Pati disclosure internal email
Brown not targeted by fees reduction’
Medical scan fees factbox
• The fee schedule for MRI and CT scans is set by the Ministry of Health for King Edward VII Memorial Hospital and by Bermuda Health Council for community healthcare providers.
• In 2017, under the One Bermuda Alliance administration, there was a change in the way the fees were calculated and a relative value unit methodology was adopted. According to a Ministry of Health spokeswoman, this was to enable the complexity of a procedure to be considered when setting a fee rate.
• The change resulted in far lower fees, which came into effect on June 1, 2017, and affected the hospital, as well as two clinics owned by former premier Ewart Brown.
• Compensation expected to total $3.6 million — $2.4 million to the Bermuda Hospitals Board and $1.2 million to Dr Brown — is to be paid to them as a result of the reduced fees.
• A new schedule which came into effect on November 1 last year raised the fees a little, but not back to the level they were at before June 2017. For example, before June 1, 2017, the fee for a “CT head limited study” was $1,642. It dropped to $275 on June 1, 2017, and rose to $365.70 on November 1 last year.
A top civil servant insisted that Ewart Brown was not being “politically targeted” by a reduction in fees for medical scans in an e-mail sent to a high-ranking colleague.
Jennifer Attride-Stirling, Permanent Secretary of the Ministry of Health, made the assertion in an e-mail to Tawanna Wedderburn, the chief executive officer of the Bermuda Health Council, soon after the new charges came into effect, about a month before the General Election in 2017.
The ruling Progressive Labour Party government has since described the slashing of fees as an “economic vendetta” by the former One Bermuda Alliance administration against Dr Brown and has given the former premier $820,000 from the public purse in compensation, with another payout of $420,000 expected.
But Dr Attride-Stirling, referring to consultation over plans to change the way the fees were calculated, told Ms Wedderburn in a June 12, 2017 e-mail: “I just wanted to record how long this process has been ongoing to add weight to the case to dispel the allegations of political targeting.”
Her comment, revealed under public access to information, appears at odds with a claim made by health minister Kim Wilson in Parliament in November that the “change in fees ... were imposed without warning or consultation”.
Ms Wilson, in response to a question from Opposition MP Patricia Gordon-Pamplin about how she came to conclude there was no consultation, added: “The information was provided to me by the technical officers who were intimately involved in that process at the time.”
David Burt, the Premier, added: “Is the technical officer lying?”
Ms Gordon-Pamplin, a former Minister of Health, replied: “Not lying, just misinformed.”
Dr Attride-Stirling and Ms Wedderburn are the two public servants likely to have had most dialogue with Dr Brown about proposed changes to the fee schedule for the diagnostic imaging scans he provides at his clinics, Bermuda Healthcare Services in Paget and Brown-Darrell in Smith’s.
The health council sets the fees for private providers and Dr Attride-Stirling was its CEO before she became permanent secretary at the Ministry of Health.
In another e-mail on June 12, 2017, she noted to Ms Wedderburn that a review of the fees began in 2012 and the first meeting with healthcare providers was in December 2013. Ms Wedderburn succeeded Dr Attride-Stirling as health council CEO in 2015.
The BHeC announced on December 7, 2018 a “separation of employment today between the council and its former CEO Ms Tawanna Wedderburn”.
No reason was given for Ms Wedderburn’s exit.
Dr Attride-Stirling’s e-mail to Ms Wedderburn was shared in a Pati disclosure by the Ministry of Health last year.
Also included was e-mail correspondence between Ms Wedderburn and Dr Brown.
Ms Wedderburn told the former premier in a May 18, 2017 e-mail: “The health council began advising Bermuda Healthcare Services about anticipated fee changes in September 2016.”
Dr Brown replied: “I must say that your definition of ‘consultation’ has always concerned me.”
He and his lawyer Jerome Lynch QC have said publicly that BHeC cut the diagnostic imaging fees “without any consultation”.
The health council issued a statement in January last year which said it was “incorrect for the Brown-Darrell Clinic to suggest that it has been targeted. The health council adopts the same approach to all service providers”.
Ms Wilson was taken to task in the House of Assembly on November 23 by Ms Gordon-Pamplin and OBA backbencher Jeanne Atherden about the expected $1.2 million payout from the public purse to Dr Brown. The Opposition members asked if private businesses adversely affected by the new sugar tax would also get compensation from taxpayers.
Ms Wilson said they would not, because they were consulted, unlike Dr Brown. Former Opposition leader Ms Atherden, who approved the reduced fee schedule when she was Minister of Health, said: “The minister is indicating that there was no consultation before the DI fees were taking place.
“I believe that this is incorrect because there was consultation ... I wonder how the minister came to that conclusion, that the sugar tax had consultation and DI did not.”
Ms Gordon-Pamplin asked: “Given that there will be no compensation for financial loss to businesses who have been similarly, negatively, financially impacted [by the sugar tax], is the minister suggesting that this is a special deal for family and friends?”
Prompted by Dennis Lister, the Speaker, she rephrased the question to ask why “preferential treatment” had been given to former PLP leader Dr Brown.
Ms Wilson replied that she had already answered questions in Parliament on the topic in February. The minister did not respond to a query from The Royal Gazette about whether there was any consultation.
A Ministry of Health spokeswoman said: “This has been discussed at length in the public domain and there is nothing more to add.”
Medical scan fees change: what they said
“We believe that the Government and the BHeC failed in that there was no consultation with the only stakeholder outside of the hospital who provides CT and MRI services, in contravention of any proper standard between state and citizen.
“Moreover, I believe that the Government, with the assistance of the BHeC, concocted a methodology that unfairly, grossly and negatively affects the only provider of such services in Bermuda: my clinics.
“It is difficult to see any basis for such methodology that does not lead one to conclude that its sole aim and effect was [to] target my clinic: that is also illegal.” — Ewart Brown, in a letter to then premier Michael Dunkley, on May 30, 2017.
“The formal consultation meeting with approved facilities, following a year of development which they were aware of, took place on December 13, 2013.” — Ministry of Health permanent secretary Jennifer Attride-Stirling, in a June 12, 2017 e-mail to health minister Jeanne Atherden, BHeC CEO Tawanna Wedderburn and BHeC health economics director Ricky Brathwaite, about the change in methodology for calculating diagnostic imaging fees.
“This conversion to RVUs has been in process for at least two fiscal years before I came to the council. I know ... the fee schedule was pulled at the last minute for FY (financial year) 2014 and that conversations and consultations took place well in advance of that.” — Dr Brathwaite, in response.
“Agreed ... I just wanted to record how long this process has been ongoing to add weight to the case to dispel the allegations of political targeting.” — Dr Attride-Stirling, in response to Dr Brathwaite.
“Thanks Jennifer for the history. We are challenged with finding written documentation of meetings. I do see presentations in the folders and will continue to look.” — Ms Wedderburn.
“OK. The presentations must definitely be on file and I likely have the meeting invite in my calendar. If push comes to shove, I have my handwritten notes of the December 13, 2013 consult meeting.” — Dr Attride-Stirling.
“Businesses will not be compensated for the financial impact of the sugar tax. There was public consultation before a decision was made concerning the sugar tax and businesses had time to prepare. This does not compare to the change in fees which were imposed without warning or consultation on DI (diagnostic imaging).” — health minister Kim Wilson in Parliament on November 23, 2018.
“Could the minister advise this honourable House how they came to the conclusion that there was no consultation when, in fact, there was?” — Opposition MP Patricia Gordon-Pamplin, during the same session.
“That information was provided to me by the technical officers who were intimately involved in that process at the time.” — Ms Wilson, in response.
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