Hos­pi­tals, State Prob­ing Caribbean Med School

The Star (St. Lucia) - - COMMENT - By


Three Con­necti­cut hos­pi­tals may stop pro­vid­ing hand­son train­ing to stu­dents from a Caribbean med­i­cal school whose grad­u­ates are banned from prac­tic­ing in six states.

The hos­pi­tals came un­der scru­tiny last month when a Courant in­ves­ti­ga­tion re­vealed Spar­tan Health Sciences Uni­ver­sity’s min­i­mal en­trance re­quire­ments and bare-bones fa­cil­i­ties. Its stu­dents are not even al­lowed to train in hos­pi­tals on the school’s home is­land of St. Lu­cia.

State health com­mis­sioner Dr. J Robert Galvin also said he is will­ing to send state reg­u­la­tors to in­ves­ti­gate Spar­tan if no na­tional body can be per­suaded to take on the task of in­spect­ing off-shore med­i­cal schools.

Galvin said he launched his own probe into links be­tween Spar­tan and the Con­necti­cut hos­pi­tals af­ter read­ing the Courant re­port.

St. Mary’s Hos­pi­tal in Water­bury, Grif­fin Hos­pi­tal in Derby and St. Raphael’s in New Haven all have ac­cepted Spar­tan stu­dents for prac­ti­cal train­ing on pa­tients in sur­gi­cal and can­cer de­part­ments, among oth­ers.

``I think we need to do some­thing to as­sure the peo­ple of Con­necti­cut that any­one who comes to work in our hos­pi­tals is prop­erly ed­u­cated and ac­cred­ited,’’ Galvin said. Spar­tan of­fi­cials of­fered no com­ment for this story. Galvin, who was re­cently ap­pointed com­mis­sioner of the Depart­ment of Public Health, said he ex­pects the hos­pi­tals will vol­un­tar­ily stop ac­cept­ing Spar­tan trainees for clin­i­cal ro­ta­tions un­til a team of qual­i­fied in­ves­ti­ga­tors can de­ter­mine whether the school is ``up to snuff.’’

Con­necti­cut does not ban hos­pi­tals from train­ing stu­dents from any schools, nor does it ban grad­u­ates of any spe­cific schools from prac­tic­ing. Un­like med­i­cal res­i­dents, who have grad­u­ated from med­i­cal school and are li­censed physi­cians who work for rel­a­tively low pay in ex­change for spe­cial­ized train­ing, stu­dents on clin­i­cal ro­ta­tions are gen­er­ally in their third or fourth year of med­i­cal school. They do phys­i­cals, take pa­tient his­to­ries and per­form mi­nor pro­ce­dures un­der the su­per­vi­sion of a res­i­dent. Wil­liam Powanda, a spokesman for Grif­fin Hos­pi­tal, said the hos­pi­tal is re­view­ing its re­la­tion­ship with Spar­tan as part of a broader look at Grif­fin’s med­i­cal ed­u­ca­tion pro­gram. Powanda stopped short of say­ing that Grif­fin had suspended the prac­tice of ac­cept­ing Spar­tan stu­dents while the re­view is un­der­way, but said that stu­dents from other schools would be given pri­or­ity for ac­cep­tance.

There are no stu­dents from Spar­tan cur­rently at Grif­fin, he said.

``It’s kind of a broad re­view that’s look­ing at the en­tire stu­dent pro­gram and dis­cretely at the re­la­tion­ship with Spar­tan as well,’’ Powanda said. ``While that process is in place, we are choos­ing to ac­cept stu­dents from schools other than Spar­tan right now.’’

Galvin’s in­ter­est has sparked a sim­i­lar re­view at St. Raphael’s and St. Mary’s, hos­pi­tal of­fi­cials said.

Cur­rently, there is no na­tional or­ga­ni­za­tion that sys­tem­at­i­cally as­sesses the qual­ity of for­eign med­i­cal schools. For li­cens­ing pur­poses, many states, in­clud­ing Con­necti­cut, rely on a di­rec­tory of in­ter­na­tional schools pub­lished by the World Health Or­ga­ni­za­tion in Geneva.

That di­rec­tory, how­ever, is lit­tle more than a list­ing of med­i­cal schools that are rec­og­nized by the coun­try in which they are lo­cated. Even the au­thors of the WHO list warn against re­ly­ing too heav­ily on their di­rec­tory for qual­ity as­sur­ance, point­ing out at the be­gin­ning of the guide that they do not for­mally rec­og­nize or ac­credit the schools.

Some states, such as New York and Cal­i­for­nia, have their own teams of in­spec­tors for off­shore schools. But those states are such de­sir­able des­ti­na­tions for the mostly Amer­i­can stu­dents that the schools are gen­er­ally will­ing to foot the bill for their own in­spec­tions in the hope of gain­ing ap­proval. Smaller states don’t have that kind of eco­nomic clout.

That’s why a group like the Fed­er­a­tion of State Med­i­cal Boards, a trade or­ga­ni­za­tion based in Texas that rep­re­sents state of­fi­cials who is­sue med­i­cal li­censes, would be a log­i­cal body to as­sume the task of in­spect­ing for­eign schools, Galvin said.

While FSMB of­fi­cials ac­knowl­edge that a na­tional stan­dard for eval­u­at­ing for­eign med­i­cal schools would be valu­able, ex­ec­u­tive direc­tor Jim Thomp­son said his or­ga­ni­za­tion is ill-equipped to do the job. ``Ac­cred­it­ing a med­i­cal school is not a sim­ple process,’’ Thomp­son said. ``When U.S. schools are ac­cred­ited, a team of five peo­ple de­scends on them for five days and re­views stacks of doc­u­ments 24 inches high.’’

Thomp­son ac­knowl­edged that five peo­ple would start bump­ing into each other af­ter five min­utes dur­ing an in­spec­tion of Spar­tan, which con­sisted of a sin­gle build­ing with four class­rooms, one lab and three ca­dav­ers when The Courant vis­ited last Oc­to­ber.

But even the ap­par­ent sim­plic­ity of in­spect­ing such a small school would cre­ate its own set of bu­reau­cratic ob­sta­cles.

``In that case, what in­for­ma­tion would some­body want to have from th­ese schools?’’ Thomp­son asked. ``Are you go­ing to have to lower the stan­dard for in­ter­na­tional schools?’’

Even if no na­tional sys­tem for ap­prov­ing in­ter­na­tional schools is es­tab­lished, the con­cerns about Spar­tan and its con­nec­tions to Con­necti­cut hos­pi­tals are such that Galvin would be will­ing to send his own in­ves­ti­ga­tors to St. Lu­cia to in­spect the school.

``I’m of the opin­ion that some­body should take a close look at this place,’’ Galvin said.

Fail­ing that, the health depart­ment could in­sist that all hos­pi­tals fol­low the lead of the UConn Med­i­cal Cen­ter, which trains stu­dents only from schools in North Amer­ica that have been ap­proved by the Amer­i­can Academy of Med­i­cal Col­leges.

But smaller hos­pi­tals such as St. Mary’s and Grif­fin, which are not part of an es­tab­lished med­i­cal school or lo­cated in a ma­jor city, have a hard time at­tract­ing stu­dents from U.S. and Canadian med­i­cal schools. For them, ac­cess to in­ter­na­tional stu­dents is crit­i­cal to their goals of achiev­ing the pres­tige, and eco­nomic benefits, as­so­ci­ated with be­ing a teach­ing hos­pi­tal.

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