Bill makes Miller ‘sick’

| 14/01/2011

(CNS): The MLA for North Side was feeling ill when he spoke Wednesday on the proposed amendments to the Health Practice Law. However, it wasn’t just the flu that was making him feel bad but the content of the bill. Legal changes brought by the health minister were, Mark Scotland said, designed to address calls for change and to accommodate Dr Devi Shetty’s proposed health city. The bill enables government to designate medical tourism facilities and introduces a special register to allow health practitioners from India and other countries to work in Cayman. Miller, however, said that in all his 30 years in politics he had never seen a more disturbing bill as it had the potential to destroy everything that had been done by local professionals to improve Cayman’s heath care over the last 40 years.

Introducing the bill, Scotland said it formed part of government’s agreement made with Dr Shetty’s group to recognize Indian health practitioners and allow them to practice here without their qualifications being gained in any of the current limit of seven countries. He added that, with medical tourism fast approaching $100 billion per year, it was a sound decision for government to pursue the industry which will bring jobs, revenue and business opportunities.

Scotland said in order to get the Shetty project, which has been given exclusivity for five years after it opens, the government has had to make certain concessions, and a key factor was to ensure medical practitioners from India and elsewhere would be able to register here. He said the country could not expect Dr Shetty to make such a major investment and not be able to recruit the staff.

The new special register will only allow those registered on it to practice at specific health facilities and not transfer to other medical units. “I know there is contention that the registry will be lowering standards but that is not the case,” Scotland said, adding that the medical professionals will still have to meet certain criteria and it was not in Shetty’s or anyone’s interest to employ substandard practitioners as everyone wants medical tourism to work.

Nor, he said, would it open the floodgates to health workers the world over and disenfranchise locals, as he said Shetty’s hospital would be encouraging more Caymanians into medicine and that immigration would still be in control.

Ezzard Miller, however, said it would not only lower standards but could undermine any possibility of making a bid to create medical tourism. In a two hour presentation Miller pointed out numerous problems with the law and that government, not a medical board, would be deciding what was designated a health facility and who could be on the special register without offering clear criteria.

He said the country’s high first world medical standards were being thrown out to satisfy the demands of one developer who had so far not even purchased one acre of land.

Warning of the dangers of developing a two tier system with differing quality of care, Miller said he was not the only one who believed this. Reading from a letter from the Cayman Islands Medical and Dental Society signed by its entire executive council, Miller said the profession was opposed and asked the ministerto withdraw the bill.

In their letter the doctors query the need for a special registration and say the amendments will create this peculiar situation of two parallel health care systems. The doctors were also very concerned that the registration of health practitioners would be removed from the authority of legitimate professional bodies and placed in the hands of politicians, as well as the designation of a medical tourism facility. Warning of polarization of the medical profession and unfair competitive advantages, the doctors said they had not been properly consulted on the bill but offered to help government develop high quality patient oriented health care.

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  1. Indian In India says:

    Healthcare is a prettycut-throat ( pardon the pun) business, and the lions share goes to the players with the most optimised business model. Devi Shetty hospitals has arguably the lowest costs per procedure, with other operating standards being comparable, if not better than, competing developed world healthcare providers. And the man is a visionary, but thats just personal opinion.

    Point is, his SERVICE model, is optimised, scalable, backed up with good team ( both medical and para-) for tropical/ subtropical asian conditions ( chennai, bangalore, kolkata ) and theres no reason why the model couldnt work in The Caribbeans.

    Thinking further, who needs American doctors, or for that matter, American patients… Helping patients in need in South and Central America will probably comprise bulk of the business in the next 20 years. Brazil and Argentina already have much higher levels of type 2 diabetes and its nastier cousins, cardiovascular and renal disease, than 20 years ago, even after accounting for population growth.

    It’s a good model, a workable model. Remember, the only thing worse than "no healthcare!!!" is no healthcare.   (But the Caymans government would do well to study the Indian regulations on foreign investment in India before they let the good Doctor in . Theyre tough, but fair.)     If properly regulated, such services have huge rollover benefits to other sectors, and generate a lot of goodwill thats good for business in general. 

    just my two centsworth.


  2. Anonymous says:

    I do not think that Shetty will happen. They are not waiting for the Cayman bill to pass before they buy land, they wait for the "Affordable Care Act" in the US. That is the basis of the whole medical tourism concept, get the Americans to get cheaper health care out side their territory.

    Once that bill has passed, the basis of the hospital is gone.


    • Anonymous says:

      They know the Cayman bill will pass because Mckeeva is special interests puppet. 

  3. I wish says:

    I wish the Government would change a few laws so that I can get setup in business here too. Ive been here from birth and have yet to be treated so special

  4. Anonymous says:

    It is interesting that the Medical & Dental Society itself is in favour of the malpractice cap for non-economic damages (damages for pain and suffering)

  5. Home Grown says:

    Cayman does not have it’s own board certification for medical specialists, just a registration process that insists that all medical specialists working in Cayman must be on a specialist register in another country; e.g. an orthopaedic surgeon from the US must maintain him- or herself on the specialist register in the US in order to register and work as an orthopedic surgeon in Cayman.  This process ensures the maintaince of high standards, because only board-certified, properly registered, up-to-date (many hours of continuing medical education are required each year for a doctor to be maintained on a specialist register) doctors can work here. 

    Furthermore, there is a list of countries that Cayman accepts as having high enough board-certification/specialist registration standards to work here.  No prizes for guessing that India is not on the list!  XXXXX

    It seems the government intends to create a seperate "special" registration process for doctors who wish to work in the Shetty hospital.  A registration process overseen by politicians (not the usual medical body that registers doctors in Cayman) in order to allow those without the currently required board-certifications and registrations to by-pass the usual registration process to practice here.

    The Rt Hon member for North Side understand how the proposed legislation therefore threatens the standard of medicine practiced in Cayman. 


  6. Anonymous says:

    Ezzard will always fight this type of proposed progress. He’s a politician paid like a US Congressman who was elected with 253 votes.  Even for a tiny village that’s not exactly a busy politician. And where could the proposed hospital be? East? North Side?. Why would he want that kind of responsibility? What a headache.

  7. Anonymous says:

    I wish Mr Miller would shut his failed businessman’s mouth and allow our contry to progress into the 21st century.

    This shetty hospital and all the ancillary services will be great us.

    • Anonymous says:

       He doesn’t see it as progress.  He sees it as detrimental.  Its always nice to have a dissenter out there with a different point of view from the sheeple.

    • Anonymous says:

       Thomas Jefferson was a failed businessman

  8. Culture Saver says:

    I think the perception of the brand of medical tourism that Dr. Shetty is bringing is being skewed here. The only reason that Indian doctors cannot currently be allowed to practice is because they are not one of the 7 western countries on the approved list. Do we really think that these countries have the only good doctors in the world? There are many countries outside of this block that have exceptional health care facilities and doctors (Cuba right next door for example). If you do the research through the UN, Dr. Shetty’s doctors have a lower mortality rate than those in the US. They make exponentially more surgeries than their counterparts, which leads to better doctors (practice makes perfect, right?). The reason Dr. Shetty gets to provide these services at a lower cost is partly due to lower insurance costs due to lower tort liabilities. This also lowers the overall costs as doctors won’t have to carry such expensive individual malpractice insurance. This is a business model that creates more bang for your buck. It does not lower the standards of the medical profession. In fact I believe it increases the standards as you weed out the ambulance chasing lawyers, and money grubbing insurance companies. If you review the case histories on malpractice in countries with unlimited malpractice damages, you’ll see that even though patients sometimes win large sums, it takes years to go through the process while the patient is broke with no job, and the lawyers end up taking 40-70 percent of the award for their services. So unlimited damages doesn’t necessarily mean better results for patients. Lawyers are the ones that make all the money, on both sides of the lawsuits.

    Remember folks; going to the hospital is voluntary. If you personally don’t feel like having an Indian doctor than you can continue to use local doctors and go off-island for certain procedures such as you do now. Health care is a personal decision and people should have the right to go where they want. This project is not replacing our existing and good facilities or doctors. This project provides for smart long term development and lessens are need and dependency on the financial industry and tourism, both heavily impacted by global economic patterns. Healthcare is fairly immune to these impacts. People get sick in good and bad times.

    I am definitely not in agreement to a lot of things being proposed right now, but this is one that people need to get behind.

  9. Anonymous says:

    Have you ever heard Mr Miller say anything positive? Do some research on Mr Shetty on the net and he appears to be a very good and honourable man. The business for Cayman is exactly what the island needs – a recession proof growth industry. Embrace it.

  10. Libertarian says:

    Medical Tourism here is what we need… but not like this!  Not when the local practitioners are going to loss out because of it.

    • Dred says:

      You are so funny!!

      So you are worried about doctors who are driving the Bentleys, Jags, etc? So what about us at the bottom of the food chain aren’t we entitled to a little some some. What about us huh don’t we deserve good medical care that’s affordable?

      Basically this is like the demonopolization of Careless & Worthless ooh I mean Cable & Wirelesss. Do you recall how they use to charge us $1.40/min to the US? That same call is CI$0.30/min. That’s competition. This is about fair prices not murdering us with prices so they can go play golf in the afternoon or dine at the Ritz.

      NOW they will have to compete for their share of the pie instead of just enjoying the expensive Cayman way. Welcome I say to Dr Shetty. WELCOME WELCOME WELCOME!!!!!.

      Am I fond of what we have to do to get there, probably not but I believe every country has good doctors. Cuba for instance has some of the best doctors in the world but are their credentials respected here?

      Now if we could only "DeMon opolize" Electricity also. Maybe we would be able to LIVE in our own country.

      Do you know for the average person on the street it makes more sense to loose a days work than go to a doctor and get a sick day. You do the math. If you make less than CI$10/hr you best just loose the day cause doctors run CI$75 to CI$100 today and CI$10 x 8hrs is CI$80. So what do you gain?

      This is the kind of position we are in today. Some businesses are demanding doctors notes for any sick day not just 3 days in a row. So a person making CI$7 per hr working 8hrs actually looses between CI$19 and CI$44 by going to a doctor to get the sick day.

      Some of these doctors are pulling near a quarter of a million dollars a year and you feel for them because maybe now they’ll make $175k instead.

      Those who aren’t trying to kill locals will fair far better than those who were murdering us so I don’t care.

      Take the visitation of the Pediatricians for the first time at the Hospital. Can you believe that went from CI$100 to CI$1,000 for visit? How in the good God almighty do you justify that kind of hike?

      They set themselves up for this so they deserve it full force. Personally I will use the new hospital for everything I can and I encourage others to as well. Force local practioners to lower their prices.

      I have no issue supporting any local doctor now that provides services at a fair value even if the hospital is lower like Dr Caudieron. CI$50 a visit is fair. CI$1,500 for delivery is fair. You can compare those against others at CI$3,500 for delivery and more.

      • Libertarian says:

        Yes, those at the bottom of the food chain deserve medical care that is affordable!  When Dr. Shetty’s hospital is introduce, he will compete with the Caymanian doctors and this will MAY cause a fair price or cost reduction. Indeed it will get rid of the assumed medical LOCAL monopoly you speak of.  And you and I have complaints with the costs.

        But here is the otherside to the coin – Not only should the medical market be free, but a fair one too! 

        If certain concessions and allowances are given to Dr. Shetty, but Dr. Tomlinson is not allowed to have such special considerations, where is fairness???  To be fair is a moral law or principle!  The market yes becomes competitive and prices may fluctuate for the betterment of most local patents, but the question is, are you going to grant concessions and allowances that will probably in the long run, create a "Dr. Shetty monopoly," which may be worse for Cayman???  

        It is like you and I talking about another electrical company to compete with CUC so cost can be lowered. But how much concession would you give to the new company?  If you give too much favors to this new company, you may probably kill the CUC goose and start a new and worse monopoly. It would be a disaster!  

        The UDP government is making the wrong precedent by giving Dr. Shetty too much leverage over local practitioners and doctors. This has nothing to do with money, what car these doctors drive or where they dine.  I am not in favor of their pricing or cost for treatments, but the "immoral precendent" by which government is laying up for the future development of the medical field, is not a good one. It will end up biting us in the end.  It is like giving Dart special allowance of 90 times 90 years to own the Cruise Berthing facility!  We just can’t sell ourselves like this!  We just can’t make deals with big shots and forget about everybody else in the Cayman Islands!  The markets ought to be free and fair to both the rich and poor. The less government interferes, providing equal opportunities, the better it is for everyone.

    • Anonymous says:

      Please explain how the local practitioners are going to lose out?

  11. Marek says:

    Goodness me people, calm down. If you’re not happy with a cap… that is absolutely NOT A PROBLEM… keep the insurance you have in place, jump on a plane and head over to Miami.  Or for xpats, back toCanada or the UK.

    Look Shetty is a business, period… end of story… nothing more.

    All the complaining… but you’ll be out there looking to buy land and capitalize on the project. You’ll be bidding to do work to build it, sell it goods and provide services.

    Calm down, let this thing takes its course. Hopefully it gets past these hurdles because … it’s good business for the island.


    • Anonymous says:

       "All the complaining…" your complaining about the complainers, that makes you a complainer too.  A complainer that has absolutely no substance in 4 paragraphs.

    • The Original Anon says:

      Would you let your wife have an angiogram here- please, be honest?

  12. Hal I. Burton says:

    I am in discussions with the government for an eco-friendly bumper chromium plant on SMB I see this legislation as a positive step forward for myself and my offshore investors. What’s wrong with that??

  13. Anonymous says:

    Hello CNS,

    Can you  fnid out where exactly is the Shetty hospital is going to be built eg. block and parcel Nos. not just eastern districts. Also can you find out if there are any pictures of it or  a web site we can vist to view it.

    CNS NOTE: We have asked the players involved on many, many occassions and as yet they are refusing to say anything other than various locations have been identified and are being considered. A chance meeting on Friday revealed that until all of the laws are in place ie this bill, tort reform and organ donation the investor will not purchase any land, any where.

  14. Anonymous says:

    who cares …the shetty hospital won’t happen…the economics behind building and running the hospital make it unfeasable….

  15. Anonymous says:

    The limit on the compensation for malpractice is very worrying & should not be allowed.

    • Lachlan MacTavish says:

      Personally I dislike the litigious USA society. It really has gotten out of control. But I am also suspect of the quality and type of medical service that will be provided by the Shetty group if part of the deal is to limit compensation to individuals that are harmed by malpractise. 

      • Aqua Bono says:

        The limit should have only applied to non-residents.  Whatever happened to "moral hazard"?

    • I'm a Docta says:

      Why is it worrying?  Please read the legislation. There is no suggested limit on compensation.  Just like now, there can be unlimited economic damages to cover any lost income and the cost of treatment.  The only part that will be capped at $500k is the punitive damages.

  16. Anonymous says:

    Dr. Shetty claims he will be training local doctors, but this bill does not even mention the potential for a ‘path-to-practice’ for local doctors.  What’s the point of St. Matthews or even Shetty operating a medical school on the island when they will never be able to stay here to get licensed? 

    What this bill needs is a clearly-defined path-to-practice similiar to the one found in the Legal Practitioners Law.  Only then will young people be enticed to enter the medical profession as a career.

  17. Anonymous says:

    Local professionals in the Health care system in the Cayman Islands just cannot get enough.  They have raped and garnered in millions of dollars practicing in Cayman for all of these years.  It is time some of you people retire and move aside.  Let fresh blood enter. New people, new doctors, We want doctors  that are familiar with the complaints of the various people on here now.  Besides it is absolutely nerve wracking that a person has to wait between 6 to 7 months for an appointment to see a doctor.  That is a huge problem on the Island.   Why should we not have the kind of Hospital that is being proposed.?  Just because some professionals dont want to share a penny.  Its been long enough and we want fresh and afordable doctors.

    • My2Cents says:

      Could not agree more. This is about progress, not protectionism of theold and out-dated.

    • Pending says:

      It has nothing to do with sharing a penny you clown. Do you see any correlation between allowing any doctor from India to practice at this hospital and the cap that Mac has put on the liability pf these doctors?


  18. Michel Lemay says:

    Another sellout that I call a blind charm. You are not the only one Mr. Miller. This short term approach just to please 1 man and creating such destabilisation of the Medical Industry. It’s like no one is immune from this government as they want to control everything and not even consulting properly our Medical and Dental Society? Let’s pass the bill and we’ll worry about the rest later as it comes. The infrastructure in itself with the amount of the "medical practicionners" coming here in itself will give more stress to an already fragile tolerence of things done not for Caymanians or should I say the fortunate few. And what gets me no guarantees for work for Caymanians because the reality is they would need to start training now. Yes sickening is the right word. How many more surprises Mr. Premier, because I know at the rate your going you want to make history. Mind you that you will be remembered has the man who ruined this country, yes sir you and the boys.

  19. Libertarian says:

    How government officials start making laws to support one developer and doctor with his pesonal ideology to make the almighty dollar when they themselves are not verse in the medical field, is mind-boggling!

    We have too much restrictive laws here and concessions, I feel!  It all has to do with favoritism and keeping the locals bogged down with expenses. They favor the big man, but do little for the local man who wants to at least start his own business without having to pay high fees, permits, and licenses. Governement, I feel, is interfering too much with the market, and I am afraid with such restrictions and hikes, will end up killing the golden goose. 

    I see they’re privatising the Water Authority… sounds good, but to what end?  Will they then put down fees and import duties?  Will they then reduce the size of a very fat government?  To what end would you privatise?


  20. Anonymous says:

    What worries me is the limit on damages to 500k. Even at a modest 50k per year salary that is only 10 years of income. What happens when a local decides to use this new facility for a surgery.

    If the surgery goes wrong and they end up unable to work, they will only be able to sue for enough money to live for 10years (around here probably less). What is that person going to do at the end of 10 years? die? live off the government?

    Especially if the doctor has disappeared back to India!!!!!!!

    Say NO to this legislation!!!!!!!!!!!!

    • anonymous says:

      there is no cap on “economic damage” in this bill.

    • Anonymous says:

      500 K is alot of money, do you think doctors mean to make mistakes? Accidents happen.

    • Anonymous says:

      the limit is on NON-ECONOMIC damages.

    • Truthseeker says:

      Nice argument, but based on a false premise. The proposed cap is on non-economic damages. Non-economic damages refer to pain and suffering and loss of amenities in personal injury cases, rather than loss of earnings or medical expenses.

  21. Anonymous says:

    This bill makes me sick as well! who is Mark Scotland and Mckeeva fooling? they really think that we’re stupid! i tell ya one thing i don’t want none of them touching me!

    if they’re not qualified from the list of countries we should not accept them in this country. that is why Mac passed the 500,000 malpractice bill because he know it will be a lot of malpractice claims when the  indians start to practice here. Mac destroys everything he get his hands on the medical sector here he is going to destroy that too.

    every developer say they’re going to produce jobs, produce jobs yes, but for who? not the many Caymanians that need work! we see this recently with Dragon Bay they use that for an excuse to get all they want from these stupid politicians we have

  22. My2Cents says:

    Clearly Mr. Miller you are just in the way of the future development of Cayman. Please step aside.

    • Everyone Else says:

      Clearly, you are the only one of a handful that feel that way. Step aside- you are only hindering reasoned debate.

      • Everyone Else besides the guy calling himself "Everyone Else says:

        Clearly you want the Cayman Islands to remain in recession, decend into poverty, and live with the crime.  Looking at everything that is on the table for an economic future for Cayman, this is the one thing that is not clearly BS. 

        Do try to not screw this up for all of us.

      • Anonymous says:

        Clearly you are one of the same bomb throwing 20 people that write CNS everyday.

      • Anonymous says:

        Clearly you are both making claims based on what you feel, not on actual facts