WHEN Government delivered its first Throne Speech under the leadership of Premier Ewart Brown last November, there were few surprises for political pundits to seize upon. A Royal Gazette editorial the following morning declared that the new regime’s policy outline was heavy on rhetoric and that ideas needed to be “fleshed out”.But buried within the verbiage, the pledges to crack down on crime and to encourage positive lifestyle changes, was one cast iron, guaranteed promise - “Government will move to abolish the so-called Indigent Clinic at the hospital. Bermudians lacking financial means will no longer have their dignity undermined as a prerequisite to accessing basic and necessary healthcare,” Government trumpeted.

The Opposition was quick to question the shock decision, declaring that patients would lose out if forced to get treatment from private practices rather than the Government-funded one-stop shop.

A little more than four months on, that one Opposition grumble has snowballed into widespread public protests and an ongoing public relations disaster for Dr. Brown. Reporter GARETH FINIGHAN examines how the controversy has developed.

GOVERNMENT might not have anticipated such a backlash, but its decision to shut down the Medical Clinic was certainly a shock. Why? Because less than a year earlier, the same Government gave the facility its full backing through increased resources.Following extensive independent research and analysis, Government recognised that the clinic was providing an essential service - and that that service needed to be expanded rather than wiped out. It subsequently doubled the Medical Clinic’s hours of operation in December 2005 and last year recruited a third physician to deal with the steady flow of patients who, for whatever reason, were unable to get treatment from the private sector. Nursing staff were also upgraded from part-time to full-time.

Government has now backtracked on that policy, declaring patients can be treated just as effectively through private surgeries “of their choice”.

But rather than empowering the poor and sick, critics say patient care will be undermined under the new set-up. They argue that many patients are unable to make appointments at private surgeries because they don’t have telephones or transport. The clinic is also able to cater to “walk in” patients who show up without making an appointment, something that general practitioners are unable to do.

And many private clinics are also inaccessible to patients in wheelchairs, who will have to make additional journeys for medication or if specialist treatment is needed.

It is perhaps not surprising that, when the closure was confirmed last month - clinic staff were told that they will be reassigned to new jobs within the hospital in June, although Government has refused to confirm this - concern was transformed into action. A petition opposing Government’s decision is now being circulated and last week campaigners picketed the House of Assembly.

“People are still very upset about this, they’re wondering where they’re going to get their medical supplies, “Shadow Health Minister Louise Jackson said.

“It’s a bit like Government telling people that they are going to be moved out of their house without telling them when they will be moving or where they will be moving to. You just don’t treat people like that, particularly the old and the sick, many of whom don’t have anyone to help them.”

It is this lack of public consultation, a belief that the closure is unjustified, and a fear that services will be diminished under the new system, that is driving the current protest.

And so far, the Premier has failed to convince many patients on all three points of concern.

The only motive Government initially gave for the turnaround was that patients were having their dignity undermined.

That reasoning, expressed repeatedly by the Premier, appears suspect at best. Clients who spoke to this newspaper had nothing but praise for the facility. Furthermore, a 2003 survey of 130 clinic patients revealed that nearly 97 per cent were grateful for the clinic and wanted its services extended. Just four respondents said they would feel more comfortable visiting a private practice. It is not known if more recent surveys have been carried out or on what basis the Premier reached his apparently groundless conclusions. He did tell demonstrators last week that “we consulted the people through their doctors”, but that claim was laughed down. Round One to the critics?

In recent weeks the Premier has suggested another reason for re-routing treatment away from the clinic - that the current arrangement is not cost effective.

Again, critics and clients have scoffed at this notion, pointing out that, with all treatment facilities under one roof, the programme could not be run more efficiently. Free transport is provided to the one central location at King Edward VII Memorial Hospital and, once there, patients have an array of services and medications at their disposal. The Premier even conceded last week that, although the system was “rotten at the core”, it did run “very well”.

And again, critics have questioned how the Premier came to his conclusions. The clinic’s latest financial statements provided by the Bermuda Hospitals Board, cover the 12-month period from April 2005 to March 2006. In nine of those 12 months, the clinic was still operating on a part-time basis — the current full-time structure was not implemented until December 2005. As a result the average cost of each appointment under the new system cannot as yet be ascertained. Round Two to the critics?

Dr. Brown has also repeatedly insisted that services will not be cut.

“Let me assure the people of Bermuda that if I have to drive them to a clinic myself, they will not be without appropriate care,” he said last week.

“They will have access to doctors like they have never had it before.”

But that declaration appears to contradict statements the Premier made earlier in the week. Speaking to protesters outside the House of Assembly, he hinted that the number of appointments each patient is allowed could be restricted, and that even the least well-off will have to make some form of financial contribution. He also went on to attack the idea of the nanny state, saying that people should not be dependent on handouts.

“It’s important to understand what happens to people in a welfare state,” he said.

“I have lived in the US and seen what happens when people have their entrepreneurial spirit and ability to self-sustain taken away from them because the state came in to provide for them. We don’t want that and we are not going to have that in Bermuda.” Round Three to the critics?

Moving to reassure patients that the new proposal will be to their benefit, Dr. Brown said that, so far, six private surgeries had agreed to take on Medical Clinic patients. That detail has only raised another question - is it fair for Government to claim that patients will be able to visit the physician of their choice? One doctor, speaking on the condition of anonymity, said: “Currently patients can see any one of three doctors at the clinic, so he’s extending the choice from three doctors to six doctors - not exactly a huge increase in view of the fact that there are at least 60 private practitioners on the island.”

That one observation may well pull the rug from underneath Government’s current course of action. In order for the new system to be effective - and to keep to its promise of more choice - Government will presumably need the cooperation of private healthcare providers. They have so far remained silent on the issue and the>Mid-Ocean News understands that at least some are reluctant to condemn the move for fear of repercussions.

The one doctor who did speak out against the closure, Medical Clinic physician Catherine Wakely, was dismissed from her post the day after going public with her concerns.

But in a survey carried out a few years ago, it is understood that just two private practices said they were willing to open their doors to clinic patients.

So far Mrs. Jackson - like thousands of others - is unconvinced that the Premier can justify the closure of what he still refers to as the “Indigent Clinic”. She is even more adamant that patients will suffer under the new system.

“I am listening to the hundreds of people whose quality of life he is about to damage by closing the clinic,” she said.

“He doesn’t seem to care what they think or what they want and he is angry at me - name-calling even - because he doesn’t want me shouting facts from the rooftops that contradict the story he is telling.”

Referring to clinic patients, she added: “They would be perfectly willing for the clinic to be closed down if it was going to be replaced by something better. But Dr. Brown has no such idea in his head or he would have told us about it long before now.”

While Mrs. Jackson believes that the Premier is “making it up as he goes along” others have gone further, accusing him of conducting a one-man vendetta against the clinic. Health Minister Philip Perinchief has been completely invisible whenever the issue is raised. In an unorthodox move, when the Mid-Ocean News e-mailed fresh questions to the Minister this week, a spokesman referred us to Medical Clinic doctor Stanley James, who is also believed to be an associate of Dr. Brown.

Critics back up the vendetta theory by suggesting that the Premier, who runs his own private practice and is currently developing a second, is simply making up excuses to have the facility shut down.

Last month one of many patients thI>Mid-Ocean News has spoken to, asked: “Dr. Brown says that every patient should have their own choice of physician - well, my choice of physician is down at the medical centre - what gives Dr. Brown the right to deny me my choice just because he wants it closed down?”

The Premier may condemn the dependency culture of the nanny state, but his alleged response to that type of question - “even blacks resisted the abolition of slavery” — implies that, sometimes, he believes Government knows best. He may well be listening to the people, but is he really hearing what they are saying?