Former Health Minister and Bodden Town MLA Gilbert McLean has raised serious concerns with the state of the HSA.
In an interview with the Caymanian Compass this week, Mr. McLean said he has little confidence that the HSA will be in a financial break-even position by July 2009, because the political will does not exist to challenge a prevailing attitude that people don’t need to pay for their hospital bills.
‘The majority of the populations – including those that bloody-well have the money to pay – believe that healthcare must be free, if provided at the government hospital,’ Mr. McLean said.
‘People are treated there all the time and they never pay.
‘When they get in a bit of a squeeze they run to the politicians and they in turn call the HSA using language like ‘Ms Lucy Grey called and she said she has one little bill there’ when that little bill could be $20,000. ‘See if you can help somehow or work something out for her’.’
‘This usually interprets into Ms Lucy Grey don’t ever pay though a payment plan has been put in place for her.’
His comments come after HSA acting CEO Lizzette Yearwood told the Legislative Assembly 28 May that Government bail-outs will be a thing of the past by July 2009.
On 22 June, Health Minister Anthony Eden told the Legislative Assembly it was not realistic for health facilities to provide free healthcare anymore, saying the current healthcare model – if left unchecked – will cripple government financially.
Mr. Eden has not announced any further plans to turn around the situation he described, but suggested the Portfolio of the Civil Service needed to look at introducing a co-payment model for government employees.
Mr. McLean said the Ministry is more likely to allow doctors and insurance companies to up their prices before any political pressure is applied to collect fees that are rightly due.
Responding to recent news that the search for a CEO to replace Ms Yearwood has been called off for now (Caymanian Compass 3 October), Mr. McLean said he disagrees with the decision, but is not surprised.
He thinks an outsider is needed to be able to make the tough calls and take the drastic actions that are necessary to make the HSA financially viable.
‘I have been an advocate of that forever. I believe that is necessary; someone who is qualified to come in from the outside and fix the system and get it up and running.’
‘In the mean time, you identify and you train a person who can take that over when they have gained sufficient knowledge and experience. I have always taken that position. There are others that have criticised me for it but, hell … that is what the hospital needs.’
That process can only succeed, he said, if the person hired is not politically victimized for doing the job they were hired to do – a reference to the hospital’s last CEO, Craig Brown, who was fired in controversial circumstances.
He said the incident has had a major effect in tarnishing the authority’s name as an employer to potential recruits.
‘That was irrational … I would like to believe it wasn’t about sensitivity, or lack of sensitivity,’ – a reference to Mr. Brown’s alleged lack of sensitivity in firing then Chief Operating Officer Kathy Gomez, the sister of Cabinet Minister Charles Clifford and wife of senior civil servant Kerney Gomez.
‘My god, the big corporations of the world don’t hire people too much based on their sensitivity but on their qualifications and ability to manage.’
Mr. McLean fears things at the HSA may have degenerated further since when he was Health Minister, but claimed a culture of secrecy at the HSA and Ministry makes it difficult to establish.
‘I understand they have sent down an edict; from top to bottom. From the Ministry straight down into the hospital, that if they want trouble, they just open their mouth about anything.
‘There is real terrorism over there, as I understand. They have threatened them with their jobs … I’ve been told by people that know … they are suppressing information left, right and centre, instead of openly going all out to fix the situation.”
‘I know (it happens) because I was the first to take that culture on and expose to the public that there was like $50 million outstanding (in debt) that I found.
‘I wasn’t altogether popular when I took the position that the hospital had to damned well charge for the services it was giving, and it had to collect.’
Turning the HSA around will be a major task, he said. ‘It takes someone with the will and the courage to do it. You are going to catch hell over it.’
Yesterday, the Caymanian Compass reported Mr. McLean is considering running for office again at the next election. Sighting frustration with the Government on healthcare, their level of borrowing and spending and the cost of living, Mr. McLean ruled out running with either major political party, instead pointing to a possible third-party candidacy.
Responding to Mr. McLean’s comments, Mr Eden issued a statement Thursday that said: that said:
‘Yesterday’s and today’s Compass reports draw attention to various personnel movements in the HSA. I will not comment on this in detail, but it reminds the public that health care provision requires the right mix of many skills.
‘This is part of the challenge of health services. This is of course not limited to the HSA. While the HSA is a priority, we will not lose sight of our public health mandate, which is to ensure the people of the Cayman Islands will continue to have access to high quality public health programs.
‘As an example we have just expanded our dental health services at the Prospect Primary School and will be working with the Education Ministry to address physical education in schools.
‘Also, as evidenced by the current project to rebuild health services at the West Bay clinic, it is clear that we are committed to strengthening the health care infrastructure in the Cayman Islands.
‘However, lasting improvements will require the establishment of an appropriate governance model for the HSA, which is now underway.
‘We anticipate that this will require the amendment of the HSA law and other related legislation. We will also, within this frame work, prepare an appropriate job description prior to recruiting a CEO for the authority,’ he said.