A critical review of comments

I have been following the various contributions in the Times which refer to the Medical Council of Malta.

The respective comments have been made in the wake of three news items in The Times (August 12, August 16 and September 3) and after an editorial, also in The Times (September 6).

The last intervention (September 27) was made by Stephen Fava, president of the Medical Association of Malta, who correctly pointed out that "the Medical Council is distinct from the Medical Association of Malta (MAM)". Dr Fava described shortly what the functions and responsibilities of the Medical Council are, or should be.

Prior to Dr Fava's comments, one read a remarkable article (September 23) by Joseph Muscat, an esteemed former teacher of mine, who also reflected shortly on the origins of the Medical Council of Malta while comparing it with the General Medical Council of the United Kingdom.

In a previous article (May 9), Prof. Muscat had commented that "the recent amendment has made an important institution which is the Medical Council more democratic and transparent, essential qualities which it has lacked in sufficient measure", when he was referring to article 9 of the Health Care Professions Act (Act XII of 2003).

In his comments, which were published on September 23, Prof. Muscat opines that "the leader of The Times (September 6) does therefore a public service by bringing light to bear on the role and current performance of the Medical Council - Malta". Prof. Muscat goes on to say that "the inferences you draw from the complaints you receive from your correspondents lead you to believe that all is not well in the state of Denmark and this conclusion is probably correct".

Prof. Muscat argues that an urgent problem is "the lack of conviction within the Medical Council itself that its primary and major role is the protection of the public against the unprofessional conduct of some doctors".

Dr Fava correctly points to the fact that "experience from other countries shows that up to 80 per cent of complaints that are lodged with similar regulatory bodies are considered frivolous and therefore thrown out very early on without the need for extensive and prolonged proceedings" (September 27). This corresponds to my practical experience which I gathered in Germany in the course of 30 years and more.

I wish to come back to the report in The Times (August 16) which, in a way, was ethically imprudent for the reporter deemed it fit to mention the name of a practising doctor, who was involved in a complaint. In this report, I could read that the accused doctor had disposed of a clinical result within a week of receiving this result. The doctor informed the patient's relatives that the test had been done at a hospital, at which hospital the doctor had personally seen to the biopsy material. No records of this test could be found at the involved hospital.

I now quote from The Times report (August 16) which, as far as I know, has been neither revoked nor contested: "Therefore, although the Medical Council did not make a specific finding as to whether or not the result of this smear test existed, it said that the doctor could not be blamed for disposing of the result".

Throughout the inquiry it had become clear that the doctor was an emotional person and a character witness had described the doctor as "very meticulous and correct", among other positive remarks.

The test in question was that of a cervical smear as a means of screening for cervical cancer, of which the patient in this particular case ultimately died within two years.

Now, even in a regular medical practice, it should be imperative that slides, which are submitted for expert examination, should be stored for at least 10 years. The same principle holds for archiving biopsy reports. This has at least been the practice, which I have been used to throughout the years of my employment as a hospital pathologist.

The reporter of The Times wrote that "therefore, although the Medical Council did not make a specific finding as to whether or not the result of this smear test existed, it said that the doctor could not be blamed for disposing of the result".

This conclusion, which was reached by the Medical Council, is indeed a unique decision and any person with specialist experience in the field should find it quite difficult to understand.

Tolerating carelessness and negligence means negating the efforts towards quality assurance in medical practice. Sanctioning carelessness and negligence in medical practice is even worse.

Dr Fava opines that the "MAM also agrees that the decision's motivations should be stated (i.e. give a reasoned judgement). This is essential both to preserve the rights of the complainant as well as to protect the doctor's name from wild speculation in unscrupulous media which could misinterpret the council's discretion as lack of impartiality. Ultimately, the public has to be satisfied that justice is not only being done but is also seen to be done" (September 27).

The story of the proceedings, and judgement, as reported in The Times issue of August 16 is the blatant contrary to Dr Fava's wishes.

If the public is not satisfied that justice is being done by the Medical Council so will the public wish to have recourse to the law courts.

One calls back to mind the recent case, as reported in the newspapers, where a young boy died in hospital, possibly because necessary antibiotics were not administered in due time, possibly because the consultant in charge of the patient did not even check whether these antibiotics were being administered at all. The parents of the young boy instituted legal proceedings, which were stopped ex officio by the Attorney General then in office.

Who can therefore protect patients' rights in Malta?

One can only agree with Prof. Muscat when he writes that "the Medical Council in its current state cannot command public confidence... such is the well-founded verdict of The Times" (September 23).

The Medical Council of Malta in its present constitution is neither transparent nor democratically elected. It has 12 members, five of whom have been appointed by the Prime Minister, one has been appointed by the University and two others are dentists. One could therefore say that it is the Prime Minister, and not the public, who has a 41.66 per cent representation in the Medical Council.

Furthermore, there is neither a pathologist nor a gynaecologist to be found as a member of the Medical Council of Malta.

I can agree with Prof. Muscat when he says that "every member should be representative of his group, e.g. general practitioner, specialist or association, etc. and should be elected by secret ballot from that group. In this way the representative and democratic character of this quasi-judicial body can be ensured. There should be no room for crony appointments".

Lay representation in the Medical Council of Malta might remain a problem.

In Germany, we have a Gutachterkommission, an experts' panel, in the respective Chamber of Doctors of each federal state. The members of such a panel are an eminent judge, the chairman, to ensure the legality of proceedings, a physician, a surgeon, a gynaecologist and a pathologist. The term of office is five years. The advice of additional specialists is sought in particular cases. Lay representation is not foreseen. There are however highly professional patients' rights organisations that employ their own medical experts and medico-legal counsel. These patients' organisations enjoy high esteem.

The audiovisual and print media also play an important role.

The secretary general of the Medical Association of Malta is a regular official guest visitor of the annual conference of the German Federal Chamber of Doctors and he should therefore be well acquainted with medical practice and medical policies in Germany, which could also offer some new aspects for the role of the Medical Council of Malta.

I agree with Dr Fava when he opines that "the Medical Council is made up of men and women of undoubted integrity". However, Malta's foremost problem is perhaps Malta's size, with inevitable family and/or professional connections.

The title of the editorial of The Times (September 6) Medical Council: Change or Die cannot be refuted as long as present conditions continue to reign in Malta.

Dr Said is a retired histopathologist holding a postgraduate diploma in health services administration, Kleve, Germany.