The Cayman Islands Health Services Authority has nearly 60 vacant positions which are either being covered through overtime expenses or left vacant, according to the authority’s chief executive.

Most of those staff positions are for clinical healthcare staff, such as nurses and doctors, Health Services Authority Chief Executive Lizzette Yearwood told the Legislative Assembly’s Public Accounts Committee this week.

Ms. Yearwood said auditors noted last year that the authority had a budget for 890 total staff, but only had 833 employees.

“[There is] difficulty recruiting our professional staff,” Ms. Yearwood said. “There are some positions that have been on our books now for a couple of years; oncologist [cancer specialist] is one that we’re just not able to attract the individual that we desire with the remuneration packages that we have.”

In other areas of the hospital, staff members are experiencing a high turnover rate. Ms. Yearwood noted this is particularly true in the nursing profession.

At the moment, the health authority is covering vacant nursing positions through overtime payments to fill-in staff members. The Cayman Islands Auditor General’s Office noted in a 2016 financial evaluation of the Health Services Authority that hospital system overtime payments had increased 310 percent in one year between 2015 and 2016.

Ms. Yearwood said the public hospital faces a different kind of recruitment challenge with its nurses and front-line clinical staff.

“With nursing staff, there’s a high turnover … in some other jurisdictions, they’re actually giving citizenship papers to certain professionals,” she said. “We’ve been trying to compete in that sort of environment.”

Deaths or serious illnesses had occurred involving other health authority staff members, Ms. Yearwood said, leaving their positions unfilled.

In its 2016 evaluation of the authority’s financial statements, the Auditor General’s Office warned the hospital system about overreliance on overtime payments to cover vacant shifts.

“Reliance on overtime to such an extent could have a detrimental impact on staff well-being and the quality of care,” Auditor General Sue Winspear said.

Prospect MLA Austin Harris, a member of the Public Accounts Committee, noted that the auditor general’s statement is not the first time concerns have been raised about hospital staff overwork.

“There have been certain suggestions before this committee that … the hours worked by your staff are having a detrimental impact on the patients at the Health Services Authority,” Mr. Harris said.

“I disagree with that” Ms. Yearwood said. “It has not come to my attention. If the staff [members] are tired, we definitely ensure that they have time in order to have some downtime. Overtime is shared amongst the staff; it’s not one or two individuals that do the bulk of it.”

Nursing and other clinical staff work 12 hour shifts, four days on and four days off, Ms. Yearwood told the committee. She said hospital staff have been spoken to about the longer shifts, but they have indicated they prefer the longer time off.

“We haven’t seen any difference in the work,” she said.

West Bay MLA Bernie Bush said that is not the response he has received in discussions with hospital staff. “Out of the 14 nurses I spoke to, 10 did say [the longer shifts] were a problem,” he said. “Being tired, being stressed … leads to, especially in the medical field, big mistakes. We’ve had our share of mistakes, even as much as we try to cover [them] up, we’ve had our share of mistakes at [the] HSA.”


  1. Who, if not HSA leadership must know about this occupational hazard:

    “Working nights is bad for your entire body. Researchers found that nurses working night shifts had a 15-18% greater risk of developing heart disease in a recent study in Chronobiology. This risk even applies to those with no prior illnesses. Now we have similar results in the brain with respect to stroke. Folks who work nights are simply under-compensated. Surgeons, hospitalists, intensivists, nurses, police, EMT’s, factory workers, fireman etc. face enormous health risks and occupational hazard. No one is talking about these risks. The hidden costs are massive. The amount of people chronically ill in these positions is now at un-precidented levels. Night shift premiums should be a lot higher and people who work night shift should receive “health spending accounts” to mitigate and offset the problems caused by circadian disruption. It is now published and well known that human mitochondria are all run by circadian signaling. Paying somebody a dollar more an hour to work night time is not adequate risk benefit ratio.
    Companies and organizations who employ night shift workers will hopefully become more diligent towards understanding the risks. Since 1986 I have worked shift work in my training and in my job. I had no idea that trade I was making at the time. I might have still done, it, but I would have liked to know the ledger for my health account and compare it to what I was getting.
    During all this time in training I worked in environments and rooms illuminated with artificial blue light.
    I understand night shifts are not going away anytime soon in the modern world. I do think these risks need to be negotiated apriori; economically they are believed to be necessary for many industries. It is time we do a better job and addressing this. If we don’t it can be expected that more people will fall ill, sick pay will continue to be high, and our costs will bankrupt the health care system. Ultimately we will all pay for it in one way or another in the long run.” ( Dr.Jack Kruse, a neurosurgeon&optimal Health educator).

    “….people who work night shift should receive “health spending accounts” to mitigate and offset the problems caused by circadian disruption.”

    For skeptics: The Nobel Prize in Physiology or Medicine 2017 was awarded jointly to Jeffrey C. Hall, Michael Rosbash and Michael W. Young “for their discoveries of molecular mechanisms controlling the circadian rhythm”. Life on Earth is adapted to the rotation of our planet. For many years we have known that living organisms, including humans, have an internal, biological clock that helps them anticipate and adapt to the regular rhythm of the day. Their discoveries explain how plants, animals and humans adapt their biological rhythm so that it is synchronized with the Earth’s revolutions.

  2. Ms. Yearwood and Mr. Harris,
    please read my comment (above).

    HSA staff face enormous health risks and occupational hazard. NOT JUST PATIENTS.

    Why Auditor General Sue Winspear has better understanding of this, but not HSA board?

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