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Ruggles Ferguson |
The war of words are continuing between the Grenada Bar Association (GBA) on the Keith Mitchell-led government in St. George's on the issue of prisoners with tuberculosis at the Richmond Hill Prisons.
The government has consistently denied that anyone has tested positive for TB while GBA President, Ruggles Ferguson is insisting that the claim is untrue.
In the face of calls from government for Ferguson to retract his statement about TB in the prison, the GBA boss has urged the authorities on the island to come clean with the public on the issue.
He repeated claims that 64 persons were tested for TB at the prison and that 21 came back positive "with readings between 10 - 22 millimeters, confirming the presence of Tuberculosis within their respective systems".
Following is the full text of a letter that the GBA President sent to Health Minister, Senator Ann David-Antoine on October 10 on the issue:
Hon. Ann David-Antoine
Minister of Health
Ministerial Complex
Botanical Gardens
ST.GEORGE'S
Dear Madam,
Re: Tuberculosis (TB) at Richmond Hill Prisons
I write further to my letter dated October 8th, 2007 and in response to one of even date addressed to you and copied to me (received Oct. 9th) , among several others, from the Chief Medical Officer ( Dr. D. Mukerjee).
Firstly, let me state for the record that I am no 'self-professed' or other expert on Tuberculosis. I am simply a patriot concerned about the health and well-being of citizens and other inhabitants of Grenada, with an added professional and moral responsibility, as President of the Grenada Bar, to address issues affecting lawyers and the legal profession.
I wish to maintain the concerns expressed in my previous letter regarding Tuberculosis at the Prisons, and to further confirm the reports that over twenty (20) inmates are infected or suspected to be infected with TB.
Not only are our concerns well-founded and justified, but the self-serving, arrogant, unconvincing, ambiguous and inconsistent response of your CMO has now heightened our alarm bells.
Your CMO seems more interested in attacking and destroying the messenger rather than focusing on the message, enlightening the nation on the basics of TB and soothing the fears of a concerned legal profession.
Let me state for the record, Hon. Minister, that on the Monday, October 1st, 2007 I contacted three top officials - a senior health official within your ministry, a senior doctor within the public health system and a senior prison official - regarding reports that
one inmate at the Prisons was suspected to be suffering from tuberculosis.
I first conveyed to the senior health official all the information I had in my possession on the suspected case: the name of the inmate; the date he was released from hospital, the name of one of the doctors who attended to him, and the problems he was encountering in the prison subsequent to his release from the hospital.
I specifically requested that the information be passed, as a matter of urgency, to you, the CMO and Dr. Bert Brathwaite (Medical Director).
I indicated to the senior health official that, though very concerned, I was dealing with the matter quietly and diplomatically so as not to create unnecessary alarm.
I made it clear, however, that given the highly infectious nature of TB and the concerns of both prisoners and prison officers alike, I would be forced to make a public statement on the matter if the concerns were not promptly and seriously addressed.
After all, lawyers, prisoners, prison officers, court officials and members of the public interact almost on a daily basis.
I was impressed with the immediate concerns and gratitude expressed by the senior health official upon receiving the information.
The senior health official promised to act promptly and advised that I should send a letter to you on the matter via confidential cover.
Minutes after speaking with the senior health official, I contacted the senior doctor, also relaying the information in my possession and expressing my concerns.
The senior doctor assured me that he was aware of the inmate, that tests so far had revealed that the inmate was not suffering from active TB, but the case was being closely monitored.
Given my discussions with the senior health official, the senior Doctor and the senior prison official, the assurances that the inmate was being and would continue to be monitored and that steps would be taken to protect other inmates, and my own packed schedule, I felt confident that the matter would be handled urgently and I did not bother to send off any letter to you.
Against that background, you will well appreciate my alarm at the start of this week upon learning that over twenty (20) inmates at the Prison had last week tested positive for TB, based on preliminary tests done among less than one-third of the prison population.
Given the above, I am amazed to hear your CMO state that he happened to be in the prisons on October 3rd on other business (Prison Review Committee) when he 'saw' nurses conducting TB tests and made certain enquiries. Further, that he was told then about the one inmate suspected of being infected with TB.
Up until those statements were made, I was operating under the genuine but obviously mistaken belief that your CMO had in fact commissioned the preliminary tests and was actually on top of the situation. Regrettably, by his own words, he has certified otherwise.
I challenge the CMO to deny the following:
* That out of 64 persons tested (preliminary PPD test) at the Prisons last week 21 tested positive, with readings between 10 - 22 millimeters, confirming the presence of Tuberculosis within their respective systems;
* That those 21 persons are considered to be infected with TB and are required to do further tests to determine whether the TB is active;
* That up to Monday morning (Oct. 8th when I wrote to you) no further tests were done to determine whether those infected persons were suffering from active TB with the capability of transmitting the same to other persons;
* That up to the said Monday no further preliminary tests were done on the rest of the inmates to determine whether they too have been exposed to or infected with TB;
* That no one can say definitively that those 21 infected persons are not suffering from active TB until further tests, including chest x-rays, are done.
My concerns are way past that single inmate about whom discussions were held with the health authorities last week. We are now faced with multiple cases, based on preliminary tests, that may or may not turn out to be active TB cases.
Since Monday (Oct 8th) I have spoken to several senior, experienced and well respected practitioners - including a medical specialist - who have all commended the Bar's position on this matter and who have confirmed that, based on the preliminary tests, a potential crisis could be in the making.
One has ventured to say that with the high readings (10-22 millimeters) of the 21 persons, there is a more than strong probability that there are a few persons with active TB within the prison walls.
Another has described the approach by your Ministry officials to the matter as simply being 'crazy' - his words, not mine! Yet another has condemned the approach of your Ministry officials as wholly inconsistent with the modern approach to preventing the spread of TB and the protocols established by the World Health Organization (WHO).
Many stakeholders within the health system have been expressing concern about the presence of TB cases, not just within the prisons but outside as well.
Only your CMO and senior health officials seem intent on leading (or misleading) the population to believe - without doing the necessary scientific tests - that there is no TB problem within the prison.
I have been advised by competent health officials as follows:
* That all the infected persons at the prisons ought to be subjected to chest x-rays forthwith to determine whether they are active TB carriers;
* If a chest x-ray determines that any infected person carries active TB, that person must me isolated forthwith;
* If the chest x-ray establishes that the person is not an active carrier, then that person must embark on a six (6) to nine (9) month period of appropriate medical treatment to cure the current infection; and
* If the person who is currently infected, but does not have active TB, is not subjected to a course of treatment to cure the current infection, that person runs the risk of developing active TB.
Your CMO had no basis therefore to confidently and categorically declare to the nation on Monday (Oct. 8th) that there was no case of active TB at the prison and therefore there was no need for concern.
Your CMO well knew then that further tests (chest x-rays) were not done on the 21 persons who had positive readings in the preliminary tests.
I am reliably advised by medical experts that only those further tests would establish conclusively whether there are active cases among the 21 persons.
Such statements by your CMO were therefore highly premature, misleading, irresponsible, unprofessional and unbecoming of a medical officer holding such high position.
Yes, I am no expert in medicine, 'self-professed' or otherwise! But at least many of us non-experts could recognise potential danger when we see it, simply by applying simple rules of common sense.
Thankfully, we do not have to depend on your CMO alone for expert advice on Tuberculosis, since information is available from the information super highway (the internet) and from many other local and other practitioners who are genuinely concerned about the health and well being of the Grenadian people.
Once again, we repeat our concerns and the recommendations made to you in the October 8th letter, a copy of which I enclose for ease of reference.
Based on the response of your CMO, it is now obvious that your ministry officials are not prepared to take our concerns seriously.
Hon. Minister, we urge that you seek independent, competent, professional advice in this matter, preferably from your regional colleagues.
We look forward to your prompt action in the interest of public safety.
Ruggles Ferguson
President
cc. Rt. Hon Prime Minister
Director of Public Prosecution
Registrar of the Supreme Court
Chief Magistrate
Permanent Secretary, Ministry of Health
Madame Justice Clare Henry
Mr. Justice Francis Cumberbach
Members of the Bar
