Declaring it has been “pained” by the Jodian Fearon situation, the embattled Andrews Memorial Hospital (AMH) is speaking out, saying it has never been approached for or rejected efforts at registration or certification since it began operating 76 years ago.

The private healthcare facility is not among the four hospitals on the 2020 gazetted list of registered institutions although a 2016 government document recognises 11 such facilities. The hospital also signed an agreement with the Government last month to serve as an overflow ward for non-COVID-19 patients from the Kingston Public Hospital.

Registration for private hospitals is required under the Nursing Homes Registration Act (NHRA) of 1934, but last week, the chairman of Andrews Memorial Hospital (AMH), Pastor Everett Brown, said the facility has never been assessed for anything except its cafeteria services, “which it has never failed”.

That assessment is done under the Public Health Act.

While health sector sources have suggested that some institutions have frowned upon being asked to register under the NHRA, Brown said his facility is not among them.

“Andrews Memorial Hospital never rejected certification under the Nursing Home Registration Act … We have never been approached for assessment by the MOH (Ministry of Health and Wellness) for registration or certification,” he said.

Brown added that since last Sunday’s exposé by this newspaper, the health ministry has reached out to the Hope Road, St Andrew-based hospital to start its regularisation process. He said that once the facility became aware that the onus was on the institution to apply, it immediately did so.

“Before last week, we were not aware of the requirements under the act. (So) I signed the application form this (Thursday) morning,” said Brown, who heads the Seventh-day Adventist Church in Jamaica.

The administration of Hargreaves Memorial Hospital has also indicated that it has started the process to comply with the law.

“We were contacted by the health ministry since Sunday. They are in the process of formalising the registration,” said Chairman Calvin Lyn, insisting that even without the legal status, the Mandeville-based hospital has been complying “with all their requests and rules over the years. We’ve had inspections.”

Hargreaves is expected to be inspected within the next two weeks.

Up to press time, The Sunday Gleaner did not receive a response to questions posed to the ministry’s Standards and Regulation Division on a directive by Health Minister Dr Christopher Tufton for the immediate inspection of about 17 private hospitals.

Representatives of some private facilities also declined to speak on the record.

Fixing the certification issues

s a serious problem with the regulatory framework which he said the Government needs to fix urgently. That fix, he argued, must include a legal regime that properly considers private hospitals, which, based on their advanced specialised services, are not fully captured under the nursing homes law.

“It needs to be modified … [to] make it applicable specifically to hospitals,” he said.

Brown wants that, too.

“We would agree that there ought to be statutes in place to identify and treat with private hospitals as such and would comply with any requirement of the law,” he said. “(But) we are not aware of any requirement in the law to seek permission from any department to operate our private medical facility.”

Lyn and Dr Michael Banbury, CEO of Medical Associates Hospital in St Andrew, were surprised over a week ago when The Sunday Gleaner informed them of the requirement.

Although several private operators have claimed ignorance of the NRHA’s requirements, Tufton has said that the Attorney General’s Chambers provided advice in 2010 asserting that private hospitals were regulated under the NHRA. The advice was sought because operators were resisting the 86-year-old law.

Inspections and registration under the NHRA are only triggered on the application of an entity. But following the concerns stemming from last week’s news report, the Government is getting around the NHRA by using the Public Health Act, which means the authorities do not have to wait on operators.

While not giving a timeline, Tufton, who has acknowledged weaknesses in the legislative framework, said he will restart a process for the passing of the Health Facilities Act, which would govern private hospitals.

“This is an admission I’m prepared to accept some burden for – the need for fast-tracking and ensuring that that legislation is brought to implementation. I have to make sure that that happens,” the minister said.

He also admitted that he was not aware that Andrews was not certified when the Government brokered the April agreement with the private facility to accept patients from the Kingston Public Hospital. The agreement will still stand because it is of “value”, Tufton said.

NHRA registration is valid for two years and generally signals that an institution has met the minimum standards in areas such as physical environment, operating procedures, equipment, patient management and staffing. A registration certificate is only granted after inspections are done and the chief medical officer is satisfied with the outcome.

Only Art of Surgery, Winchester Surgical and Medical Institute, Baywest Wellness Hospital and Hospiten Jamaica Limited are recognised as registered private hospitals, even though Tufton reportedly ordered 17 inspections.

We’re saddened by Jodian’s death, says hospital chairman

Andrews Memorial Hospital was thrown into the headlines recently after first-time mom, 23-year-old Jodian Fearon, died after giving birth following a tragic series of events in which she ended up at three different hospitals – AMH being the first – with care reportedly delayed by hours.

Last week, Pastor Brown said the hospital staff were hurting over the tragic turn of events and offered no comments on whether AMH believes it was unfairly targeted, as reports that she was turned away from the hospital after displaying symptoms of the COVID-19 respiratory disease stirred public anger.

“As much as we wish to clear our good name and speak openly to any extent possible about the events surrounding this very sad case, we have been advised by our attorneys to offer no comment at this time on any matter to do with Ms Fearon’s regrettable and untimely passing,” Brown said. “We continue to hope and pray for the best outcome for her beautiful baby, and that her family will be comforted and supported through this unimaginable time of grief.”

AMH was the first to announce it could not treat COVID-19 patients because it did not have intensive care facilities.

“There is an ICU (intensive care unit), but it became non-functional in 2013 and has remained non-functional since that time,” Brown explained. “It is our desire to operationalise it as soon as we can.”

The hospital is also reported to have failed to file its annual returns with the Companies Office of Jamaica for the last two years.

“In 2017, we changed our financial software, and as a result of such a transition, it has caused some delay in the processing of financial statements, which is required for the registration. Since then, we have been able to complete 2018 and 2019 financials and we have taken steps to have the same filed imminently,” Brown explained.

Art of Surgery boss details process

Dr Reaud Gafoor, managing director of the New Kingston-based Art of Surgery – one of the four registered hospitals on the gazetted list – took The Sunday Gleaner through the process of registering a private medical facility.

He said that the process begins with the entity submitting an application for registration to the Ministry of Health and Wellness.

Once the application is received, the applicant is issued with a number of Standards Manuals and Protocols “pertaining to such issues as infection control, operating theatre procedures, disaster preparedness and others”, he said.

“The onus is then on the facility to ensure that its physical premises and practices fall within ministry’s standards, and that it is compliant with the checklist of protocols outlined. This may require upgrading existing infrastructure, operational policies, re-training of clinical staff and administration to facilitate a safe and efficient practice and governance, and the institution of various self-regulatory mechanisms to ensure maintenance of those standards,” Gafoor said.

A rigorous inspection is then carried out by a team of assessors from the health ministry’s Standards and Regulation Division.

“The team includes public health and safety officers, technical advisers and medical clinicians. The facility infrastructure in inspected thoroughly, including floor and wall integrity, and conformity to infection-control standards, air-filtering mechanisms, biowaste disposal facilities, dangerous drug storage provisions, electrical and plumbing safety, and many other issues,” Gafoor told The Sunday Gleaner.

“Records are checked to ensure that maintenance protocol for equipment is being followed as well as that clinical guidelines are in place, and backup/emergency protocols identified to ensure patient safety in the event of unforeseen circumstances,” he added. “Any deficits are recorded and documented, and the facility is given a timeline to make necessary amendments. Once compliance can be confirmed, the application for hospital accreditation goes to the Nursing Homes Registration Committee for approval.”

erica.virtue@gleanerjm.com [3] and jovan.johnson@gleanerjm.com [4]