The Tribune

BEFORE the May 2012 elections, Prime Minister Hubert Ingraham toured the Princess Margaret Hospital’s state-of-the-art critical care unit, which by then was 95 per cent complete. The building contractor assured Mr Ingraham that the new unit would be ready by October of that year – only five months away. Construction had started in November, 2011. Everything was running smoothly and on schedule.

Money to complete the building and purchase the equipment was in place. As far as is known, the financing was to come from National Insurance funds. “At that time,” we were told, “no additional money was needed, except for the recruiting and training of staff.”

However, even staff training had started in readiness for an end of year opening. A 52-week critical care programme, accredited by the Royal College of Nurses in the United Kingdom, for the training of patient care assistants, anaesthetic assistants and emergency medical technicians was well underway.

The elections were held on May 7, 2012. By midnight that night, the Ingraham government was out and the Christie government was in. It was not long before the plans for the Princess Margaret Hospital’s Critical Care Block started to unravel.

From then until its official opening last month — January 22 – the magnificent building stood, lights on around the clock, but – despite last month’s hoop-la at its opening — nowhere near ready to receive its first patient. Already it was more than two years behind schedule.

And therein lies the scandal that — failing a Freedom of Information Act — should be thoroughly investigated by the Public Accounts Committee under St Anne’s FNM MP Hubert Chipman.

The 52-week training course, on its completion, was discontinued and the Bahamian nurses, now trained, were released or terminated. As of this writing – Saturday, February 28 — a number of hospital beds remain closed, and none of the six operating theatres is open. It is hoped they will be ready for opening in about two weeks time. It is understood that they can’t yet open for lack of staff.

All the political promises of first class critical care for indigent Bahamians is “just not so,” said one doctor. “It’s a tragedy, but it‘s just not so.” He doubted that the intensive care unit would be open to full capacity before the end of the year because of “lack of planning, the diversion of funds to other things, procurement problems, redesign of valuable space and making changes so that their people could get financial benefits.”

To have staffing and equipment in place did not seem to be a priority. Training of Bahamian nurses for critical care duties had stopped.

At the opening on January 22, former prime minister Ingraham urged “the government to engage as a matter of urgency all those persons trained” in the 52-week programme. It is understood that some of the Bahamian staff sent home are now being recalled, but because the training programme was discontinued there were not enough trained Bahamians, therefore foreign nurses had to be recruited. “Right now,” observed a doctor, “ the nursing staff is like a little United Nations.”

The new wing had been built as a critical care block – but it lacked the essential “step down unit,” which had been in the original plans. Apparently, someone in the new administration had the not-so-brilliant idea to turn what was to have been the “step down” unit into administrative offices. “Administrative offices in a critical care unit is unheard of,” said one doctor, concluding that whoever made the decision didn’t know what he was doing.

An intensive care unit is decided by the ratio of nurse to patient. For the seriously critical unit there would be two patients to one nurse, in the less critical — “the step down”— there could be three or four patients to one nurse.

With the removal of the “step down” instead of 20 available recovery beds there are now only 10. There should be 10 beds in the extra critical area, and 10 in the less critical or “step down.” And so for the patients on the surgical ward there are no beds for the less critical cases — instead there is an administrative block.

“Before the new unit was built,” said one doctor, “we had nine beds for intensive care, now, we have increased that by only one – we now have 10 beds” – elimination of the “step down” unit meant 10 lost beds. However, of the 10 remaining several are still closed because of a shortage of staff.

And even though the hospital was opened last month it is still not fully operational. It was probably forced to open because the questions being asked about it remaining closed for so long were becoming embarrassing. It would be more than embarrassing if the full truth were known.

However, one plus was the removal of the laboratory from the General Hardware building on Collins Avenue to a floor on the Critical Care Block thus assuring more efficient lab delivery and readings.

But there were other delays with Health Minister Dr Perry Gomez negotiating a $35m loan with CIBC bank for the purchase of equipment, and the disagreement between General Electric’s Bahamian suppliers, who it is understood had been granted the contract to equip the hospital, but was apparently being pushed aside by another local group close to the government. This in the end attracted the displeasure of the US government. Then there was the dispute with Cavalier Construction over constant design changes, construction delays, rising cost to the taxpayer and a claim for an unpaid bill of $5.5m.

Not to forget, of course, in documents obtained by Tribune Business the PHA’s $45m private placement launched last year showed the first phase of refinancing plans intended to repay a $55m Royal Bank of Canada loan plus provide the Princess Margaret Hospital operator with more working capital.

And then there was the dispute between the Public Authority and their managing director over the $48.3m fully subscribed bond which, according to Tribune Business in January last year, cost Bahamians several hundred thousand dollars in interest payments, because it was left sitting unclaimed in a bank account for over two months. With the bond proceeds sitting idle, these loans were not repaid and were still active, hence the additional interest payments that the PHA incurred to service them.

And now the government is coming to the Bahamian people with a new tax. This despite the fact that the Critical Care Block, reported to have had all of its financing in place with an opening date set for the end of 2012 or early 2013, has now opened more than two years late, but is still not fully functional. This time – so soon after VAT – a National Health Insurance tax has been announced to start in January 2016.

Government is now really testing the patience of the Bahamian people.

We suggest that the brakes be put on at this point and nothing be done about any new taxation until there is a thorough investigation of how taxpayers’ money has been spent – or misspent — on the PMH Critical Care Block that has cost many millions, but is still not in full operation.