Re: Regenerative Medicine Therapy and the Joseph N. France Hospital
Nineteen years ago in 1997, I returned to the Federation, having graduated as a board certified surgeon by the American College of Surgeons two years earlier.
My intention was to serve my country and contribute in a significant way to the development of the health care system of St. Kitts and Nevis.
I have worked here as a surgeon for the last nineteen years and have also been a part of the hospital executive as Medical Chief of Staff for more than a decade.
My commitment to the health care system of St. Kitts and Nevis is unquestionable and during that time I have worked with several Ministers of Health and Permanent Secretaries to ensure the delivery of quality health care for all.
It would come as no surprise therefore that when I was asked to act as Chief Medical Officer, upon the retirement of Dr. Patrick Martin until the position is filled, that I readily accepted.
I am happy to serve my country in anyway possible within my capabilities and I am ready to shoulder my new responsibilities.
I also want to at this point address a matter that has been the topic of great discussion as it relates to Regenerative Medicine Therapy and the Joseph N. France Hospital.
First we must understand what is Stem Cell Therapy.
Stem cells are cells capable of renewing themselves through cell division, and under certain physiologic conditions can be introduced to become tissue or organ specific cells with special functions.
Stem cell therapy promotes the reparative response of diseased, dysfunctional or injured tissue using these earliest cells or their derivatives.
People who might benefit from the stem cell therapy include those with spinal cord injuries, type 1 diabetes, heart disease, stroke and osteoarthritis, just to name a few.
It is the next chapter of organ transplantation, and uses cells instead of donor organs.
There are two main types of stem cells – embryonic obtained from embryos and somatic or adult stem cells.
There is a lot of controversy surrounding embryonic stem cells, which involve sacrificing an embryo, but research on adult stem cells has been going on for the last sixty years. Also being studied are various types of progenitor cells found in umbilical cord blood.
More than a year ago under the previous administration, the opinion of the medical body was sought in relation to the commencement of a regenerative medicine clinic using adult stem cells and there was generous support for it and significant progress way made towards its commencement although it never came to fruition.
A proposal was again brought for the establishment of a regenerative medicine clinic, and the CMO, Dr. Patrick Martin, was written to by Dr. [Eugene] Redmond who spearheads the project.
In his letter to Dr. Martin, he
1. Indicated his interest in facilitating the development of medical tourism in St. Kitts that would provide economic benefit to the island.
2. That he suspected that the Government Ministers would be looking to the Medical Board for advice about the best direction forward to ensure that the project is safe, ethical and successful.
Dr. Martin responded to Dr. Redmond, indicating
1. That pursuant to the Medical Act, the Medical Board is established to regulate certain categories of practitioners and that the Medical Board had no authority to give advice to the Government about medical advancements.
2. He advised that the board members be approached singly for their opinion.
3. He indicated that he was for the initiative.
The board members were written to by the Permanent Secretary for their advice and there was no one on record, including Dr. Martin, against the initiative.
The proposal was taken to Cabinet and approved.
A request was later made of the hospital executive to rent three rooms for the commencement of the clinic that would only serve foreign patients enrolled in the study, and there was never any plan to use local tissue products.
This would not have been the first time that rooms on the private ward were leased out to a private medical entity.
For many years, half of the private ward was leased out to a private group in relation to a drug abuse clinic.
Three rooms were identified in the back of the private ward and outfitted.
Upon completion of the outfitting of the rooms, the Executive of the Hospital was informed of the start date of June 13th.
The CMO called me on June 11th, inquiring if I was aware of the start date, and I told him yes and expressed surprise at his question. I told him he should have known and indicated to him that if there were communication problems at his level in the Ministry he needed to address it. Dr. Dwain Archibald was identified as the local physician to work along with the team.
On the 13th of June at about 10:30am, while I was doing my surgical clinic, I received a call from the Matron, indicating that the CMO Dr. Patrick Martin had gone to the private ward and, in the middle of the therapy being instituted, order immediate cessation.
He ordered Dr. Archibald to stop and ordered the Brazilian doctor, Dr. [Silvia] Lagrotta off the premises. His reason being that her license to practice had not been processed.
According to the Statutory Rules and Orders of the health institution, “the Chief Medical Officer has the authority to consult with the executive management committee individually or collectively on matters that pertain to the delivery of quality medical and health services.”
The CMO did not consult any member of the executive prior to storming unto the private ward. He also had numerous opportunities to voice any objections prior to the project reaching this stage.
As Medical Chief of Staff, I decide to take charge of the situation the same way I had addressed other crises over the years.
I first met with Dr. Lagrotta and the coordinator of the project who assured me, that upon discovering that her license had not been approved, that she was not involved in any direct patient care.
They were however concerned about the patients’ well being, as severe allergic reactions could occur if Dr. Archibald was not allowed to complete the treatment that Dr. Martin had abruptly stopped.
The treatment involved the intravenous injection of 20 mls of plasma that was fully screened and then the administration of medications to prevent allergic reactions.
I then visited the Ward to observe for myself and saw about four patients who had already received their plasma and needed medications to prevent the allergic reactions.
In the interest of the well being of the patients, and realizing that this was well within the capabilities of Dr. Archibald’s ambit, I gave him the permission to proceed and indicated to him that he was free to call me if he needed help.
I could not recklessly stop the treatment mid-stream and allow the patients to suffer.
As physicians, we are guided by the principle of “first, do no harm”.
I then called the Permanent Secretary, the Senior and Junior Ministers of Health and apprised them of the situation and the decision that I had taken and they all supported my action.
A total of six foreigners were treated without any untoward reactions and discharged.
At no time I got any report or saw any evidence that the doctor involved was directly involved in patient care.
I must state here that one does not require a license, however, to give medical advice. We all communicate in person and via the Internet with colleagues for advice in medicine. Every time an air ambulance lands with a doctor, there is exchange of information and advice regarding treatment and no license is given to the accompanying physician on the air ambulance.
When patients go overseas for chemotherapy they return with orders and guidelines for treatment, which we follow.
The telemedicine project that was run at the Joseph N. France Hospital for several years had the full support of Dr. Martin, which involved consulting with doctors online and directing treatment based on reports received even though they were not licensed to practice in the Federation.
I do hope that I have addressed a number of the questions raised over the last couple of weeks and look forward to continue my service to my country. I thank you.