Fort Wellington doctor undergoes supervision, remediation after opioid abuse complaint

-medical council’s disciplinary committee still to decide on fates of two others

While the Disciplinary Committee of the Medical Council of Guyana (MCG) is still to pronounce on the fates of two of three Fort Wellington Hospital doctors, who were found to have misused opioid medications in their treatment of a former Region Five councillor, the other had to undergo supervisory practice and remedial studies.

“The initial investigation concluded [in] August, 2017 and found that there was sufficient evidence to support possible misuse of opioid analgesics by two of the physicians. The matter has been placed before the Disciplinary Committee but is still to be concluded,” Chairman of the MCG, Dr Navin Rambarran said in response to questions from Sunday Stabroek.

“A further recommendation was that one of the physicians undergo supervisory practice and remediation of his knowledge of the use of analgesics was taken into account. This was achieved soon afterwards through collaboration with the Office of the Chief Medical Officer and the doctor’s remediation is ongoing at a training institution,” he added.

It is unclear why almost a year has passed and the Disciplinary Committee has yet to make a decision on the other two doctors.

Last October, Rambarran had explained that while no timeframe was set for when the committee should complete the process, given the “seriousness of the allegations” it was expected that it would be expedited and a decision would be made swiftly.

A formal complaint was made last year by PPP/C Member of Parliament Harry Gill against Dr Steven Cheefoon, Dr Ivelaw Sinclair and Dr Adrian Van Nooten, who are all attached to the Fort Wellington Public Hospital, in West Coast Berbice. Dr Cheefoon is also the Regional Health Officer of Region Five.

Letters were written by the MCG to the doctors named in the complaint and they replied. In addition, the MCG questioned several persons and analysed the Fort Wellington Hospital’s log book for prescription narcotics to see “the frequency of how the drugs were prescribed and administered.”

Gill charged that the doctors facilitated former Region Five councillor Carol Joseph, who was accused of abusing her authority to access large amounts of prescription pain medication.

Thus far, neither the Ministry of Public Health nor the Ministry of Communities has launched any investigation into the case.

Joseph resigned from the Region Five Regional Democratic Council on April 21st last year, two days after Stabroek News published a report on her alleged abuse of medication. The matter had been drawn to the public’s notice by Gill after Nurse Sherlyn Marks reported to him that her complaints to senior medical officials about the Joseph case had been ignored.

Marks was abruptly transferred by Region Five Regional Executive Officer Ovid Morrison after the news item on Joseph’s case appeared in this newspaper. Morrison’s transfer of the nurse has been condemned and there have been calls for it to be rescinded. The Ministry of Public Health subsequently said that Marks had breached public service rules and that it had sent her to the Department of the Public Service for action.

In his complaint to the MCG, Gill had pointed out that Marks had written to then Minister of Public Health Dr George Norton on the matter on December 13th, 2016. In that letter, Marks had said she was being harassed and intimidated by Joseph because of the complaint she had lodged with Dr Chefoon about the medication that was to be administered to Joseph. Marks also sent her letter to a number of other regional and health officials who did nothing about it.

Gill noted that the Medical Practitioners (Code of Conduct and Standards of Practice) Regulations 2008 state that a medical practitioner “shall not expose his patients to risks which may arise from a compromise of their own health status (eg dependence on alcohol or other drugs, HIV infection, hepatitis and the like).” In addition, they also say the Medical Council may regard “the prescription or supply of drugs of dependence otherwise than in the course of bona fide treatment as a serious professional misconduct.”

He urged that the MCG conduct the investigation, in keeping with its own Code of Ethics and Standards of Practice, to protect the integrity of the medical profession.

‘Conduct’

In giving an update on an investigation by the GMC, Rambarran said that the investigation centered particularly on the conduct of the doctors in their treatment of Joseph from 2009 to when the complaint was lodged, and whether there was any impropriety in prescribing pain medications during the period of management, as initially reported by Nurse Marks.

The Chairman said that he wanted to underscore that the GMC’s regulatory role in investigating this case covers only the practice of the medical practitioners. “Even though reports from others, including Ms. Carol Joseph and Nurse Marks, were taken into account, it is not within the remit of the Council to form opinions or make recommendations at any point in the investigation regarding these individuals as they are not medical practitioners,” Rambarran said.

He had earlier explained that the sending of the findings to the Disciplinary Committee “does not necessarily mean that anyone is guilty, it is just the procedure that we take, according the Medical Practitioners Act.”

“The committee looks at the case to see if there are penalties or wrongdoings and we have decided that there is merit for the complaint. They will now bring in the persons, according to the Act and which falls under the Disciplinary Committee to see what steps are to be taken. But like I said, it does not mean a doctor was guilty, it just means that without our finding merit in the complaint, it could not go forward. We confine our reviews directly out of the Health Act and [therefore] it is not something we can decide upon,” Rambarran explained.

The council looked at and reported on its findings into what roles the three doctors played in the matter where Joseph was

accused of abusing her authority to access large amounts of prescription pain medication.

According to regulations accompanying the Medical Practitioners Act, it is the MCG that determines the merit of the complaint. “Having regard to any explanation or representation made by the person against whom the complaint is made (MCG) may-(a) determine that the complaint is not established and that no further inquiry need be held; or (b) refer the matter in whole or in part to the Disciplinary Committee. (5) If, during the complaint hearings, the Medical Council determines that no inquiry shall be held, the Secretary to the Medical Council shall inform the complainant and the person against whom the complaint is made of the decision in such manner as the Medical Council may direct. (6) Where the Medical Council is of the opinion that a complaint so made might, if factually established, call for the application of disciplinary measures, the Medical Council shall refer the matter to its Disciplinary Committee to hear and report its findings and recommendations to the Medical Council to determine the case,” the regulations state.

“If the Medical Council is of the opinion that it is inexpedient or dangerous or not in the public interest that a person under inquiry should continue to practice during the pendency of a disciplinary proceeding, the Medical Council may, by order in writing, suspend the registration of the medical practitioner, pending the outcome of the inquiry,” the regulations say.

In dealing with the complaints, the law says that the Disciplinary Committee shall decide its own procedure but shall have due regard to principles of natural justice.