Local doctors have accused the Bermuda Hospitals Board (BHB) of putting profits before patients' well-being as they call for a review of the Hospitalist Programme.

A group of Bermudian GPs are in the process of appealing to the BHB for access to junior hospital staff, who they claim are providing them with no support. Instead, these junior officers have been ordered to look after only those patients who have relinquished their own GP in favour of a hospital-approved doctor.

In a recent letter obtained by the Mid-Ocean News from the BHB to island GPs, the Board stressed that, should a doctor choose to care for his or her own patient at the hospital, "house staff will not be taking care of the patient unless there is an emergency consult".

The unsigned letter, faxed en masse, includes a clause stating that even if a critically ill patient being cared for by his or her GP gets into "an extremis situation" at the hospital, the patient "will not be automatically transferred to the Hospitalist service, unless that is requested".

Local GPs now claim that the Hospitalist Programme is not living up to its initial promise: that each patient would be seen by a house doctor daily.

"The hospital has basically cut us off," says one Bermuda-born GP.

"Most of us wanting to admit our patients cannot do it without sacrificing their care. It's untenable. You've lost most Bermudian doctors in the hospital right now; they've brought them all in. All of them are internists. They're really just overseeing their junior staff. We were promised the benefit of the Hospitalist Programme was that these internists would see patients daily. I can't be sure that is happening."

This GP added that without enough ancillary staff, KEMH junior doctors find themselves doing simple tasks typically carried out by nurses.

"Junior staff are being overused for small things like renewing orders or drawing blood," he said.

"Nurses should be doing that but there are never enough of them. There is no benefit to the Hospitalist Programme. There are a lot of GPs not trained or not comfortable with hospital medicine, but this hurts those of us that are. We don't have the support no matter what the BHB says, and now we have added 'back talk' from nurses."

He added that a lack of support from hospital staff for his patients presents a serious danger, especially if those brought to the Emergency Room with a serious ailment have to wait overnight to be seen by a doctor.

"The big thing is that we need house officers to come down and see patients we admit," he said.

"If I admit a patient through the ER with, say, pneumonia, I have to go based on what an ER doctor tells me. I then have to wait to see them the next day. What should happen is that the junior staff sees them and reports back to me, acting as a middleman. The nurses are just not used to it and there are not enough ancillary staff. We'll never have enough nurses; the hours and salary are unattractive. There are places like California and Arizona where they are paid a lot more."

Another local GP agreed that the Hospitalist Programme needed an overhaul, claiming a "double standard" in favour of house officers.

"It's fair to say we were all in favour of the Hospitalist Programme at first because the island was short of medical specialists," he said.

"But some of us wanted to reserve the right to continue looking after our own patients and refer on the complicated ones. We now have a system whereby I look after my patients with no support from junior hospital staff.

"There's a two-tier admitting system. When I admit someone, I have to go in and write all the notes, then come back in the middle of the night because no one else is caring for these patients.

"I provide almost 100 per cent of the care. Prior to this I had full support and access to hospital staff. As GPs, we're very fed up. It's a double standard."

A Bermuda resident who experienced the downside of the Hospitalist Programme first-hand contacted the Mid-Ocean News after his wife suffered a stroke and waited over two days to be seen by a doctor.

"My wife was in hospital five weeks ago with a mild stroke," he said.

"From the time I took her to the ER, she was there two and a half days. As far as she was aware, the first doctor she saw was the one who checked her out on the final day. She asked to see her GP and was told she couldn't as she was under hospital care. It sounds crazy to me. Two weeks later I went to see my GP for a regular check-up and asked what this business was all about.

"He told me about the letter all GPs had received. If a GP wanted to see their patient, they could, but they would not have the help or support of hospital staff. This is a disaster. If you want to see your GP you should be able, and you should get all the help you need. Apparently the real kicker was the last sentence: 'This has been approved by the Premier'."

While a group of local GPs is currently is the middle of an appeals process, those who spoke to the Mid-Ocean News hold out little hope of a change to the system.

"We are in the process of appealing, but they're not going to change their mind," said one GP.

"The hospital is making a lot of money ¿ about $200 for a first time consultation in the Hospitalist Programme.

"They make so much money so they have no real reason to change it now. You're asking them to take money out of their pockets that they just put in there.

"It'll take a disaster with someone's patient for anything to change. It's financial."

The other local doctor added: "We're fighting it. We're not happy and we're not taking it lying down. We'd be happy if we were given back use of the junior hospital staff."

The BHB has defended both the programme and the decision to assign KEMH house officers to the hospitalists.

BHB chief of staff Dr. Donald Thomas III added that the Hospitalist Programme is intended to bring KEHM in line with healthcare organisations in the UK, US and Canada.

"We recognise that there has been some disappointment over the reassignment of the house officers to the hospitalists, but this development has been taken in the best interests of patients," he said.

"Our Hospitalist Programme has only been running for just over a month, however, and we will continue to listen to feedback from our physicians as we are all looking to achieve the highest quality of healthcare for patients in Bermuda."

BHB chairman Herman Tucker (pictured above) concurred, and promised that the board would review patient, physician and staff satisfaction each month based on feedback.