legal counsel and remained silent when questioned by members of the council at the April 5 hearing.

However, Dr Austin told this newspaper yesterday that he had informed the council that his lawyer was out of the country on April 5 and was expected back later that day. As a result, he told the council that he was not prepared to say anything or to ask any questions in the absence of his attorney. The council, he said, refused to reschedule the hearing to allow his attorney to be present. "I was therefore not given a hearing."

According to the East Canje-born surgeon, the council is biased and has had an agenda to discredit and prevent him from working for several years now dating back to his tenure at the New Amsterdam hospital.

He accused the council of discriminating against him and pursuing a vendetta. "Members of the council and their associates in political circles have been heard boasting recently that they would put me out of business and this is what they are attempting to do."

According to Austin, he had served several years at the New Amsterdam Hospital with distinction but his attempt to fight a decision to transfer him to Georgetown was seen as an affront to those in authority. "The vendetta against me, however, began long before that while I was at the hospital."

Austin had successfully moved to the courts a few years ago seeking redress in the wake of a decision by the Minister of Health to transfer him to the city. He subsequently resigned from his post at the hospital and opened a private clinic in New Amsterdam.

The Medical Council had previously sought to bar Dr Austin from performing surgical procedures after a patient had died under his care. However, Austin moved to the courts again and was granted an injunction against the council, allowing him to continue conducting surgeries at his clinic.

According to Austin, the council cannot defend claims of being biased against him since an undetermined number of patients have died at private clinics not only in Berbice but across the country over the years without the council moving a finger against the practitioners involved. "Not only have patients died under the care of private doctors but also at public hospitals without anyone being held culpable or penalised. Over recent times several patients have died at the New Amsterdam Hospital. You hear of investigations being conducted but the findings are never made public and those responsible are never identified or punished," he argued.

Austin said he would continue to practise despite the public statements by the council since he has not been officially informed of its decision. He also intends to seek redress in the courts.

Ramsammy lauds Medical Council on Austin disbarment
Wednesday, April 27th 2005 www.stabroeknews.com
Minister of Health Dr Leslie Ramsammy yesterday commended the Medical Council of Guyana on the disbarment of Dr John Austin, former medical superintendent of the New Amsterdam Hospital, after the council found that his negligence resulted in the death of a patient.

In a press release from the Government Information Agency (GINA), Ramsammy said: "I hope the council ensures that the doctor receives formal notification of its decision and he would not be permitted to practise without the council's registration."

According to Ramsammy, the council is a legal entity and is "entrusted with certain roles: one such role is to ensure proper behaviour by those registered to practise medicine."

At a hearing on April 5, 2005, the council ruled that Austin's name be removed from the register of medical practitioners in view of the malpractice. But up to last week the doctor was still practising at his New Amsterdam office.

He told Stabroek News that he had not received any notification of the council's decision and learned of the ruling through articles in the newspapers.

The hearing centered on the death of 57-year-old Roopchand Haransrajiea, of Number 73 Village, Berbice who died four days after Austin operated on him. The patient had to be sent to the Georgetown Hospital after doctors at New Amsterdam could do nothing else for him. He reportedly died from septic shock as a result of his intestine being sutured to his abdomen.

Ramsammy said the Medical Practitioners Act sets out that there needs to be regulations to address disciplinary actions in relation to medical practitioners, adding that the council could be assisted by such regulations. He said the minister could make such regulations on the advice of the council.

In an interview with Stabroek News, Austin said he was not given a hearing by the council since, according to him, the council had refused to reschedule the hearing to a date when his lawyer would have been available. He had remained silent on the day of the ruling.

The council had successfully moved to the courts to prevent Austin from performing operations after he was fingered in another patient's death, but he managed to obtain an injunction against the council which allowed him to continue.

He told Stabroek News recently that he intends to seek redress in the courts on the latest action by the council.

Bryan Mackintosh's note: Do you really think that Ramsammy is pleased that the medical council took the name of his fellow PPP card bearing member off of the list of the doctors registered to work in Guyana? I doubt it very much, soon enough this doctor will bribe someone in the court system and sure enough he will be working and operating once more, to tell you the truth, if those stupid Berbicians actually are willing to let this doctor operate on them after he has killed a few of them already, then I say let the man work, let the stupid who don't listen, feel the pain if they are stupid enough.

Debarred Berbice doctor free to practise again granted injunction against Medical Council
By Daniel Da Costa Thursday, April 28th 2005 www.stabroeknews.com
Former Medical Superinten-dent of the New Amsterdam Hospital, Dr John Austin has been granted an injunction against the Medical Council of Guyana which recently debarred him from practising as a surgeon.

The ex-parte injunction was granted by a judge in the Georgetown High Court on Thursday, following an application by Austin's lawyer R.E. Gibson. The council's decision had been made at an April 5 hearing which Austin attended but where he remained mum because of the absence of his attorney.

Chairman of the council, Dr MY Bacchus had said then that the body found Austin guilty of professional malpractice. Bacchus said the decision was based on the testimony of the family of Roopchand Hansrajiea of Number 73 Village, Corentyne who died following a hernia procedure conducted by Austin at his New Amsterdam Clinic last October.

It was also based, he said, on a statement submitted to the council by Austin and the testimony of a doctor at the Georgetown Hospital who treated the patient. Hansrajiea died at the Georgetown Hospital on November 4, four days after the procedure.

In his affidavit, Austin's lawyer pointed out that he had written to the Council on March 23, informing its members that he would have been out of the country on the day scheduled for the hearing and requesting a postponement to April 5. However, he returned to the country late on the afternoon of April 5 and as a result missed the hearing.

The following day, April 6, Gibson wrote to the council seeking a new date to examine Austin. The council replied on April 15 stating that the council had met, reviewed the evidence and ruled that Austin was guilty of professional misconduct and was therefore erased from the register of medical practitioners.

Through his attorney, Austin argued that he was not afforded the basic right of leading a defence. He said that the conduct of the council was unfair and its decision to prevent him from practising should be set aside as unconstitutional.

The matter has been fixed for May 30 when the council must show cause why Austin should not be allowed to continue practising at his Republic Road and Essex Street Clinic in New Amsterdam. In the meantime Austin continues to practise.

It is the third time in as many years that the surgeon has moved to the High Court seeking redress in disputes with the Ministry of Health and/or the Medical Council. In 2002 while serving as medical superintendent at the New Amsterdam Hospital he moved to the High Court and was granted an injunction preventing the Minister of Health from transferring him to the Georgetown Hospital. He however subsequently resigned and opened a private clinic.

That matter is still before the court. Early last year Austin again sought redress in the court when the Council attempted to bar him from performing surgery after a boy had died under his care. He was granted an injunction by a judge allowing him to continue performing surgeries pending the outcome of the matter. This case is also still before the High Court.

Yesterday the doctor's clinic was open and he was attending to patients. Speaking with this newspaper during a break, the East Canje-born surgeon accused a senior government functionary of attempting to obstruct the course of justice and to block the granting of the injunction. According to Austin he has evidence to support his statement.

Bryan Mackintosh's note: what did I say, this country is beyond hope, what does it take to make a Judge realise that a doctor is incapable of carrying out surgical operations, if his fellow doctors deem him unfit then what more than that do you need? How many more persons should this doctor kill before he is deemed incompetent and have his license revoked?

Debarred Berbice doctor case for High Court hearing May 30 -medical council says no injunction granted
Friday, April 29th 2005 www.stabroeknews.com
The Medical Council of Guyana has to appear in the High Court on May 30 to show cause why an order or rule nisi of certiorari should not be issued in the matter concerning the debarring of Dr John Austin, its Chairman Dr MY Bacchus said.

But in the meantime, the name of the New Amsterdam-based doctor remains erased from the register of medical practitioners until the hearing and determination of the matter before the court, Bacchus said. This order was filed on April 21, 2005. In a press release yesterday, Dr Bacchus said contrary to a Stabroek News report yesterday, the court had not granted an injunction against the council. What was issued, he said, was an order for service of proceedings against the council "in order for the said council to reply."

Dr Bacchus said Dr Austin would be committing a criminal offence if he continued to practise. Up to Wednesday, Dr Austin's office was open and he was attending to patients. He had been granted an injunction last year allowing him to perform surgeries after the council attempted to bar him from performing such procedures after the death of a boy under his care.

On April 21, Dr Austin through his lawyer filed a Notice of Motion with affidavit in support seeking a writ of certiorari directed to the Medical Council.

The matter stemmed from a series of hearings that the council held following allegations that Dr Austin caused the death of a Berbice patient, 57-year-old Hansrajiea Roopchand, in November last year. The man died while undergoing corrective care at the Georgetown Hospital four days after his surgery done at Dr Austin's clinic.

Those hearings began on March 16 and concluded on April 5, with the council ruling that the doctor's name be struck off the Medical Practitioners' register, in accordance with section 17 (3) of the Medical Practitioners' Act 1991. But the doctor continued his practice notwithstanding, claiming that he had not been given a fair hearing, nor had he received any letter to the effect that he could no longer practise.

The council in its press statement said that the letter was sent out through registered mail on April 15 and Dr Austin signed as receiving it on April 18.

Berbice doctor may face criminal prosecution
Wednesday, May 4th 2005 taken from www.stabroeknews.com
The Medical Council of Guyana has written to the Office of the Director of Public Prosecutions (DPP) seeking criminal charges against Dr John Austin who continues to practise medicine despite the fact that his name was struck off the register of Medical Practitioners in Guyana.

Chairman of the Council, Dr MY Bacchus said yesterday that he is still awaiting word from the DPP on what is to be done. He said that as far as the Council is aware, Dr Austin is practising at his New Amsterdam clinic. Stabroek News saw patients being attended to at the doctor's office last week.

On April 5, the Council ruled that Dr Austin's name be erased from the register after concluding that he was responsible for the death of Hansrajiea Roopchand, 57, of Number 73 Village, Corentyne, who went to Dr Austin's clinic for a hernial operation. He died on November 4, 2005 at the Georgetown Hospital.

The Council is to appear in Court on May 30 to show cause why its proceedings against the doctor should not be quashed.

Dr Austin is maintaining that he was not allowed the benefit of counsel, since the matter was heard in the absence of his attorney, who had been seeking medical treatment overseas. During the hearing in which the Council made its decision, Dr Austin remained silent for want of his attorney.

Dr Austin is also contending that the Council instituted disciplinary action against him before finding him guilty of professional misconduct or malpractice. He could not be reached for comment yesterday.

The letter that the Council sent to the doctor stated that the surgery that he (Dr Austin) performed on November 1, 2004 exposed the patient to excessive risks, since he performed the surgery and anaesthesia single-handedly and there was no record of haemoglobin analysis being done.

The letter said too that when the doctor saw the patient, the latter had a pulse rate of 88/min and BP 60/50, "which clearly indicated that the patient was in shock." The Council charged that despite these conditions Dr Austin failed to take steps to resuscitate the patient before referring him to the New Amsterdam Hospital.

"The quality of care offered fell well below the standard of care expected," the Council said in its letter. According to the Council, the surgical findings at the Georgetown Hospital included foul smelling air escaping from the peritoneal cavity; faecal peritonitis and 2.5 to 3 litres of feculent fluid and faeces in abdominal cavity. Further, part of the man's abdomen was sutured to his intestine.

The Council also found that the doctor had kept poor clinical notes and inadequate documentation.

The Council's letter said that the findings of the post-mortem were in line with statements that Dr Austin gave to the Council after he was asked to respond. But the Council said that the information that Dr Austin provided does not support the Registration of Death that he issued on November 4, 2004 as to the cause of death.

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Trinidad ready for a 'medical' shake-up

Gerard Best Sunday, March 20th 2005 www.trinidadexpress.com

http://www.trinidadexpress.com/index.pl/article_news?id=67889576

ATTORNEY ANAND RAMLOGAN is ready to shake things up in this country's medical fraternity.
In an interview with the Sunday Express last Friday, Ramlogan said too many victims of medical negligence are left to languish and suffer without any hope of remedy.
Ramlogan wrote a new chapter in the nation's history last year when he won a rare medical negligence case 25-year-old Rana Ramlal against the South West Regional Health Authority (SWRHA) over the death of Ramlal's newborn baby.
Ramlogan identified the core of the problem as a lack of expert medical evidence to support medical negligence claims.
"You cannot win a medical negligence case unless you have expert medical evidence," Ramlogan said.
He explained, however, that only the doctors themselves had the kind of expertise needed to win medical negligence cases. Ramlogan described the conundrum as "virtually insurmountable", pointing out that in the last 40 years, there have only been two High Court judgments on medical negligence.
"And that is not a reflection of the wonderful state of the medical practice in Trinidad and Tobago. It is, rather, a sad reflection of a deficiency on the part of our society," Ramlogan said, adding that the lack of High Court judgments pointed to the more deep-seated issue of a kind of complicity among local doctors.
"The reason why we do not have any jurisprudence on medical negligence is that the medical fraternity, like the legal profession, is very close-knit," Ramlogan stated.
"Because we live in such a small society, it is virtually impossible to find doctors from the local profession who are willing to testify against their colleagues."
According to Ramlogan, this is how doctors avoid "betraying" their colleagues:
"They escape it by two things, either calling astronomical fees or, alternatively, saying that they are willing to give advice behind the scenes.
But they're simply not willing to subject themselves to cross-examination in court. And the reason for that is that they'll become ostracised and they'll be looked upon with scorn, as if they've somehow betrayed their colleagues."
Many victims of medical negligence choose to sign lucrative out-of-court settlements with binding confidentiality clauses before summarily condemning all these techniques used by doctors to protect their colleagues.
That behaviour, Ramlogan insisted, is inconsistent with the fundamental principles outlined by the Hippocratic Oath.
"I think one implication of the Hippocratic Oath is that you will stand up and point out the bad eggs where there is gross malpractice and medical negligence," Ramlogan said.
To believe that the doctors' behaviour would change, said Ramlogan, would be "wishful thinking."
All the same, the lawyer announced that he has already filed about 25 cases of medical negligence, calling particular attention to a concentration in these cases in the areas of obstetrics, gynaecology and orthopedics.
In addition, Ramlogan called for the establishment of a disciplinary authority to receive and assess medical complaints, suggesting that the current problem of medical negligence could be addressed by the establishment of a three-member panel comprising a non-Trinidadian chairman, a medical expert and a member of the legal profession.
"There are no doctors in Trinidad and Tobago who are willing to testify against their colleagues," he repeated.
"The reason doctors are so flippant and casual about medical negligence is they know no-one can sue them.
So a patient who complains about negligence, they just get a run-around and eventually they get frustrated."
Ramlogan spread the blame for the current problem, pointing a finger at the victims who sometimes accept settlements, at members of the legal profession, at politicians and, ultimately, the doctors themselves.
The attorney is already in the process of bringing in foreign doctors to testify in medical negligence cases.
But the good doctors, he pointed out, have nothing to fear.

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Another Trinidadian feels the full force of the law

Prominent Trinidadian gynecologist, Dr Godfrey Raj-kumar, has been found guilty of "infamous or disgraceful conduct in a professional respect" by the Disciplinary Tribunal of the Council of the Medical Board of Trinidad and Tobago (MBTT).
The Tribunal has found Raj-kumar guilty of fraudulently tampering with a patient's medical records and has ordered the revocation of Raj-kumar's "certificate of full registration" from the Register of Medical Practitioners.
President of the MBTT Council, Dr Steve Smith, stated yesterday: "Doctors have been somewhat nonchalant or dismissive of the Council of the Board. I hope that this will send a signal to remind people that the Board is empowered to take disciplinary action. When there are legitimate complaints against doctors, the people have recourse to complain to the Board. I think this will remind doctors that they have a fiduciary relationship with the public that they must be ever-mindful of."
Smith has already informed Health Minister John Rahael, by latter dated April 4, that Raj-kumar's licence was to be revoked "with immediate effect," and that public notice of the revocation would be published in the Gazette.
However, Smith yesterday conceded that the Council's decision was not set in stone but was still open to a process of appeal.
Apart from the issue of Raj-kumar's falsification of a patient's medical records, the judgment of the Tribunal identified several other critical issues to be further investigated, namely: "The issue of whether or not Dr Raj-kumar was negligent in the manner in which he cared for Mrs (Narissa) Mohamdally; Dr Raj-kumar's carrying out of a surgical procedure for which he had not obtained informed consent; and Dr Raj-kumar's betrayal of trust which both the patient and her relatives had in him when he reassured them that he would allow Mr Mohamdally to witness the procedure on his wife."
At the centre of the case are the circumstances surrounding the death of Narissa Mohamdally, a 28-year-old former employee of RBTT Bank, who died on November 10, 2003, about one month after she had visited Raj-kumar at his Lukuni Clinic for a routine dilatation and curettage (D&C) operation. In October 2003, immediately after the D&C operation, Raj-kumar sent samples from Mohamdally's uterus for analysis to Micro Lab, a private medical laboratory owned by Dr Shaheeba Barrow, a consultant histopathologist.
However, upon receiving the samples, Barrow, according to an affidavit she submitted to the MBTT, telephoned Raj-kumar and informed him that the tissue that he had sent was not from the uterus but was in fact "normal small bowel mucosa only" (fluid from the intestine). This was a very strong indication that in the process of scraping the uterus an "intestinal perforation" ( a puncture in the small intestine) had taken place.
By sheer coincidence, about one month later, after two surgical interventions failed to save Mohamdally's life, the pathologist performing the autopsy on Mohamdally at the Port of Spain General Hospital was none other than Dr Barrow herself.
According to the affidavit, while reviewing the hospital medical notes, Barrow discerned a report which bore her signature but which did not resemble the report that she herself had sent to Raj-kumar about a month earlier. She immediately wrote a letter to Raj-kumar pointing out this discrepancy.
Barrow's letter, which she sent on November 12, 2003, the day after Mohamdally died, was copied to the Head of the MBTT Medical Ethics Committee. However, the Board took no action against Raj-kumar until six months later, when attorney Anand Ramlogan was granted leave by Justice Peter Jamadar to apply for judicial review and for an order of mandamus directing the MBTT Council to investigate the complaints made by Dr Barrow. Raj-kumar seems to be ignoring the decision handed down by the Council and is apparently still engaging in private practice. A telephone call placed to The Lukuni Clinic, at 2 Lukuni Road, South Valsayn, revealed that Raj-kumar is still accepting appointments.

Big pay raise for Trinidad and Tobago's Doctors
Joint negotiating team awaits final word from CPO
Louis B Homer South Bureau www.trinidadexpress.com
Wednesday, May 4th 2005

After an 18-month battle senior doctors at the nation's State-run hospital are in line for big pay increases.
Basic salaries for specialist medical officers are to jump from $10,400 to $15,000 a month and for resgistrars, who are in charge of wards, will see they pay rise from $9,500 to $13,500 a month, under a new contract agreed to by the Government and the Medical Professionals Association of Trinidad and Tobago.
The agreement, which was sent to the Chief Personnel Officer, last week also provides for increases for overtime, and transport, continuing medical, education and communication allowances.
This, it was learned, will give the doctors on average before tax earnings of about $28,000 a month.
Health Minister John Rahael told the Daily Express yesterday: "I am very happy that the negotiations have come to a conclusion. I hope that with the settlement the doctors will continue to provide improved health care to patients."
A senior official at the Ministry of Health also told the Daily Express yesterday: "New salary recommendations for the doctors were sent to the Chief Personnel Officer, at the end of last month, for approval and anytime now new contracts would be ready."
MPATT's acting president Lakhan Roop, said: "We have reached a settlement and are awaiting final word from the Joint Negotiating Team."
Negotiations for new contracts for the doctors, which led to threats of industrial action on several occasions over failure to reach an agreement, began in late 2003 between the JNT headed by Chairman of the South West Regional Health Authority Imtiaz Ahamad and officials of MPATT.
Last March, MPATT wrote Health Minister John Rahael asking for a new team of negotiators to be appointed so that the negotiations could be completed.
Rahael acceded to their request and appointed Reynold Cooper, Permanent Secretary in the Ministry of Health to head the negotiating team. Ahamad remained as a member of the team,
In all there were more than a dozen meetings between the JNT and MPATT.
Cooper said: "As soon as approval is received from the Chief Personnel Officer the JNT will be ready to start the 2006 to 2009 wage agreement."
The negotiations began shortly after the JNT settled with junior doctors at State-run health institutions following more than a year of bruising negotiations, during which the doctors staged a work-to-rule. The move resulted in several patients being sent to private nursing homes for treatment at a total cost to the Government of some $600,000.

Bryan Mackintosh's note; the exchange rate for the Guyana dollar against the TT dollars is TT$30 to G$1, that means that the Trinidadian doctors would be working for TT$15,000 x 30 = G$450,000 per month. The doctors in the public system in Guyana barely pick up G$150,000 per month, its  no wonder that the ministry of health cannot attract qualified doctors to work at the public hospitals in Guyana. When tax is taken out of the already small salary of the Guyanese doctors, they are left with very little.

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