Calling a recent auditor general’s report an “indictment” of the entire local healthcare system, a Chrissie Tomlinson Hospital surgeon Wednesday blamed the Cayman Islands Ministry of Health for a series of “incompetent” failures, including the refusal to listen to local doctors on a number of issues.
“Things are not right at the ministry and unless we do something about it, we’re going to continue to get the same thing,” Dr. Darley Solomon told the Legislative Assembly’s Public Accounts Committee on Wednesday afternoon. He cited a “shameful disrespect” between private doctors and the ministry, as well as a lack of communication with government that he described as “unbelievable.”
Auditor General Sue Winspear’s report, which was made public Monday, stated the Cayman Islands government has neither the resources nor the information available to properly manage an increasingly complex healthcare system for its resident population.
Ms. Winspear’s office also noted in a secondary public interest evaluation released along with her healthcare system audit that private sector healthcare system users were increasingly shouldering more of the territory’s overall health costs in the past five years. Total health-related expenditures in the Cayman Islands increased by nearly 26 percent between 2010 and 2015 for private and public system users, the report stated.
Despite a total health-related expenditure of $269 million during the government’s 2014/15 budget year, Dr. Solomon said physicians were not getting paid any more for services rendered. Last year, the government announced that it would not increase standard health insurance fees – the rate doctors are reimbursed for services by insurers.
Those fees have not increased since 2005, and Cabinet decided against a recommended fee increase in November 2016. A consultant’s study of the fees recommended that insurance companies’ payments be increased by 12.3 percent and then reviewed annually after that. That consultant’s report was completed in late 2015 but was not released until a year later.
A government statement released in November 2016 said 139 doctors were asked to provide financial information for the study, but only 40 responded in any form and just 10 provided financial information.
“The government got a report, sat on it for a year … and they’re saying basically it was the doctors’ fault,” Dr. Solomon said, claiming that many private sector doctors were never contacted or were not given time to respond, even though they have raised issues concerning standard health insurance fees for years.
“The lack of communication with the ministry is unbelievable,” the doctor said.
Dr. Solomon said the head of the Medical and Dental Council, the appointed board that registers doctors, had repeatedly sent emails to government officials about the issue but did not get a response.
“That’s embarrassing. That’s embarrassing to my country, that’s embarrassing to my profession, and somebody needs to step up and say it,” he said.
Public Accounts Committee Chairman Ezzard Miller asked Dr. Solomon, who was appearing as a witness before the committee, how communications could be improved between the government ministry and private sector healthcare providers.
“I am seriously perturbed professionally by what has been going on for the last five to 10 years,” Mr. Miller said.
Dr. Solomon, a former chairman of the Medical and Dental Council and former president of the Cayman Islands Medical and Dental Society, said the issue came down to accountability. He said it did not appear to him that Ministry of Health management “felt compelled or curious” about what the chairman of the Medical and Dental Council or the president of the Cayman Islands Dental and Medical Society thinks of healthcare.
“It’s frustrating to see the way the leaders in healthcare treat physicians,” including doctors at the Health Services Authority and private physicians, Dr. Solomon said. “It’s time for urgent action. This sore has been festering for too long.”
‘Separate and unequal’
Dr. Solomon also told the Public Accounts Committee that a number of local physicians were concerned about what they saw as “separate but unequal” medical professions in Cayman – referring to certain concessions the government has provided to Health City Cayman Islands, which opened in early 2014, that were not offered to other private practitioners.
Dr. Solomon said he did not want to be an “obstructionist” to Health City, which he hoped would serve to improve healthcare standards in Cayman. Also, he found it hard to argue with the hospital’s results in treating children from around the world for congenital heart defects. Since the hospital opened, more than 60 children from Haiti alone have undergone surgeries at Health City that they could not otherwise afford.
“You have to appreciate good medicine. [The deal] was done wrong, but hopefully, Health City is going to help us to increase our standards here,” he said. “I don’t blame Health City. Any businessman is going to do anything they can to increase the bottom line. Where is the ministry? Who’s holding them accountable?”
Continuing hearings on both Thursday and Friday touched on a range of subjects in the Auditor General report, with testimony from Cayman Islands National Insurance Company CEO Lonny Tibbetts, Health Services Authority CEO Lizzette Yearwood and HSA Medical Director Delroy Jefferson.
Among the topics were escalating healthcare costs and lagging changes to the HSA’s “chargemaster” price roster; the challenges of gaining malpractice insurance and Mr. Miller’s suggestion the authority create a captive health company; collection of statistical information from medical tourism practitioner Health City as part of efforts to build Cayman’s medical database; government funding – approximately $100,000 per year per medical graduate – for internships, and possibly extending training to hospitals in Jamaica and Barbados; and “capacity building,” recruiting and training Caymanian physicians to meet future needs.
When contacted by the Compass, Ministry of Health Chief Officer Jennifer Ahearn declined immediate comment on Dr. Solomon’s remarks, saying, “Given that the PAC hearings are on-going, I think it would be premature for the ministry to comment at this time.”
Mr. Miller adjourned the committee Friday afternoon, saying the group would reconvene at 9 a.m. on Thursday, Feb. 9.