CIG should review duty deal with HCCI, court says
(CNS): A Grand Court judge has found that the Cayman Islands Government “acted inappropriately when it awarded fee waivers and concessions” to Health City Cayman Islands for “extremely lengthy periods” without putting the deal before Parliament. The court also said the CIG should publish the criteria for tax and duty giveaways or other concessions in these types of agreements.
In a mixed judgment on the legal action brought by Doctors Hospital against the government, Justice Richards Williams didn’t decide fully in either side’s favour but he has called on government to review the deal with HCCI.
The contract signed by the UDP administration in 2010 with Dr Devi Shetty to build Health City, which gave away as much as $800 million in concessions and waivers, became the subject of a legal challenge by the Doctors Hospital when those concessions were transferred to an additional facility in Camana Bay and another medical tourism facility, Aster Cayman Medcity, was given a similar deal.
This was signed just before the PPM-led coalition government was voted out of office in 2020. The new agreement for a proposed $350 million hospital in West Bay also included a number of major fee waivers.
However, the Doctors Hospital (formerly the Chrissie Tomlinson Memorial Hospital), which is in the process of expanding, has said every time it needs to import new medical equipment, it must apply for a duty concession, which it may or may not get, and has no discounts on work permits or other government fees.
The local hospital has said this is unfair because each administration since 2010 has acted as though it is legally obliged to honour the contract with HCCI. In addition, there are inequities relating to the professional requirements of overseas doctors at the hospitals designated for medical tourism compared to those practising at other hospitals or clinics. Therefore, the management at Doctors Hospital filed for judicial review last year.
The hospital was seeking declarations from the court that it was unlawful for the government to grant waivers to Health City and Aster while it was refused similar concessions, that there should not be a two-tier system and that the government was not bound or fettered by the contract it had signed.
After a three-day hearing in April this year, Justice Williams issued his ruling this month, which was released to the public on Friday. Although the judge fell short of the “wide declaration” that Doctors Hospital was looking for, he did find that the government had acted inappropriately in awarding substantial waivers and concessions for extremely long periods without putting the deals before Parliament.
“There is no evidence filed by the Respondent (the government) to show that it has considered or taken into account anything other than the granting waiver provisions in the Agreement or to show that it has conducted any updated reevaluation in relation to the ongoing concessions,” he said.
Justice Williams said the government should now review the deal and that it was not eternally bound in its power to raise taxes by the 2010 agreement. He confirmed that the government’s statutory power to refuse to waive duty was “unfettered”, so governments are not bound indefinitely by deals made by their predecessors.
He said decisions by the government to grant tax concessions to interested parties to stimulate development were not in themselves unlawful. “Government may offer tax breaks to induce development which can limit future income,” but it was a matter of degree, the judge said.
“The issue is not the granting of individual waivers or concessions, especially if they are for a reasonable period of time. The issue arises due to the insular process Cabinet adopted to reach that decision, as the granting of such concessions over an extended period of time and then acting in a manner that is consistent with a belief that the government (and successive administrations) are bound by the Contracts to continue to give the waivers without further review,” he added.
Justice Williams also found that “despite the clear merits” of having properly published criteria for concessions, it was not appropriate for the court to declare that the government must do this because it wasn’t unlawful not to. But he said it would be “well advised and would be acting in a manner consistent with good governance if it did”, especially since the government has accepted that it should for the last seven years.
During the course of the case, the inequities over the registration of doctors were largely addressed. An official from the Health Practice Commission confirmed that, regardless of the technical registration and qualification differences between doctors at medical tourism facilities and those who work at all the other medical facilities, they had, in fact, been held to the same professional requirements.
The government already has guidelines for designation and has agreed there will be further reviews to maintain standards. Since a 2011 amendment to the law, all doctors must reach the same high professional standards.
In a statement following the ruling, Dr Yaron Rado, Chief Radiologist and Chairman of the Doctors Hospital Board, welcomed the judgement, even though they did not get all the formal declarations they wanted. He said the judicial review had succeeded in securing crucial developments for the healthcare sector.
“The Grand Court has… recommended that the legislature considers the need to amend the wording of the Health Practice Law and Regulations to make matters crystal clear in this important area of patient safety,” Dr Rado stated.
He said that as a result of the legal challenge, all doctors must now meet the same high standards before they are approved to practice in the Cayman Islands “and before they may hold themselves out as specialists in a particular field”.
He noted that the Grand Court found in favour of the claim that CIG’s powers to collect taxes cannot be fettered by long-term contractual promises and it should not commit to long-term subsidies. “The effect of this is that CIG is now free to collect taxes from Health City and Aster to the value of hundreds of millions of dollars,” Dr Rado said.
While Aster and HCCI were not directly part of the judicial review, they were interested parties. In the wake of the ruling, Health City issued a statement noting that over the twelve years since the deal with the CIG was signed, it has received just US$15 million in concessions and waivers, which is only a fraction of the agreed amount. In return, it has invested some CI$250 million and brought around $80 million worth of business into the economy.
HCCI also outlined its credentials and defended its “highly trained medical specialists”, who have “saved and improved the quality of countless lives in our community”. During the case, the Registrar of the Health Practice Councils confirmed that the hospital itself and the physicians registered under the “Institutional List” have always met the standards of doctors on the “Principal List” and are subject to the same educational requirements.
Health City further noted that its practitioners have never been exempt from the biennial licensing requirements, as Doctors Hospital had claimed during the case.
“Health City has consistently published our quality of outcomes that routinely surpass the benchmark for United States hospitals. These have been available to the public on our website. No other medical institution on island and in the Caribbean… provides this level of transparency to the public.”
HCCI noted that before it opened its doors, patients waited hours on end for air ambulances in serious life or death situations and that it provides quality healthcare at a fraction of the cost of the hospitals in the United States, where people had previously been taken. Aside from kickstarting the concept of medical tourism, the hospital said it was filling healthcare gaps and the concessions made this possible.
See the ruling and statements in the CNS Library.
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Category: Business, Health, Medical Business, Medical Health
Governor, would you pleasee appoint an Indep Commission to review the salaries and benefits of MPs as well?
They vote themselves a creamy lucrative top salary and golden parachute for life even when unelected.
and their recent big pay raises self awarded in this time were a shame when so many suffering!
The court said the Cayman Islands Government should publish the criteria for tax and duty giveaways or other concessions in these types of agreements. A part of this review should be cost-benefit data in regard to concessions. Cost-benefit analysis data absolutely should have been a part of the concession grant process. Cost-benefit data comparing Health City to potential similar concessions involving Doctor’s Hospital should certainly be a part of the review process.
Among the benefits data should be stats and dollar figures relating to:
-How many Caymanians provided employment
-How many Caymanians provided training
–How many lives saved
–Effect on the local economy
–Patients treated locally who would have had to go abroad due to lack of treatment options here: estimated net savings
–Impacts on health insurance premiums
–Impacts on general wellness of the population
— School programs where students have gotten first hand experiences in a health care environment
The list indeed goes on.
The data must be made public.
If no such cost-benefit data was gathered as part of the concession process, for shame on that government: they were negligent and operated blind. If detailed cost-benefit data is gathered and reported to the public as part of the current review process, shame on PACTless!
“During the case, the Registrar of the Health Practice Councils confirmed that the hospital itself and the physicians registered under the “Institutional List” have always met the standards of doctors on the “Principal List” and are subject to the same educational requirements.”
This is nonsense and the Registrar is playing fast and loose with the truth. The educational standards of doctors from India cannot be properly credentialed. This is why the Health Practice Law restricted Indian doctors (and doctors from other jurisdictions) from working in Cayman — until the Bush Gowerment introduced the Institutional List to circumvent the law, just to allow HCCI. This single action slashed the quality of healthcare in Cayman. Where else in the civilized world is there two registration systems for medical practitioners?
Look closely and you’ll see Institutional List practitioners in some private clinics that have managed to register as medical tourism facilities.
What is the purpose of the Local Companies (Control) Act if Cabinet exempts persons (like HealthCity) from ALL provisions of this law?
Such exemptions are not even published (Gazetted).
Why do you think they are not gazetted?
Compare how many Caymanians Health City has provided employment and training to, how many lives it has saved, how many school programs have visited Health City where students have got first hand experiences in a health care environment. The list goes on. Comparing doctors hospital to Health City is not apples to apples.
Provide the data so we can see exactly what they have provided over the years.
Yes, then we can divide those “benefits” by the total $ sum in concessions to see if Cayman has received good value for money.
@8:55:You have touched on a significant problem with the concession review. No one is mentioning a cost-benefit analysis. Cost-benefit analysis data absolutely should have been a part of the concession grant process. If it was not, it should certainly be a part of the review process. And it must be made public. Lack of transparency is one failure of PACTless.
They have not provided any scholarships for medical education. All talk.
Great news that our courts have acknowledged we have Pigs; I Honorable Leaders and Businesses feeding at the trough!
Can we now look back to the point in time when these “concessions” started to become the norm?
The Old Holiday Inn/ Ritz deal would be ideal; then every single one thereafter.
Cayman really needs to do better. There is just too much corruption when it comes to the MPs and the civil service. They were told by the last auditor general to put a policy in place in regards to waivers and concessions. Have they? NO. Because they know if they do they can’t make those back door deals which they benefit from. Also, its high time now we start looking into the bank accounts of these MPS and their political supporters and those who received waivers and concessions.
5.56pm I could not agree more, check their bank accounts. These “deals” stink to high heaven. How many M.P’s, civil servants or senior govt. officials have been convicted of corruption in the last 50 years?.We are the only country in the world where all such persons here have an “unblemished record”.
In general, this is a very welcomed judgment. The Government must now use this judgement to revisit all the most odious and repulsive concessions granted to Dart, all of which run incredulously well beyond any reasonable period of time and cuts across more than one sector. If the Government has a grain of integrity – this is a matter that should and must be revisited at its soonest. Government has an obligation to do so in the best interests of Cayman and in fairness to any other persons competing in the same space as Dart, now that Government has been put on notice by this Judgment.
“If the Government has a grain of integrity” …… clearly you have not been paying attention.
Mr Dart and his group of management will never let that happen so just shut up!
Such hostility! LOL!
The moment you allow a company (hospital) to come in here with the sole purpose of making money of sick people, you know you are in trouble.
Healthcare, insurance and utilities, should be 100% in the hands of the people , therefor government.
Oh dear god no. Have you seen how government runs the turtle farm? Or anything the government here runs. They can keep their hands off my healthcare.
The government can’t even run a bath. Just drive up East End and take a look at that mess of a mental health facility. Your in cuckoo land my friend.
I agree with your concept, unfortunately you’ll get more Kenneth Bryans in charge.
cayman…a place with hospital sized laundry facilities….
Haha good one but you can also get ya heart fixed
This argument is all about money. If you ask whether the quality of health care is better with Shetty hospital open than it was without, the answer is they provide high tech and high quality care not otherwise available.
which is sort of the point of what the law suit is about. Other hospitals can’t compete with that because they didn’t get the duty concessions and waivers. Maybe if Doctors Hospital had also received these kind of concessions they could have spent more money on updated technology to increase the quality of care.
Appeal it….very little fairness
A lesson for those thinking of doing business here. They can never make up their mind just what level of corruption they will follow this year. Ask the hotels how they are doing without staff.
Those that employ and train Caymanians, and have done so for years, are doing just fine!
Statements about what politicians ‘ought to do’, while undoubtedly correct in this case, are unenforceable and not worth the paper they are written on in terms of bettering our country. Too many of the current bunch only care about what they can get away with for their own benefit and don’t give a rat’s a$$ about what morality or common decency say about what they ought to do.
I have no doubt that the decision is correct in a narrow legal sense. However, as a non-attorney I had naively thought that the rule of law meant that no discretion given to a politician in our country was completely unfettered.
Sadly, this decision reads like a roadmap for how to lawfully make arbitrary decisions as a corrupt politician. Our politicians now only have to formally abolish or refuse to develop all policy considerations in every decision they take in order to make ‘lawful’ entirely arbitrary decisions that too often benefit no one but themselves. Sad day.
CNS can you confirm the total amount of concessions received by HCCI so far over the last 10 years please. I note that a reference is always made to up to $800 million in concessions but since I remember this being a percentage it would have required billions of investment by HCCI to actually achieve that amount. I read in a report on this story from another newspaper that the concessions to HCCI so far are less than $15 million. I am sure that most of your even most critical readers would agree that if it is true that is a small price to pay for a facility and the services provided by HCCI. Based on that number it looks like the Government got an excellent deal for the country.
CNS: If you had read the whole article you would have seen that the same information is here, too. The info is taken from the press release from HCCI, which we have in the CNS Library, linked at the bottom. All we can do is provide the info. We can’t make you read it.
Of more interest is what information does HCCI have to support the claim that they brought $80 million business to Cayman. Does this exclude the local market?
@3:24:
The gross dollar sum of “business” brought to the islands is largely irrelevant. It is a gaslight number meant to impress people of the facility’s worth. The relevant factors are: 1.How many dollars does the hospital input into the local economy per year? 2.How many dollars of the hospital’s profits remain in the Cayman Islands per year?
“the Cayman Islands Government “acted inappropriately when it awarded fee waivers and concessions”
I would bet my left nut it’s the same with all of these kinds of deals granted for the last 30yrs…
On top of that they do no track anything sits very probable that these developers have not honored their end of the bargain either.
Getting tired and infuriated of our daily updates of Govt ineptitude in absolutely EVERYTHING they touch. Bunch of wasteman/women from tip to bottom.
You should not blame everything on ineptitude…..there is undoubtedly also corruption although it does not get prosecuted.
Some of them are so effing stupid they don’t know what corruption is; just like transparency.
This will never happen as now Dart is behind Health City and as he controls this island, no one will dare go against his organizations wishes.
Dart are just leasing land to HCCI and not behind Health City.
Amongst many other new services, this new facility will offer services not available in Cayman, including bone marrow transplantation and other advanced oncology services.
But because it is on Dart’s land, it must be bad. If you prefer travelling to Miami for a few months to get these services, go for it. But many in Cayman will prefer specialist treatment in Cayman, where they can remain in their homes with family and friends, and not in a Miami hotel room.
If Dart is just leasing the land to Health City, then why is DECCO (their construction company) building the project? Health City is now another Dart venture just like everything else they get their hooks into.
DECCO….anyone who works in one of the their new buildings has experienced the level of workmanship you get from them…..
The cheapest price wins! It is all a buddy system anyway financed by big daddy.
From the second last page of the judgement, “I am not satisfied that it is appropriate for the Court to make a declaration that the Respondent is obliged to publish a transparent statement of the criteria that will apply when considering concessions.”
Too bad, it would be interesting to know the going rate for Cabinet approval of a resort development expressed in the number of million dollar condos/quantum of real estate fees that need to be given to a politician/consultant in exchange for planning approval plus concessions.
Still I expect that the mentees of ‘Wig and Robe man’ have been given the formula, that may include having one’s spouce get involved in a real estate business.
Another victory for the UDP/PACT alliance.
sad/funny thing is…its all happening again on smb/wb road.
9:37, Every single development for the last 20yrs; across all 3 islands.
cig scammed again.
cut-price health care in the cayman islands…?…medical tourism…?
it never made sense from day one. the dogs in the streets knew this.
Health tourism isn’t happening any time soon on island, for the very simple reason that our health insurance system is broken beyond the pale and to be frank , farcical. As long there are no proper equivalency agreements set up with the U.K, USA, members of CARICOM nations and a government that will bring the hammer down on employers on island that fail to meet their contributions.
Our prices for healthcare on island are WORSE than in the USA for equivalent procedures . Let me remind you that Cuba provides affordable advanced care even through private facilities at prices a fraction of Cayman.
For all intends and purposes HSA’s is providing at best Jamaica style care at prenium USA prices , this alone bars any developpement of medical tourism.
Doctors hospital IMHO could do better, but they already do provide by far better care than HSA although their pricing still steep when it comes to elective surgeries compared to similar procedures in the USA .
For health tourism to happen we have to first and foremost fix the insurance system on island, negotiate more extensive affordable coverage with insurers, set up equivalence agreements which can only happen if the government steps in at every stage of the negotiation which I think PACT isn’t tooled enough to engaged into.
PACT ACC and FCU have a pressing obligation to the public to review every sweetheart concession, land swap, and nickel in duty waived to favored developers and special friends over the past 20 years. Some of it came with significant responsibilities to the public and resident tenants that were not honored.
You must know that ‘He of the absurd Wig and Robe’ and his proteges in Cabinet will never allow any decision of a UDP administration (no matter if called UDP or PACT) to be looked at too closely.
HCCI is no doubt a very significant and important asset to the Cayman Islands community. That is not the question here – the question is; should the like of any gowerment (especially one led by McKeeva and Co. be allowed to make such concessions with no end date? Of course not. And anyone who believes in the concept of “good governance” will agree with the Court, that clear guidelines for eligibility to such concessions be made public and with clear timelines.
Yep, MacKeeva and UDP, a tangled web indeed.
The Dept of Commerce & Investment publishes a list of all active Local Companies (Control) Act licensees at Local Companies Control Licensing – DCI (gov.ky). Health City is not on that list as holding a licence to operate a health care facility.
Health City does not hold a local companies control licence as it appears that Cabinet (around 2011) granted the holding company of Health City (and its subsidiaries) an exemption from all provisions of the Local Companies (Control).
Section 4(3) of the Local Companies (Control) Act reads: “The Cabinet may, in exceptional circumstances, having regard to the public interest, exempt any company from all or any of the provisions of this Law subject to such terms and conditions as the Cabinet may deem fit.”
And what if they do not “review”? It is all a farce.
#Leggewasright.
Same as it ever was.
Same as it ever was.
-David Byrne
Congrats to Gene Thompson, he has managed to secure this deal three times now. Health City, Tech City and Astor Health. That is what you call real power.
I have lived in these islands for over thirty years. Influence and Power can be bought for cheap in the Caymans because there is no accountability or consequences for abuse or corruption once the right civil servants and politicians are involved. It’s been this way for decades and continues today in the islands time forgot.
You’ve lived in these islands for 30 years yet you still call it the ‘Caymans’ smh
Health City claimed that local people would be employed wherever possible, yet it seems that many administrative staff are from India and reading this article it appears they may get discounts on their work permits which if true, is an affront to all employers in Cayman, not just Doctor’s Hospital.
I wonder whether any expatriates at Health City are able to have their children educated at Clifton Hunter high school? All of course heavily subsidized by the Caymanian people. Anyone know?
The only poor service I have gotten at Health City was from the hired Caymanians. Without the skills and excellent work ethic of the workers from India HC would just be another third world hospital.
I was coming hear to say exactly the same. The Indian staff give exemplary service. But try to get the Caymanian staff to do their jobs, or do anything promptly or correctly and you can forget it.
Health City is worth every cent for the top quality doctors and healthcare you get there. I feared for my life when I got sick and was taken to HSA and they didn’t have any of the specialists I needed, but I’ll trust my life always to Health City who have sorted out multiple medical problems for me.
Not really fair. You hire who is capable. Your passport doesn’t make you capable. I was there during covid, 2 employees were refusing to wear masks. They weren’t from India, I can tell you that much. You can guess where they were from.
Actually HCCI employs more young Caymanians than HSA and the ones HSA does employ are on temporary contracts with no benefits. This is the new way of doing business in the Banks also.
Is it just me, or does COG seem to lose every single judicial review case? Call me a cynic but …..
Government usually loses.
Let the light shine on all concessions granted during the past decade. Who approved them? Who received them?
Take the concessions away from developers and grant them instead to medical facilities across the board in order to bring down the cost of health care here.
What goes underreported is millions of dollars of surgery and procedures HCCI provides free of charge to people regionally and further afield.
On Friday morning, several children from Mongolia arrived in Cayman (on the Delta flight from Atlanta) who are receiving heart procedures at HCCI. They were accompanied by parents, and volunteers and interpreters from the Children’s Heart Project of Samaritan’s Purse.
These life saving and life changing surgeries have taken place in Cayman for years at HCCI. Many families in Cayman have served as hosts for these folks. Maybe CNS can do a positive news story on the generosity of these Cayman families and the doctors and staff at HCCI?
People in high places will now be scrambling for cover
5:12, Or on the first flight out like they do for everything that might affect their precious little worlds.
Former Planning ministers Kurt Tibbetts and Joey Hew must be know their deals including all the secret development agreement deals they brought to Cabinet are next for the full under the microscope examination. About bloody time leave no stone unturned and expose it all.
Mandarin Beach Bay for one!
Another pie in the sky deal