The Bermuda Hospital Board [BHB] has provided some answers to questions posed by the OBA’s Louise Jackson about the resignation of the former Chief of Staff Dr Donald Thomas, however the BHB did not release the reason for his resignation.
Dr Thomas was employed as Chief of Staff from 8 June 2008 to 1 October 2012. He was placed on “administrative leave” during this past summer, and formally resigned on October 1st 2012. The BHB have always declined to comment on what exactly prompted the “administrative leave” and resignation.
In a statement released yesterday Mrs Jackson asked a number of questions, saying “The BHB’s two-paragraph press statement announcing Dr. Thomas’s resignation is simply not good enough.”
“Its lack of transparency on this issue – aided and abetted by the Minister of Health – is exactly the kind of thing the Bermudian people have had enough of, particularly given that the controversy involves the management of millions of dollars of public money and the cost of people’s health care treatment,” continued Mrs Jackson.
The Questions & Answers are printed verbatim below:
Mrs Jackson: Why was Thomas hired in the first place given his questionable job history in California and licensing problems in Florida?
Dr Thomas’ appointment as Chief of Staff was announced in 2007. The release regarding his appointment outlines why and how he was appointed.
Mrs Jackson: Why was he suspended in the first place – and what procedures has the BHB put in place to make sure these problems won’t be repeated in the future?
BHB cannot detail individual matters. With regards to BHB procedures, certain accountability structures have been strengthened recently following the implementation of a Performance Management Framework.
Additionally, BHB’s planned Clinical & Corporate Governance Review will be looking at organisational strengths and weaknesses. BHB is very pleased that the Ombudsman of Bermuda has agreed to provide public commentary on the process and final report of this review.
Mrs Jackson: Why won’t the minister release Dr. Thomas’s salary information as required by the Bermuda Hospitals Board Act?
BHB Executive salaries have never been publicly disclosed.
Mrs Jackson: Was Dr. Thomas on fully paid administrative leave since being suspended in July?
BHB has previously confirmed that Dr Thomas was on paid administrative leave. It has acted consistently in line with its own policies and within contractual and national legal requirements.
Mrs Jackson: We understand that Thomas has a major role in the creation and operation of Health Partners Limited (HPL). Will the Minister explain HPL’s $714,000 loss which was cited in the most recent BHB financial statements?
HPL is a wholly owned subsidiary of BHB. The loss experienced by HPL in 2010-11 related to the costs of certain businesses in HPL being less than the revenue earned. The BHB Concierge service is in HPL and was primarily established to ease the journey for patients and their families travelling overseas, for example, for cancer treatments.
The revenues from this service in the year cited did not cover the cost of the staff and other operating costs. Additionally, an investment was made in Ultimate Imaging, which is a joint venture between BHB and the owners. BHB felt there was a benefit to patients to have a diagnostic imaging service in Hamilton and the JV was a more cost-effective way of establishing a presence rather than a new service.
However, in the fiscal year under review, the surplus from this service was less than the investment made. HPL’s financial statements are audited as part of BHB, and the 2010-11 financial statements for HPL are currently undergoing their own more detailed audit by the Office of the Auditor General.
Mrs Jackson: What role did Dr. Thomas have in redirecting patients away from many of the local healthcare diagnostic firms, as well as charities like the Bermuda Cancer and Health Centre, and putting these small businesses and their employees at risk of business failure?
The only direction of services BHB is aware of is through its own employed physicians. As has already been publicly reported in The Royal Gazette the clause in the obstetrician contracts that has them refer their patients for diagnostic services at the hospital is currently being reviewed.
It is vital to note that BHB does not want to put its competitors out of business. BHB believes it is in its best interest to collaborate with healthcare partners in order to find efficiencies across the system.
Mrs Jackson: The hospital has been the largest single driver of escalating healthcare costs in Bermuda in the last two years, which has caused every Bermudian to pay more. What role did Dr. Thomas play in the sharp increase in salaries at the BHB? What role did Dr. Thomas play in increasing specialist fees, some by 300 percent over the last several years?”
Specialist fees are approved every year by the House as part of the budget setting process for Standard Hospital Benefit. The increase in salaries in the 2010-11 financial accounts had more to do with increasing the number of employed physicians and other staff, which increased the services offered by the hospital, rather than a simple increase in salaries.
However, we are in agreement with the Hon. Mrs Jackson that in the current environment, BHB should – and is already – reviewing its service profile and physician specialty offering. Work is already underway, and physician contracts and subspecialties are included in the Clinical & Corporate Governance Review that is planned.
The BHB also said that “given the concerns raised,” they would like to provide and update of its Clinical & Corporate Governance so that there is clarity on its scope and how BHB will be made accountable to its findings.”
The BHB’s full statement follows below:
Bermuda Hospitals Board is today pleased to provide more detail about its planned Clinical and Corporate Governance Review. The Request for Proposal (RFP) has been made available internationally and the short-listing process will take place this month.
Venetta Symonds, Chief Executive Officer, comments: “We remain committed to updating the community throughout this process. We have to run the hospital ethically and responsibly to ensure our focus is on high quality healthcare services at the lowest cost. Our first step for this review is to ensure we find a quality, experienced organization that will be thorough and independent. Once the tendering process is complete, BHB will announce the successful company and provide a more detailed timeline for completion.
“In recognition of any concerns that the BHB has initiated and will pay for this review, I am pleased that the Ombudsman for Bermuda has agreed to be involved in the public interest. In accordance with the Ombudsman Act, she will have full scope to provide input to and question the reviewer or other persons and to review documentation. She will report to the Parliament and the public on both the process and the full final report of the reviewer. ”
The Clinical and Corporate Governance Review has been planned for the following reasons:
- To ensure robust corporate governance standards are in place
- To identify obligations and liabilities relating to the growth in the number of BHB-employed physicians
- To address concerns expressed in the community regarding quality of care
- To review preparations for the operational readiness of the new hospital facility
- To address BHB responsibilities of the National Health Plan
- To ensure financial preparations enable BHB to meet obligations of the KEMH Redevelopment Project, despite the economic challenges
- To review the transition to a new corporate management structure under the new Chief Executive Officer
The scope of the review includes the following specific areas:
- The Board and Senior Management Team – composition, team working, effectiveness
- Training, knowledge and information for members
- Board sub-committees particularly current Governance Committee and Medical Staff Committee
- Accountability, reporting lines and delegation of authority
- Transparency and disclosure requirements in addressing potential conflicts of interest
- Contractual and managerial arrangements for physicians
- Processes for providing assurance on Clinical Governance
- Robustness of financial and procurement controls
- Use of performance indicators and appropriateness to the delivery of organisational goals
- Use of benchmarking data
- Use of health industry efficiency tools e.g. demand and capacity planning
- Scope and effectiveness of risk management arrangements
- Ombudsman Disappointed With Hospital Review
- Video: ‘Eat Well Bermuda’ Launched
- Jackson Questions Dr Thomas’ Resignation
- Bermuda Hospitals Board 2011 Annual Report
- BHB Announces Patient Satisfaction Results
- Auditor General To Review Hospital Finances
Articles that link to this one:
- Health Minister On BHB/Dr Donald Thomas | Bernews.com | October 2, 2012
- Louise Jackson: ‘BHB Continue To Stonewall’ | Bernews.com | October 6, 2012