MLA takes aim at hospital’s management

| 10/10/2017 | 68 Comments

(CNS): The representative for Bodden Town West made it clear he was far from impressed by the answers given to the Public Accounts Committee Tuesday by Health Services Authority bosses. Chris Saunders, who is an accountant, said the numbers in the hospital accounts simply did not add up and he had serious concerns about the growing bad debt and management failings, and asked when anyone would be held accountable for the incompetence. He questioned the culture at the HSA and warned that during his term as an MLA he intended to look very closely at what is going on at the hospital.

HSA Chief Financial Officer Heather Booth was the first of a number of witnesses called to PAC to answer questions about the latest set of qualified accounts from the authority that appeared to show the hospital going backwards rather than forwards on the myriad financial and management challenges facing the local healthcare system.

Saunders said that he was looking for some comfort from the authority’s management that they understood the reasons for the audit qualifications, the auditor general’s concerns about the problems and how they could be addressed in future. But he said few of the witnesses were able to offer that comfort, as he queried how it was that the public could have any confidence in the organisation, which is being heavily subsidized by taxpayers, who are really paying for it twice: once through the public purse and again through insurance premiums.

“The numbers don’t add up,” he said, as he raised concerns about what he said was nepotism at the authority, which had to stop. “I don’t care what happened previously, for the next four years there will be an extra pair of eyes on the HSA …there is a culture in the HSA that is not in the interests of good governance and accountability and you will find yourselves back here and answering questions,” he told the CFO. 

Saunders claimed to be hearing too much about a lack of training and support at the authority, especially in the finance department, and “too much friend-friend going on”. He suggested the PAC would be asking the Office of the Auditor General (OAG) to look at the human resource’s policies, as he implied that poorly qualified people were being placed in jobs because they knew the right people.

He added that he was “not overly impressed by the responses” from the senior staff and he queried who was able to evaluate whether the accounts department at the hospital had the necessary skill levels it needed.

In a full day of witnesses, Saunders grilled the senior staff about the many financial problems, including the HR manager, who was taken ill during the proceedings and had to be admitted to the hospital.

Saunders pressed leaders on issues regarding the growth and management of the bad debt, as well as the massive amount of adjustables the OAG had to do to be able to audit the accounts, effectively ending up doing the work of the HSA’s finance department, he said.

Opposition Leader Ezzard Miller, who chairs the committee, also raised his concerns about the massive increase in the bad debt. After accumulating around $69 million over twelve years, he was concerned about how it leapt up to $122 million in the last two years.

The committee asked a lot about this dramatic increase, which CEO Lizette Yearwood said was down to a problem with the adjudication and dispute of claims with a major insurance company. Miller questioned why the authority was still not able to differentiate between debt that was difficult to collect, genuine bad debt that should be written off, and doubtful debt that might be recovered.

“I don’t want to say you are cooking the books but that’s what it looks like,” he said, pointing to the error of how debt is being recorded.

Saunders said the numbers coming from the HSA couldn’t be trusted and the conclusion was that the hospital has a major disconnect and does not know or understand where its revenue was really coming from, which he described as a “major issue”.

With so many shortfalls in the finances and the bad management, Saunders said the HSA was falling short and the public could not be confident they are getting quality care or value for money. “When we look at the trends …the hole keeps getting bigger”, he said.

Saunders suggested that the CEO of the hospital should be thinking about the strategic direction of the HSA and attempts to fix the problems. “The solution can’t be business as usual,” he said, adding that the hospital boss had to change the direction the facility was going in. 

He also took the board chair to task and demanded leadership from that body, which he said was meant to hold the management at the hospital accountable. 

“As a CPA I have seen some alarming things” in the hospital accounts, he said, indicating that the HSA’s books were as bad as it gets. He criticised the level of governance and financial performance adding, “We need some comfort from the board that management is being held to task and it is not some kind of fun club.” 

Check back to CNS for much more from the PAC later.

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Category: Government oversight, Politics

Comments (68)

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  1. Anonymous says:

    Such GOOD NEWS that hopefully something will be done about this MIS-MANAGEMENT at HSA!!!




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  2. Anonymous says:

    Politicai Aýccountability for the HSA disaster – where is It? Who previously was the Minister assigned responsibility for health – the current Premier Alden McLaughlin.

    What policies did he initiate under his previous administrßtioun?

    The HSA problems are a classic example of un accountable political inompetence.




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  3. Anonymous says:

    It is no surprise that the HSA continues to spiral. Healthcare management is a business which requires extensive specialized education, fellowship and work experience climbing the healthcare corporate ladder. For example a CEO has typically spent time working as a COO or a CNO climbing the ladder to COO to eventually gain the experience to obtain a position as a CEO. It is imperative that a Cheif Financial officer of a hospital be trained in healthcare sciences in order to understand the fiscal responsibilities for running a successful healthcare institution.

    In order to execute a prosperous organization the individuals in charge must possess the skills of healthcare executives. The question from the public and the board should be what training and education do the current HSA leaders possess to be in their current positions.

    The best healthcare facilities pride themselves on excellent, educated innovative leaders. It is the CEO’s job to place their finger on the pulse of the organization. Their job is to ensure success through leadership, initiatives and excellent business practice. It is the COO’s job to ensure that the hospitals infrastructure is functioning. The COO executes initiatives, putting the CEO’s operational plans to action. The CNO is in charge of best nursing practice within a facility. The CNO is a vital role leading the healthcare facilities initiatives and ensuring that the nurse management have the tools and resources to empower the nursing staff in their efforts to provide safe and compassionate care. Finally it is the CFO’s job to execute the financial targets ensuring that the departmental budgets are adhered to. The CFO has the responsibility to identify areas of excellence and weaknesses. It is also their responsibility to identify fiscal opportunities within the organization.

    Each of the above rolls work together to execute best practices within a healthcare environment. These leaders empower and listen to the needs of mid level management and in the best facilities mid level management empowers front line employees to be active in providing feedback to improve practices.

    Who ensures the HSA is using best practice? Are the leaders executing the best healthcare administration practices and who overseas it? Are the mid level leaders qualified to be managers? Are the the staff being allowed to practice using the most updated best practice? Are they being afforded educational opportunities by outside sources? These are questions that need answering.

    It is time for independent oversight within the HSA. Staff qualifications must be reviewed, Staff education must be supported, the facilities infrastructure must be dealt with to meet current demand. A business plan to identify areas of need as well as redesign the current infrastructure to better fit the needs of the society.

    The HSA must not only get their fiscal house in order. It must identify better ways of delivering modern healthcare through current best practices in modern medicine. Cayman needs to demand better.

    With all do respect to the local community. Cayman deserves the best safe, modern healthcare delivered by the most qualified individuals. The HSA needs oversight by the International Joint Commission. It needs to be restructured by an independent party to ensure non bias. The College of the Cayman Island needs to support Healthcare Management specific degrees with overseas practical components in order to facilitate future healthcare leaders.

    The HSA has not become a mess overnight. It is many years of poor planning, mismagement and the “good ol boy” mentality of hiring practices that currently plagues the organization.

    All we can do is ask our leaders to do what’s best and take the time to reflect and make the difficult decision to clean house.




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  4. Anonymous says:

    Heard that someone recently filled a senior position and no one seems to know how he got that position. I also heard that the position was not advertised and that there is a young Caymanian who is qualified, and with the right training, could have easily fill that post. CNS, do you have any idea if this is so.




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  5. Anonymous says:

    Shame on you CNS for not making it clear in the article that Mr Saunders is a qualified Certified Public Accountant, as opposed to an accountant which does not require any qualification.




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  6. Anonymous says:

    politics politucs! ha ha ha….start at top chris😇😈




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  7. Anonymous says:

    Try to hire a few like shomari Scott- by the way he is a brilliant Caymanian!!




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    • Anonymous says:

      Some in the top echelon of HSA would not want the likes of Shomari but he would be an excellent choice for a senior position. However, if the Board and government are serious about improving the management at HSA, they should start by identifying qualified and capable Caymanians to be trained for senior positions. They MUST make sure that there is a training programme and the programme is implemented, since no matter how brilliant you are, without the right training and support, you can become frustrated, to their delight since they prefer their own.




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      • Anonymous says:

        To see change at the HSA, start at the top of all the sections and get rid of all those anti this that and the other. The majority of those who are sidelining the locals are from elsewhere. When Caymanians apply for jobs they are never contacted and their friends and associates are goven the positions. Drain that nepotism Swamp.




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      • Anonymous says:

        Yep ! they love especially from Jam. So many qualifies Caymanians with a CPA give them the top job




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    • Anonymous says:

      In his public life, yes.




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  8. Anonymous says:

    Just in case you failed to understand, I will repeatedly repeat that I am an accountant. I am a CPA. I know more than you. etc.




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  9. BELONGER says:

    There are obviously major problems at our Health Services Authority in Human Resources and Finance etc…

    However, I have a question: How much of these financial problems at HSA and elsewhere in Govt are associated with politicians supporting able bodied Caymanians into a life of welfare for political votes ?

    For example: I was driving by Birch Tree Hill West Bay on Monday and saw a young lady who is maybe 25 years old who lives in the welfare apts opposite Capt Joe & Osbert Drive.

    I swear every time I travel this road, (quite often) she and several
    others cannot look down and see their feet. She and the other one folks are getting free rent, free medical, free utilities, free food, free FLOW TV, two of the latest smart phones in each hand but yet it’s so Fu&@$? hard to swallow a daily pill or get a six month jab up their backside ?

    Don’t we have social workers to advise these people that a penis vs a vagina will result in another mouth to feed by the tax payers ?

    I know we need our Caymanian population increased but I’m sorry these able bodied knockup’s and others are digging a hole deeper and deeper for us all, all with the encouragement of our district MLA’s.

    The politicians will then go to Finance Commitee and beat their gums for the cameras, when they are in fact the root cause of the problems supporting able bodied Caymanians into a life of Socialist Welfare.




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    • Anonymous says:

      Take those baby machines to the HSA and cut their thoughts out. Tired of seeing these machines producing criminals. Stop wasting taxpayers money on lazy scabs.




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  10. Anonymous says:

    My humble suggestion: The Board should interview all Caymanian employees at HSA to learn of the deliberate attempts to frustrate them so that they would leave XXXX




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    • Anonymous says:

      You are so right, because they already have a friend lined up to come for the job. You know we get upset over expats ( and some of them deserve it) but a lot of Caymanians in management positions in government as well as private sector has no time for their own. Now we have this Minister of Health who does not have a clue. I heard that the staff at the ministry of health are overjoyed because since he is so clueless he will believe whatever they tell him and the top brass at the hospital was put in a tailspin after the Minister’s first visit because everything they tried to discuss went right over his head. This is how much our Supreme leader think of us. He knows the hospital has been in shambles for years and he also knew that this Minister could not handle the job, but he didn’t care about. What a legacy he is leaving behind? He prize himself on being able to form coillitions that can’t work and are hanging on by a thread.




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      • Anonymous says:

        Also the chairman of the board don’t have any experience and does not qualify for the Job




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        • Anonymous says:

          Except he runs a multi million dollar company and has been for over a decade, but that’s no experience. Smh. How ignorant, but then again this post isn’t even in proper English so we can’t expect better.




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        • Anonymous says:

          Exactly. How did he get that post?




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          • Anonymous says:

            Working in management positions while in college and being placed in various leadership positions while working for government plus he has worked and run his family business while you were still wetting your bed.

            How is it some people are so qualified but yet can’t ever get promoted?




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      • Anonymous says:

        we have a similar situation in the financial services industry!




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  11. Diogenes says:

    One of the better choices the Caymanian people made in the election, a loudmouth who will actually stir up shit when he needs to whether it’s walking out, getting on the news and pointing out problems or asking the important questions in the LA, Mr Saunders has yet to disappoint, proud to be a voter in BTW, say what you want about him and his accent because he went to school in another country, the man is there to represent cayman, he has raised his family here, built a career here, anyone who talks about him and some Jamaican conspiracy don’t know him and are probably just mad because he had the sense to run this time without a party holding his leash ( and as we can clearly see he was not a “secret” CDP member) Very happy with him so far and hope he continues doing the people’s work keeping the government accountable
    Of course I have my biases but so far he has my vote in 2021
    Diogenes




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    • BELONGER says:

      Well said Diogenes. If I could only get someone like Chris Saunders in West Bay West that would be FU$&@?! GREAT !!

      The problem for me in WBW is that my representative has been elevated in chambers and with the house not in session for many months of the year, that gives a lot of spare time to get bored and hit the slots overseas.

      After all, he did publicly say it was a lonely office to find himself at.

      I would say so far that Chris Saunders is probably one of the most impressive MLA’s that I have seen enter the LA in the last 15 – 20 years.




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      • Diogenes says:

        I can understand your anger at the MLAs from WB they seem content to sit back and take the pay, while doing nothing for the people using the power they are provided with, It is extremely disappointing watching election after election of the exact same people getting into power just because they were the incumbents.The problem in Cayman is the electorate, Cayman needs to break away from this whole “Him and my daddeh went to school together so I’ll vote for him” or ” One day I saw so and so in Fosters and he helped me put my groceries in my car so I’ll vote for him”. We all know what kind of palm greasing politics goes on when no one is looking or when the candidates go door to door, having private conversations, making promises they don’t have the votes to keep. It needs to end.

        These MLA’s are first and foremost legislators and potential Ministers, they need to be competent and hardworking, once they are elected, they won’t have anyone breathing down their necks to get anything done other than the minority of citizens who talk to them at their offices or meetings.They have to take initiative and be willing to give themselves work. If you are a voter in GT or WB don’t just vote for the status quo PPM/CDP candidate because you know he/she is going to win, vote for the person who you think can do the best job and work well with others. Vote for the person who you are confident will work without oversight to improve the islands. Vote for the person who is going to show up to the meetings and make sure that the people are represented well. They also need to make sure that when the create new policy that the rest of Civil servants are carrying out the peoples wills, too many times have I heard about Ministers instructing the ministries to do something just to have a staff member push that to the bottom of the pile of things. The bureaucratic red tape needs to be disposed of, we need efficient and common sense changes made to the systems in place for the betterment of the people.

        This also should go without saying, it doesn’t matter if your candidate wins or not, whoever is elected in your constituency is your representative, so just because an independent wins in a constituency doesn’t mean that all the PPM and CDP voters should be pushed aside and ignored, talk to your representative, follow them on social media, go to the community meetings, send them emails and messages whether you wanted him/her to win or not, they are what you are stuck with for 4 years.

        People in Cayman vote for the same people every four years and then complain when nothing gets done, it is no one’s fault but your own, you enable the MLAs to sit high and mighty with no fear of repercussions and reelect the”no” vote they could have drastic effect on this territory. You want something to get done? You have the votes you control who has the power in the LA, put the pressure on them and make them see that you will not tolerate incompetency and ineptitude in government agencies under their watches, they are to be held directly responsible for the goings on of the government.

        Diogenes of Cayman




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  12. Anonymous says:

    The obvious thing here to look at, and I haven’t gone into too much detail on the headline figures, is what amount of the above has gone beyond the statute of limitations? CNS do you know? Once you figure that out then the balance is what you could realistically class as “collectable”!




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  13. Anonymous says:

    We’ve been reading about the HSA accounts receivable debacles for well over a decade. It’s like a fouled toilet in a public washroom where nobody in charge has grabbed a plunger or bothered to call the plumber. How many more years will we all plug our noses and watch the HSA add to an unserviceable situation? The senior people that have looked the other way need to be fired. If we want to change direction, voters need to compel their idle servants to set a new heading. Voters need to petition for this, as well as marking a deadline for passage of the Standards in Public Life Law. Having faith in any other process/Minister/or other miracle worker has proven to have been misplaced.




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    • Anonymous says:

      Simple, no one wants to do the write off and have in on their record for a loss of XXXXXX. Better to leave it as a receivable than to have the loss on their record.




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  14. Anonymous says:

    I’m smiling at the ” fire them” comments. Everyone wants Caymanians to be in charge. If you keep firing them you run out and have to employ expats!




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  15. Anonymous says:

    Oversight needed in the hiring practices of HSA, especially the PSF department. Also, Caymanians are deliberately not trained to fill certain positions. Moreso, many subtle means are employed to stifle Caymanians; not training them and then criticising them when they make mistakes XXXX




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    • Anonymous says:

      Ah, now the excuses…hired by nepotism, everyone else blamed for not training them.




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    • Anonymous says:

      8.33, everytime we read about the WP argument, there are hundreds of qualified Caymanians without a job whom those shameless expats are taking work from in the most convoluted of ways…make your minds up please…always a reason why something is not working, nothing ever done about it..




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  16. Lester Hulse says:

    I really hope Mr. Sanders is able to do something about this, management should be held accountable and if they can’t do their jobs replace them with more capable people. I don’t use the hospital often but when I do bills are very long coming and twice processed too late to collect from my insurance company and I had to pay.




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    • Anonymous says:

      I was sent a bill 18 months after treatment! When I went in to pay the poor front desk staff were shocked I had bothered! Management heads need to roll.




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    • Anonymous says:

      If they processed to late for your insurance, you don’t have to pay. That is their own fault.




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  17. Anonymous says:

    This has to be the biggest scandal in Cayman after the FA and FIFA, which are not exactly separate given CarePay. The entire management structure, including the CEO should be removed forthwith and the ‘business’ put into administration with a firm of professionals who know what they are doing brought in. And set them on an incentive scheme to recover the money. This is an absolute disgrace, no commercial company would survive. How are they evening paying their staff with such a deficit.




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  18. Anonymous says:

    What an utter shambles, this institution is staggering to its knees, it believes that it can exist as an extension of social services by robbing the islands insurers.
    The management are at best, inept, incompetent, nepotistic and lazy yet they all draw large salaries, are never seen and spend most of their existence ‘not attending ‘meetings about ethereal issues, that have nothing to do with the financial security of the hospital.
    The staff that are left,have not received a pay rise for almost a decade and some are well beyond retirement, there is no desire to afford them proper opportunities to better their education, for the benefit of the patients.
    Many departments rely on charity to fund their infrastructure, there is no planned or rolling maintenance, the pharmacy regularly run out of drugs and there is no planned equipment replacement program.
    Every few years they tell us that they are returning to profitability and write off millions in uncollectable debt, the finance department exist in the 18th century and collections are the responsibility of a team of mostly well intentioned unqualified assistants.
    This is a self destructive organisation entirely dependent on the goodwill of the few remaining staff to make it function, morale is at an all time low and the place is falling apart.
    Someone in government needs to put a stop to this broken dream and bring in a proper hospital management company to run it as a business not a charity.




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  19. Call 911 says:

    After the CarePay debacle how does Mrs. Yearwood still have her job as CEO of HSA?
    The leadership is weak and over their heads at the management and HSA Board level. The chairman Jonathan Tibbetts is ineffective and is only there to protect his fellow brackers and certain interests. The time has come to hit the reset button on the HSA leadership and management as it has become an expensive mess full of cover ups and nepotism.




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    • Anonymous says:

      You did read the article? Jonathan Tibbetts was brought in years after the debacle. He canceled the CarePay contract. He is the one working to turn the ship around. You don’t turn a cruise ship around inside George Town harbor so just watch and see what happens when everything is in order and a clean opinion is delivered to PAC next year.




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  20. Anonymous says:

    Finally someone with good accounting background to get to the bottom of this. They take forever to try to collect from the insurer so much so that the insurance company deems it ” to late” to collect. Then of course the patient is left with the bill. This has happened to me over and over again. Because I hate getting these late bills and threatening to be sued for these minimal amounts so I go ahead and pay out of pocket, then the blasted amount keeps showing up on the statements month after month. I then have to go back to ge financial dept. to deal with it again. They are do incompetent that it make you sick all over to have to deal with them. Don’t let me begin on the HR fiasco. Chris Saunders is right, too much friend- friend business going on. Do not let up until you get to the bottom of this and get it sorted out. Do not accept these ” glibbed and fake ” responses. For years they have been going down to the LA with this nonsense because there wasn’t anyone there who understood accounts. It is now a new day in the LA.!!




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    • Anonymous says:

      If he was such a successful big shot as an accountant, why did he become an MLA? A truly able accountant stays an accountant, works his way up in the firm then retires with lots of money, like Roy McTaggert or Dan Scott.




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      • Anonymous says:

        I guess he became an MLA to clean social services and the HSA. Certainly worth the salary don’t you think?




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    • Anonymous says:

      He won’t last long, calling out cronies never does you much good here.




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  21. Anonymous says:

    Hear hear, the cronyism starts with the tilted Brac board and backwards management. The health care provided and the medical staff are good, it is the top heavy management that needs a swift kick. Me thinks it’s time to retire the long-failing CEO.




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  22. Anonymous says:

    We have an Hon. Minister of Health who knows didley squat about health care management or accounting and the last one was no better.

    Why is the Minister and the Board of Directors not asking these same questions that Miller and Saunders are asking, on a daily basis?

    When a Government is cobbled together on the basis of simply getting the required majority numbers, instead of bringing in the people with the relevant backgrounds in the various departments, this is what ensues.

    Thank God for the PAC and the media, otherwise the public would be non the wiser as to how badly some of these departments are run.




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  23. Anonymous says:

    Everything around Cayman is friend – friend. Old story; its not what you know but who you know. Don’t forget those votes either!




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  24. Anonymous says:

    Change management ASAP!!!




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  25. Anonymous says:

    I once tried to pay a bill while at the hospital. I was asked if I had the bill with me. I didn’t, but I knew the amount I had to pay. I was told that I would have to go home and get the bill as the clerk didn’t know what to credit the amount to, despite having all my other details and patient number. Left the hospital shaking my head and no, I did not go home to fetch the bill.




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  26. Anonymous says:

    Free paper bun…..




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  27. Anonymous says:

    Yes Mr. Sanders, please clean up the PFS department in HSA, too many friend friend and Jamaicans with no qualifications is working in the back collecting a lot of money for doing nothing. There are many qualified Caymanians out there. 90% working in the PFS department are Jamaicans!!! So [email protected]




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    • Anonymous says:

      A first-world hospital requires first-world Management and staff in every department. We get what we pay for.




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  28. GTer says:

    For us, the people, to witness accountability, we need to see particular persons removed and replaced from their present positions.

    This mismanagement of public resources is unacceptable and, worse, incredibly unsustainable.




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  29. Anonymous says:

    Did you say he is an Accountant?

    Having a qualification in Accounting and being an Accountant are two completely different things!




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