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Doctors sceptical over reworked health Bill

Contentious legislation aimed at regulating private healthcare providers and the equipment they use is due to be retabled in Parliament in November but some doctors fear they still won’t be happy with the reworked Bill.

The Royal Gazette understands that after a number of meetings between Bermuda Health Council and a physicians’ working group over the summer, the Bermuda Health Council Amendment Act 2016 has been altered to alleviate some of the concerns which led to the bill being withdrawn from the House of Assembly in July. But the council is said to have dug its heels in on various sections of the bill and doctors still aren’t clear which pieces of equipment will fall under the Act.

The legislation originally tabled in the House referred to “high-risk technology” and listed CT scanners, MRI machines, X-ray machines, radiation-emitting equipment, diagnostic imaging machines, laser or surgical equipment, medical imaging equipment, nuclear medical instruments or devices, dialysis machines, and equipment that uses sound waves.

But a source, who spoke to this newspaper on condition of anonymity, said a clear enough definition of what high risk meant was missing from the Bill and still hadn’t been shared with physicians.

“There are some points they have agreed with but there’s a few in there which they simply won’t change,” said the doctor. “[For example], the jail sentence for a doctor who imports a piece of medical equipment without permission.

“It’s heavy-handed and the definition of what constitutes ‘high-risk’ technology has still not been decided upon. The medical community is being asked to approve of something for which critical definitions have not yet been finalised.

“An MRI machine is simply not an example of high-risk equipment. It may be expensive and hi-tech but not any more dangerous than an ultrasound.

“The examples [the health council] gave weren’t high risk at all. They want to try to limit technology. It’s medieval. They are rushing this through and it needs far more input and time to get it right than a few months of consultation. There’s a consensus out there that this is heavily biased and is very oppressive to private medical institutions in Bermuda.”

The Act and two accompanying sets of regulations are aimed at giving the health council powers to control the entry of high-risk technology and monitor “self-referrals”, ie instances where doctors making referrals for tests financially benefit from the tests.

Ricky Brathwaite, programme manager for health economics at Bermuda Health Council, said earlier this month that current checks being conducted on medical equipment were inadequate and did not guarantee public safety.

But Ewart Brown, the former Premier and owner of two clinics which have MRI and CT scanners, said the proposed new regulations were unnecessary and an attempt to hurt black-owned businesses, including his — a charge vehemently denied by Dr Brathwaite.

The source who spoke to this newspaper said the health council stood to make a great deal of money from the 2.5 per cent fee it was proposing to charge medical facilities each time they applied to import a piece of “high-risk” medical equipment, with no guarantee that their application would be approved.

He said MRI scanners would typically cost about $2 million, meaning the council would get $50,000 apiece. That extra cost could deter doctors from making the investment, claimed the source, arguing that more scanners would surely drive down the cost of an MRI scan.

King Edward VII Memorial gets about $1,600 from insurers for every scan it conducts and private practitioners get $1,300.

Dr Brathwaite has said the regulations are aimed in part at tackling rising healthcare costs but the source said that didn’t make sense since local physicians only made up six per cent of total health expenditure on the island, according to the health council’s own figures.

“I ask myself what’s driving this legislation,” said the doctor. “It just doesn’t make sense to go for the thing that is not your biggest cost.”

Tawanna Wedderburn, the health council’s chief executive officer, was offered the opportunity to comment on Thursday. She said an update on the changes to the Bill and regulations would be provided in the next few weeks.

“The health council is still making changes to the legislation and it would be premature to comment on the changes at this time.”