Cayman health chiefs respond to air ambulance concerns

Public health bosses this week attempted to play down the significance of concerns expressed by the auditor general over the process for flying seriously ill patients overseas for medical care.

In a joint statement, the Cayman Islands Health Services Authority, government insurance company CINICO and the Ministry of Health accepted some of the findings of the auditor general’s report and promised those issues would be addressed.

They also explained some of the reasons for the issues identified by the auditor general and suggested their exposure to risk, in terms of lawsuits, was limited.

“We strive wholeheartedly to ensure that the emergency air evacuation process is managed efficiently from start to finish, and to secure the best possible outcomes for each patient. “While our system is not without flaws, which we are determined to address, its effectiveness has also been repeatedly proven,” the statement read.

Cayman Islands Auditor General Alastair Swarbrick emphasised a range of issues with the process of flying seriously ill patients overseas for medical treatment.

He said patient care could be jeopardised and the Cayman Islands government potentially exposed to lawsuits if the existing system continues. He pointed out that the air ambulance broker, named as Executive Air, had no direct contract with CINICO, no relevant trade and business licence and no permit to operate as a “ground handler” at the airport.

All parties would have had the opportunity to respond to his concerns and have their comments included in his public interest report, which was filed with the Legislative Assembly in June.

The Health Services Authority and CINICO were also asked for comment when the Caymanian Compass published a story on the issue, also in June, but declined to offer anything substantive.

Addressing some of the key issues raised by the auditor general, the statement acknowledged that CINICO had no direct contract with the air ambulance broker.

They said the company was the only air ambulance broker in the Cayman Islands and charged no direct fees to CINICO. They suggested a direct contract could cause problems by limiting CINICO to the use of that particular broker, exposing them to potential price gouging.

The statement said that Executive Air has a trade and business licence to operate as an air ambulance broker. It said the three organisations were unaware that the company required any other kind of trade and business licence to provide services, including ground handling at the airport.

It said the absence of a permit as a ground handler for the company could be explained by the fact that the Civil Aviation Authority explicitly requires licences for the provision of services related to handling commercial aircraft only.

The auditor general had also raised concerns about a $900 fee apparently being charged by the company to air ambulances for ground handling services. The statement said CINICO was not aware of this but would investigate any evidence the auditor general could provide.

The statement said both the air ambulance broker and a third party administrator, a firm called CMN, had been instructed to use the services of air ambulance companies licensed and authorised by the Cayman Islands Airports Authority. CMN has a contract requiring it to select air ambulance companies through a competitive bid, but the broker does not, the statement accepts.

“It is acknowledged, however, that as no contract exists between CINICO and the broker, the requirement for evidence and results of the bidding process is not mandatory.

“At the same time, it must be noted that the majority of emergency air evacuations produced by the broker have yielded similar value to those procured by CMN.

“Neither the broker nor CMN actually transports, handles or provides any physical care for the patient being transported.

“Instead, the true exposures exist with the service providers: HSA (medical triage, stabilisation and transport to the air ambulance), then the air ambulance provider (maintenance of medical stabilisation and any care administered during the transportation to the overseas receiving facility).

“As such, the local broker’s exposure to risk and, through them, any risk that might accrue to the government would essentially exist with the solicitation of an unlicensed provider. At this point we would like to emphasise that the local broker has held an exemplary record of service for well over 20 years.”

The statement adds that the ministry, CINICO and the Health Services Authority have been aware of issues for some time and are making changes to procedures for evacuations which they believe will address most of the auditor’s concerns.

In a brief statement Wednesday, the office of the auditor general stated it was pleased to see a response to the report and looked forward to a full discussion of the issues in Public Accounts Committee.