Health Minister On Lamb Foggo Centre Closure

November 15, 2013

Health and Seniors Minister Patricia Gordon-Pamplin spoke on the BHB’s decision to close the Lamb-Foggo Urgent Care Centre in St. David’s today [Nov 15] in the House of Assembly.

The Minister said, “I have tried not to be inhospitable to the Opposition for their role in placing the BHB in this dire situation, however, when misinformation continues to emanate from their quarters, it is important to put the facts to the Bermudian people.”

lamb foggo urgent care center

“The construction of the UCC was two-fold. One, to provide readily accessible urgent health care to residents of the east end, and secondly, to ensure that the situation that obtained when Hurricane Fabian made the Causeway impassable would not disadvantage those east of the bridge who might need medical attention. It might be noted that another similar facility was planned for the West End, however, this never materialized.

“I believe that a sensible and visionary approach for the East End would have been to use the funding to make the bridge safe, as our hospital is twenty minutes away. It should also be noted that the people of St. George’s would have been equally unable to access this facility if the swing bridge was out of commission.

“It is also worthy of note that of the key drivers of the original plan, advanced by David Hill, the then CEO, Neil Rolfes, the then Chief Business Development Officer, Dr. Donald Thomas,III, the then Chief of Staff in conjunction with Kuron, the consultants brought in by the BHB, not one remains to ruminate on their plan, or the disaster left in its wake.”

“It was very clear, however, that the business plan dictated that a minimum of 8,182 visits would be needed for this establishment to break even. The reality is that an average of 5,500 people used the facility, and the people of Bermuda were left to pick up the shortfall, not directly through the consolidated fund, but through the resulting higher insurance premiums and higher costs of health care.

“The BHB has determined that this money can be better used to support other vital services that are needed nationally, such as Dialysis, Oncology, Diabetes and the Emergency Department. Government and all Bermudians want to see a safe, high-quality, patient-centered Hospital continue to provide acute-care services for all. The BHB is the only entity with the mandate to do so.”

Minister Pamplin’s full statement follows below:

Good Morning Mr. Speaker,

I rise today to provide a statement on the decision of the Bermuda Hospitals Board to close the Lamb-Foggo Urgent Care Center in St. David’s.

Much has been said in the public domain, and criticism has been heaped on me personally from all quarters.

Mr. Speaker,
On my ‘failure to consult’, I appreciate the Leader of the Opposition giving me the opportunity to remind the public and my parliamentary colleagues that this government in general, and this Minister in particular, will not shy away from making or supporting difficult decisions that are pragmatic and morally right, and will not fall prey to those things which are simply politically expedient. It is this approach that has cut this country off at the knees, and it is one that I will not perpetuate.

I have tried not to be inhospitable to the Opposition for their role in placing the BHB in this dire situation, however, when misinformation continues to emanate from their quarters, it is important to put the facts to the Bermudian people.

The construction of the UCC was two-fold. One, to provide readily accessible URGENT health care to residents of the east end, and secondly, to ensure that the situation that obtained when Hurricane Fabian made the Causeway impassable would not disadvantage those east of the bridge who might need medical attention. It might be noted that another similar facility was planned for the West End, however, this never materialized.

Mr. Speaker,
I believe that a sensible and visionary approach for the East End would have been to use the funding to make the bridge safe, as our hospital is twenty minutes away. It should also be noted that the people of St. George’s would have been equally unable to access this facility if the swing bridge was out of commission.

The business model for the UCC was based upon the government’s infusion of some $800K per annum, just for the facility to break even. During the PLP administration, NO FUNDING was allocated for operational consideration. Further, the inability of the BHB to get audited financial statements since 2010/11 would not have allowed the former government to have a clue as to the operating deficit of the entire hospital, never mind the UCC, and the necessity to fund the new acute care wing, in conjunction with plant operations for the existing structure, along with the crumbling infrastructure at MWI, has put further strain on the BHB financing.

It is also worthy of note that of the key drivers of the original plan, advanced by David Hill, the then CEO, Neil Rolfes, the then Chief Business Development Officer, Dr. Donald Thomas,III, the then Chief of Staff in conjunction with Kuron, the consultants brought in by the BHB, NOT ONE remains to ruminate on their plan, or the disaster left in its wake.

It was very clear, however, that the business plan dictated that a minimum of 8,182 visits would be needed for this establishment to break even. The reality is that an average of 5,500 people used the facility, and the people of Bermuda were left to pick up the shortfall, not directly through the consolidated fund, but through the resulting higher insurance premiums and higher costs of health care.

The Hospitals Board clearly articulated the position in their press conference last week, and I reiterate some facts of this situation:

  • The Lamb Foggo Urgent Care Center [UCC] was running at a loss. On average, only 14 people attended per day, which amounted to about 5,500 persons per year. This attendance included many people who bypassed KEMH in favour of shorter wait times at the UCC, hence this service was not in reality, an East End service, but rather, morphed into a service that was simply ‘not KEMH’This volume was not sufficient to cover the operating costs of the facility. The UCC has sustained significant losses since its inception:
    • For Fiscal Year 2009/10, the loss was –$103,725
    • For Fiscal 2010/11, it was –$350,000
    • For Fiscal 2011/12 it was –$309,494 [unaudited]
  • In Fiscal Year 2012/13, once all of the allocations relating to that cost centre have been applied, such as medical insurance, personnel costs and coverage provided by Emergency Personnel covering staff leave, unaudited indications are that there will also be a loss.
  • The daily out-of-hours service catered to people with urgent, not emergency, needs. People arrived at the UCC mostly with sprains, cuts, bumps, bruises or needing basic x-rays, and under the current availability of the service, you are only allowed to be sick between 4:00 p.m. and midnight.
  • By ceasing the UCC service, people do not lose access to care. The options they have now still exist, including:
    • Travelling to the Emergency Department if needed, or
    • Visiting their own General Practitioner [GP]
  • By ceasing the service, however, BHB is able to save about $250,000 a year. The service itself cost at least $2.5 million to run.
  • The BHB has determined that this money can be better used to support other vital services that are needed nationally, such as Dialysis, Oncology, Diabetes and the Emergency Department. Government and all Bermudians want to see a safe, high-quality, patient-centered Hospital continue to provide acute-care services for all. The BHB is the only entity with the mandate to do so.

I am confident that when presented with the facts, Bermuda will choose financial prudence, quality and sustainability.

The Bermuda Hospitals Board (BHB) is currently reviewing its costs and activities with a view to improve efficiency, improve quality and to raise patient satisfaction. However, it is no secret that BHB is facing a shortfall of funds by the end of this fiscal year. This is combined with the requirement to meet the obligation to pay the first installment for the new acute care wing of the hospital in 2014.

Mr. Speaker,
We all know that times are difficult. And the BHB is no different in needing to tighten up in areas of expenses. The BHB is also currently working to improve controls and enhance its Corporate Governance. One of the important decisions the BHB Board needed to make was surrounding the UCC. We have been advised that there are many more difficult financial decisions ahead, some of which may be supported by this government, and some may not.

To suggest that the OBA government is using two of its members who sit on the board to somehow make the decisions is just patently false.

Mr. Speaker,
The public were justifiably concerned about the short time-frame between the announcement and the expected closure of the UCC. However, in fairness, the BHB has made statements about its financial health and the need to reshape its services over the past several months.

Clearly the residents of the East End of the island appreciated the Urgent Care Center. No one disputes that. However, if we look widely at what is appropriate for Bermuda’s healthcare system, and for all of Bermuda, it is also clear that managing costs is the priority.

  • In 2012/13, the cost per patient visit at the UCC was $422. This was nearly double the cost of a primary care visit in Bermuda.
  • In contrast, a visit to the Emergency Department for a minor illness or accident visit would be between $276 to $392, not including the diagnostic tests. In other words, the care provided at the UCC can be more efficiently provided elsewhere.

The evidence that healthcare costs should be addressed urgently is that Bermudians have long found it difficult to afford rising healthcare premiums. In part, this decision to close the UCC will have a positive impact with respect to premium increases and will affect all Bermudians.

Mr. Speaker,
Two other important questions still remain unanswered:

1. What will happen to the UCC building and facility that received substantial investments to be developed?

2. What will happen to residents in the East End in the event of an emergency situation, such as a natural disaster or incident at the airport?

First, both the BHB and the Ministry recognize that while BHB cannot run a viable service from the facility with the current business model, another provider may be able to operate from the site at lower cost. For example, primary care providers are not as expensive as Emergency Department personnel. For this reason I have been personally working with the BHB to review alternative uses of this facility.

In fact, while the Opposition was making political hay out of the dire situation that they created, I was discussing possibilities for this facility with individuals who I hope will be able to provide a service. Time will tell if the overtures yield success.

Second, the safety and access to healthcare of East End residents in the event of a hurricane or other disaster is of great concern to us all. We are especially concerned about the provision of care when the causeway goes down. Clearly there is no medical alternative on the East side of the causeway at those times. These are issues of national importance and should be addressed accordingly.

Government has a National Security Disaster Committee to look at these issues. The Committee is considering how we respond to disasters and will consider how this changes if the UCC facility is not available. These issues need to be discussed at the national level in partnership with all emergency and first response personnel and this work is already underway.

Mr. Speaker,
I am sure you will agree that it is painful to have to acknowledge that over $5million was spent in the construction of this facility, and a further $2.5M on outfitting this facility. If we can make lemonade out of these lemons with a concept that could work, with or without BHB involvement, this government, with the support of the Bermudian people, is willing to try.

In closing, Mr. Speaker, I want to assure the public that the Government will continue to evaluate any recommendation put forward by the BHB and its Executive team to ensure that the health needs of our entire community are well served on an equitable and sustainable basis.

Thank you, Mr. Speaker.

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Comments (27)

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  1. LaVerne Furbert says:

    Bernews, is this the amended version of the Minister’s Statement? I know that the Speaker had to chastise her on more than one occasion this morning, telling her she would out of order and that she should remove certain statements from her statement.

    • Victor says:

      Or in other words, the Minister was not permitted by the PLP leaning speaker to tell the whole story. Suffice to say, it was a Donald Thomas project so undoubtedly the project was effected with the utmost of integrity. By the way, can I sell you a bridge in St. Georges?

      • LR says:

        Actually no, in Parliament, a ministerial statement is for government policy, not political attacks.

        • Victor says:

          Indeed, just like such eminent statesmen as for instance Dr. Ewart Brown ,Ms. Renee Webb and Col Burch did during their day. Now, about that bridge for sale, a second one for not too much more can be thrown in too.

    • swing voter says:

      she should have simply removed all references to PLP failures and inserted ‘Donald Thomas and the then BHB failures’

  2. Islander says:

    Exactly Ms. Gordon-Pamplin

    • understand much says:

      $250K a year is less than they are paying for their official CFO to sit at home a collect a full salary while on “administrative leave”….when is that situation going to be resolved? The current CEO of the hospital was very much a party to the UCC development as well as the orgy of spending on the “needs” for the new acute care wing….Bermuda may not have had a new hotel built in years but this place will put a hotel to shame once it is done.

  3. Truth is killin' me... says:

    If you ask me…this whole island is “OUT OF ORDER!”

  4. Funny says:

    Hold on, this place is only open 4pm to midnight?

    • Susie Quattro says:

      Yep. And it only gave first aid. All that stuff about it “saving lives” was just nonsense. If you had anything life-threatening you had to go to KEMH, whether it happened between 4.00-midnight or not.

  5. Common Sense says:

    If the LF care centre is not sustainable economically it has to be closed! This again was another short term vote winner put in place by the PLP which the island could not afford in the long term, just like the fast ferries. They look great and win votes, but they lose money over the long term!
    I understand why residents in the East End may be upset, but 20 minutes to a hospital would be considered a luxury in most parts of the world! If they are concerned about access to an emergency facility when the causeway closes, why dont we have some medical personnel and an ambulance moved to the east end before the causeway is closed? We could have a small facility set up there with basic medical equipment, to be manned only in an emergency. Its not rocket science, its common sense!

    • What Grinds My Gears says:

      Agreed. What you just suggested is already done by the Bda Regiment. Not only are trainined medical personal stationed in the east end prior a hurricane making landfall, other support elements are also included. BUT WAIT, there is no need for the Regiment.

    • The Fact says:

      Agreed but already being done. For every forseable huricane that threatens Bermuda, the Regiment and other Emergency personal set up a facility in the East and West End in order to assist wherever needed.

  6. swing voter says:

    Close it….use the infirmary at the AirPort fire station for emergencies in the east end. The EMT firemen are trained in advanced first aid until an ambulance arrives.

  7. Missed Opportunities says:

    BHB management could have collaborated with community physicians to redirect outpatient services such as laboratory and radiology services from King Edward to the Urgent Care Center. This could have covered and passed the “break even” mark. However, since BHB is now capped by Government, it does not make sense to do this. Might as well rent out the Urgent Care Center to generate income to cover some of the cost associated with the new acute wing.

    • hhmmmm says:

      There might be too many private laboratories and radiology services in the community competing with BHB Sometimes competition is good but to what extent will it harm the only hospital on the island and possibly pushing health care costs up even more?

  8. Realist. says:

    Good job Minister Pamplin Gordon!

  9. Cleancut says:

    The only reason why there is so much opposition to this facility closing is because of Lovitta Foggo. It was her brainchild.

    IT’S HER FAILURE IF IT CLOSES!

    • Come On Man says:

      She can have all the signatures she wants. But when it comes to $ they’re not gonna change their decision.

  10. Really says:

    Another expensive pipe dream by the plp

  11. Triangle Drifter says:

    And the hits keep coming!! Whats next? Will the fast ferries be forced to run at displacement speeds to save on wear & tear & fuel.

    Doc Done Deal went all the way to where was it, New Zealand, or was it Austrailia for a couple of those. How many went off on very expensive junkets to have a look or ‘training’ for those boats, never mind the chartering of a ship to get them here.

    We could have easily bought boats from builders in Connecticut, Louisiana, or eastern Canada for far less.

    A year later, the nightmare continues. Chickens roosting everywhere.

  12. Come On Man says:

    Why is it that Bermidians don’t support anything and when it’s taken away they jump up and down and complain. If the people at the East End used it instead of going to KEMH then maybe it will still be open.

  13. St. D says:

    As an urgent care centre, the clinic was handy – but this was only 4pm to midnight. But the numbers were so slow that KEMH emergency would tell people to drive down to St. David’s for faster service. People of the east did use the clinic – why on earth would we drive up to Hamilton to wait three hours if we could come to St. David’s and wait 30 minutes (apparently even if you are the only patient, the paperwork takes half an hour). The fact is the number of people living in the East does not translate into adequate numbers.

    As a walk in x-ray/blood clinic, too many people work and go to school in the centre of the Island and of course there are less people.

    The need that the Lamb Foggo Clinic did meet was it is ACCESSIBLE. As a family with a wheelchair user, many of the doctors office are not accessible. Or they are “accessible” but a little tricky to get into – whether the width of the doors, the little step at the entrance or the elevator that may or may not work. I loved going to the Clinic knowing that other than the door not opening automatically (gave the security guard something to do), we could sail in no problem.

  14. Ex PLP voter says:

    The PLP screwed us again.

  15. Alvin Williams says:

    This issue about the intended closure of the Lamb- Foggo -centre is similar to the debate over the end of conscription which will invariably lead to the end of the Bermuda regiment. We will not miss these entities until they are needed. And since the reality of Bermuda being time to time
    being hit by a hurricane; we will need a Lamb-Foggo centre if as has happen in the past the east end is cut off from the rest of the island with the lost of the causeway. Remember all the criticism over the introduction of fast ferries until they prove their worth in the wake of just such an occurrence. As to the Bermuda regiment; if Bermuda was hit hard by an hurricane with widespread destruction and massive dislocation; before the Americans could arrive and certainly the British with their one navel ship and energy biscuits even with on ship medical personal; the Bermuda regiment will have to play the role as a first respondent. All countries have an organize and trained security force. Lamb-Foggo; the Bermuda regiment all will be missed until the need is there.