On Sunday, the Guardian's editorial very nicely summarised a number of problems that have occurred in the past ten years with the practice of forensic pathology: "Sparking this sudden refocusing on the state of forensic pathology was the range of forensic results on the death of Lance Cpl Curtis Marshall, whose death was described as asphyxia consistent with strangulation and an asthma attack in consecutive autopsies.
"In December, the Government brought in US forensic pathologist James Gill to review two autopsy reports done on Stacy Ramdeen after one reported her death as the result of a heart attack, the other citing strangulation as the cause. In the 2001 case of eight-year-old Daniel Guerra, found dead in a river at Tarouba, the causes of death were, across three autopsies, death by drowning, asphyxia before entering the river and homicidal asphyxia."
It may seem that something is wrong when so many different autopsies come to so many different conclusions but it would be wise to remember that, despite enormous progress, medicine is still more of an art than a science and differences of opinion among medical practitioners are common and indeed necessary in the search for truth. There are few problems that cannot be solved by medical people, be it GPs or specialists, sitting down far from the gaze of the public and the media and, quietly and tastefully, discussing their various opinions.
What is more difficult to resolve is when there is no clear definition of what is a specialist, as occurs in T&T.Medicine is T&T is run by the Medical Board and by the Council of the Medical Board.The Medical Board of Trinidad & Tobago (MBTT) is made up of all the registered medical doctors in T&T. There are approximately 2,500 medical doctors in both these islands. Fr Anthony de Verteuil in his book, Surgery in Trinidad, says the MBTT was established by proclamation from Governor Woodford on December 20, 1814, "to collaborate with the government with a view to control the practice of medicine in the best interests of the community."
The Council of the MBTT consists of several medical doctors, some elected by the Medical Board and, since 2007, some appointed by the Minister of Health. The Council is a statutory body and functions under the Medical Board Act Chapter 29:50, 1960. The Act establishes the Minister of Health as the line minister whose responsibility it is to ratify the actions of the Council. The functions of the Council are restricted by this Act to two things: 1. the granting of registration to appropriate medical professionals who have successfully completed a medical degree in an established university together with the keeping of an up-to-date register of qualified doctors, and 2. discipline which, in practice, means responding to formal complaints from within or outside the profession and dealing firmly and fairly with doctors whose fitness to practice may be in doubt.
The Medical Council has the power to censure and suspend for up to two years any doctor whom it finds guilty of "infamous or disgraceful conduct in a professional respect." It can also erase a doctor from the medical register and make it impossible for that doctor to practice in T&T or in any part of the world by withholding a letter of good standing.The foremost purpose of the Council, therefore, is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine.It is hampered in this by its inability in law to say who is a specialist; the Medical Board Act does not allow this.
Consequently, anyone, once registered with the Medical Council as a medical doctor, can claim to be a specialist. Despite not being a surgeon (a specialist), any medical doctor can operate. Any medical doctor can call himself a paediatrician, despite not having the necessary qualifications. Any medical doctor can open a medical laboratory, get himself a couple of lab technicians, and open a medical lab. The point is that the Medical Act under which the medical profession regulates itself in T&T, was formulated in an era when there were few specialists, most of them self-determined, and is quite unsuitable for the practice of modern medicine.
In 2007, when the minister of health, John Rahael, suggested and parliament approved the changes to the Council of the Medical Board, medical practitioners attempted to get the Government to make the necessary changes to define the various specialists. Unlike what Dr Amery Browne suggested the other day, the then Government refused. We will continue to have a problem defining who is a pathologist, who is a forensic pathologist, who is a surgeon, who is a paediatrician etc until this issue is resolved. Not the least of these problems will be the continuing confusion that exists at present in the minds of the media and the public about what is "really" going on. It may be as simple as bad law.
