EDITORIAL – Public health agency needs policy reform, not personal attacks

By now, the troubles of the Health Services Authority are well-documented and well-known. Everyone in the Cayman Islands is aware that years of mismanagement at HSA have resulted in uncollected debts, cash shortfalls and other problematic “symptoms” about which we editorialized just last week.

We see two potential courses of treatment for the HSA. The more radical prescription would be to get government out of the business of delivering healthcare, and to devolve that function to the private sector. (Under that model, the public sector would retain the responsibility for ensuring everyone has access to quality healthcare, but the services would be delivered by private physicians and healthcare professionals.)

We don’t sense that the political will exists for that particular solution, at least for the time being.

That leaves the second option: Uniting as a country behind our public healthcare system and working together to ensure that it produces satisfactory patient outcomes without bankrupting the treasury.

Earlier this month, HSA leaders were brought before the Legislative Assembly’s Public Accounts Committee to face tough questions from PAC members, particularly MLA Chris Saunders. At a follow-up hearing this past week, HSA leaders — including CEO Lizzette Yearwood and board chairman Jonathan Tibbetts — demonstrated evidence of a willingness to make necessary changes, and provided positive updates on stepped-up bill collection efforts and moves to write off some of the “bad debt” that has been plaguing the agency’s balance sheets.

Healthcare officials also described policy and procedural changes designed to forestall future financial issues.

Mr. Saunders and the PAC may have done Cayman a good service by highlighting problematic practices at the HSA and demanding straight answers from those in charge. But now, the treatment should be given the opportunity to take effect.

It is neither reasonable nor helpful to attempt to make “political hay” out of the HSA’s historical shortcomings for personal gain.

And it appears, at least to us, that is precisely what Mr. Saunders did last week when he took a “second bite” out of the HSA. Of particular concern is his questioning of the professional credentials of individual HSA officials, most notably the entity’s chief financial officer.

Either intentionally or out of ignorance, Mr. Saunders misrepresented the qualifications of CFO Heather Boothe, disputing her accounting pedigree and stating that she was appointed after a brief consultancy. (Ms. Boothe has a degree in economics and management, and possesses the relevant professional accounting certifications. She was initially hired as a finance officer, and then years later was promoted to CFO following a formal interview process.)

If those “misstatements” weren’t enough, Mr. Saunders went on to label her as the dependent wife of a doctor at the hospital, who had been in the home for two years before going to work for the health authority, and then – as a matter of course – speculated on the ubiquitous but elusive “qualified Caymanians” who could have gotten the job instead.

Mr. Saunders’ statements were misleading at best, and they smack of sexism and nativism. For a sitting MLA, that sort of language is ungentlemanly, unworthy and unfair.

Perhaps the freshman lawmaker requires a reminder from his more veteran colleagues that there is a clear line separating MLAs from the civil service. Decisions on human resources and the particulars of individual employees are well outside the remit of legislators – and, as we can see, for good reason.

In the future, Mr. Saunders should keep his focus on shaping policies, rather than playing politics, and should refrain from making personal attacks on individuals who do not enjoy access to an equivalent public platform or parliamentary protections – particularly when he’s in error.


  1. Our hospital needs to go private and sell to the bidder that will allow Caymanian poor and elderly to get free medical and dental service. End of discussion, it has only benefitted Insurance companies and they are fleecing the country. If the UK can do it, then why not us? People do not make a proper cost of living income . Only Gov’t workers do and there is too many fleecing that system also. Lets negotiate a deal that benefits the people who are spending all of their money on unnecessary inflated prices on food ,utilities, health etc.

  2. As an accountant I am bemused by the comments of Mr Saunders By suggesting Mrs Boothe should have worked with a major accounting firm. Actually there are none, they are major audit firms. Perhaps Mr Saunders can advise the public as the the big firm he worked for. Moreover had Mrs Boothe worked in a major audit firm she would be by now an expert in banking, hedge funds, trust companies and insurance companies. A fat lot of that is good for the HSA.
    Moreover these days accountants choose to go into the profession, industry or the government when they are immediately qualified. Clearly Mrs Boothe chose not the profession, and why not. Mr Saunders made the same decision.
    Mr Saunders needs to think wisely before placing boot in mouth.

    • You can’t be serious. Obviously you have never worked in a public accounting firm. It is also obvious you have no idea who auditors are, what they do and what education they must have to get a job. GAAP is the auditor’s bible, so to speak. And GAAP is Generally accepting accounting principles. All The Big 4 have offices in the Cayman Islands and each provides Audit, Tax and Advisory services. All require knowledge of GAAP.
      It is appears that you, just like many others are confused what qualified means. Getting a bachelor degree in accounting doesn’t make you a qualified accountant. You would not be even allowed to sit for a CPA exam. You need additional education. Getting a bachelor’s degree in any other field would also require credit hours in Advanced accounting courses. Once you satisfy educational requirements, you would be allowed to sit for a CPA exam. Passing the exam would give you a certificate that would certify that you have passed the exam. 500+ audit hours are required to apply for a CPA license. Those 500 hours must be certified by a licensed CPA. That is how it works.
      So Mr. Saunders is absolutely right. Mrs. Boothe should have started in one of the accounting firms moving progressively up to a senior manager position. Being a senior manager in a public accounting firm requires a CPA LICENSE, not a certificate that certifies that one has passed a CPA exam. From a senior position she could have moved to a health care industry, provided she was pursuing additional, industry related education, starting perhaps in a smaller than HSA organization as a controller.
      You can check the career steps of the Jackson memorial hospital CFO that is available on LinkedIn.
      Perhaps making public Mrs. Boothe’ CPE courses taken since she has become a member of ACCA would have provided more information about her qualification.
      “Accountants(who) choose to go into the profession” would not go too far without getting widely recognized accounting certifications.

      • Mrs Bell having been the managing partner of PWC and one of the predecessor firms Coopers and Lyrand in the Cayman Islands for a period of 31 years may I respectively say that you really have no clue about the audit and accounting profession. Just why should Mrs Boothe be educated in the big audit firm. As you know there are no big accounting firms. Moreover why should Mr Saunders have not been educated in a big so called accounting firm. What is good for the goose is good for the gander. By the way a senior manager in an accounting firm does not neccitate a CPA licence. You are belittling my colleagues who qualified in New Zealand, Australia, Canada, India, South Africa, Ireland, Scotland, Jamaica , etc. In most of these countries a CPA qualification is meaningless and such a person with that qualification will not be permitted to practice.

        By the way the UK accounting qualifications are recognized to be more superior than those of a CPA. An add point of course is that the CPA course does not include UK law, upon which Cayman law is based. US law is of no consequence in the Cayman Islands. Knowledge of UK law and its derivative, Cayman law is essential for a person holding the position of Mrs Boothe.

        In conclusion how can you possibly say Mrs Boothe should have been with a big so called accounting firm and Mr Saunders be exempt. The big firms do audits in Cayman with a bit of consulting and insolvency. They do no accounting work because their fees would be too costly.

        May I suggest you consult one of the big ten accounting firms to ascertain what services they provide. After all a little learning is a dangerous knowledge.

  3. Mr Miller, I am delighted that you favour the idea of Cayman having a UK style Health Service, but I don’t think you will get that by selling to a bidder!
    For your information, the NHS is paid for out of taxes, Cayman doesn’t do those! Other similar services are paid for by a Social Security levy, and as that is also a tax, I don’t suppose thats going to suit you either. I once suggested this course of action to a minister who loved the idea, until his colleagues told him no tax no way!
    Other ways include Health Insurance, and that does exist in Cayman, but you have to pay for that. The Cayman way was to form an Insurance company to provide cover for those that could not provide for themselves, it has the look of the NHS, because government would essentially pay the cost for those that couldn’t, a lovely idea, but it fails if government can’t or won’t pay, eventually the system collapses, and it seems to have done so, as i predicted it would the day it started!
    That last point is the reason why no “bidder” would be interested if they had to provide a free service to many of the residents, they would go bankrupt! No, a proper government has to admit it has responsibilities, and pay for them!

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