The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Public Hospitals Authority (PHA) has imposed strict payment controls “to preserve funding for urgent priorities” after “exhausting” its overtime budget within just three months of the current 2025-2026 fiscal year.

The operator of the Princess Margaret (PMH) and Rand Memorial hospitals, as well as the Sandilands Rehabilitation Centre, warned in a January 13, 2026, internal memorandum that with effect from this month all overtime payments for doctors, nurses, medical and other staff will not be processed unless first approved by the office of PHA managing director, Dr Aubynette Rolle.

The instruction has sparked concern among PMH staff, with Muriel Lightbourn, the Bahamas Nurses Union’s president, telling Tribune Business that it was placing healthcare “in a peculiar position” by seemingly implying that her members and other medical professionals may not be paid due compensation for overtime worked.

And Dr Duane Sands, the Opposition’s chairman and an ex-minister of health, while confirming he had seen the PHA memorandum said it exposed “unrealistic budgeting” as well as staff shortages at the three healthcare facilities. He added that the fall-out, especially if legitimate overtime compensation is denied, could impact the provision of healthcare services and quality of care to the Bahamian public if staff refuse to work extra hours because of non-payment.

Ryan Bastian, the PHA’s deputy financial controller, in the memorandum that was sent to all hospital administrators, financial controllers and their deputies, plus payroll departments, said the Authority is implementing “mandatory managing director approval for overtime payments”.

He wrote: “This memo serves as formal notice on the direction of the managing director [Dr Rolle], effective immediately (January 2026 pay period), that all overtime payments require prior approval from the managing director’s office before they can be processed.

“With effect from the January 2026 pay period, payroll departments are required to notify the managing director’s office of any overtime payable and obtain written approval from the managing director before any overtime amounts are entered on to the pay sheet and processed. Overtime payments are not to be included in payroll processing without the managing director’s written authorisation.”

Explaining the rationale for the move, Mr Bastian added: “As of September 2025, the overtime budget allocation has been exhausted. This control is being implemented to preserve funding for urgent priorities (for example, critical hires) and to strengthen oversight of overtime expenditure. Your full co-operation and strict adherence to this requirement are appreciated.”

Tribune Business efforts to obtain comment from the PHA before press time last night proved unsuccessful despite multiple calls being made and messages sent. While a response was said to be forthcoming, none was received before press time last night.

Dr Sands told Tribune Business that, besides likely exposing staffing shortages as a result of the 2025-2026 overtime budget being exhausted in just three months, the PHA memorandum is also “an acknowledgement of unrealistic budgeting”.

The Government’s own Budget data for the 2025-2026 fiscal year appears to back this up. While the PHA was allocated some $247.856m in Bahamian taxpayer funds, representing a $15.4m or 6.6 percent increase over the prior year’s $232.456m, the Authority had already spent $203.665m or 87.6 percent its 2024-2025 budget after just nine months.

At that pace, the PHA was on course to spend a total $254.58m for the 2024-2025 full Budget year, meaning it would have overshot its allocation by almost $22m. “It’s almost like budgeting $10 when you know it’s $100, and then the response is ‘see what you can make so with’,” Dr Sands said of the PHA’s budget and implications of the memorandum.

“The problem is, because you have not appropriately budgeted, you have to cut back on essential services. There are certain challenges because you are telling the staff to provide an essential service, and have to do the work, but can’t get paid. How is it you could exceed the budget knowing you have a shortage of nurses? It speaks to unrealistic budgeting that has serious consequences for service delivery.

“You basically have a service where there is no sustainable financing provided for the level of care you know you have to provide. It’s the same issue with National Health Insurance (NHI), the same issue with vendors providing goods and services for healthcare. It’s across the board services where you have so under-budgeted you have hobbled the services you are mandated to provide and paid to provide,” Dr Sands added.

“To go on and say you’re going to expand NHI, expand drug and pharmaceutical access… With what? Basically, the managing director’s office is going to be in the business of micro managing every single ward, every single shift. If I need someone to work overtime, I’ve got to get approval from the managing director’s office…

“It’s impossible to reconcile a scenario where you have an acknowledged shortfall of 400 nurses and other healthcare professionals but have not budgeted to make up that shortfall.”

Ms Lightbourn, the nurses union president, said she is seeking clarity from the PHA after members voiced concerns to her. “I trying to reach out first to Mr Bastian, the financial controller at PHA,” she said. “I have some concerns about that.

“So once I would have spoken to him, I would speak to my members because some of them have reached out already to me concerning it. I just asked them to give me an opportunity to speak to him, and then I will speak to them. 

“It did say, if we have any concerns, to speak to him, so I will first speak to him. I was trying to reach him earlier today, but I didn't get any response from him. So as soon as I reach to him, whether I get to him tomorrow or not, I will speak to my members.”

Ms Lightbourn said she is under the impression that if nurses work overtime they might not be paid for their services. If that is the case, she added: “Nobody is work for free.”

“It is a concern to me as it pertains to our members…. when we look at the fact that you're asking for overtime to be paid based on the managing director’s approval,” she said.

“So what you're saying to the nurses is if I'm called to do overtime, I work the overtime, that nurse work the overtime. However, if the managing director says, ‘Well, this can't be paid’, then what happens? The nurses don't get paid for what they work. 

“And so it's putting health care in a peculiar position, because as a nurse and as the nurses’ president, I would say to them, well, if they call you to work in overtime, you don't work it because you're not sure whether you're going to get paid, whether the managing director is going to say, 'Okay, I could approve that’,” Ms Lightbourn continued.

“Nobody is work for free. When you work, you expect to be paid. And that's exactly what it is. Especially overtime, because you're saying that, 'Okay, I'm going to take the time from my family’, all this other stuff, all these other things.The nurse could have a social life. You're taking time from her social life.”

Ms Lightbourn added: “My take, like I said, is overtime is something that the nurse can make a decision whether she wants to work it or not. And most of the time, when you work overtime, you're taking time away from your family. You're taking time away from a social life. 

“And so for me to work it and then be said that it's paid on the managing director's discretion, no. That's not cool. And even so, say somebody call in sick early in the morning. The shift starts at 8am for nurses, somebody calls in sick, say, 6.30am. Where are you going to find a managing director to approve that? Or are you saying that they work it, and then after they done work it, the managing director decides whether you're going to get paid for it or not? That's not acceptable

“And then even still, they're saying that the overtime that the nurses have already worked, that that is not going to be paid in January's pay stub,” Ms Lightbourn said. “You should not be able to make that decision when the nurses have already worked that overtime.

“So most of them, they're looking forward to that overtime on this payday. So you can't say it's not big. No, that's too definite. So I really need to have his understanding of that before we go any further with that, because I need to know and my members need to know.”