Loop News understands that a year ago, in April, 2021, the Grand Court of the Cayman Islands granted Doctors Hospital leave to apply for a judicial review of the lawfulness of the grant by the previous Cabinet of the Cayman Islands government of concessions to Health City Cayman Islands and Aster Cayman MedCity. Now that lawyers appear to have completed their arguments on both sides and the judicial review proceedings have concluded, Dr. Yaron Rado, Chief Radiologist and Chairman of the Board of Doctors Hospital, has now reiterated his statements already in the public domain regarding the handling of the concessions and his concerns for the Cayman Islands medical profession as a result of the alleged differences in qualifications of doctors on the Principal List and the Institutional List.
Under the Health Practice Regulations, an applicant shall be eligible for full registration where the applicant is fully registered as a health practitioner in Australia, Canada, Jamaica, New Zealand, South Africa, the United Kingdom or the United States of America. In addition, the applicant must meet the Caribbean regional registration requirements, to practise as a health practitioner, as set out by any relevant organization including, but not limited to, the Caribbean Association of Medical Councils or the Regional Nursing Body. Among other things, the applicant must have obtained qualifications from the University of the West Indies or any institution accredited by the Caribbean Health Education and complete any internship required by the University or the institution where the applicant has obtained such qualifications.
Where a registered practitioner applies for renewal of the registered practitioner’s practising licence the Council with which that person is registered shall, in considering such application, first be satisfied that the applicant has obtained any or all of the continuing educational requirements specified by the Council for the practitioner’s type of profession during the period in which the practitioner was registered with the Council.
The Health Practice Regulations also state that a person who applies for registration as a specialist medical doctor shall provide written evidence that that person has obtained the necessary post graduate qualifications and completed at least three years’ specialist training in posts recognised for such training by the Medical and Dental Council.
In relation to the Institutional List, the Health Practice Regulations state that an applicant shall be eligible for institutional registration and licensure where the applicant is fully registered as a health practitioner in a country other than Australia, Canada, Jamaica, New Zealand, South Africa, the United Kingdom or the United States of America.
In terms of qualifications for registration on the Institutional List, the applicant must have obtained qualifications from an institution approved by a relevant Council in accordance with guidelines approved by the Cabinet and published by the Council in the Cayman Islands Gazette or passed an equivalency examination approved by a relevant Council.
Differences between the lists
According to Rado, one of main differences between the Principal List and the Institutional List is that “unlike doctors on the Principal List, the Health Practice Regulations don’t require institutionally registered doctors to have any postgraduate qualifications or any special training.”
Institutional List practitioners need only have obtained their qualifications from almost any medical school in the world (vs Principal List providers who must be registered from one of seven countries: Australia, Canada, Jamaica, New Zealand, South Africa, United Kingdom, and the United States).
They are also not required to provide proof of specialist qualifications to call themselves a specialist or consultant, let alone a proper residency program (5 years), a fellowship program (an additional two years), and then three years of post-specialisation experience as required for the Principal List.
Rado also noted that up until April 6, 2022, the Cabinet did not produce “any criteria for reviewing the designation of facilities” and “did not require facilities to meet any particular criteria before designating them.” “In other words, there has been nothing to stop facilities from employing inexperienced Institutional List doctors with minimal supervision,” according to Rado.
Way forward for lists
In order to establish a level playing field between practitioners on the Institutional List and the Principal List, it has been suggested that applicants for both lists be required to meet the same criteria when applying for a licence. Once they are required to meet the same criteria, there will likely be no need to have two different lists of practitioners in Cayman as they may all be asked going forward to have the same high standards and qualifications to practice in the healthcare industry in the Cayman Islands.
In the meantime, Rado said that “the Cayman Islands Medical and Dental Society (CIMDS) have recently launched the “Green Tick” campaign to raise awareness about healthcare providers’ two separate registration lists.” Accordingly, people are invited to “educate themselves so they can make informed healthcare choices for their families,” Rado added.
In relation to concessions, Rado said that “Doctors Hospital paid CI$ 1.2 million in stamp duty to acquire its current site and has spent more than CI$ 1 million in customs duty alone over the last three years.” In comparison, other healthcare providers were allegedly granted tax breaks in the form of concessions.
Rado emphasized that “whilst the Government has a discretion under the various laws to waive the duties payable by healthcare facilities, indeed by anyone, waivers must be applied for… but there must be a “transparent guideline or criteria by which these applications are assessed against.” In an ideal world, Rado’s sentiments would seem practical, especially where transparency is now said to be of utmost importance and should therefore lead to concessions guidelines and details of concessions being published and being subject to public scrutiny.