Lingering questions about Couva hospital

THE EDITOR: The South West Regional Health Authority (SWRHA) is responsible for 700,000 citizens who live in the counties of St Patrick, Victoria and parts of Caroni. Just one hospital in San Fernando services this catchment area.

The Point Fortin Hospital transfers patients needing urgent care to the San Fernando General Hospital. Both had a cumulative bed capacity of 680 up to 2011. With an additional 300 beds at the San Fernando Teaching Hospital, that total rose to 980.

All the country’s other hospitals – six in all including Caura – are in the North – along the east-west corridor. Their cumulative bed complement is 1,700.

The Couva hospital was handed to the Government in July 2017. That hospital has a capacity of 230 beds – 80 pediatric and 150 adult. That hospital, we were informed, would have been under the jurisdiction of the SWRHA. It is in an area that is within that RHA’s sphere of control. The Couva District Health Facility located in Balmain, Couva, falls under the aegis of the SWRHA.

User fees were initially charged at the Eric Williams Medical Sciences Complex (EWMSC) when it was first commissioned by the NAR government. That arrangement was quickly abandoned because of protests at the cost of services and the convoluted government bureaucracy involved when those who could not afford them needed access.

Health Minister Terrence Deyalsingh said nothing of the terms and conditions of employment of professional staff at the Couva hospital. Would they be employed by the university, the Ministry of Health, the “special purpose company” or the SWRHA?

In 2004, neither the hospital facilities at the EWMSC nor the staff employed there fell under the administrative control of the University of the West Indies. The administrative arm of the university was powerless to correct this anomaly. It is logical to expect that the same anomalous arrangement would affect the hospital’s functional efficiency, the process of professional development of academic staff and, by extension, impact most crucially upon the quality of professional development and services.

Since that hospital and that one alone would function as a “fee-for-service” acute-care hospital, with the State subsidising costs for those who require services but cannot pay, it follows that those who can afford would have quicker and easier access. Such a policy would set in train the establishment of a “two-tier” healthcare system within the public healthcare sector.

The minister and his party now running the country have always had a problem with the “public-private” work mix among doctors. Now he has gone one worse: he is creating a quasi-private, publicly financed health facility to which access can be had by people who have money to pay (privately) for services.

Would professional staff at that hospital be paid on par with those employed by the ministry, the SWRHA and the UWI? Should a doctor be offered a locum job by a university hospital abroad to expand his professional expertise, which of these three bodies would be responsible for his salary, and for hiring and paying a replacement? Would doctors working at the Couva hospital, administered in the way the minister proposes, be allowed “private practice?”

Finally, and most importantly: how would the chaotic and confused administrative plan the minister outlined contribute to solving the problem of “private-public” mix in respect of specialists at that hospital? And in what way does such an arrangement advance the cause of solving the minister’s original problem: that of an existing dearth of specialists? In fact, whence does he plan to get his specialist staff?

STEVE SMITH via e-mail