LETTER: Something amiss regarding the licensing of health facilities in Guyana

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Dear Editor:

How many health care facilities in Guyana are presently licensed? To my amazement, I discovered that only two healthcare facilities in Guyana operate with a current (2018) license. These are the Georgetown Public Hospital Corporation (GPHC) and the Balwant Singh Memorial Hospital. The Balwant Singh Memorial Hospital only recently obtained its license after it sent a lawyer’s letter inquiring why their license was not being issued. Other healthcare facilities have been inquiring, but have faced a non-responsive partner in the Ministry of Public Health. Several of them are now contemplating the approach of the Balwant Singh Memorial Hospital of sending lawyer’s inquiries. The consequence is that every one of the health facilities operated by government and the private sector, other than these two are operating illegally, without a license. This is an untenable situation. Why has the Ministry of Public Health failed to license the health care facilities?

To its credit, Guyana is a handful of developing countries that have developed a licensing requirement to operate health care facilities. A Health Facilities Licensing Act was enacted in Guyana in 2007 when I was Minister of Health. In 2008, I signed an Order bringing into effect the Health Facilities Licensing Regulations. Every health facility that is operating in Guyana is required to be licensed. This includes all public (government-operated) and private health facilities. For a period until 2015, all hospitals, public and private, were subjected to annual licensing process, including inspection. Until the end of 2011, I personally ensured that the inspections were done on a timely basis and the license issued. Since 2015, I am aware that the law has been abrogated in many ways. Some of the hospitals and stand-alone laboratories have operated since 2015 without any license.

Some hospitals have been inspected for 2018. I am not certain that all hospitals have been inspected. The Inspectorate, in accordance with the law, was an independent, peer-review body, at least up to 2015. It was made up of inspectors from both public and private sector. It was a collaborative process intended to improve quality. Usually, the inspectors will flag certain deficiencies and provisional license would be issued, until the flagged deficiencies were remedied. Then a full license was issued. Each year, therefore, hospitals and laboratories operated with either a provisional or a full license. These had to be prominently displayed for the public to see. But several of the private hospitals have indicated that following inspections, they have been in the dark. The situation has been chronic since 2015. This is not acceptable.

The whole idea of a licensing process was to lift standards and to protect patients. The law ensured that certain minimum standards were met. It also ensured hospitals create a number of internal audits, including clinical audits, some of which could be ordered by the Ministry of Public Health. The law ensured that patients had a process of appeal and that their rights were respected. The nonchalant approach and the routine manner in which the Ministry has ignored the law promotes practices that are inimical to the welfare of patients and that discourage standards.

The law permits the Ministry to send inspectors at anytime. One example, when I was Minister, a team visited a private hospital where a patient’s family queried the high bill they received for a minor surgical intervention. The patient’s bill was close to $800,000 for an amputation of a toe. The clinical audit found that the bill was inflated and the patient’s bill was adjusted. But the inspecting team also queried a number of actions of the hospital pertaining to quality of care. Another example, is when the inspectorate team queried the safety of an X-Ray room and forced a hospital to construct disability ramps. Yet another example, was when the inspectorate queried the quality of medicines imported by a certain hospital. This law can only benefit Guyana and lift quality, while protecting patients. The reckless and nonchalant approach of the Ministry of Public Health in fully implementing the health Facilities Licensing Act is an abrogation of responsibility.

I am, therefore, publicly asking the Ministers of Public Health to tell the nation how many hospitals and other health facilities are presently licensed and when they were licensed. If there are facilities that are not licensed, either with full or provisional license, the Ministers have an obligation to inform the public of the reasons why they have withheld these license, even provisional license. In accordance with the law, if a facility cannot get even a provisional license, the facility cannot operate. The non-issuance of license must mean two things – that these facilities either do not meet the requirements for even a provisional license and must be closed or that the Ministry has simply been too tardy. At the very least, we need to know.

Dr. Leslie Ramsammy

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