Audit finds multiple problems with HSA pharmacy

| 17/11/2021 | 61 Comments
Cayman News Service
HSA Smith Road Centre Pharmacy

(CNS): A catalogue of problems were identified by an audit of the Health Service Authority’s Outpatient Pharmacy Services. With issues such as two failed back-to-back procurement exercises to secure the supply of essential medications and a law that is four decades old with no overarching provision to control the quality and safety of medicines, the ability of the HSA to deliver efficient and effective pharmacy services was called into question against the backdrop of a global pandemic.

Despite these and other worrying findings by the Office of the Auditor General, the health ministry has failed to respond to the report, which found a number of challenges regarding how the $9 million worth of medicines is managed and dispensed each year.

The audit found that the hospital’s pharmacy is impacted by shortages of physical space and staffing levels, an outdated pharmacy law, issues relating to measuring, monitoring and reporting, as well as gaps and loopholes in the system, an absence of a code of standards for pharmacy staff and a lack of general policy or strategic direction.

However, the audit did find that the HSA had established standards for the selection of medicines aligned with international standards. It has a Drug and Therapeutics Committee responsible for the medicines that can be used and distributed by HSA practitioners, and medicines are sourced from jurisdictions with high quality standards.

A number of Improvements have also been made to the pharmacy inventory system, reducing stock-outs and lost medicines. But there are still myriad issues that need to be addressed to make the pharmacy safer, more focused and to provide better value for money.

“The Health Services Authority provides vital pharmacy services for a large proportion of the population, including many of our most vulnerable people,” said Auditor General Sue Winspear, as she released the report Tuesday. She said there were many things the HSA was getting right, but raised a number of concerns and urged the authority to work on improvements.

The report highlighted two failed procurement exercises over the last two years for the supply of medicines that had a number of deficiencies and the contracts had to be abandoned.

“The HSA spends around $9 million a year buying medicines and it is important that it obtains value for money from this,” Winspear said. “It was disappointing to note that lessons from the previous procurement exercise did not appear to have been learned. The procurement exercise that started in late 2019 was started far too late and took too long, leading to contracts, that were not providing value for money, being extended multiple times. That procurement exercise was eventually abandoned in early 2021 and a new one has now started.”

The report documents numerous problems with procurement that has resulted in existing contracts that do not ensure value for money being extended multiple times. A third attempt is currently underway that is expected to be completed by January 2022, which Winspear said must utilise the lessons from the last two failures.

She also pointed to the pressing need to address the outdated legislative framework and lack of strategic direction at the national level for healthcare, and by extension pharmacy services.

“Not for the first time I am having to report that the legislative framework for pharmacy services is significantly out of date and there is a lack of strategic direction at the national level for healthcare,” The auditor general warned. “The Pharmacy Act, which dates back to 1979, is not in line with current good practice and creates risks for the control and regulation of drugs that are able to be brought into the Cayman Islands. This needs to be rectified as soon as possible.”

In the audit Winspear also expressed concern about the failure of the ministry to respond to the audit and its more than three dozen recommendations, even though she said the civil service management was given more than two months clearance time.

“This is both highly unusual and disappointing, especially when I previously reported in 2017 and more recently in 2021 that there are significant gaps at the national level for healthcare as the legislative framework is outdated and there is no overarching strategic plan,” she wrote in the report.

Although the report makes it clear that the HSA has put in place measures to ensure that it uses and dispenses high-quality and safe medicines, the report raises a long list of issues that are undermining the quality of public sector pharmacy services.

See the report in the CNS Library.

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Category: Government oversight, Politics

Comments (61)

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  1. Rick says:

    Apart from the ancient queuing system, I am always well served when I attend the hospital pharmacy (which I admit is not very often). In fact, I am impressed by the service, knowing how poor the rest of government service is. And I am not easy to please! I am sorry for the bad experiences of others. Maybe I am just lucky?

  2. Anonymous says:

    The pharmacy in the Brac gives good service.

    • Anonymous says:

      The service was a lot better and the environment spacious when the refills were at Smith Rd, but I supposed that was too efficient.

  3. Anonymous says:

    All the Authorities are Givernment, who payed to get all them started ? Authorities are expected to fund themselves. But when they need money, who do they go to to get it , GOVERNMENT/DUTIES PAYERS . If u DON’T believe check Cayman Airways and Turtle Farm, ETC

  4. IamteamHSA says:

    Where is the Chief Pharmacist amidst all of this kerfuffle? Does he not report to the Medical Director? Who will be held accountable?

    • Neverwannabeacivilservant says:

      11.21am What a silly question, we all know accountability has never existed in the Civil Service.

      • Anonymous says:

        I would word that differently to say; “not in Government and the top tier Officials in Civil Service”. There are a whole lot more very good to great minor Civil Servants within Governments, working above and beyond. If the top Officials were doing their jobs properly &/or efficiently, then they would be on top of all that needs to be done by those under them, that’s why they hold the positions and get the BIG pays!! Like the old saying goes: “If you can’t stand the heat, then leave the kitchen” …js

    • Spoken Truth says:

      Who is to say that the Chief Pharmacist isn’t reporting to their higher up(s), because there are many Chiefs at HSA?! I learn every so often of another person head of something or the other there. Furthermore, from what I read in this excerpt, the blame and malfunctions within the HSA Pharmacy, sounded like Mrs. Winspear’s complaints would be laid at the feet of the higher ups at HSA and the Ministry of Health, beyond the Chief Pharmacist!!

  5. Anonymous says:

    So the question is after you’ve taken you BP meds to calm yourself down, What’s Sabrina going to do about all this? The simple answer which will never happen would be to bring in Walgreens or CVS. easy to use, online refill reminders and people who actually answer the phone. In your dreams Cayman…. Sabrina, DuWayne the Brain, does anyone see a pattern here…

  6. Anonymous says:

    What’s new?! They all need to go! They constantly lose ppl prescription and don’t talk about refill orders. It’s clear they have no work ethics. You can count on one hand the real workers in that place.

    • Anonymous says:

      I am sure there is a huge administrative deficit. However. I get refills every month. I WhatsApp my request and the medication is unfailingly waiting for me the next day. I have absolutely no complaints on that score.

      So let us give credit where credits is due.

      • Anonymous says:

        It is the management not administration. Learn this and your office space will succeed buddy!

        • Anonymous says:

          Why try to split hairs over management versus administration: same difference:

          Administration: the process or activity of running a business, organization, etc.
          “the day-to-day administration of the company”

      • Anonymous says:

        I agree. I also don’t see the GT pharmacy flooded with people the way it used up be.

        That signals that prescriptions are moving faster than they used to.

        I really think the pharmacists are doing a great job.

        I got the impression from this story that the AG was more concerned about outdated legislation, procurement procedures, and the broad management of the safety and sourcing of medicines.

        While this does impact the average patient, most of us have little problems with actually getting our prescriptions filled on a day to day basis, which is what most of the complaints are directed at.

        The frontline professionals are doing a good job and it must be discouraging to hear all this unfounded griping.

  7. Anonymous says:

    You only have to look at the CEO of the HSA on her inflated salary and the obviously out-of-her-depth new Chief Officer of Health to see why audit reports are never dealt with effectively…

  8. Anonymous says:


  9. Anonymous says:

    The Pharmacy Law is too old.To have a law where to list all medicines and vaccines approved is too crumbersome similar to medical licensing in various countries for a small country like ours. If we create that system too much beaurocracy and we wouldnt have expertise.
    Hence our current Health Practice Law states to approve health personnel approved by some countries such as uk,canada,usa,jamaica. Similarly it provides for allowing importing of medicines and medical supplies approved by these countries and WHO.
    So it is easy for getting WHO approved drugs and vaccines.
    To approve these again in Cayman means what extra expertise we have.
    So as we import from uk we take uk approved vaccine.
    Similarly we should accept all certificates from of all who approved vaccines. If who questions non approval we dont have any reason or answer.
    Based on that approvals we should direct our customs ,and advise local practitioners.
    It was not a good practice for cayman preparing separate vaccine list for covid other than of UK or WHO.

  10. Anonymous says:

    I get all my pharmaceutical supplies in West Bay.
    Good prices for a dime bag

  11. Tired Caymanian says:

    And to think the CEO of this hospital makes more $$ than an elected official. How is she not held accountable?


    • Anonymous says:

      if elected officials made more than the CEO do you think they would be accountable?

    • Anonymous says:

      CEO makes more than the Deputy Governor. The Deputy CEO makes almost as much. Disgrace.

      • Anonymous says:

        Who recommends salaries of HSA staff including CEO. Who approves. It is the CEO who recommends and Board approves. Same with water Authority. Govt has no say in it.
        Some time ago the Govt proposed all statutory authorities salaries should fall within govt structure. But Boards rebelled as they will loose control but they want Govt to rescue when they have financial problems.
        It is a good idea to review all.

  12. Anonymous says:

    So third world Cayman. Why is that?

    • Anonymous says:

      Because no civil servant ever spends their own money, oversight and fiscal prudence are irrelevant inconveniences.

  13. Elvis says:

    I think the staff do a great job considering all the hypochondriact people they have to deal with.

  14. Anonymous says:

    Let is not look at the amount of meds selling on black market stolen from the pharmacy by workers and pirated on the street.

    Yeah talk about that. I know about it first hand.

  15. Anonymous says:

    Apart from the HSA’s issues as they relate to pharmaceutical problems, get staff to answer their phones. This may help to elevate some of the stress people encounter as they have to make umpteen tries before someone answers their call. In doing so, less need for medications to curb people’s anxieties etc.

    • Anonymous says:

      I remember a few years ago, there was a lot of advertising that you could get your scrip filled at any HSA pharmacy. During that time, I happened to be on Grand, visiting from the Brac, and went to the pharmacy at George Town Hospital to fill a scrip. I was told by the LOUD (as in the packed waiting room heard it all) Scottish lady who was the tech that was supposed to help me, that I needed to fill my scrips on the Brac. She said that by trying to fill a scrip on Grand, I was stealing medication from Grand Cayman clients. It wasn’t until I asked to speak to a manager that another tech came over and filled my scrip. It was so embarrassing and so un-called for. Hope she’s received some training in customer service.

      • Anonymous says:

        Sorry to hear about that. That should not have occurred. Glad someone else with commonsense sorted it out for you.

    • Caymanian says:

      I wish I could like this like a million times. I try find a medical person and its easier to speak to Biden in the USA. Automation has replaced good customer service.

  16. HSA staff member says:

    And the HSA just recruited a new DCEO. Mr. Dunn needs to be the CEO. Lizzette needs to go. I said what I said!

    The entire SMT for HSA has to go. I pray Osbourne B and team looks into this issue as a matter priority. Too many people working at HSA are afraid to speak out or speak up! It is mind boggling.

  17. Anonymous says:

    It’s about time!! Thank you AG Winspear. Now I hope the HSA will take prompt corrective actions. While they are at it, please fix the pharmacy process at WB District Clinic!!

    Currently, patients have to:

    1. Stand in line to present their requests to the pharmacist and get a coded receipt;

    2. Relocate and stand in line to pay that receipt to the cashier (who has access to the same coded receipt online on the same system which the pharmacist used to print it);

    3. Go back to the pharmacist and stand in line for the third time to collect the meds.

    Clinic staff says this process is to stop people walking out without paying.

    The same can be achieved in 2 steps instead of 3. Simple:

    1. Patient checks in with cashier, who pulls up their name and prescription details on the shared system. Patient pays;

    2. Patient then takes the receipt to pharmacy and collect meds.

    Not sure why they can’t see the problem and change it. Hope they do now!!

    • Anonymous says:

      Typical of make work programs in CS, one has the bullet, another has the gun and oh we need another to pull the trigger and yet another to hold it.

    • Anonymous says:

      Thank you for bring your remarks up I go through the same issue every month.
      Sometimes have to back the next day because they forgot to give me one of medications and then go through the whole back and forth again.
      When the gentleman was either before he was great and respectable as well as caring.

    • Anonymous says:

      Sounds the same as the post office when you collect a package!

    • Anonymous says:

      Unless pharmacist enters the meds the cashier cant collect.unless collected pharmacist cant give out meds.
      So two step not possible.

  18. Anon says:

    They need to get rid of the CIO at HSA. His ego is too much and he is the wrong man for the job. The CEO also needs to go..she is paid too much to just bluff.

    They have a new Board right? Com Ozzie, take out the cow cod!

    • Anonymous says:

      There have been complaints about the leadership of the HSA for a long time. It does not appear that anything has ever been done to bring about any meaningful change. Why is that?

    • Anonymous says:

      Board needs to stop hiring from Jamaica. You would swear you’re in Kingston when one visits the HSA. Now CTMH Drs following same pattern.

  19. MackB says:

    Where is the accountability? Will the new Minister for Health simply continue to do what has always been done or will we see her provide actual leadership and hold those within the ministry and the HSA is senior positions responsible for the failures outline in the report. Most pressing is the accountability for the failure to responding to the findings in a timely manner.

  20. Anonymous says:

    I’m surprised that anyone is surprised.

    HSA is an organization that struggles to actually charge people and collect its A/R.

    Traditionally the standard of care provided has been at much higher level than the manner in which the system is administered.

  21. Neverwannabeacivilservant says:

    World class or world -ss?.

  22. Anonymous says:

    cig and civil service…can’t go 5 mins without humiliating itself.
    but don’t worry…keep taxing the private sector and expats to keep the party rolling!

    • Anonymous says:

      But be sure to keep giving duty and other concessions to the already rich developers. We don’t want to spoil their party either. Concession have to stop. If Cayman is wonderful that you want to be here: pay your fair share. The common people of Cayman have to.

  23. Anonymous says:

    world class again from the civil service….time for more awards/pay increases franzie!!
    welcome to wonderland ….zzzzzzzzz

  24. Anonymous says:

    World class of course. Fire everyone and try again

  25. Anonymous says:

    3rd world class

  26. Anonymous says:

    well PACT the blessing is it’s only supposed to come in 3’s. There’s perceived mismanagement of the Covid problem, lawsuit by a med supplier, and vaccine running out.

    Did the relevant Minister misunderstand that 3’s doesn’t equate to ‘3 dozen’ when neglecting to respond to the Auditor General ? – mind boggling

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