Overtime 'scam' by doctors cost $38,000 in single month
The Bermuda Hospitals Board is haemorrhaging cash through unearned overtime payments to senior doctors, it has been claimed.
Complaints have been filed against one doctor accused of regularly walking off the job after completion of his rounds midway through a shift.
It was alleged the medic returned to the hospital at the end of his shift to “clock off” — and claim a full day’s pay.
Hospital sources said the practice was a “scam” in which medics are “milking the system” — and also put patients’ lives at risk.
Hospital administrators were accused of ignoring the waste after being alerted to the problem five months ago.
But a BHB spokeswoman said this week that the schedules were under review, although she added “hospitalists” — senior doctors — are sometimes required to cover heavy volumes of patients.
Rota records at King Edward VII Memorial Hospital revealed that six hospitalists were assigned to cover six wards between 8am and 4pm every day.
A medical officer — a junior role — is tasked with covering all six wards on their own between 4pm and 8pm, although a hospitalist is on call to deal with seriously-ill patients if required.
But documents leaked to The Royal Gazette show that all six hospitalists who worked the 8am-4pm shift were often authorised to work overtime to 8pm — even when a medical officer was on duty or available.
A rota that covered 30 days in June and July showed several hospitalists were allocated 12-hour shifts on two days, even though a medical officer was covering the 4pm-8pm shift,
All six hospitalists covered the six wards for 12 hours while none of the available medical officers were called in to work on three other days in the rota.
A single medical officer was at first assigned to cover the 4pm-8pm shift on another day.
But when he notified superiors that he was unable to work, all six hospitalists on the 8am-4pm shift were told to put in four hours of overtime — to cover the single absence.
Concerns about the practice were raised with BHB management in July, but have yet to be tackled.
One medical officer pointed out in a July e-mail to deputy chief executive Scott Pearman and chief financial officer William Shields that the hospital could have saved $38,000 during the 30-day period if hospitalists had not worked unnecessary overtime.
In his e-mail, leaked to The Royal Gazette by an anonymous whistleblower, Seyon Kiriyadoss asked why all six wards could be managed by a single medical officer on some days, yet on others up to six hospitalists were assigned to cover the same shift.
He pointed out that he had been allotted the 4pm-8pm shift on June 30, and was to be the only medic on duty covering the six wards.
But six hospitalists covered the shift for him after he told the hospital he could not work that day.
Dr Kiriyadoss’s e-mail said: “If I was working on that day, I would have to cover all six wards and got paid for four hours.
“Since I was given off, six hospitalists were made to work four hours each and end up getting paid 24 hours.
“If a medical officer was scheduled to cover the wards from 4pm to 8pm instead of making six hospitalists work, BHB could have saved 24 hours of hospitalists’ salaries.
“How wise and cost-effective is that? Only someone who has enormous money at their disposal and is searching for ways to spend that money can take such a decision.
“Come on BHB, please revise our existing strategies to spend the budget efficiently and wisely. Leave alone the Covid crisis — how is this cost-efficient, even in a normal situation?”
The Royal Gazette has also obtained rotas and other records for March and April.
A single doctor was unable to come to work — and up to five hospitalists were given overtime to cover for him on five occasions over the period.
Hospitalists do work from 8am to 8pm every Monday, but for the rest of the week one MO is usually assigned to cover six wards.
The Royal Gazette spoke to two BHB employees, who asked not to be named, who claimed the issue had been swept under the carpet by management.
One insider said: “Everyone knows what’s going on and management just ignore it.
“If a medical officer isn’t available for a shift, it should be fairly easy to rope in another MO to cover.
“Instead, six hospitalists are asked to put in overtime and cash in for hours when there’s very little work to be done.”
A second worker added: “It never used to be this way — there are plenty of medical officers to cover the 4pm shift.
“But things suddenly changed six months or so ago. Now there are days when no medical officers are put on the rota and several hospitalists are allowed to put in 12-hour days.
“I don’t know why the policy seems to have changed. We haven’t been told why the rota is now being organised in that way, but it seems that hospitalists are now getting extra shifts and overtime, while medical officers are getting fewer.”
Dr Kiriyadoss’s e-mail also outlined his concerns that one senior medic had neglected patients by leaving work early and returning to the hospital several hours later to sign off.
He wrote: “I have witnessed instances where a hospitalist scheduled to cover a ward goes home after seeing all patients in their assigned unit, then returns to the hospital to clock out with his swipe card at the end of the shift.
“Understandably, one would sometimes need to step out of the hospital campus for a short period during a shift, but there is always a process to be followed.
“This particular hospitalist regularly leaves the hospital most of the weekends by midday and returns to swipe out at the end of the shift.
“Not once was an official e-mail sent out to advise who is covering during his absence.
“There was a day when he left the hospital at midday and returned to swipe out at 12 midnight. He has been doing this for several months, if not years.
“It means he is officially getting paid to be at work but is actually at home, which is highly unethical.
“More concerning, though, is who would be responsible if a patient’s condition suddenly deteriorated in the hospitalist’s absence.”
One of the two sources said that hospitalists could complete their rounds — and examine every patient on any given ward — by lunchtime. But they should remain on site and be available inside two minutes in the event of an emergency.
The source said: “Leaving the hospital and going home is definitely a no-no, even if you have a wingman to cover your back.
“Unfortunately, we have a system in which certain doctors are given carte blanche to abuse the system at the cost of the patient and the taxpayer.
“It’s a scam and doctors are milking it.”
A BHB spokeswoman said yesterday: “BHB regularly reviews use of overtime throughout the organisation and has started work on reviewing hospitalist and medical officer schedules.”
She also confirmed that hospitalists did sometimes put in extra hours to cover the absence of a medical officer.
The spokeswoman added: “But this decision has frequently been made against there being high numbers of patients, or more acutely ill patients, something which cannot be understood looking at the schedule on its own.
“This is, however, an area we are looking at as part of the scheduling review and, if we can make improvements that are less costly and maintain safety and quality, we will implement them.”
The Royal Gazette first put questions to the Bermuda Hospitals Board about an alleged overtime scam at the King Edward VII Memorial Hospital last Thursday.
Further questions were sent on Monday and Tuesday, along with a list of dates on which infractions were said to have happened.
A Bermuda Hospitals Board spokeswoman said that a review of schedules for hospitalists and medical officers was now under way late on Wednesday.
She added: “Work already is well advanced for reviewing and updating schedules for nursing – our biggest professional group.
“Meetings started this month on schedules for medical staff, including hospitalists and medical officers.”
The spokeswoman said that changes to the schedule were introduced earlier this year, when hospitalists were given more 12-hour shifts in order to “reduce double-time/overtime expenditures”.
She added: “The cost of staffing and use of overtime is a constant area of focus for BHB, even more so as we try to respond to the financial impact of the Covid-19 pandemic.
“Changes to the hospitalist and medical officer schedules had been made this year as a first step to improve patient care as well as reduce double-time/overtime expenditures. This included more scheduled 12 hour shifts for the hospitalists.”
The Royal Gazette highlighted the schedule for June 30 when asked to provide examples.
A single medical officer was at first assigned to work the 4pm-8pm shift.
A total of six hospitalists were drafted in to cover for him when he was unable to do so.
This newspaper asked: “The obvious question is, if that single MO can’t work, why isn’t he replaced by another MO? Failing that, why isn’t he replaced by a single hospitalist? Why do all six hospitalists need to stay on?”
The BHB did not answer the question directly.
The spokeswoman said: “There have been dates when hospitalists have stayed longer to cover an unexpected medical officer absence, but this decision has frequently been made against there being high numbers of patients, or more acutely ill patients, something which cannot be understood looking at the schedule on its own.”
The spokeswoman added that KEMH had been hit with staff shortages this year, along with a heavy workload because of the Covid-19 crisis.
She said: “Generally in 2020, our hospitalist and medical officer service has been impacted by being short staffed.
“This has been hard to remedy in the pandemic and required constant adjusting of schedules to ensure safe care is always provided. This has been the backdrop against which we have had to manage the immense workload of preparing for and managing services during the pandemic.
“While schedules help structure and plan work resources to meet needs, there are unexpected impacts that require in-the-moment decisions on how to ensure safe care is provided.
“We do our best to adapt to meet both the number of patients and also how sick the patients in the hospital are with appropriate physician cover.”
But the response did not pass muster with one hospital source who highlighted that rotas are drawn up for a month – and that hospitalists are given overtime shifts when the rota for the month ahead is first being compiled.
The source asked: “How does the BHB know at the start of the month that a ward will need extra staff on a particular day, when that day is several weeks away?”
The spokeswoman said: “We are also doing our best to respond to some very challenging financial restrictions as a result of the pandemic.
“Our focus is always safe, quality care, and we always remain open to improving and doing what is in the best interests of Bermuda and our patients.”
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