EDITORIAL – Cayman’s ailing health authority

Government math can be tricky. But here’s a reliable conversion rate: One round of legislative testimony from Health Services Authority officials approximates to one week of troubling news headlines.

Their recent appearance before the Public Accounts Committee, for example, yielded the following stories in the Compass: “HSA will sue to recover debts,” “HSA promises ‘clean accounts’ by 2018,” and, the coup de grace, “Government $1.2 billion healthcare liability figure may be low.”

We don’t have to delve far back in the Compass archives to discover a host of stories on those issues and other narratives of systemic dysfunction in HSA. For starters:

“Section 12” immunity – A clause in the HSA Law indemnified public hospital staff from punitive legal action in cases where patients were harmed or even killed. After the judiciary and the Compass highlighted the existence of the immunity clause, officials denied that the language was inserted into the law on purpose – despite the fact that HSA had deliberately invoked the clause on a number of occasions to stymie legal proceedings.

CarePay – Last week’s lifetime FIFA ban of former Cayman football chieftain Jeffrey Webb (who has pled guilty to a litany of offenses in U.S. federal court in the context of the global FIFA corruption scandal) should remind Cayman residents that the local CarePay scandal still smolders. Here, Webb faces allegations that he conspired with former HSA Board Chairman Canover Watson to defraud the public healthcare system of hundreds of thousands of dollars. Only Watson has been brought to trial, where he was found guilty and sentenced to seven years in prison. (He has appealed.) Judging from the evidence that arose in court during the trial, criminal investigations and law enforcement revelations should be far from finished.

Ambulance – Ostensibly, it was good news when the Cayman Heart Fund and other good Samaritans announced they had raised enough funds to purchase a much-needed, life-saving ambulance for the HSA. The bad news is that it should have been our government – not the community – who paid for the vehicle.

Bad debts – The HSA’s lack of funds for ambulances is directly related to the authority’s continuing inability to collect some $90 million in outstanding medical debts. This may not be entirely, or even mainly, the fault of health officials; their collection efforts have been hamstrung by orders from elected lawmakers. Officials recently indicated a change in tactics in order to make people “pay up.” We’ll believe it when we see it … in court.

Inadequate accounting – HSA hasn’t managed to provide accurate accounting for its expenses and revenues since 2004. The authority promises it will produce “clean” financial statements to auditors by the year 2018. Why not much sooner?

Escalating liabilities – Even the “squeakiest” of HSA reports would only be an accurate portrait of an ugly financial situation. Recently, under questioning by lawmakers, Financial Secretary Ken Jefferson was compelled to revise the government’s estimated $1.2 billion in public healthcare liabilities to an even-more-astounding “at least $1.2 billion.” Inexplicably, it seems officials didn’t factor into its previous calculation all public servants (i.e. the thousands in statutory authorities and government-owned companies), not just core government employees.

Overseas spending – To obtain a more complete picture of healthcare in Cayman, one must also consider healthcare delivered to residents of Cayman, outside of Cayman. Our best estimate is that each year, some $150 million to $200 million is siphoned off from the local economy in the form of overseas medical expenses.

The above is a preponderance of evidence against the long-term performance of public health officials and the system they have created and perpetuated. Almost without exception, the troubles with HSA are indictments of officials … not physicians or staff.

Like far too many government endeavors in Cayman, it is the system that is in desperate need of reconstructive surgery.