HSA under fire at LA

Health Minister Gilbert McLean admitted during Finance Committee at the Legislative Assembly that there are fundamental problems with management at the Health Services Authority.

Minister McLean was responding to members’ questions with regard to an additional $4.82 million as equity investment to subsidise an operating loss within the HSA to go on the Supplementary Appropriations Bill. The cost originally budgeted for in the 2004/05 budget was $4.5 million, making the proposed new sum $9.32 million. The proposal was later voted in the House to stand as part of the Bill.

Under questioning from George Town MLA Alden McLaughlin, on ‘what appears to be a haemorrhage with regard to the financial status of the authority,’ Minister McLean said there was a great need for money in the HSA.

‘From forever, what was once the Health Department and is now the HSA, it never had the type of capitalisation it needed to function,’ said the Minister.

When the department became an authority two years ago it was not given any start-up money and has been carrying debts for a decade or two, he said.

Hurricane Ivan came along and where before it had been possible to delay payments to creditors and suppliers, after Ivan it took longer periods to pay and suppliers made demands that they hadn’t before, he said.

‘The hospital came under pressures to deliver service and to pay for supplies to do that.’

The Health Department had never had a proper financial service, he said.

He was not criticising his predecessors in this regard, he said.

The Minister pointed out that there is now a finance unit in the HSA, properly structured, as recommended to them by financial consultants Ernst & Young.

He described it as an agonizing situation that the HSA has to attempt to find a beginning out of 30 years of such a state of affairs.

‘The $4 million being asked for is needed to pay off outstanding debts that have been here for decades so that the authority can start on a fresh footing,’ he said.

Mr. McLaughlin said that unless there was some plan to address these issues he feared that the next time it would be substantially more than $10 million being sought for the HSA.

‘I’m not saying it should be making a profit but it’s falling more deeply into the mire every day.’

Minister McLean said the management problems could not be fixed in the 24 months the HSA had been in operation.

Following a request from Northside MLA Edna Moyle the Minister said the HSA Board has responsibility for the administration and management of the hospital.

‘It formulates policy and issues directives to management. Management is supposed to carry out directives but there have been instances where this has not been carried out,’ he said.

In answer to questions from Ms Moyle he said that $4 million in outstanding debts was owed to suppliers and some bills were left unpaid for six months.

‘This money has to be paid because this country can’t afford to be embarrassed and I’m sure some of those suppliers were from overseas,’ she replied.

‘We can’t wait six months for the Minister to be told that the suppliers are not supplying until they get paid their money. The Minister needs to be kept up to date. It’s not only the staff not billing or paying, it’s the Board.’

Ms Moyle said she knew the Cayman Islands was not paying its suppliers overseas because she had heard it in Miami.

Minister McLean commented that the issue of timeliness in him needing to know issues has been a problem and it was addressed at the last board meeting.

‘I should not be held responsible to ask for money if I’m not told about it,’ he said.

Mr. McLaughlin said he believed some five doctors on the staff had left the HSA between the end of December and last month. He named the doctors.

Minister McLean said only three doctors were leaving in 2005: one left to go in to private practice, another resigned to go and make more money while another left because his family wanted to leave following Hurricane Ivan. He said some others had left last year and one of those had been fired for improper behaviour as a doctor.

The Minister said the HSA has recruited a GP to start in early April, a locum cardiologist for 4 April and they are also recruiting a full-time cardiologist to replace one of the doctors that had left.

In response to East End MLA Arden McLean’s comment that there are 700 staff members at the hospital, the Minister said there are 620.

Financial Secretary Kenneth Jefferson asked the Minister what was to be done about unrealistic rates and the HSA not capturing from all of the services it provides.

The Minister said there is a Chargemaster where each item is charged and put in a computer system and rates have been applied to each of the services.

Mr. McLean asked the Minister if delays in billing were one of the causes of the HSA’s debt, because if billings were not put in on time an amendment made to an insurance law meant insurance would not be paid.

The Minister said there has been a backlog but although time limits have been put in place on billing, 180 days was the longest time allowed ‘unless there’s good reason’. He said that billings were improving, but insurance companies don’t always pay on time.