By LARA PICKFORD-GORDON Tuesday, August 4 2009

Regional Health Authorities have received a proposal for the provision of neurosurgery consultancy services from the private sector.

The proposal entails the doctors providing their surgical services monthly at a flat fee. When asked about it yesterday Health Minister Jerry Narace said, “We are treating with all that as we speak.” He assured that medical coverage for neurosurgery patients was being provided as “arrangements are in place”.

According to one source the proposal from the doctors was “astronomical” while another view was that “it’s a service in short supply, and local neurosurgeons feel it is an opportunity to cash in”. However, Secretary-General of the Medical Professionals Association, Dr Balkaran Ramkisson, sought to counter these views and said that the RHAs had invited bids for the provision of neurological service and proposals were submitted. “The RHAs have not been able to work out something agreeable for services provided.”

Ramkission said MPATT was aware that a number of critical aspects needed to be worked out and it was not just a question of remuneration. He said supplemental staff (middle grade doctors) to support the consultants and “someone to be on call 24 hours”, trained nurses for neurological patients, adequate theatre time, equipment and an area dedicated for neurosurgery patients were also necessary. “It’s a question of putting things in place for the neurosurgeon to provide a reasonable level of service,” Ramkisson said. The shortage of specialist doctors was highlighted with the British tourists Peter and Murium Greene who were flown from Tobago to Trinidad for treatment of their injuries.Newsday learnt that patients from Tobago are usually taken to the Port-of-Spain General Hospital, but because the injuries to the Greene’s faces needed a maxillo-facial surgeon, which PoSGH did not have, they were transported to EWMSC, Mt Hope. EWMSC does not have a neurosurgeon for adult cases as its specialist resigned a few months ago. The doctor was required to be on call round the clock. Dr Richard Spann, who is the neurosurgeon for paediatric cases at EWMSC, was asked to provide service for the Greene’s. Dr Spann, who is based at the Community Hospital of Seventh Day Adventists, Cocorite, is also providing surgical coverage for the San Fernando General Hospital.

Port-of-Spain General Hospital which is under the North West Regional Health Authority has neurosurgeons which provide services to other RHAs.

Ramkission noted the arrangements made for the Green’s and questioned “what happens to similar cases that go to the public institutions without a neurosurgeon on staff?” He wondered what happened to patients in need of other specialised services which were lacking.

In response to questions from Newsday, the Communications Department of the Health Ministry said there are eight neurosurgeons in TT and this is “an acceptable number given the internationally accepted ratio of neurosurgeons to population.” Three of these neurosurgeons work in the public service. The release referred to statements from Narace on July 22 in response to Dr Gopeesingh in the House of Representatives, in which he said two neurosurgeons—one from Cuba and one from India were included in the 119 specialist doctors the Ministry was bringing to increase the complement of public service doctors. The Cuban is due to arrive in September. The Ministry said it was untrue that patients requiring neurosurgical services were being neglected: the Ministry acquires these services at its (the Ministry’s) cost from the private sector. It also said Dr Gopeesingh’s comment that five doctors are awaiting positions in the public sector was inaccurate. The Ministry said local doctors are given preference over foreigners in the public sector. It said all patients in need of neurosurgical services receive it at the Ministry’s expense.