The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

A Supreme Court judge has slammed the Bahamas Medical Council’s “dismissive and patronising” approach to rejecting an expatriate doctor’s bid to be licensed as a radiology specialist - a decision that forced her family to split-up.

Justice Loren Klein, in a July 22, 2022, verdict branded the regulatory body’s attitude towards Dr Gauri Shirodkar as “perplexing” as he overturned its rejection and ordered that her registration application be reconsidered.

A qualified medical doctor and radiologist, who had previously been licensed by the Council and employed by the Public Hospitals Authority (PHA) for almost a decade between December 2010 and December 2019 as a “radiology registrar”, Dr Shirodkar’s troubles began when she applied to be licensed as a specialist in June 2020 ahead of going into private practice in The Bahamas.

“Her hopes were dashed in three terse lines in a December 30, 2020, letter from the Council,” Justice Klein recorded. The letter stated: “The Bahamas Medical Council has reviewed your application for specialist registration in radiology. We regret to inform that your application was denied. The Council was unable to verify your specialist qualification in radiology.”

The judge added: “Somewhat taken aback by this decision, she again wrote to the Council to try to persuade them that she met the statutory qualifications to be registered as a radiology specialist and to reconsider their position. The Council reconsidered but did not relent. In an equally short and cryptic letter dated January 13, 2021, it reiterated that it was “...unable to verify your specialist qualifications in radiology”.

Radiology involves the conduct and analysis of x-rays, a technique frequently used to treat and diagnose illness. Dr Shirodkar sought to overturn the Council’s decision via Judicial Review, challenging the rationale and soundness of its decision-making and the process involved, and while efforts to resolve the dispute out-of-court “looked very promising at one point” they “eventually unravelled”.

In the meantime, The Bahamas’ loss proved the UK’s gain. “Unemployed in the meantime, Dr Shirodkar made the difficult decision to leave her husband (who is also a medical doctor and radiologist working in The Bahamas) and return half a world away to the UK with her young daughter to seek employment,” Justice Klein noted. “Ironically, she found employment with the National Health Service (NHS) in the UK as a consultant radiologist.”

The Medical Council, which is a statutory body empowered via the Medical Act, is charged with protecting the Bahamian public’s health, safety and well-being by licensing and registering all medical practitioners to ensure they are all properly trained and qualified. The main person giving evidence on its behalf in Dr Shirodkar’s case was Dr Merceline Dahl-Regis, the Government’s former chief medical officer and head of the Minnis administration’s COVID-19 response.

Justice Klein said the Council’s initial response to the doctor’s application on October 5, 2020, was that she needed to supply evidence of her “specialist registration” with the UK’s General Medical Council (GMC). The Bahamian Council’s “review committee” assessed her application on November 23, 2020, recommending that it not be granted, and this was communicated to Dr Shirodkar on December 30, 2020.

She replied on January 5, 2021, setting out her qualifications and also explaining how she had registered with the GMC as a general practitioner before being offered a consultant radiologist post at Northampton Hospital in the UK. However, the Council again denied the application in a response that was “terse and contained only the very general explanation that the Council was unable to verify the applicant’s specialist qualification”.

Dr Dahl-Regis, in an affidavit, alleged that Dr Shirodkar did not possess the required three years’ training in radiology prior to entering The Bahamas while adding that she did not submit an approved work permit from the Department of Immigration with her application. This, though, was bitterly contested by the doctor.

And Justice Klein found that the Medical Council’s rejection was unlawful because it did not follow the statutory requirements set out by the Medical Act. This provides that only the Council’s Assessment Committee can review a doctor’s licensing application - not the “Review Committee” referred to by Dr Dahl-Regis, as it has no legal authority to perform this function.

The judge also found that the process did not give Dr Shirodkar the right to make her case by submitting representations and having the Council consider them as part of the decision-making process. “I am also satisfied that in the circumstances of this case, the Council failed to give reasons, or failed to give adequate reasons, to the applicant,” Justice Klein found.

“In this regard, it has to be borne firmly in mind that the formal reason (and perhaps the only reason) given to the applicant for refusing registration was simply that the Council was unable to verify her specialist qualifications. There is considerable indeterminacy of meaning in that statement.

“It is not known, for example, whether this was intended to mean that the Council could not determine whether the qualifications or certificates presented by the applicant were authentic, or that they did not know whether they correlated to the qualifications set out under the Schedules” in the Medical Act relating to different specialist practices and their licensing requirements.

Describing the Immigration-related work permit concerns as “a red herring”, as it was not a matter for the Council, Justice Klein found: “In my judgment, the farrago of affidavit evidence presented by the respondent [the Council] after the institution of Judicial Review proceedings, far from clarifying the decision-making process and the basis on which it was taken, only further exemplified the flaws in the process, as well as the errors in reasoning.

“The conclusion of the Council that the applicant needed to be on the specialist register of the UK GMC to be considered eligible to be registered as a specialist in The Bahamas involved a clear error of reasoning, and there is nothing in the Act that would justify such a conclusion.

“In coming to that conclusion, the Council seemed to conflate the role of the professional body, the GMC, charged with registering medical specialists for the purposes of regulating their practice in the UK, with the academic or clinical qualifications which the [Medical Act] schedule sets out as being acceptable for specialist registration under the Act.”

Pointing to Dr Shirodkar’s other qualifications, and work while at PMH, Justice Klein added: “In the circumstances of this case, I would hold that the Council’s logic and process of reasoning in concluding that the applicant was not qualified to be registered as a specialist due to a cited lack of the three years’ post-graduate training was an irrational and unreasonable decision in the circumstances of this case.....

“While I could not find anything to attribute bad faith or malice to the Council, the dismissive and patronising tone adopted by the Council at times in its affidavits to explain its interaction with the applicant is perplexing. The applicant, as appears from all of the reference letters written on her behalf, is a competent physician, well respected by her colleagues, and it seems most unfortunate and regrettable that she should not be accorded what, to my mind, is the basic professional courtesy one would expect the Council to routinely extend to any registered medical practitioner.”