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Health Minister chastizes memo from Medical Director and promises to investigate the matter

Dominica’s Health Minister, Cassani Laville, has expressed concerns over the issuance of a letter to numerous doctors at the Dominica China Friendship Hospital (DCFH) by the Medical Director of the DCFH Dr. Ruby Blanc regarding the suspension of elective surgeries due to the lack of medical supplies.

Dr. Blanc in a memo dated January 11, 2024, to doctors who perform surgery at the hospital that has gone viral on social media stated that “elective surgery at the Dominica China Friendship Hospital (DCFH) has been suspended until further notice due to the lack of medical supplies.”

“I regret to inform you that due to diminished supplies of pethidine as well as spiral needles, the elective surgery list will have to be temporarily suspended effective Monday, January 15, 2024,” the memo stated.

Pethidine is indicated for the treatment of moderate to severe pain and is delivered as a hydrochloride salt in tablets, as a syrup, or by intramuscularsubcutaneous, or intravenous injection.

According to the memo from Dr Blanc, minor surgical cases and cases involving the lower limbs “may be able to be accommodated” however, “any elective surgeries being requested must therefore be discussed before submitting names, with Dr Beck Jno Baptiste OIC, Anesthesia.”

“Be assured that significant efforts are being made to remedy the situation,” she wrote.

But in response, Health Minister, Cassani Laville, was not amused at the memo and expressed his disappointment stating that the letter/memo was issued “without proper authorization” and promised to “investigate the matter.”

He also blamed the matter on the “lack of communication and oversight in stock management within the hospital administration”.

“Today, I came to discuss the implication of this incident and the steps that must be taken to resolve the situation…I must express my deep concern that a decision of this magnitude, directly impacting patient care was weighed without proper consultation and approvals,” he said.

Not amused, Laville said, “It is deeply concerning that I would find out about this on social media. “

According to him, he met with the management of the hospital twice within the past eight days – with Prime Minister Roosevelt Skerrit on January 5 and on January 8 – and the matter was “never brought to his attention.”

He explained that the Dominica Hospitals Authority Act of 2021 gives the Hospital’s Board the primary function of coordinating the administration of the authority, “notwithstanding it is the board’s responsibility to make recommendations to the Minister on the development of the authority and the services provided at the designated health facility.”

“It is therefore alarming to witness such a crucial decision being made without following the established guidelines of the Act,’ he stated and the lack of communication regarding the shortage of essential medical supplies also highlights an oversight in stock management of essential supplies. Furthermore, the absence of documented decisions, alerts, or recommendations leading up to this situation is particularly concerning,” the health minister retorted.

Laville said the respective agencies within the health ministry will be held “accountable for the situation.”

“I have given the mandate for the implementation of the electronic, logistic management system to be operational by February 16 and the responsible agencies within the ministry will be held accountable,” he remarked.

The Health Minister went on to state, that given the gravity of the situation he has asked the hospital’s board, the CEO, and the Hospital Medical Director to convey a meeting to address the following issues:

1. The unauthorized issuance of the letter.

According to him, this needs to be investigated to “address the circumvention of proper approval protocols in the issuance of the letter related to hospital services.”

2. Lack of communication and oversight.

“We must examine the failure in communication and oversight regarding the stock management of essential medical supplies,” he said.

3. Documentation of decisions.

“It is essential to establish a documented progression of decisions, alerts, and recommendations related to stock shortages and critical issues” Laville explained

4. Patient confidentiality.

“We need to foster a culture of confidentiality as patients confidential is sacrosanct, “he stated.

He also said that he has requested feedback from the board within two days.

“In which time we will launch an investigation,” Laville stated.

“This timeline allows for prompt resolution, and effective communication to address these pressing issues with a clear distinction of how the system allows doctors the privilege of conducting private surgeries in the hospital setting. “

“However, under certain circumstances, it becomes necessary to temporarily suspend these private operations to meet the demands of performing critical and elective surgeries within the public hospital system, especially when stock availability is low or when there are marked increases in urgent cases. These measures are standard practice aimed at ensuring the equitable delivery of health care services,” the health minister remarked.

He also indicated that “not all surgeries will be affected.”

“To avoid any misconceptions, I would like to clarify that the suspension of elective surgeries does not apply to all surgical procedures but primarily affects non-urgent procedures that can be delayed,” he stated.

He said that the meeting he requested between the Hospital Board, CEO, and Hospital Medical Director aims to address many of the issues mentioned in his statement and prevent similar incidents from occurring in the future.

“The Ministry of Health remains committed to providing quality medical services while upholding proper governance and transparency,” Laville concluded.