Doctors Hospital Advances Legal Action Around Hiring Institutionally Registered Medical Practitioners In The Cayman Islands, Claiming Patient Safety Is Otherwise At Risk

GEORGE TOWN, Cayman Islands, July 22, 2021 /PRNewswire/ -- Doctors Hospital has applied to the Grand Court in Cayman for leave for judicial review of the ongoing failure by the Government of the Cayman Islands ("the CIG") to formulate and publish criteria against which healthcare facilities are assessed before being designated as a facility that may employ 'institutionally registered' medical practitioners.

Doctors Hospital's central complaint is that the CIG has failed to formulate, publish and apply a transparent criteria for designating and supervising these facilities so the public can be assured there is adequate supervision of the less qualified and less experienced practitioners they employ.

In the absence of such criteria, Doctors Hospital claims, Cabinet's power to designate a facility is liable to be exercised arbitrarily and in a way that fails to promote the purpose of institutionally registered practitioners only, being permitted to work at certain facilities.

A pre-action protocol letter was sent to the CIG on 23 April 2021, which asked it to "identify whether there are any criteria for granting and reviewing designations under s.24A(2)" of the Health Practice Act (2021 Revision).  The letter also asked to "confirm CIG commit to publishing criteria within a specified timeframe". The Attorney General's Office replied on 18 May 2021, admitting that:

(1)  there are no criteria, published or otherwise, for granting and reviewing designations,

(2)  CIG is unaware of the reasons why the only facilities designated to date (Health City, the Health Services Authority and Total Health Ltd) were granted designations, and

(3)  there are no arrangements for supervising the ongoing suitability of those facilities as places institutionally registered practitioners may practise.

By letter dated 18 June 2021, Doctors Hospital offered the CIG a final opportunity to commit to publishing criteria for granting and reviewing authorisations, failing which it would commence legal proceedings. No reply to that letter has been received.

Doctors Hospital accepts that the Legislature was entitled to introduce a tier of registration, whereby less qualified and less experienced practitioners are permitted to practice in the Cayman Islands. However, in creating a system where these practitioners may only work at facilities designated by Cabinet, the Legislature must have intended that these facilities will adequately supervise those practitioners.

Cayman Islands' lack of regulation of doctors claiming to be "Specialists"

Doctors Hospital's application also refers to the lack of any regulation setting the requirements to be met for institutionally registered practitioners to be registered as specialists in a particular field (such as oncologists or obstetricians). This lack of regulation risks patients being treated by insufficiently trained and inexperienced doctors without their knowledge, further risking potential harm to patients and the rising costs of health care via increased insurance premiums.

“As stated before, we believe in fair and competitive marketplaces,” says Dr Yaron Rado, Board Chairman and Chief Radiologist of Doctors Hospital. He added, “Further, we need this system to be transparent and safe for people engaging in healthcare in Cayman. We understand individuals are being granted institu-tional list registration for positions without completed residency programmes. This is alarming to us and should be alarming to everyone. To be registered as a specialist on the principal list, you need at least four years post-medical degree specialist training; to successfully sit a Board exam to be licensed in Cayman. None of this is overseen on the institutional list. So we will continue to challenge the government about this.  Ultimately, what is at stake is the health and well-being of the people of Cayman and the standard of healthcare that the Islands deliver. To maintain high standards, Doctors Hospital has chosen only to employ fully registered practitioners who are on the principal list. 

About the system of 'institutionally registered' practitioners.

Similar to jurisdictions such as Singapore, the Cayman Islands has a tiered system of registering health professionals. Before being licensed to practice, practitioners must register on the 'principal list', the 'provisional list' or 'the institutional list'. The law sets various criteria for being eligible for each list.

Practitioners registered on the principal list, deemed the most qualified and experienced, can practice without supervision;

Practitioners registered on the provisional list, deemed to be adequately qualified but lacking experience, must practice under the supervision of a practitioner on the principal list; and

Practitioners registered on the institutional list merely need to have qualified at a medical school listed in the World Directory of Medical Schools. This directory aims to list every medical school worldwide and admits that it is not an indicator of quality. These practitioners may be employed only by a health care facility Cabinet has designated as permitted.

The statutory scheme for institutional designation was introduced in 2011 and offered as an inducement by CIG to Narayana Hrudayalaya Private Limited, which owns and operates Health City, according to a contract dated 7 April 2010. The scheme came under renewed focus when on 21 December 2020, the CIG entered into a contract, with Aster Caribbean Holdings Ltd.  This contract included a commitment by CIG to use its best endeavours to secure the designation of the proposed Aster Cayman Medcity hospital ("ACMH") as a place at which institutionally registered practitioners could practice.

On 19 April 2021, the Grand Court granted Doctors Hospital leave to apply for a judicial review of the lawfulness of CIG's commitment to granting vast work permit fees, customs and stamp duty concessions to Health City and Aster Cayman MedCity. They argued that these "concessions unfairly distort competition between healthcare providers in the Cayman Islands and could ultimately compromise the quality of healthcare available.