Poor insurance linked to death

Gross shortcomings with Cayman’s standard health insurance contract have been cited in the death of a Filipino work-permit holder at a Honduras hospital in late February.

Carol Romero, 32, an employee of Blockbuster Video at Grand Harbour, was hit on 21 January outside of the shopping complex by a woman police said was drink-driving. The 38-year-old driver was arrested at the scene but had not been charged at press time.

Ms Romero was rushed to the Cayman Islands Hospital and later transferred to a facility in Honduras with critical head injuries, after centres-of-excellence hospitals in Florida proved too expensive and attempts to transfer her to Jamaica and Cuba also failed.

After an almost month-long battle, Ms Romero had been showing signs of recovery at the private Cemesa Hospital in the Honduran city of San Pedro Sula, when insurance funding for her treatment ran out. She was then transferred to a public hospital in the city, but died three days later on 20 February.

Like many of Cayman’s low-to-middle-income workers, Ms Romero’s standard health insurance contract offered only $25,000 of coverage per incident of care – a pittance compared with the $250,000 guarantees hospitals in South Florida had requested. While government has an unofficial policy of guaranteeing such costs for Caymanians, no such offer was made to Ms Romero.

Her employer, Debbie McTaggart, admitted she was shocked when she realised how little coverage the standard insurance policy provided. She said she could not believe the $4,000 benefit for air ambulance transfer – the minimum required by law – wasn’t enough to actually get Ms Romero anywhere. Health officials have previously put the cost of an air-evacuation from $10,000 to $30,000.

‘I thought it would be adequate coverage,’ Mrs. McTaggart said. ‘I didn’t think that the insurance company would sell you something that doesn’t get you anywhere. There is no $4,000 air evacuation. You can’t get to any place with $4,000.’

In a prepared statement emailed to the Caymanian Compass, British Caymanian Insurance General Manager Derry Graham said his company provided additional funds, over the $4,000 policy limit, to ensure Ms Romero was air evacuated.

‘To the best of my knowledge the air evacuation took place as soon as possible,’ Mr. Graham said.

Mrs. McTaggart criticised the insurer for not making more funds available to Ms Romero once the $25,000 ran out, based on the possible liability of the driver in the crash, whose motor policy is also with BritCay.

But Mr. Graham defended the decision not to release funds against the driver’s policy, saying ‘our policyholder has not been charged with any criminal offence nor has any civil claim been instigated against her in relation to this incident.’

Attorney Lee Freeman, from the law firm Preistleys, confirmed his firm will bring a civil claim against the driver seeking compensation, including money for lost earnings that would have been remitted to Ms Romero’s dependants – her elderly parents in the Philippines.

Ms Romero’s two brothers, Leo and Leoandro, also work permit holders on Grand Cayman, are understood to have returned to the Philippines for their sister’s funeral and could not be reached for comment.

One more death

Ms Romero’s death is just the latest medical emergency to be linked to a basic insurance plan that medical and insurance figures agree is failing Cayman’s low and middle income workers.

The inadequacy of the standard health insurance contract – the minimum plan of benefits employers are required to provide their workers – exploded into controversy in late 2007 after a series of cases where foreign workers found their insurance did not cover the cost of the emergency medical treatment they desperately required.

There was Bulgarian national Kaloyan Kisyov, 20, whose basic health plan could not get him treatment in the US after he fell off a boat, fracturing his neck in September 2007. He was transferred to a Jamaican hospital where, even there, his bills nudged toward $100,000. Friends frantically tried to raise funds while Mr. Kisyov fought for his life.

Weeks later, first-time Jamaican mother Shellesha Woodstock made headlines when she gave birth to a premature baby aboard a Cayman Airways flight to Jamaica, after being told by HSA officials, while in labour, she could not afford to have the child in Cayman.

An investigation later found Ms Woodstock’s employer had let her insurance policy lapse, but her insurance turned out not to be directly related to the advice she received because hospital staff never checked whether her insurance policy was valid.

In November 2007, prematurely born Jamaican twins died at the George Town Hospital after efforts to transfer them to neo-natal facilities in Jamaica and the Bahamas failed because the mother’s health insurance was insufficient.

Health Minister Anthony Eden defended a so called ‘two-tier’ system of health care, under which government would guarantee the cost of medical care for Caymanians but not for work permit holders.

Leader of the Opposition McKeeva Bush said at the time that government should do everything it can to save lives, regardless of where people are from.

‘We have these people working in our country and we have to find a way to deal better with it,’ Mr. Bush said.

Superintendent of Health Insurance Mervyn Conolly said in November 2007 he would recommend Health Minister Anthony Eden increase the maximum benefits under the standard health insurance plan. Mr. Conolly is yet to receive a response on that proposal from Mr. Eden, but he told the Compass Friday he believes the Ministry is assessing the likely effect increased benefits would have on insurance premiums.

Mr. Conolly agreed that the standard health insurance plan prescribed by law – now in its 12th year – is inadequate in light of today’s healthcare costs – particularly when emergency overseas care or serious illnesses is involved.

But he cautioned that any increase in benefits will be matched with increased premiums that employers must pay. In a country in which health insurance is mandatory for everyone increasing benefits too much could be counterproductive, he added.

Mr. Conolly urged both employers and employees to be sure about what their insurance policy provides.

‘They shouldn’t wait until an emergency to research the level of coverage they have,’ he said.

It’s a lesson that Mrs. McTaggart has learned the hard way – she has since cancelled all her employees’ insurance policies with BritCay and has taken out more comprehensive policies with another company.

She warned others not to make the same mistake.

‘The standard plan is sub-standard – it is not adequate to do anything,’ she said. ‘You think you have insurance but you really don’t have anything.

‘You really better check into what your coverage is,’ she said.

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