EDITORIAL – Patients must come first

Most Barbadians will be concerned that yet again the internal dynamics of the Queen Elizabeth Hospital (QEH) has led to the disruption of the usual patient care and services at that institution, with BAMP calling out its members as a result of a fallout between that organisation and hospital management.The industrial action began a week ago with those doctors who are members of BAMP responding only to emergency situations at the QEH. Fortunately not all medical practitioners are members of BAMP and so the junior doctors were not involved in the withdrawal of services, which was confined largely to the consultants and senior doctors.This did not, however, minimise the serious nature of the action since the experience of the consultants and senior doctors is an integral part of a facility which deals not only with life-and-death emergencies, but with everyday medical problems, many of which are better handled with an experienced input.The dispute which triggered the walk out related to Dr Ramabarat, a consultant and former head of the Department of Radiography whose contract was terminated. This action led to swift response by BAMP two Fridays ago, which announced 48 hours after the dismissal, that “from today with immediate effect, no elective procedures whatsoever will be carried out and this includes no elective surgeries or any other elective services”.Frankly, the problem appears to have developed because of a breakdown in communication between the parties since, according to a statement put out on behalf of BAMP, certain contractual issues had surfaced earlier and a meeting was requested with the chairman. Subsequently, meetings were held between BAMP and management and its advisers; and the doctors who were promised a response within “two weeks” after the last of these meetings. Yet it was while they waited for the response that the contract of one of their number, Dr Ramabarat was terminated, while another consultant obtained a court order temporarily restraining management from dismissing him.While it seems clear that anyone hired under a written contract, may have his services terminated pursuant to that contract, it is equally clear that, as BAMP says, “getting rid of medical personnel without any respect to the existing practices or human dignity, even if it is legally right, is fraught with dangers”.It might have been better if the decisions to terminate had not been effected while the doctors were awaiting a response because that sort of action, if accurately reported, was bound to generate a vigorous response from BAMP as well as fuel suspicions which, well founded or not, can disturb even the calmest of negotiating waters.We are pleased that Minister Donville Inniss has used his good offices in trying to resolve the situation, but Dr Irvine Branker, a senior medical practitioner and a member of the board of management of the hospital has rendered a major public service in issuing a statement dealing head-on with what he calls “a vicious and unfounded rumour” about the Board having a list of specific QEH doctors that it wishes to terminate. Dr Branker said that he wants to “assure my colleagues in the medical fraternity that the QEH board has no individual, personal, political or other ulterior motives to the termination of any contract”.The QEH may not be an essential service under the definition used in the relevant legislation, but as our only public general hospital it is as essential to the national wellbeing as the fire and police services.One of the outcomes of this latest dispute should be an agreement between the unions and the management at the QEH. There should be a protocol which recognises the right of the doctors to withhold their services; as a last resort, but sets out certain agreed steps which should be exhausted before any strike action is called. Strike action should really be a matter of last resort given the essential nature of medical care, and the common objective of management and the doctors to deliver the highest quality of patient care.