While praising the services and professionalism of the Health City Cayman Islands staff, the Health Services Authority’s top doctor said last week that the medical tourism facility has some unfair advantages over other local providers with which it is now competing.

HSA Medical Director Dr. Delroy Jefferson was asked about the issue in a meeting of the Legislative Assembly’s Public Accounts Committee, which was reviewing a 2015 report from the Auditor General’s Office that examined certain aspects of the East End private hospital.

The auditor general’s report, which alleged that government had “acted unlawfully” in negotiating two major land deals (one of which involved Health City), concluded that the former United Democratic Party administration committed to “tens of millions” of dollars in concessions for the Health City project without “adequately researching the costs involved.”

“There is a risk that, should Health City expand to its full size, the Cayman Islands government could come under pressure to provide infrastructure which it cannot afford,” auditors found. “While employment of Caymanians would increase and there would be private benefits, there would not be a proportionate growth in tax revenues due to the concessions given the company.”

Dr. Jefferson told the committee that in his view, the duty concessions in the government’s contract with Health City were fine if the facility’s purpose was to provide “medical tourism,” a service which did not exist prior to the hospital’s opening in February 2014. However, Dr. Jefferson noted that the hospital appeared, at least in some cases, to be competing with local doctors for patients.

“There is a fear that it is going to hurt the local providers who have not benefited from the same [duty] concessions,” Dr. Jefferson said.

During the accounts committee meeting, George Town MLA Joey Hew asked Dr. Jefferson whether the HSA was satisfied with the patient care of individuals who had been referred to Health City.

“I am pretty satisfied with the level of care that’s coming out of Health City,” Dr. Jefferson said. “The level of care to date has not been a big problem at all.”

Health City Cayman Islands local partner, businessman Gene Thompson, was contacted for a response to Dr. Jefferson’s comments in the committee. Mr. Thompson said he was still formulating a response by press time Tuesday.

The issue of Health City competing with local private sector providers is one the Cayman Compass first identified in mid-2014, following the revelation of internal government emails sent to Finance Minister Marco Archer. According to one email sent in August 2014, CINICO officials noted a number of “challenges” regarding client referrals to Health City.

“A number of these referral requests are for services that are already provided locally via existing providers,” according to an email sent by CINICO Chief Executive Lonnie Tibbetts on behalf of the insurance company’s Risk and Appeals Committee to Minister Archer on Aug. 29. “As you may recall, one of the pledges of [Health City] was to not interfere with the existing services provided by local physicians/facilities, including the Cayman Islands Health Services Authority. As such, we all share the common understanding that [Health City] would be used exclusively for tertiary services and/or secondary specialty services not previously provided locally.”

Those services included pulmonary treatments, pediatric endocrinology and orthopedics, among others, the email noted. Mr. Thompson said at the time that the hospital was in discussions with government about patient referrals and was essentially trying to head off potential situations where Health City was forced to turn away local patients who wanted to use its services. However, Mr. Thompson said the Health City Cayman Islands business model was not based on providing local healthcare services.

“Our hospital is designed and built to bring in international medical tourists from the Caribbean and other overseas jurisdictions,” Mr. Thompson said.

“In the meantime, if we can assist in providing high quality healthcare at a lower cost to the Caymanian people … it’s our honor to do it and we are contractually obligated to do it.”

According to Mr. Tibbetts’s August email to Minister Archer: “The authorization and/or support of a referral to [Health City] for services already available locally presents all of us with a number of dilemmas. This will likely result in displeasing the existing local provider[s] and possibly causing irreversible damage to longtime relationships.

“If we pledge exclusivity, or steer a significant amount of our members to one facility, we risk the financial viability of one or more providers/smaller competitors, who may, in turn, close, thus inadvertently creating a monopoly in the long run or other challenges.”

For instance, Health City provides both non-invasive and invasive cardiology techniques at its facility in East End. Local healthcare providers do not perform invasive cardiology treatments, but currently non-invasive treatments are shared between the Cayman Heart Health Center and TrinCay. Those two agencies provide doctors to perform those services at the Cayman Islands Hospital in George Town on a rotating basis.

If patients were sent to Health City instead, Mr. Tibbetts argues in the email, TrinCay might not offer such services in the future, forcing the Health Services Authority to shutter its emergency cardiology treatments.

Health City doctors would not be allowed to substitute since their doctors are not licensed to practice outside of the Health City Cayman Islands facility.