Playing Doctor: Tonet Viray,
Aklan Healthcare System & Political Nepotism
By Ben Hur P. Mobo, Jr. MD, MPHAssistant Professor of MedicineYale University School of Medicine And Director, Occupational Health ServiceVA Connecticut Healthcare System
The recent news about Tonet Viray hit me with both strong sadness and utter disgust: sadness for Tonet, the person and for the Aklan healthcare system; and disgust for political nepotism at its worst.
Tonet is not a stranger to me. When I learned that he had completed his medical degree and had stayed in Aklan to practice medicine, I felt glad for him. In a way, this was my reaction to the exodus of medical practitioners to the United States and other countries to pursue higher education and hopefully better prospects in life.
I, too, left in 1995 to pursue residency in Internal Medicine, fellowship in Occupational and Environmental Medicine, and Master in Public Health. After finishing in (year) 2000, I was asked to stay on as a faculty member. But even as I moved up the academic ladder at Yale and the administrative track at the VA Connecticut Health-care System, I always kept an eye on Aklan’s healthcare system.
Thus, the news about Tonet is of interest to me—both as a practitioner of medicine and from a pubic health perspective. In general, I have the full admiration for doctors who wittingly or by force of circumstance practice medicine in the Philippines, Aklan in particular. What I cannot fathom, though, is the fact that Tonet had passed himself of as a fully licensed physician. There is no shame in admitting flunking the medical board exam. I know how difficult my board exam was. And so there should be no shame in taking it again and again if need be.
But to practice without medical license is "criminal", at least here in the United States. This is especially true in the age of advocacy for patient safety, patient privacy, and patient autonomy. To practice without valid medical license is to break the very tenet of medicine to "first do not harm". In the United States, someone who passes himself off as a duly licensed doctor is committing fraud (byimpersonating a doctor). Any person examined by someone impersonating as a doctor, in effect, did not give consent to be touched.
The whole patient-doctor relationship does not hold. Thus, with each examination, the impostor commits battery. Any and all pelvic and breast examinations, deliveries, and circumcisions can be argued as sexual assaults. All surgeries can be made out as mutilations or attempted manslaughter. And any death can be made out as homicide or manslaughter. The point is: the hospital or in this case the Aklan government might have exposed itself to multitudes of criminal and civil suits by employing an unqualified individual. On top of that, if the hospital submitted medical claims and received reimbursements for alleged services rendered by an impostor, those too can be fraudulent.
For a graduate of medical school to not re-take the medical board is a sign of either laziness or of tempting fate. I know of friends who struggled many times over just to pass the board exams. To do so is to have the self-satisfaction of calling themselves doctors and to be able to further their medical education. For someone to pass of himself as duly licensed and have the gall of applying for public office is to tempt fate.
Or he is completely relying on the utter incompetence of the creden-tialing process that wittingly or unwittingly ignores his lack of proper credentials. The Tonet I knew was a humble and self-deprecating young man. This could be a lapse of judgment.
Is Tonet the only one party to this case? Tonet was government-appointed personnel three times over. Is Aklan really in such dire shortage of real doctors as to appoint someone without license thrice? Beneath it all, could Tonet truly have passed himself off as duly licensed physician and got himself two promotions solely on his own merits and actions? Tonet’s appointments and rapid rise in the Aklan public healthcare chain must have ruffled some well-earned feathers and stepped on some well-polished toes.
Given Tonet’s very close proximity to the appointing powers, one can only speculate the significance of the issue of when politicians play favoritism or nepotism. To me, Tonet is a case of political nepotism gone awfully wrong.
In closing, just last week the Veterans Affairs secretary tendered his resignation in large partbecause of perception of inadequate health care provided to veterans and the highly publicized molds issue at the Walter Reed Medical Center. Such is the serious ramification of chain of responsibility. I submit Tonet’s case is far worse in many levels.
I call for the Aklan Medical Society to police their ranks, and for the Philippine Regulatory Commission to uphold the professional standards. I think it is also ripe time for a comprehensive investigation to look into any anomalies involved in appointments to public health offices and to rectify the mistakes made, including civil and criminal charges where appropriate. To paraphrase, a public health office is a public health trust. Let the best prevail. If not, at least let us appoint a qualified individual, not an impostor, to play doctor to the people of Aklan. /MP
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