BHB withholds emergency department review records
Procurement paperwork for an external review of King Edward VII Memorial Hospital’s overcrowded emergency department will not be published until after the contract is awarded.
A Bermuda Hospitals Board spokeswoman told The Royal Gazette: “The procurement process is nearing completion. The procurement documentation will be shared, along with details of the contract awarded, after the process has concluded and in line with BHB's obligations under the Public Access To Information Act.”
The board was ordered by the Ministry of Health almost two months ago to find an external reviewer to conduct an “independent, focused operational assessment”, aimed at “immediate corrective action” after KEMH’s corridor care crisis was exposed by former emergency department chief Edward Schultz.
But a joint June 2 statement from the ministry and the BHB revealed that the contract had not yet been awarded.
Public authorities, including the BHB, often publish tender details or requests for proposals when seeking external bids for contracts, but that has not happened for this review.
Shadow health minister David Rogers said he was “concerned about the nearly two-month delay in the execution of the promised external review of the emergency department” and about the “limited communication and transparency surrounding the procurement process”.
Mr Rogers, a One Bermuda Alliance senator, said: “Given the significance of the issue, it would be reasonable to expect this process to be moving with greater urgency.”
He added: “It is not unreasonable for the public to expect information regarding the process being used, the timeline that has been established and when a reviewer is expected to be appointed.”
Ben Smith, the Opposition leader, has questioned whether a review of hospital “inadequacies” would cover patients who might have “suffered harm or loss of life” as a result.
Mr Smith said: “Former Chief of Emergency Services Edward Schultz, who served Bermuda for three decades and recently submitted a comprehensive report to the Ministry of Health and the Bermuda Hospitals Board, warned that overcrowding, patient boarding and bed shortages at King Edward VII Memorial Hospital create conditions that can lead to adverse outcomes and even death.
“Can the Minister of Health assure the public that no patient has suffered serious harm or loss of life as a result of the systemic failures identified in Dr Schultz’s report?”
He said he had queried David Burt, the Premier, on the subject last Friday in the House of Assembly and “received no tangible response”.
Mr Smith said his questions concerned patient safety rather than politics, and that the public deserved answers, with concerns to be independently examined.
He added: “The people of Bermuda have been frustrated for years about hospital overcrowding. This frustration existed well before the insightful report from Dr Schulz.
“Dr Schultz’s public communications have belatedly triggered some government action. But unless the independent investigation includes prior patient harm, the Government's response gives no comfort to people impacted by the hospital failures. The issue of patient harm requires urgent independent intervention with public transparency.”
A source with knowledge of BHB processes, who asked not to be named, said the review was “specialist” and so it was “not anything that anyone on the island can put their hand to”.
“You wouldn’t expect it to be advertised in Bermuda,” they said of the contract. “[BHB] would need to reach out to Canada, the United States or the United Kingdom.
“I suspect they have probably put it out to six or eight groups. It could well be a hospital that does the review or an accreditation group.”
Mr Rogers said: “I do understand the difficulty of the procurement process but there are some governance issues that are associated with blind or no-bid RFP projects.”
The Royal Gazette asked the BHB for the procurement paperwork but the spokeswoman declined to share it.
She did not respond when asked why it was being kept under wraps.
The joint statement described “a robust and expedited procurement process” to find an external reviewer “under the governance oversight” of BHB chairman Collin Anderson.
It also noted a reduction in the time patients admitted to the island’s only emergency department are waiting to be transferred to a ward.
BHB figures show that on a single day in February, the median time between an inpatient bed request from the emergency department and admission to a ward was 8,133 minutes, which amounts to about 135 hours or more than 5½ days.
On a single day in April, the time was 6,381 minutes — ie, 106 hours or more than four days.
The June 2 statement said that in May, admitted patients had to wait a median of about 20 hours before transferring to a ward, which was still more than three times the board’s six-hour target ― but represented a meaningful improvement.
Mr Rogers praised hospital executives for making public their target but suggested the six-hour target was “very ambitious”.
He questioned whether the reduction in wait times was more to do with the changing of the seasons than any specific actions taken by the BHB.
“To date, the only significant intervention publicly highlighted has been the identification of 12 additional beds in the hospital's old wing,” he said.
“While any increase in capacity is welcome, Bermudians deserve to know what broader strategy exists to address the underlying challenges facing emergency care and hospital operations.”
Dr Schultz warned in April of the serious risks associated with patients languishing in emergency department hallways — often referred to as boarding or corridor care — instead of being transferred to acute care wards.
The health ministry then issued a “formal” directive to BHB to take on an external provider for a review of the situation.
The emergency department crisis coincides with the BHB’s chief executive and president, Scott Pearman, being on extended leave. Judy Richardson, Chief of Nursing, is acting chief executive in his absence.
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