Parliamentary limits and bad behaviour

Kudos to Dayton Campbell, Dawn Lindsay, and Hugh Dixon.

And just who are these three? Dr Campbell is president of the Jamaica Medical Doctors' Association, Dawn Lindsay is a pharmacist and member of the Pharmaceutical Society of Jamaica, and Hugh Dixon is vice-chairman of the Public Sector Pharmacists' Association.

And why do they deserve kudos? The trio stood up to rude and abusive government members of the Human Resources and Social Development Committee (HRSDC) and refused to be intimidated when they appeared as guests before the committee on October 6. I like a vigorous Parliament, but condescending rudeness and arrogance to public servants is not on.

Government MPs, veterinary doctor St Aubyn Bartlett and Franklyn Witter, sharply attacked these health professionals for expressing views different from the Government's over user fees in the state health services. Dr Campbell had recommended to the HRSDC that the Government should amend its blanket no user-fee policy to one limited to providing free health care to children, the disabled, and the poor who are unable to pay.

Not taking sides

He further suggested that fees should be collected from health-insurance providers for services provided to their subscribers in state facilities since these companies were gaining substantial windfalls from not having to meet these contractual costs and there was no reduction in premiums.

Messrs Bartlett and Witter took these eminently sensible recommendations by professionals operating in the health services, and backed by a World Bank-supported study, to be a political attack against the Government and proceeded to roll out their heavy weapons.

Bartlett, reportedly, went so far as telling the guests to the committee, "You are not to be heard!" In the verbal battle, Dr Campbell boldly fired back, "I won't come down to your level! I am not afraid of you! We don't come here to be affronted by anyone. We did not come here to take sides."

After the firestorm, Hugh Dixon told The Gleaner, "We are professionals. We don't business with their political leanings. What we are interested in are the facts."

And the facts are indicating some serious problems with the delivery of service in the state health services and a deterioration of service delivery since the precipitous removal of user fees as a purely political move shortly after the 2007 general election. Minister Rudyard Spencer and the Government have been strenuously defending the move, which ignored the concerns and advice of professionals in the system, despite the growing body of evidence that it is not working well.

Budgetary support has failed to compensate the loss of user fees. Politics, not to mention arrogant rudeness to public servants by government parliamentarians, cannot beat the economics of health-care provision.

According to another news report, this one carried by the Observer on the very day that government members of the HRSDC sought to shout down health professionals, "A review of Jamaica's social safety-net programmes carried out on behalf of the Government of Jamaica (GOJ) and the World Bank has recommended that the policy of offering free health care to everyone at public health institutions be scrapped, and replaced with a system of user fees for persons who can afford to pay." That was exactly Dr Campbell's position before the committee.

System not sustainable

The objective of The Review of the Social Safety Net Provisions and Capacity, according to the news report, was to assess the provisions and capacity of the social safety net in Jamaica. The study involved determining whether existing interventions are efficient, effective and sufficient in addressing needs and vulnerabilities; assessing the human, financial and physical resources and capacity for delivery of safety-net services by the state; and providing recommendations for improvement.

Among its recommendations is this one about user fees in the state health services: "On the fees in public health facilities, the GOJ should consider the options suggested by the Vision 2030 Jamaica Health Sector Report, which include establishing fees for clinical services and medicines for those that can afford it and a fee-waiver system for the poor."

And free health care is generating abuses of the system by users. The president of the Pharmaceutical Society of Jamaica, Valerie Germain, told the HRSDC that patients are facility-hopping, obtaining multiple prescriptions and stockpiling drugs for resale.

The Government already has an established mechanism in the Programme of Advancement Through Health and Education (PATH) for identifying and registering the poor and vulnerable. Rather than spending time abusing guests of the HRSDC who made evidence-based objections to universal free health care, government members of the committee could better spend their time figuring out how to get the health-insurance industry to pay for the services its subscribers use in the state health facilities and for which premiums have been collected for coverage.

And the matter is not so difficult. An actuarially determined flat annual fee could be charged to each health-insurance provider. This is probably the simplest route. The biggest difficulty is to keep the fee from disappearing into the maw of the ever-hungry Consolidated Fund and make it directly available to health services.

Another approach is to link patient identification to the subscriber databases of the companies. A little more complicated and more costly to administer, but not unmanageable.

An audit should also be conducted of education services, from whence cometh the king riding on the winds of a similar political cancellation of cost-sharing.

Llewellyn under fire

Meanwhile, another parliamentary committee is up in arms against the director of public prosecutions for declining an invitation to appear before it.

According to the report by The Gleaner, "Members of Parliament's Internal and External Affairs Committee [which is chaired by opposition member and spokesman on national security, Peter Bunting] were on Wednesday incensed by Director of Public Prosecutions (DPP) Paula Llewellyn, who rejected an invitation to appear before the committee to discuss aspects of the office. Llewellyn instead sent a letter with advice from Attorney General (AG) Ransford Braham, outlining reasons why she should not appear."

Minister of Justice Delroy Chuck had also written separately to the speaker of the House to say that the request of the committee was "inappropriate and ill-conceived and should not be accommodated".

The related Observer story reports, "Paula Llewellyn says she declined a meeting invitation from the Internal and External Affairs Committee of Parliament because the circumstances under which she was asked to appear would be in breach of the Constitution. Llewellyn ... also held that it would be unethical of her to attend the meeting as her office was handling cases involving parliamentary colleagues of the members of the committee."

Inappropriate, she says

The DPP said, in her own defence, "Let me state for the record that after perusal of the contents of this invitation, I formed the view that there were legal issues involving constitutional matters surrounding the functioning of the Office of the DPP as established by ... the Constitution ... . This would, in my view, militate against the appropriateness of accepting this invitation to review the matters outlined, including notable prosecutions by the Office of the DPP."

She pointed out, the Observer story says, that the attorney general, in his response to her, outlined that "the words 'control' and 'direction' in Section 94 (6) of the Constitution contemplates that the director of public prosecutions ought not to be under:

a) The power or influence of anyone;

b) The reproof or censure of anyone, or

c) The supervision of anyone.

She then reiterated her commitment to transparency and accountability, which, she said, has been a hallmark of her tenure as DPP since 2008. However, she said that she would not wish to do anything that would undermine the constitutional authority of her office or breach time-honoured administrative protocols between the ODPP and the Ministry of Justice.

The DPP pointed out, the story continued, that under these administrative protocols, the Ministry of Justice, which has portfolio responsibility for the ODPP, receives annual reports from her office for onward submission to Parliament.

A fuming Peter Bunting declared that "a dangerous precedent is being set". Correctly so. But not by the DPP, the AG, or the justice minister. A member of the committee went so far as to describe the AG's legal opinion as "hogwash" and further derogatory terms were heaped upon his advice.

Is lawlessness overrunning the legislature?

The Constitution, at Section 94, confers sweeping powers upon the DPP. And at subsection (6), in its possibly now archaic wisdom, explicitly declares, "In the exercise of the powers conferred upon him [Paula Llewellyn, a woman, was not anticipated] ... the director of public prosecutions shall not be subject to the direction or control of any other person or authority."

Legislators don't like it? Times have changed? Citizens globally are demanding more accountability and transparency, and Jamaica and the ODPP are not exempt, as this newspaper editorialised last Monday and its Gavel parliamentary op-ed column commanded, 'Rethink that decision, DPP', while proclaiming, 'Llewellyn's refusal to face parliamentary committee worrying'.

Change the law!

But don't diss the law and the conscientious keepers of the law, and with such contemptible contempt. Not only is this arrogant rudeness, it is a "dangerous precedent" taking the legislature into the realm of lawlessness. That is, not feeling its own self shackled by the law, but willing to act above and outside the law. Thoughtful Jamaicans, supportive of the rule of law, must support the DPP in again turning down another invitation to appear before the extraconstitutional supervisory committee on Wednesday, October 19, at 10:30 a.m.

Martin Henry is a communication specialist. Email feedback to columns@gleanerjm.com and medhen@gmail.com.