Local doctor and Government MP Ewart Brown blasted a local insurance association after a letter came to light regarding the need for visiting overseas medical specialists and questioning his clinic's "integrity''.

The letter, dated July 29, 1998 and addressed to former Health and Social Services Minister Wayne Furbert, calls into question the necessity of having medical specialists from US-based Lahey Clinic visit the Island to treat local patients.

The author of the letter, Health Insurance Association of Bermuda (HIAB) president Judy Panchaud-White, states: "The concept of visiting specialists is a worthy one, however, without controls, it has led and will lead to further escalation in health care costs for the Island.'' The letter indicates that Mrs. Panchaud-White enclosed a copy of a Bermuda Health Care Services advertisement promoting visiting specialists.

And Mrs. Panchaud-White stated: "This type of advertising will encourage residents to book appointments without their own general practitioner concurring that such a consultation is medically necessary.

"Further, it may result in additional referrals overseas to the Lahey Clinic for follow up care and further testing.'' She questioned if the then-UBP Government was aware of any "financial incentive'' to Bermuda Health Care for the promotion of foreign specialists.

And Mrs. Panchaud-White asked: "Are these medical specialists medically needed in Bermuda? What procedures should be followed in order to determine what residents medically require the services of these visiting specialists?'' Mrs. Panchaud-White on Friday admitted that the HIAB was "very concerned'' about the overall cost of health care, noting that costs were rising at a rate of ten percent per annum.

But she said HIAB "fully supported'' the Oughton Health Care Review Report, found that Bermuda needed to establish overseas links with "Centres of Excellence'' to support the local health care system -- especially for cancer and cardiac patients.

She added: "Health care must not be rendered in a fragmented manner; links must be developed which can -- fully -- support Bermuda so that Bermudians and our guest workers receive quality health care at an affordable cost.'' And Mrs. Panchaud-White said she planned to express her concerns to the newly-appointed Health Minister Nelson Bascome.

But Dr. Brown stated: "Bermudians have the right to seek the best medical care available, and we don't think anyone has a right to question our integrity.

"What concerns me is that whenever I or some other professionals design something new, if people like Judy Panchaud-White cannot attack the value of the project itself, they start raising the question of integrity.

"We are at opposite ends of the care spectrum,'' he added.

Dr. Brown gave as an example: "It's like being upset because a brain surgeon is coming to town.. .what happened before he came? Bermudians died from brain tumours.

"The Bermudian public has a right to seek specialist treatment -- but in many cases, we suggest they get a referral from their family practitioner.

"Many doctors have boycotted the programme -- called "Quality through Linkage'' - because there is the tendency to allow politics to interfere with their patient's care.

"But less than a third of referrals to Lahey Clinic come from Bermuda Health Care and (in reference to Mrs. Panchaud-White's question about financial incentives for Bermuda Health Care) it's entirely none of her business.'' Then-Health Minister Mr. Furbert responded to the letter by saying it was not a direct attack against Dr. Brown or his clinic.

And he said he had "no problem'' with any business arrangement Dr. Brown might have with Lahey Clinic.

But he added: "There is no doubt that with specialists and new equipment coming into Bermuda, health care will cost more -- and that must be a general concern.

"As a country, we have to be concerned. No doubt Bermudians like the best, but specialists must be used appropriately,'' he added.

"(What Dr. Brown said) is true -- it is a right -- but we have to be aware of costs and be responsible as a Government and as individuals.'' Mr. Bascome could not be reached for comment.