The Minister of Health and KHMH

IMG_4634There are some things that are just too absurd to be ignored at times, and Prime Minister Dean Barrow’s suggestion that the Minister of Health cannot be held accountable to any degree for last month’s neonatal deaths at the Karl Heusner Memorial Hospital is certainly one of those things.

Last week, Barrow told the media that he “doesn’t know what the Minister [Hon. Pablo Marin] has to do with it…this is a statutory body that is run by a board of directors.”

Barrow went on to say that the Ministry of Health is not involved in the administration of the KHMH.

That makes a lot of sense! That must be the reason why the Chief Executive Officer of the Ministry of Health, Dr. Peter Allen, is on the KHMH’s Board of Governors.

Actually, that must be the reason why on pretty much every statutory body’s Board of Directors/Governors there is at least one representative from the relevant ministry.

For example, the Central Bank—a statutory body—has ranking representatives from two ministries: the Ministry of Finance’s Financial Secretary Joseph Waight, and the CEO of the Ministry of Trade, Mike Singh.

The same thing could possibly be said of Belize Trade and Investment Services (BELTRAIDE)’s Board of Directors, which is chaired by Mike Singh.

Pretty much every other statutory body in this country has either direct ministry representatives or government representatives, including the Social Security Board’s Chairman Doug Singh, the former Minister of Police.

His deputy chairman is also a fellow government representative: Mr. James Murphy.

THE KHMH Act of 2000

Of course, the Karl Heusner Memorial Hospital Authority Act of 2000 describes the institution as an “autonomous” body that is to be responsible for the day-to-day administration of the hospital. That is to be acknowledged.

However, that same Act is filled with references to the role of the Minister of Health.

For example, the KHMHA Act states that there “shall be a Board of Governors of the Authority, appointed by the Minister, … the Board of Governors shall be the principal policy making organ of the Authority.”

The minister also has a role as it pertains to the appointment of staff:

“The Board may, after consultation with the Minister, appoint and employ, at such remuneration and subject to such terms and conditions as it thinks fit, a suitably qualified person to be Chief Executive Officer of the Hospital, and the person so appointed shall, … be responsible for the day to day management of the affairs of the Hospital and the Authority.”

In terms of policy directions, we find in the Act the following statement: “The Minister may, after consultation with the Chairman, give to the Board directions of a general character as to the policy to be followed in the performance of any of its functions, and the Board SHALL give effect to such directions [emphasis added].”

So far, we see the Minister of Health’s role in terms of choosing the Board of Governors, his role in choosing the hospital’s Chief Executive Officer, and his role in establishing  overall policy directions.

In regard to his policy-formation role, at the very least the Minister could have outlined what new policy directions he would be discussing with the Chairman. But he opted for complete silence.

Members of the Board of Governors

The Ministry, outside of the direct influence of the Minister of Health mentioned above, also has a more prominent role in this “autonomous” statutory body.

Under Part IV of the Act, we find that the Board of Governors “shall” consist of a two ex officio members: one representative from the Ministry responsible for Health, and one from the Ministry of Finance.

But in section 11 (1) (c), the Act states that five persons from the private sector are to be appointed by the Minister of Health. These individuals should have “knowledge, qualifications and/or experience in areas of business administration or management.”

Section 11 (2) goes on to state that the “Minister shall appoint one of the Governors … to be the Chairman of the Board and the members of the Board shall elect from among their number a Deputy Chairman.”

The Board reflects Health Minister’s decisions 

The Prime Minister wasn’t entirely inaccurate or misleading in his comments. The Board is deemed to be the principal policy- making organ of the Authority.

In that capacity, it is responsible “for the overall administration, management, maintenance and development of the Hospital, and for ensuring that the quality and standards of services provided by the Hospital be efficient, timely, appropriate and cost-effective to the beneficiary patient, the Hospital and the Authority.”

And it is true that the Minister of Health, in accordance with Section 14, can only “terminate the appointment of a Governor” under specific conditions. But with that knowledge, that means that the Minister ought to have taken much more care in choosing those who would make up the Board of Governors.

Continuing on that motif, he ought to have taken care when consulting with the Board to select a Chief Executive Officer for the hospital.

Let us recall that the “Board may, after consultation with the Minister, appoint and employ, … a suitably qualified person to be Chief Executive Officer of the Hospital.”

Therefore, it is quite a stretch to say the Minister cannot be held accountable to any degree and that he has nothing to do with the institution.

At the very least, he should be taken to task for choosing a group that took too long to respond appropriately.

The recent deaths at the hospital—which are apparently rooted in some form of administrative breakdown—are a direct reflection of the Minister of Health’s decisions in choosing the Board and his failure to ensure that adequate principles and overall policy direction emphasized efficiency, prompt response, and professionalism.

The Breakdown

Speaking of administration, The Reporter spoke this week to former KHMH CEO Alvaro Rosado who stressed that the Quality Control Unit should have caught on to the bacteria, which reportedly caused seven of the 13 deaths, much earlier than it did.

He explained that under his watch, the Newborn Intensive Care Unit was tested for bacteria daily.

Rosado added that any deviation from the average number of deaths in the NICU would have been immediately reported, and the CEO would not have to be finding out about the outbreak via the media.

The minister had a direct role in selecting eight of the nine persons that make up the board of governors. He ought to have been very much aware of what was occurring at the hospital, especially considering that his ministry’s Chief Executive Officer, Dr. Peter Allen, is also a member.

The Prime Minister also should have been equally aware, as the board also has a “representative from the Ministry responsible for Finance.”

The entire sequence of events represents an egregious failure on the part of the Minister of Health—and by extension the Prime Minister who appointed him  as  Minister of Health—to act appropriately.

In conclusion

The common sense response to the Prime Minister’s comments should be the following question: How can the Minister of Health not be responsible, in any way, for a health-related disaster?

The “not-responsible” Minister was rightly present and sitting at the KHMH press conference, thereby indicating that he is involved and in some way responsible.

The fact of the matter is that there has been no sense of apology to the people directly affected  not only by  this recent crisis, but also by those deaths that occurred at the Northern Regional Hospital.

There  has been no apology, but we see a Prime Minister functioning as the prime apologist for his Ministers and those appointed by them.

Whether or not Marin needs to go is debatable. However, there is no way that the Minister of Health can divorce himself from the happenings at the KHMH.

He may not “micro manage” the institution’s day-to-day business, but he is responsible for general policy direction and oversight.

Let’s consider

In the end, it is also something for the Belizean people to consider.

In the same way, Marin ought to have taken care when selecting the KHMH’s Board of Governors and the hospital’s CEO;  in the same why he was to ensure that he established proper policy directions.

We, as a people, ought to have taken care when choosing those we want to represent us.

We seem to have also accepted the status quo of area representatives doubling as ministers in ministries for which they have no real technical knowledge or background.

We constantly witness the growing politicization of government ministries and departments. This phenomenon is caused by the fact that area representatives—politicians at their core—also make up the executive arm of government.

Can we truly expect efficiency-based decisions to supercede their political ambitions?

Look, for example, at Prime Minister Barrow’s defense of Minister  Marin at Wednesday’s press conference. As proof of the Health Minister’s confidence and competence, he lauded Marin’s skills as a politician in the village council elections.

At some point, it may be necessary to consider the benefits of having area representatives make up the legislature only, while true technocrats—not area representatives—function as ministers.

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