Tobago nurses lose scholarship row with TRHA

TWO Tobago nurses have lost their legal challenge against the Tobago Regional Health Authority (TRHA) over the authority’s refusal to recommend them for a scholarship to do a post-registration diploma at UWI.

The nurses, Renay Bobb-Williams and Laureen Roberts, complained the TRHA was unreasonable, irrational and unlawful in deciding not to recommend them for the diploma in health visiting because they did not have a basic qualification in midwifery.

In a written decision in which he denied the nurses leave and dismissed their application, Justice Ricky Rahim ordered them to pay the TRHA’s legal costs of defending the action, which was heard as a rolled-up hearing for leave and the substantive claim, as well as a claim for constitutional relief.

The nurses were represented by attorneys Martin George and Janelle Ramsaroop.

Rahim had to determine whether the two were discriminated against, victimised and unfairly treated, and whether the TRHA’s failure to recommend them for the scholarships deprived them of a legitimate expectation they would get them, since they had been accepted by the university.

In his decision, he held although unwritten, the policy had been followed for at least two years and was not an unreasonable one, since the authority submitted that only licensed midwives could provide services related to antenatal, post-natal, delivery and family-planning care required for home visits, and not having qualified nurses in this field could result in the closure of clinics and the termination of home visits, disadvantaging the Tobago public.

“The TRHA has made it clear that 75 per cent of its services require the support of a midwife. The irony is that the applicants, who are not qualified in midwifery, appear to be averring unto themselves specialist knowledge which they do not possess,” the judge said.

He also held they were not discriminated against, nor did they have a legitimate expectation that once accepted by UWI, they would automatically get the TRHA’s recommendation.

“If there was any representation whatsoever, it would be that of UWI which set out its criteria for admission to the programme one of which was a qualification in midwifery. But a representation by UWI is not a representation by the TRHA and cannot be deemed to be a representation of the TRHA.

“Further, the reliance on the acceptance by UWI cannot form a basis for imputing the representation to the TRHA,” he said, adding that it could not be that the university would have the final say on whether an RHA would recommend a permanent employee for the course.

Rahim said the programme at the university was not a scholarship, but a three-semester programme, and since public funds were being used to pay the compulsory and tuition fees, there must be “financial oversight, resource and needs considerations,” by the authority responsible for recommending payment be made.

Last June, the nurses,who had been employed by the TRHA for more than 12 years and assigned to the Scarborough General Hospital, applied for the full-time post-registration diploma programme, which began in January.

The basic requirements were that applicants must be citizens of TT; hold permanent positions with an RHA or a private-sector institution; and be registered with the Nursing Council.

The special requirements were that they must be on the general register of the council; have a post-basic qualification in any health-related programme; have a post-basic qualification in midwifery and/or psychiatric nursing (for male nurses only); satisfactory experience in community health service or show evidence of a special interest in community health nursing; and any other suitable qualification the Faculty of Medical Sciences might deem appropriate.

The scholarships are awarded by the Ministry of Health and candidates are recommended by their RHAs.

The two nurses admitted they did not hold any qualifications in midwifery.

They met with the human resources department and were told that the board had refused to recommend them because they were not licensed midwives. They wrote to the chief executive director of the TRHA, who told them of the existing unwritten policy that registered nurses who were not qualified midwives could not do the diploma.

In response to the claim, the TRHA said they should have known of the policy which is aimed at ensuring that employed district health visitors are suitably qualified to provide the required service at various health centres in Tobago.

The TRHA submitted that 75 per cent of the health services in Tobago require a qualification in midwifery. Wesley Orr, the chief executive director, explained the importance of a qualified midwife and the impact it would have on health services in Tobago if good service was not provided. It was also explained that the policy was so that the authority could reap the benefits of its investments – some $200,000 per nurse – and to avoid further costs to employ a licensed midwife.

The authority also submitted that they knew of the policy, since they asked to meet with Orr to find out whether the policy was still in force.

The nurses listed many other services a district health visitor could provide without being a qualified midwife, pointing to a fellow nurse, who was not a midwife, as a comparator. They also pointed to another nurse at the South West Regional Health Authority (SWRHA) who was also not a midwife.

They argued that there was no logical reason why district health visitors could not function with or without being a qualified midwife, and not only did neither the university or the ministry require nurses to be licensed midwives, but other health services were required at health centres in Tobago, apart from maternal services. They said a midwife was only needed at the very last minute at the point of delivery.

They also claimed Orr told them if they did the diploma, they would be fired from their jobs, but he denied this. Orr also said nurses could do the diploma without the assistance of the TRHA.

Six candidates applied for the diploma and were provisionally selected. The other four were registered nurses and licensed midwives.

It was also revealed that Bobb-Williams had applied for the scholarship in 2019 and was provisionally selected, but was refused because she was not a qualified midwife.

The judge said the two nurses took the chance to apply for the scholarship although they knew of the policy.