Editorial | Medical Council must investigate

It isn’t clear if the Pharmacy Council of Jamaica (PCJ) has, as a regulatory body, formally complained to the island’s medical council over alleged ethical – and potentially dangerous – breaches by doctors in selling medicines to their patients.

But given that at least two members of the PCJ – chairperson Ernestine Watson and member, Tyrone Smith – have publicly made such allegations, including suggesting that the practice is widespread, it is urgent that Dr Milton Hardie, its chairman, causes the Medical Council of Jamaica (MCJ) to open an investigation into the matter, to determine if the claims are true, how pervasive they are, whether patient care is being compromised, and if the case is proved, offending doctors should be censured.

At the same time, Christopher Tufton, the health minister, should begin a review of the pharmacy legislation to see if it requires tightening. Or Dr Tufton might feel it better to have Parliament’s human resources and social development committee open hearings on the question.

Meanwhile, the PCJ should clarify for the public whether Drs Watson and Smith represented the position of the 10-member council with their statements. Dr Watson is a past president of the Pharmaceutical Society of Jamaica (PSJ), an industry interest group, while Dr Smith is the PSJ’s current head.

Under Jamaica’s Pharmacy Act, except in very limited circumstances, the dispensing of medicines can only be done by pharmacists licensed by the PCJ, which also approves training institutions for pharmacists, as well as acts as a regulatory body for the sector, including certifying pharmacies.

However, the PCJ’s broad regulatory authority notwithstanding, the law allows a “registered medical practitioner”, or nurses or midwives acting at the direction of doctors, to supply drugs to patients “for the purpose of medical treatment”.

LOOPHOLE EXPLOITED

This is a loophole that Drs Smith and Watson – who are pharmacists and pharmacy operators – say is being exploited by medical doctors for financial gain.

“What is happening is that doctors, in an effort to commercialise their business, are buying excess medication from the distributors, and are stocking their practices,” Dr Smith, the PCJ member, and pharmaceutical society’s president, told this newspaper. “After they have treated the patients, we find that … they are actually selling them the medication.”

The practice, Dr Smith claims, goes beyond doctors selling a few drugs from their surgeries in cases of emergency.

Their nurses and administrative assistants, without the training or appropriate certification, he argues, operate like quasi-pharmacists in environments that don’t, or may not, meet the standards required of pharmacies.

This does something else, the complaint goes: it removes an important layer of oversight from prescriptions that trained pharmacists add to the process.

That could compromise patient care.

Promulgated in 1975, Jamaica’s current pharmacy law, and most of its accompanying regulations, are half a century old. That is a relatively long time, during which much has changed, including, Dr Watson, the PCJ suggests, ethical standards among medical practitioners. And not for the better.

She said: “When a law and the regulations of a law are written, it is based on the ethical standards of the law at the time it was written.

“Who would foresee that doctors would literally set up … shops. That’s what they are doing. They want to make money, they are not interested in health service.”

At least in one parish, she claims, pharmacies have closed because of competition from the direct sale of medicines by medical doctors.

EXAGGERATED

The Medical Association of Jamaica (MAJ), the body that represents physicians, believes that the accusations, as presented by Drs Smith and Watson, are exaggerated.

“I don’t know of any widespread issues in terms of doctors dispensing medication from their practice,” the MAJ’s president, Dr Leslie Meade, told The Gleaner. “However, we are aware there may be some who are, and many times it is because of the lack of access to pharmacies in the areas in which they practise.”

This newspaper has no basis to question the veracity of Dr Meade’s conclusion – his assessment of the facts. But neither can we do so with respect to Drs Watson and Smith, who we take to be responsible members of a critical regulatory body.

In the circumstances, the most appropriate action is for – as we suggested – an investigation by the Medical Council of Jamaica of the doctors it regulates. The council should determine whether the island’s doctors operate not only within the letter of their oaths, but in its spirit.

Additionally, without any presumption of misbehaviour on anyone’s part, the Medical Council of Jamaica, and the MAJ, as part of the continuing education doctors have to undertake, should place significant emphasis on ethics, including navigating potential collections of ethical standards and personal economic gains. The former should always win.

In fact, ethical behaviour should be an element of school curriculum at all levels, as well as part of an ongoing public education campaign by the Government, as part of efforts to overturn Jamaica’s endemic problem of corruption.