Hospital board hits back at criticisms over stipends
(CNS): The Health Services Authority’s directors have defended their performance, the stipends they receive and the number of meetings that take place each month after MPs implied they were meeting more than needed just to get paid. With some volunteer directors being paid more for a couple of meetings than some hospital staff take home a month, politicians are calling for a review of how the directors are compensated.
But the board, which is chaired by Yvette Dilbert, has hit back. In a lengthy statement, the members addressed the criticisms made in parliament during a Finance Committee meeting on Friday, in which they denied that the board meets unnecessarily, outlined the reasons why it has met more frequently and explained its heavy workload.
The directors said the HSA is the largest public institution in the Cayman Islands, managing a yearly budget of more than CI$100 million and audited revenues of over CI$200 million in 2024.
“The legal and good governance environment of the HSA demands experienced, engaged, and accountable Board oversight of clinical, financial, strategic and operational performance,” the board stated in a lengthy statement responding to the comments of MPs. “Board members are selected based on proven expertise in relevant fields, including medicine, law, finance, and business.”
Board directors are currently paid a stipend of $500 for every meeting; the chair receives $750 and the deputy $600 per meeting. The rates were approved by Cabinet and are not as high as some other boards. The CPA chair, for example, receives CI$800 per meeting, while the OfReg chair is paid $4,500 per month regardless of the number of meetings.
However, the frequent meetings have increased the remuneration bill for the HSA board members. According to the hospital’s annual reports, which were read out to parliament by opposition member Chris Saunders (BTW), the annual collective compensation bill for all board members jumped from just CI$18,813 in 2016 to over $250,000 in 2023.
Raising concerns about the significant increase in the stipend, Saunders noted that, by comparison, the Cayman Islands Monetary Authority’s annual bill for board compensation was $153,000 for 2023. He asked the health minister to provide a list of all of the meetings, the frequency, and the payments being paid to the HSA directors since 2020, given that those board members are paid per meeting and not a flat rate, as he implied that there may be some abuse as they were meeting very frequently.
“I understand some members are meeting four times per week,” he said. “I suspect that there is some level of abuse that is now going on as a result of this per meeting basis. Some of them are going to two meetings in one day… This is supposed to be a public service… This is unconscionable,” he added.
The health minister said she would get the list as requested. Meanwhile, Finance Minister Rolston Anglin told parliament that he would review how compensation is structured across all boards, given that the per-meeting payments could be an incentive to hold more meetings rather than paying directors a set amount per month for being a director.
Anglin pointed out that there had been a need to professionalise the government’s boards to ensure those with the right skill sets were incentivised to serve. But he said there was “a balance to be struck” and the government needed to take a close look at the boards that do have heavy workloads, like HSA and CIMA.
In its statement, the HSA Board stressed very heavily the huge amount of diverse and complex work that it has undertaken over the last few years and the substantial time members have committed to these obligations, including a considerable amount of preparatory work, for which they are not compensated. The meetings address care quality issues, major capital and strategic projects, regulatory compliance, hospital projects, audit scrutiny and financial performance, as well as policy reviews, the board said.
The members also stressed that all meetings are well-documented, reviewed and audited, and they have not been questioned by the auditors. The multiple meetings have been related to the slate of multifaceted issues, including, oversight of adherence to updated international accreditation standards, evolving Cayman Islands and international regulatory requirements, increase in service demand, adherence to financial requirements and organisational performance, large-scale capital investments and compliance measures related to quality, patient safety, and ethics, among other things.
The HSA also went through a demanding Joint Commission International accreditation process, which the board said required extensive oversight and governance work.
They outlined other exceptional circumstances not indicative of routine board operations, such as some of the legal cases that the hospital has dealt with. “The demands of the board have correspondingly increased,” they stated, adding that “periods of intensive activity are dictated by the organizational needs and statutory obligations rather than by any arbitrary or discretionary factors”.
Compensation reflects documented time spent in meetings or on official HSA business, “not to reward attendance arbitrarily or increase overall remuneration”.
When the board addresses simultaneous or overlapping priorities, member commitments increase, it said. “In no case is compensation increased absent a corresponding and objectively measured increase in duties undertaken,” the members added, as they defended their performance.
Listing some of its main achievements, it pointed to an increase in HSA revenues between 2020 and 2024 of 47%, an increase in Caymanian employment by 21%, and an increase in services and demand, with annual surgeries growing by 56% over the same period. The hospital has also increased the services and specialities it offers and the technological advances, such as Whole Genome Sequencing, that have been introduced to meet the broadening spectrum of clinical demand.
The board also defended the financial trajectory of the hospital, which shifted from a net profit to a loss between 2021 and 2023. The increase in expenses was driven by several structural and external factors, including an actuarial re-evaluation of the defined benefit obligation.
Many of the government-funded healthcare programmes administered by the HSA haven’t been adjusted in years to reflect the inflationary increases in medical supplies, equipment and staff compensation. The board said that this has created a widening gap between the cost-of-service delivery and the reimbursements — a structural issue to be addressed at the policy level.
See the full statement from the HSA board below and the proceedings in Finance Committee on Friday on CIGTV’s YouTube channel.
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Category: Government Finance, Politics
Fleecing without conscience, exaggerated self intelligence and arrogant corrupt pride.
Qualifications for too many Cayman Board Positions.
We have Directors’ Association, Doctors’ Association, Accountants’ Association, Auditors’ Association, Managers’ Association, Lawyers’ Association. Seems to me that strong boards for many entities could be formed from all those groups, plus honest people in the community who work in the relevant field the board’s is expected to steer.
Don’t stop the carnival
Except for Batabano. Stop that.
Why? Scantily clad attention seekers and simulated sex acts pretty much sum up the state of the culture.
Good book
Oh that’s rich, Chris Saunders implying there must be some sort of abuse. Look in the mirror, Sir.
” … Saunders noted that, by comparison, the Cayman Islands Monetary Authority’s annual bill for board compensation was $153,000 for 2023.” CIMA didn’t have to deal with the great unknown of Covid, did they Mr. Saunders?? Dealing with our very lives and health is just a tad bit more of a sticky wicket, wouldn’t you say??
Sometimes, you have to look within and not just think about your well-being. Caymanians who have done well, whether spiritually and/or financially, should volunteer their required skills to sit on these Boards. Yes, we need some specialists sometimes, but this is how you give back and build on what you were part of building. Open to the professional politicians’ friends who have done well—we all know who—but stop. Remember, time is longer than rope.
Agree. Wealthy, selfless Caymanians who are willing to step up seem somewhat rare.
Or perhaps you’re just unaware of their existence, because they are selfless and humble and don’t seek out the publicity that often comes with helping others? Not everyone is in it for the photo op.
Well written. Thank you.
When you look at the pictures from the link in the story, you’ll see they are all smiling, perhaps something they knew that we didn’t, now we understand why.
While the people have been chastising the elected officials, there are several people in the Civil Service who knew about this and did nothing. The Deputy Governor, Internal Audit, and the OAG all knew this was happening, but no one took action.
Sabrina faced accountability at the Polls. I wonder if the senior Civil Servants involved will face any accountability for allowing this to continue for years.
How many acute-care hospital beds it operates?
Where I live a Health System board of Directors operates 800 acute care hospital beds
Yep, yet another example of the C word – plain and simple. Ozzie headed up this board for years triple dipping and cashing in on his $9K a month for being the Chair. Wayne, Andre, Sebrina (PACT) put him there thanks to Wayne. We were all forced to listen to his TCCP BS during the campaign. It was insulting to all of us that pay for it.
There should be no need for a Board to meet that many times – executives make decisions, not tell the HSA what to serve the patients for lunch of what color to paint a wall.
Drain the swamp – fire these boards where they have their head in the trough.
We are waiting to see what you do Andre…. or are you too busy with your 20 social media posts a day and rendezvous with Sandy Hill. #LeggeWasRight
As a country we are throwing away millions per year on incompetent payments to boards stuffed with cronies. Please NCFC end this waste and reduce the debt facing our children and grandchildren.
Check the Port Authority board stuffed with previous government cronies and the board pay increases they have awarded themselves, plus frequency of sub committee meetings to pad their monthly incomes.
Who is the Chair person of the Port Authority board? Could Saunders comment on his cousins years on end chairmanship. Cast the mote out of your own eye before you try to dig it out of others.
You’re such a financial steward but was fined how many hundred thousands for being honest? Really!
#entitledCaymanians
Somebody ask Chris Saunders how much he is paid.
Chris Saunders, how much are you being paid?
#toomuch!
LOL
Limit the amount times a board can meet. This is abuse.
As a former HSA Board member (prior to this fiasco) we held 5 meetings per month; 4 subcommittee and a board meeting. The subcommittees were chaired by the professionals in their respective fields (Finance, HR, IT, Medical).
There is a lot of work to do at the HSA but with efficiency and structure. Seems like since Sabrina took over… the fall has been extremely evident!
That’s primarily due to the fact the Sabrina is a narcissistic incompetent. Here’s hoping she goes back to being a failed businesswoman and never runs for politics again, however I’m sure the lure of a second term that provides her a pension for life will be too much for her.
From the outside that seems like overkill.
Large publicly traded HMO’s and Hospital Systems in the USA that are infinitely more complex meet quarterly at the board level. There is a difference between oversight and executive management.
Quite frankly I expect based on the composition of the boards that all the extra meetings just complicate things for the people running or who should be running the HSA.
Bring back Canover.
I thought he was on the Prison Board where they meet every day of the week. That’s one Board that needs more members.
BBC!
Said the pot.
MPs calling this unconscionable is bizarre especially given the pay packet they’re each taking every month and when it was raised, the justification was that the pay increases were put in place by the prior administration. They were told they have every right to reject the increase … crickets.
This is blatant abuse by HSA board members but MPs, don’t pick and choose, address the similar abuse by yourselves if you have any interest in the respect from your constituents.
HSA got accreditation now, but the Doctors Hospital and Health City got it long back
of the increase of revenue by 47%, how much is from cinico and how much is paid by private insurance or self pay
How can two former employees of HSA who worked under current CEO and Medical Director, influence on operational performance by them
someone needs to analyse what percentage of private health insurance clients come to HSA, to my info they come only for major accidents or when such service is not available privately. HSA can not talk of profit/loss, as got guarantees hsa costs for care of civil servants, pensioners, cinico clients. if and when cinico opens upto pvt facilities hsa costs will not diminish but the income will diminish so loss increases.
HSA performance needs to be evaluated.
HSA has too much managers at various levels just limiting to offices where as in Cleavland clinic, Baptist, Mayo etc even the Medicall Director does provide full time clinical service, meetings limited to one hour only either before 8 am or after 5pm
11@3:19pm – that is true of most SAGCs and the public service in general. Check CIAA!
Multiple people being paid for work which can reasonably be done by fewer.
Exposure is good, but this situation didn’t just happen in all/any of those public agencies. Mr. Saunders you were in Cabinet once, did you address it then? Thanks for putting it out there, though!
Exactly, so many managers and not one said peep when the excessive overtime fraudulently claimed by the security guards was being paid, when Carepay was happening, and now this scandal. Makes you wonder what else is going on at that hospital that management is mum about. Also makes you wonder whether there’s an element of complicity.
I am trying to really understand what happened that caused this blatant abuse to go undetected for years, where were the checks and balances?
Who trains the Boards members before they are appointed? Is it that they did not understand their roles why they were meeting so often.
We have to understand where the failure occurred if we are going to prevent this from happening in the future. Was it a lack of ministerial oversight, the auditors asleep at the wheel, or as some has stated, this was a political reward to the members so no one cared?
Only thing will prevent this from happening in future of severe punishment.
ceo been there forever along with some of board members? wuz up with that? the carepay….only a couple tool the rap…? cayman kind at its best…i better just shut up! lol
HSA board hits back sounds like someone’s conscience bothering them and here lies the problem Cayman the UK & Canada are Countries Cayman is not trying to justify their egregious and greedy behavior by comparing us to the UK Health Authority shows just how high-minded and untitled these bastards are. My finally question to this Board response Where is the UK Health Authority Today?? in Shambles!! If the rest of the Caribbean is so wonderful why are so many of them piling up here in Cayman? Stop unnah bullshit HSA Board
Listing some of its main achievements, it pointed to an increase in HSA revenues between 2020 and 2024 of 47%, an increase in Caymanian employment by 21%, and an increase in services and demand, with annual surgeries growing by 56% over the same period.
If rates were not increased then the revenue increase must have come from more customers and services. How exactly does the Board take credit for this? Did they all drive around knocking people down so they had to go to the hospital?
For reference, in 2024 the board of Apple met five times. But the are no Caymanians in that board
And they’re paid about a half million each (so $100k per “meeting” according to you) and attend multiple committee meetings throughout the year. What’s your point?
When the HSA turns as big a profit as Apple, they can rightfully expect the same remuneration.
As it stands, by your logic, they owe us a lot of money
It is no wonder they are in trouble, look at those figures, where the h*** on this earth do people get paid that kind of money for a meeting and so many meetings, how much for the extras coffee, buns, bottled water and/or lunches. When will these people realise that Cayman is not the rolling money train it once was, except for those that are roaming around and getting away with their illegal s*** . Wake up and clean up Cayman before the doors shut in front of and behind you!
Jon Jon legacy alive and well. Good job to all the BT voters, lets not forget whose been in charge of this portfolio since forever.
No Accountability, but thank you Chris, i give credit where its due, this needs to be investigated and referred to anti corruption and pay orders instated or worse.
He learned from the best; Ozzie was a good teacher. It seems like scandals follow this organization. Former chair Canover Watson is in prison today for seeking to take advantage of the public’s purse. Ozzie comes along later, and you’d think he would be very careful to ensure that the Board’s action are not only fair, but are seen to be fair. It seems we dodged a bullet when the voters in BTW decided not to send him back to Parliament to be part of another Government.
Never forget when Ozzie first lost reelection. He went on Cayman 27 and berated the constituents. I am not from Bodden Town, nor do I vote there, but I lost all confidence in him as a politician from then. When people show you who they are, believe them.
This started under PACT when Ossie was chair!!
So Marlroad claims nothing comes down, I bet when her paymasters from the HSA called she removed the story about the Board real quick and not a peep about it on her show this morning. Then she wants to claim independent journalism, you have to laugh, it is clearly he who pays the piper calls the tune. 🤣
Mafia journalism. You won’t hear anything bad about the people that pay her or advertise with her gutter outlet.
‘Mafia journalism’ – that appears to be an interesting description considering everything else that is happening.
She keeps piping that HSA has never paid a dime, but she fails to realize that this is a public authority. It takes one email from Mickey Mouse to the HSA that asks for a list of all payments made to Sandra Hill/Catron or Cayman Marlroad between 2017 and 2025. There will be a big Kaboom when that disclosure is made.
Her followers are not that smart, which is why she thrives on the demographic she panders to. Lies go unchecked, followed by half ass corrections. Remind me again what CMR’s rate of accurate reporting is today? Sandra? Anyone?
Not tremendously different than Kenny’s voters.
Osbourne Bodden and jon Jon running the HSA what could possibly go wrong! This Payment scheme is obscene and disgraceful they should be made to pay back every cent they took or even better deducted out from the Jon Jon salary every month leaving him with $10 to buy groceries and gas. Angela Cullen needs to go now as for Sabrina sure glad she is gone with her aloof attitude and her all mouth husband at CBC!
deducted out from the Jon Jon salary every month leaving him with $10 to buy groceries and gas
Plus a $5 stipend for vaseline.
LOLOLOL
Boards are not meant to be operational. That is why they have Executive teams.
nah, pretty sure Garcia wrote this, but like so many other things in the document, the Board is here to take credit.
Hope the HSA board did not bill the people of the Cayman Islands to draft this press release. That is, by calling another board meeting to discuss the press release and then submitting a bill for that board meeting.
HAHAHA and so many Caymanians think foreigners are their problem.
Your problems start from within.
Piracy is alive and well in the Cayman Islands.
Not the only problem, just one of them.
Too often the selection of directors for our statutory authorities and government companies has been based on political handouts rather than competence. In general all that is required to be appointed is a Cabinet Minister who owes a favour or hopes to get some quid pro quo in the future.
We need to have a formal independent transparent process of determining relevant qualifications for every board appointment as well as vetting of all persons who are willing to act as directors, including their verified CVs.
We also need to have a standardised system of remuneration/benefits for all such directors and a system of value for money auditing of all of the boards and management structures for every one of our statutory authorities and government owned companies.
4 meetings per week is ridiculous. Boards of statutory authorities are not supposed to micromanage and in general they are not competent to micromanage. If the board determines that an authority is not being properly managed all they should do is recommend/implement a change in the relevant professional management.
We need to have a formal independent transparent process of determining relevant qualifications for every board appointment as well as vetting of all persons who are willing to act as directors, including their verified CVs.
Excellent idea, except politicians will now create a new Appointment Board and stock it with their cronies who will advise them on whom to appoint to various Boards. Note this is the current process, they just never thought about having a Board.
Wish I could ‘thumbs up’ this 1000000 times!
Direct rule looks more and more like the only option every day.
If not for the UK, the place would be a mini Jamrock
Reply we are already a mini Jamrock in many ways.
Anyone that believes this foolishness has never been to any of the problematic areas in Jamaica. Hell, I’d wager you’ve probably never even been outside of the resorts, if you’ve even been there at all.
You already have direct rule back home, and look at the shitshow going on over there.
By “back home” you mean the rightful owners of these rocks?
Same dog puppy. Tell them they should come claim it and run it into the ground like they’ve done the motherland, habibi.
Why you here, habibi
XXX…What the Board has gotten away with over the past few years is a clear example of pigs at the trough, just milking the taxpayers and public purse for anything they could get away with.
Except for the retirees, the other members all hold full-time jobs in the Private Sector. If they are doing this much work and spending so many hours on the HSA Board, when do they find time to work for their own employers?
I also note the comment “all meetings are well-documented, reviewed, and audited, and they have not been questioned by the auditors.” This is a failing by the OAG and Angella Cullen specifically. This abuse was investigated, and a report was written. MPs should ask Angella Cullen why it was never presented to Parliament.
What happened here is a symptom of a larger issue, despite the Board’s claim for well-qualified members, many of our local Boards are staffed by party supporters as political favours. Sabrina was therefore happy to turn a blind eye as the money wasn’t coming from her pocket and was keeping her supporters happy.
Let’s sit back and see what this government does. Will this be allowed to continue? Andre I am looking at you.
‘With some volunteer directors being paid more for a couple of meetings than some hospital staff take home a month..’
Volunteers get paid?
Sabrina probably did as well as she could. I do believe she was being constrained by her lack of critical thinking and qualifications. She should have never been Minister of Health! Instead of ministering she spent most of her tenure pestering hospital staff for help in doing her job. Please stop electing dysfunctional persons, making them ministers who can only screw up the systems. It is so embarrassing! Cayman is has really become an embarrassment. Their only criteria for representatives is if they can hand out cash to them during campaigns. If they are not rich enough or able to be sponsored by those rich enough we will always end up with inept politicians..
Why have frequent meetings?
Cayman has a number of professional directors all of who can tell you that Boards should not have frequent meetings unless absolutely necessary, for several strategic and operational reasons. For example:
1. Dilution of Strategic Focus
Frequent meetings can shift attention toward tactical or operational matters rather than staying focused on long-term strategy, governance, and oversight. The board may begin to micromanage rather than guide.
2. Decreased Meeting Quality
More meetings often lead to less preparation, rushed agendas, and a lack of deep, meaningful discussions. Directors may become fatigued or disengaged, leading to poor decision-making.
3. Staff burnout.
Staff time spent preparing for frequent meetings could be better used on execution.
4. Undermining Executive Authority
Frequent meetings may unintentionally undermine the CEO and management team, creating a perception that the board is second-guessing their work. It blurs the line between governance and management.
5. Risk of Groupthink or Overreaction
More meetings increase the risk of reactive decision-making instead of thoughtful, deliberate action. Boards may respond too quickly to short-term fluctuations rather than maintaining a steady hand.
6. Board Member Burnout
Especially in nonprofit or volunteer settings, over-scheduling meetings can lead to burnout and disengagement.
7. Reduced Value of Meetings
If meetings are too frequent, each one may feel less essential, reducing the urgency and impact of discussions and decisions.
Yvette, as the former HSA Faith Hospital Administrator would be unqualified to chair a board (or even be a director) in the private sector. Most well run companies DO NOT have
former senior managers of the company be on their board. The key issues are: Conflict of Interest; Resistance to Change; Undermining former colleagues; Compromising Board independence; Cultural continuity; and Power dymanics and morale issues.
Cabinet should consider replacing the Chair.
The Board Nomination criteria is what, process is when, and Nomination Committee made up of whom? Cayman’s CIG lacks grownup parameters for most appointments.
Only one qualification required… being a member of the tribe..