The Tribune

• Queries $290m outlay when ‘can’t use what we have now’
• Consultation warning: ‘No hospital without the physicians’
• Profession ‘baffled’ as left in dark; seeking minister meet

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

More than half of surveyed doctors feel the new $290m hospital is not “fiscally sound”, the Medical Association of The Bahamas (MAB) president said yesterday, as she warned: “There’s no hospital without the physicians.”

Dr Gemma Rolle, unveiling the initial feedback from Association members, told Tribune Business there were multiple unanswered questions over the proposed project including why the Government is investing hundreds of millions of dollars into “a brand new, state-of-the-art hospital when we cannot even utilise what we have now”.

Pointing to current staff shortages at Princess Margaret Hospital (PMH), which mean only four of its seven combined operations and endoscopy rooms can be used at any one time, she challenged why the focus is being placed on the Perpall Tract plans when the public healthcare system is struggling to “optimise the time and space” it presently has for surgeries and operations.

Besides fixing the system’s existing deficiencies, Dr Rolle told this newspaper that Medical Association of The Bahamas (MAB) members were “baffled” as to why the new hospital plans had been publicly disclosed prior to consultation with themselves and other healthcare professionals. They are now “eagerly awaiting” a promised meeting with Dr Michael Darville, minister of health and wellness.

Disclosing some of the initial responses to the 12 question-strong survey issued to MAB members, the Association president said of the 97 replies received to-date some 46 percent had said they were “confused” and thought “resources should be directed to optimising the current hospital system”.

This came in response to a question where doctors were asked to state their feelings on the new hospital given “the urgent needs for improvement at the current public hospital. A further 25 percent of respondents replied that they “need more information”, with just 16 percent branding the Davis administration’s plans as “exciting” and “a wonderful idea”.

As for whether constructing a new hospital is “fiscally sound, Ms Rolle said more than half - some 57 percent - either disagreed or strongly disagreed with this assertion. And over 50 percent believed the $290m, 200-bed facility will not help combat “issues of burnout, workload and resource shortages” in the public healthcare system, although 31 percent agreed it might help a little.

Doctor opinion was split over whether New Providence needs a new hospital at this time, with 45 percent backing the idea; 25 percent neither approving or disapproving; and 25 percent against. However, there was far greater unanimity over the perception that the Government had failed to properly consult physicians on a facility that will house maternal, child and adolescent care as well as diagnostics and a “hub for tele-medicine”.

If given the opportunity, 70 percent of respondents said they wanted to be involved in the planning and implementation of the new hospital, while 80 per cent agreed that Bahamian doctors should have a role in shaping its policies, procedures and practices so that physician concerns and needs are addressed in design prior to opening.

“It’s of paramount importance,” Dr Rolle told Tribune Business of the need to consult the medical profession on the project. “There’s no hospital without the physicians. We must be engaged. It doesn’t make sense if we are not.

“We are promised we will be approached once the implementation process starts, but that’s how concerned the MAB is by publicising a new hospital that the lion’s share of physicians had no idea was coming.... Many of us are baffled that the proposal has been published before even” consulting the doctors and other healthcare workers.

The MAB president read out various reactions from members, who she did not name, branding the situation as “cart before the horse” and saying they were “amazed” that the wider Bahamian public were informed before the doctors that will actually be responsible for using the new hospital and ensuring its success. One questioned why there was no push back, adding: “We take the whipping.”

Dr Rolle said some physicians who focus on child and maternal/woman care, which the new hospital specialises in, recalled discussions several years ago about developing a separate block at PMH to cater to these practice areas in a bid to drive down child mortality rates. The Minnis administration had planned to invest $55m in constructing such a facility, but the Government has now dropped those plans.

However, the MAB chief questioned why the Government was moving to develop a new hospital without first fixing the staffing shortages and other challenges plaguing PMH and the wider healthcare system. As an example, she pointed to the anesthesiologist department which has seen the retirement of several senior staff as well the departures of more junior members.

As a result, she said: “For the past two or three years, there’s been a declining utilisation of operating theatres.” Dr Rolle said this has, in practice, meant that only four of PMH’s six operating rooms and one endoscopy room have been “running at one time” due to the shortage of anesthesiologists able to administer pain relief and critical care to patients undergoing procedures.

She added that each operation room is supposed to have two personnel - a surgical technician, and a nurse - attached to it 24 hours per day, but there are only sufficient staff for three to four rooms to function simultaneously.

“These are the typical challenges,” Dr Rolle said, who explained she was very familiar with the operations room situation because she works in that area. She added that the Department of Internal Medicine, too, has been hit by the loss of staff including senior consultants, senior registrars and more junior members without being replaced, while there were delays in obtaining CAT scans, imaging and blood work results.

Asked about the staff shortage concerns surrounding the new hospital, the MAB president replied: “Do we have a number of qualified medical staff in the country? Absolutely we do. Are they in the public system? No, they’re not, and why are they not in the public system?

“Let’s put aside financial reasons.. If it was easy to work in the public system, more physicians would be there regardless. It’s very difficult to see good outcomes happen when you have limited resources and a partially functioning system.

“Do we have specialists in the country? Do we have physicians in the country? Yes, we do, but the public system is not conducive to retaining this talent.... If we cannot do procedures and surgeries, optimise the time and space we have now, why spend all this money on a brand new, state-of-the-art hospital when we cannot even utilise what we have now.”

Dr Rolle said it appeared that the proposed $290m hospital, which was initially targeted at child and maternal care “off the PMH campus”, has “blossomed into something else” by providing a wider variety of services than originally envisaged.

“We are really awaiting a meeting with the minister of health. We are eagerly awaiting it. He has promised it, and I do believe it will happen,” she added. “It’s important because there are physicians who are teetering on the edge of leaving the public system, where all it takes is one more bad outcome or just one more fatality to happen; one more reason to be frustrated or agree never to look back.

“It is important to respect, acknowledge and consider the physicians and stakeholders when these proposals are made because it may give incentive and reason for persons to be motivated and stay in the system to take care of patients who cannot afford private care.

“It shows we are being considered, we are being heard and our concerns are being addressed, and that will motivate physicians to stay in the system to make it even better,” Dr Rolle continued.

“It could save the country a lot of money to listen to people who work in the system all the time and how to get it better, as opposed to borrowing all that money for something that looks good on the outside but is dying on the inside when resources could be utilised elsewhere.”

The China Export-Import Bank, the state-owned institution which financed Baha Mar’s multi-billion resort, has agreed to fund the $290m hospital via a 20-year loan with interest at just 2 percent. The terms and conditions of the loan, including the involvement of Chinese contractors and labourers, is still being worked out ahead of a hoped-for September 2024 groundbreaking.